Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Master of Science




Thornton, Jane S.


Relative Energy Deficiency in Sport (RED-S) is a complex condition characterized by chronic low energy availability (LEA) affecting an athlete’s health and performance. A cross-sectional, mixed-methods survey was used to investigate Canadian Physiotherapists' (PTs) experience with RED-S. Sixty-nine PTs completed the survey which assessed participants’ knowledge of RED-S, their confidence in diagnosing and managing RED-S, their exposure to RED-S in clinical practice, and their education-related experience with RED-S. Participants scored an average of 25.1 (± 4.1), (71.7%) on the knowledge section of the survey, and an average of 32.7 (± 19.4), (51.1%) on the confidence-related section. There were no significant differences between the knowledge and confidence scores based on specialty (Sports, Women’s Health, Sports and Women’s Health, Orthopedics, Other). This survey demonstrated gaps in PTs knowledge of RED-S and their confidence in treating the condition. Canadian PTs expressed a need for concise educational resources to be made available regarding RED-S.

Summary for Lay Audience

Our study looked at Canadian Physiotherapists' (PTs) knowledge and experience recognizing and treating Relative Energy Deficiency in Sport (RED-S) (originally known as 'The Female Athlete Triad'). The study involved an online survey that explored PTs knowledge of RED-S as well as their confidence levels in recognizing the signs of RED-S and in managing the condition. The survey also assessed PTs exposure to RED-S in their clinical practice and in their physiotherapy training. Sixty-nine participants completed our survey. On average, PTs scored 71.7% on the knowledge section of the survey, and 51.1% on the confidence-related section. 68% percent reported that they had assessed patients with RED-S in their clinical practice. PTs expressed a need for more widespread, concise materials to be made available that could be used by clinicians to help diagnose, treat, and manage the condition and distributed to coaches and athletes to help raise awareness about the condition. Additionally, only 50.0% of PTs reported learning about RED-S in their training program, and 71.0% identified the lack of education about RED-S as a potential obstacle for treatment. While Canadian PTs knowledge about RED-S appeared adequate, their self-reported confidence levels regarding their clinical ability to diagnose and manage the condition were much lower. Knowledge of RED-S and confidence in managing the condition are essential for health care professionals to ensure early diagnosis and proper management of RED-S. Additionally, increased awareness about RED-S is needed among Canadian PTs to protect the long-term health of athletes diagnosed with RED-S and decrease its overall occurrence.

Available for download on Wednesday, July 17, 2024