Athletic Edge Physical Therapy San Diego

Your knee pain doesn’t always start at your knee.

That doesn’t mean your knee is “fine” or that weak hips are automatically the culprit. It means your knee is part of a larger system — and the way your hip, knee, and ankle work together can influence how much load your knee has to handle.

For runners, lifters, and active adults, the answer isn’t always to stop squatting, stop running, or avoid impact.

Sometimes, the better question is:

“Why isn’t my body tolerating this load?”

That’s where strength, movement mechanics, load management, and a good assessment come in.

The goal isn’t to protect your knee from movement forever.
It’s to build a body that can handle the movement you want to do.

Save this for the next time someone tells you that you just have “bad knees.”

And if your knee keeps getting irritated every time you train, it may be time to look beyond the painful spot.

Follow us for sports performance PT that looks at the whole picture.

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RED-S doesn’t announce itself with a certain body type or a dramatic weight change — it can be happening quietly in an athlete who looks completely fine from the outside. That’s what makes it tricky. It’s not about how you look, it’s about whether your body is getting enough energy to run everything it’s supposed to run — including your hormones. Here’s what’s actually going on underneath, fact-checked against the research.

Underfueling is what kicks things off, but what happens next is a lot more involved than “just eat more.” Low energy availability disrupts the hypothalamic-pituitary-gonadal axis, which is why periods stop — and the resulting drop in estrogen is what starts affecting bone health. 

Basically, your brain notices the energy gap and starts shutting down anything it considers non-essential to survival. Reproductive hormones are first on that list. It’s your body doing exactly what it’s designed to do under stress.

This is the part that surprises most people. Low energy availability affects more than periods and bone density — it also slows resting metabolic rate, which means your body needs less energy just to maintain your current weight. 

And that’s actually part of why RED-S is so easy to miss in the first place: your weight can stay completely steady while your metabolism and hormones are quietly working overtime to protect you. “My weight hasn’t changed” doesn’t mean everything underneath it is fine.

It’d be great if this were quick, but it’s not. Catching and correcting low energy availability early can prevent REDs symptoms and protect bone health — but that correction has to be sustained, not a short-term bump in intake, for the hormonal system to actually recover.

Think of it like this: the shutdown didn’t happen overnight, so the recovery won’t either. A couple of higher-calorie weeks might bring your period back, but that doesn’t automatically mean your hormones are fully back online.

This one’s easy to brush off when you’re focused on this season, but the research says otherwise. Athletes with low energy availability tend to see drops in performance, coordination, and power output, plus more missed training time from gettin