Coaching Female Runners: RED-S and What Coaches Miss

Full Transcript

Coaching Female Runners: RED-S and What Coaches Miss

Cold Open

Division 1 championships at Derryfield Park. I’m standing at the two and a half mile mark, which if you know that course is where the race actually gets decided.

One of my varsity girls comes through. She should be surging. Instead she’s gray. Her form is coming apart, her eyes are glassy, and she’s going backward through the field.

Here’s the thing that bothered me for a year afterward. We’d done everything right by the book I was using. She hit her mileage. She did the workouts. She was the most disciplined kid on the roster. And she fell apart anyway.

That was the season I had to admit something. It wasn’t her. It was the book. The training model I’d run for twenty years was built on male physiology and old-school running dogma, and it was quietly failing my girls.

Intro

Welcome back to Salty Talks. I’m Coach Saltmarsh. Twenty-five years on the track, thirty-one state champions, and today the episode I think matters most in this whole season.

One opinion, up front. The biggest threat to your girls’ team is not undertraining. It’s underfueling. And most of us were never taught to see it.

This is the topic almost every coaching resource skips, which is exactly why so many of us are working from folklore. So today: what RED-S actually is, the warning signs that show up in your training data before anything else, why the male model fails girls at exactly the wrong moment, what to change on Monday, and the conversation to have with a parent when you see it.

One thing before we start. I am a coach. I am not a physician and I am not a dietitian, and neither are you. Nothing in this episode is a diagnosis. What I’m giving you is pattern recognition and a referral pathway, because in a high school program the coach is usually the first adult in a position to notice.

Segment One · What RED-S Actually Is

Let’s get the term right, because coaches use it loosely and the precision matters.

RED-S stands for Relative Energy Deficiency in Sport. The International Olympic Committee introduced it in 2014. It builds on the older idea a lot of us learned as the female athlete triad, which the American College of Sports Medicine described back in the nineties. The triad was three linked pieces. Low energy availability, disrupted menstrual function, and low bone density.

RED-S widened the frame considerably. It describes impaired physiological function caused by relative energy deficiency, and the list is long. Metabolic rate. Menstrual function. Bone health. Immunity. Protein synthesis. Cardiovascular health.

The core idea is simple enough to say to a fourteen-year-old, and you should.

The energy she takes in has to cover her training and the basic work of being a living, growing human. Training is the second bill, not the first.

When intake falls short of expenditure for long enough, that’s what the researchers call low energy availability. And the body does something logical and brutal. It starts shutting down systems it considers optional.

Reproduction goes first. Bone maintenance follows. That ordering is not a coincidence and it’s not random. A body in a perceived famine does not build a skeleton and it does not run a menstrual cycle. It triages.

And I want to be careful about one thing, because coaches hear energy deficiency and immediately picture an eating disorder. Sometimes it is. Often it isn’t. A lot of RED-S in high school is a kid who added twenty miles a week in July and did not add any food, because nobody told her she had to. That’s not pathology. That’s a math error, and it’s the coach’s math error more often than hers.

Segment Two · The Signs in Your Training Data

Here’s the part that’s useful on a Tuesday. Some of this shows up in your log before it shows up in the trainer’s office.

First, the performance shape. Not one bad race. A plateau or a slide across weeks in an athlete whose consistency has not changed. She’s doing the work and getting slower. That combination is the flag.

Second, bone stress injuries that repeat. One stress reaction is bad luck. A pattern of shin, foot, hip, or sacral injuries in the same athlete is a pattern, and it usually has a metabolic story underneath it, not a footwear story.

Third, recovery that stopped working. She’s flat two days after a workout that used to cost her one. Resting heart rate creeping up. Getting sick more often than her teammates, and staying sick longer.

Fourth, and this one gets misread constantly, the psychological stuff. Brain fog. Irritability. Emotions she can’t regulate. Flat affect at practice. That looks like an attitude problem and it gets coached like one. It can be the neurological cost of running a developing body in deficit. If you take nothing else from this segment, take that one, because that’s the misread that does the most damage.

And fifth, the biggest one. A lost or irregular period.

I want to be blunt here, because a generation of coaching culture got this exactly backwards. Losing her period is not a sign that training is going well. It is not a rite of passage, it is not proof she’s finally lean enough, and it is not something to wait out. It is a medical red flag, and it warrants a conversation with her family and her physician.

The mechanism is worth understanding so you can explain it. Chronic energy deficit suppresses reproductive hormones, estrogen included. Estrogen is central to building bone. Athletes with low energy availability and lost menstrual function show meaningfully lower bone mineral density and a higher fracture risk. So the lost period and the stress fracture six months later are not two problems. They’re one problem, showing up twice.

Now, is a menstrual cycle a comfortable thing for a fifty-something male coach to bring up with a teenage girl? No. Do it anyway, and do it structurally rather than individually. It goes in the preseason parent meeting. It goes in the packet. It is framed as a health metric the family and the doctor track, the same way you’d tell them to watch for a limp. You are not asking your athletes about their cycles. You are making sure every family knows what a warning sign looks like.

Segment Three · The Case Study Every High School Coach Should Know

If you coach girls, you need to know Mary Cain’s story. Not as gossip. As the clearest available case study of how a system built to develop a young woman can instead take her apart.

Quick version. Cain was the most talented young American female distance runner in a generation. National records in high school. At seventeen she became the youngest American to make a World Championship track team. Then she joined the Nike Oregon Project under Alberto Salazar, the most successful distance coach in the world at the time.

What followed, in her account, was public weight-shaming, isolation from her family, and a physical breakdown that reads like a textbook chapter. She was pressured to lose weight. She lost her period for three and a half years. She accumulated bone injuries: shin, calf, femoral neck, sacrum, pubic bone. Her mental health deteriorated badly while the adults around her told her she wasn’t tough enough.

That injury list is not fragility and it isn’t bad luck. That’s the clinical presentation of prolonged energy deficiency, and it was predictable from the moment her coaches treated a missing period as good news.

But here’s the part I actually want you to sit with, because it’s the part that applies to us.

It didn’t start at Nike. In her memoir she describes her high school coach: favoritism instead of merit, punishment for choosing another sport one season, her name left off relay rosters as a power move, standing by while teammates bullied her, and a varsity spot dangled over four girls with rules that changed weekly so they’d compete against each other instead of together.

Then, when she left, she got recast as the problem. Uncoachable. Not a team player. The same reframe happened years later when she left Oregon.

It’s easy to read the Nike chapter and think that could never happen here, I don’t have a shoe contract. Read the Bronxville chapter instead. Favoritism, public humiliation, a weaponized roster spot, and turning a survival decision into a character flaw. Those cost nothing. Any of us can do all of them on a Tuesday afternoon on a public high school track. The Oregon Project didn’t invent those patterns. It just had the budget to amplify them.

Segment Four · Training Girls Like Small Men

So why did smart people look at a young woman’s normal maturation and see a problem to correct? Because the model they were using was built for male bodies.

Lauren Fleshman makes this argument in Good for a Girl and it’s essential reading. Our training systems were designed by men, for men and boys, and they fail young women in a specific and predictable way.

Look at what puberty does. For boys, in distance running terms, it’s largely an accelerant. More testosterone, more red cells, more power, faster recovery. For girls, puberty brings a natural and necessary increase in body fat, real skeletal change, and a hormonal profile that supports a lifetime of health but does not, in the next six months, make anybody lighter.

Now here’s the trap. A talented girl often peaks early, sometimes winning everything at thirteen, before puberty fully arrives. Then her body does exactly what a healthy female body is supposed to do, and her times flatten or slide for a season.

To a coach working from the male model, that looks like a malfunction. And the question that comes out of our mouths is “what’s wrong with her?” Or worse, we don’t say it, we just quietly decide she needs to train harder, or that she’d be fine if she were lighter.

Nothing is wrong with her. She’s growing up. Your job in that window is to hold steady, keep her healthy, keep her connected to the team, and let development finish. The girls who get coached through that season instead of coached at during it are the ones still running at twenty-two.

Segment Five · What Changes at Practice

Five practical changes. These are the ones I actually made.

One. Nobody trains on empty. My 7 a.m. summer practices used to be full of kids who rolled out of bed and ran on water. I told myself a good breakfast afterward covered it. It doesn’t. A female athlete’s system reads hard training on an empty stomach as a threat, cortisol climbs, and the body starts breaking down what you spent all summer building. So: something small before you run. Half a banana. A yogurt. It is not breakfast, it’s the ignition key. And a snack within thirty to forty-five minutes after the hard stuff, because that window is tighter for girls and it’s a bone health issue as much as a recovery one.

Two. Heavy things, on purpose. The low-weight, high-rep “toning” corner of the weight room does nothing for a distance runner. Heavy loading is the single best insurance policy you have against stress fractures, and teenage girls do not have the hormonal profile to accidentally become bodybuilders. My girls take up space in that room, and when they’re in there the music stops unless I approved it.

Three. No weigh-ins. No body talk. Not from me, not from assistants, not between teammates, not as a compliment. “You look so lean” is not a compliment in a distance program, it’s a training instruction, and kids hear it as one. Food is never good or bad at my practice, and no adult in my program comments on what’s in a kid’s lunch.

Four. Weight loss is never a performance goal. Ever. Not as a suggestion, not as a hint, not as a comparison to a teammate. If you think an athlete’s fueling needs work, that’s a physician and dietitian conversation, and it starts with adding, not subtracting.

Five. Protect the team culture, because it’s doing physiological work. When my girls are talking through an easy long run they are lowering their stress baseline, and a lower baseline makes the hard days land better. The kid training alone all summer worries me more than the kid running slow.

Segment Six · The Conversation

Say you see it. Now what? Because this is where coaches freeze, and freezing is how a season turns into a career-ending injury.

First, know your lane. You are not diagnosing anything. You noticed a pattern and you are handing it to the people qualified to evaluate it. That’s the whole job, and it is enough.

Second, talk to the parent, not around them. Here’s roughly what I say, and I keep it about observations, never about her body.

“I want to flag something because I’d rather be early than right. Over the last six weeks her training has been consistent and her performance has gone the other way, she’s taking longer to bounce back than she used to, and she’s picked up her second bone injury this year. That combination is something I’ve learned to take seriously rather than train through. I’d like her to see her doctor before we do anything else, and I’ll adjust her training however they tell me to.”

Notice what’s not in there. No mention of what she eats. No mention of her weight. No armchair diagnosis. Observations, concern, referral.

Third, hold the line on the training while they sort it out. Not as punishment, and don’t frame it as one. She keeps her spot, she keeps her people, she keeps her identity on this team. The fastest way to make a kid hide symptoms is to make honesty cost her the thing she loves.

And fourth, if what you’re seeing looks like disordered eating rather than a fueling gap, that goes to the family and a clinician the same day. Not next week.

Segment Seven · Monday Morning

Five things, this week.

One. Put fueling in the preseason meeting, in front of parents, in writing. Nobody trains on empty, food comes before the run, and here’s why. Make it a team rule so it never has to become a conversation with one kid.

Two. Audit your own language for a week. Count how many times an adult in your program mentions a body. Aim for zero.

Three. Look at your injury log across the last two seasons and find the repeats. Any athlete with more than one bone stress injury deserves a fresh look that isn’t about her shoes or her form.

Four. Get the girls lifting something heavy twice a week, and go in there with them.

Five. Read Cain’s account and read Fleshman. Not for the scandal. For the pattern recognition, which is the actual skill.

Close

Back to Derryfield, and that kid coming through gray at two and a half miles.

Changing how you coach after twenty years is uncomfortable, because it means admitting the earlier version might have cost somebody something. I’ve made peace with that. The injuries went down. The joy came back. That’s the whole return on it.

Our team mantra now fits on an index card. We never run on empty. We lift heavy things to protect our bones. We train to build bodies and minds that hold up.

And the thing I want you to carry out of this one: weight loss is never a training goal, hunger is never a virtue, and a lost period is a warning, not a milestone. If those three sentences are the only thing that changes in your program this fall, you’ll have done more for your girls than any workout I could give you.

I’m Coach Saltmarsh. Fuel first, then train. Keep it salty, and I’ll see you next week.