Your comments: 7 March 2018

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Marathon winner issues RED-S alert
I was the first woman to finish the London Marathon of the non-elite runners.  I went on to represent England at the Toronto Marathon in October but was unable to finish due to a stress fracture. I have been diagnosed with Relative Energy Deficiency in Sport (RED-S), more commonly known as the ‘female athlete triad’. 
A combination of over-training, under-fuelling through disordered eating/eating disorders results in an energy deficit, causing amenorrhoea. This reduces oestrogen and bone density. RED-S can also affect male athletes. 
Physiotherapists are often the first point of call for injured athletes. We play a vital role in early detection of RED-S which can result in a cascade of fractures. I have seen too many talented athletes disappear out of sport when it could have been prevented. 
My key point is that periods and energy balance are crucial to bone health. These questions should be asked as part of our assessment and we shouldn’t avoid the taboo topics of menstrual health and disordered eating. I ran a Twitter poll with more than 1,000 voters. It showed an encouraging 75 per cent would ask about menstrual health. We need more awareness of RED-S and to prevent these athletes (often in their teens/early 20s) from breaking bones again and again. Unfortunately, I’m one of them.

Touchy issues

There is no other profession that holds the gemstone that physiotherapy does. Physiotherapists have a degree, but solely hold the mandate of manual therapy and, in many cases, the client expects to be handled. Other professions are unable to touch their clients in the same manner as a physiotherapist, and, if they do, will most likely be disciplined. The right to touch has been in place for over 100 years and should not be diminished. In fact, as a smart profession, physiotherapy should enhance, embrace, uphold and promote the gemstone’s shine.
With manual treatment comes responsibilities above other university graduates. Research that shows one of the main reasons a patient goes to a medical provider is, in the first instance, to seek reassurance. While examination may require ‘hands-on’, the advice and treatment that follow may not. As a physiotherapist, any treatment probably requires touching the client. 
Reassurance also comes from the professional’s own assurance and the way advice is presented. Do physiotherapists really believe being ‘dressed as though coming from the rugby field’ provides the patient and colleagues with a sense of believing or trust?
Just as our patients’ future is in our hands, our profession’s future is too. 
Now there’s a thought, are we handling our profession with the due care and attention we show our patients? To get our treatment right for public and physiotherapy is the art, which relies on both hand and eye coordination for both the receiver and the giver.
  • Malcolm Hood, manipulative physiotherapist, Wellington, New Zealand

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