In September, I caught up with a physio friend of mine named Isy. Isy rows at Leander and previously rowed at Oxford Brookes while getting her undergraduate degree in Physiotherapy. Isy is incredibly transparent about her journey after being diagnosed with Relative Energy Deficiency in Sport (REDS), her recovery, and her return to full capacity, and she documents it on TikTok.
Awareness and education are great, but application is even better. So, at the end of this article, I have suggested some strategies Isy and I found useful during our rehab process.
REDS is a medical condition I’ve been interested in for a long time from the physiotherapy perspective. I have never personally been diagnosed with REDS, but awareness and understanding of the condition are critical for being able to identify it in patients. There was a period of six weeks in my final year of university where I was miraculously balancing being on placement, 11 sessions a week, studying and trying to fit in some work to make money. Looking back at it, I realise there was way too much going on, and it was no surprise that I got unwell later.
For context, my ICU physiotherapy placement was during a freezing winter and also during a mini-wave of COVID. Luckily I was not treating COVID patients, but I was still around a lot of sick people so took extra precautions to stay as healthy as possible so I could continue to train and not make others unwell. Training and studying or working are hard to manage at the best of times, and with hindsight, there were a few times that I had too much going on, and not long after my placement finished, my body was in overdrive. While I believe I did not have REDs or let it get as severe enough to have REDS, I was suspected medically of having something called ‘overtraining syndrome’.
Is it overtraining, or is it under-recovery? In my case, it was under recovery. But, the distinction between REDS and overtraining is for another article.
In my conversation with Isy, she spoke about how she started to feel sick more often, and it would last longer than usual. Over time, it slowly crept up more and more, and she felt silly using being sick as an excuse. “Looking back, I was so unaware of the signs, and they just crept up on me, and then it was too late.”
Isy went on to mention that a huge part of why her rehab took so long was because she didn’t recognise the signs until it was severe. At that point, the damage to the body was immense, and the logical thought would be that rehab would be a long journey to get back to equilibrium. Isy spent most of the 2023/24 season rehabbing and letting how her body would feel to guide her rehab and training.
”It has taken an entire year with little training and more rest and recovery than anything. Some days I would feel great and like I could do all three training session and other days I would feel so exhausted I couldn’t get out of bed. Only now (14 months later) do I feel back to “normal” “.
Isy and I spoke about how, when you return from injury in the final stages of your rehab, your body can trick you into thinking you are not ready.
With my own rib and wrist injury, I found that anything with intensity would always feel a lot harder than it should be. Understandably, I’d spent nine months doing lots of steady-state, low-intensity cardio and rehab in the gym but no top-end work or intensity. Isy and I agreed that while the body is fantastic, the mind can play games and make us think we were not ready, or that we could not trust we were better.
One of the key takeaways from our conversation was that when you are injured or unwell, your body recalibrates the threshold levels. For me, because I had not done any intense pieces or workouts, my body was “new,” and my threshold was a lot lower than if I had not been injured. Part of this is because I had not done any high-intensity training and also as a way for my body to try and protect itself because I would experience symptoms after high intensity. My threshold has changed again after getting back into the swing of training and consistently following a good program. This is because our bodies are actually sometimes like highly sophisticated computers. What you feed it is what you get out later.
Here is a short list of strategies Isy and I have found useful during our rehab processes:
- Make a list of all the things you have control over and do as much as you can to prevent them.
- Remind yourself that you cannot control if it happens again, but you can control how you respond to it, noticing the warning signs and acting quickly on them.
- Identify and control any triggers that make symptoms or pain worse.
- Experiment with strategies that ease the symptoms or improve the pain.
- String consistent days of good training together.
- Become educated on the topic – use reputable sources please!
- When you change the stimulus you feed the body, the outcomes change.
- Data like resting heart rate, heart rate variability, and tracking can be useful in providing insights about illness and recovery.
- Data is helpful, but it cannot and will not be able to tell you how you feel.
- Learn to listen to what your body is saying and use data objectively to add to the picture.
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