Counsel a parent and a young athlete on low energy availability and the return-to-running plan — OSCE

Communication framework

Establish what the mother already understands and fears. Ask her to tell you, in her own words, what has happened so far and what she is most worried about. The fear of losing the team place, the anxiety about a permanent bone or fertility problem, and the confusion about why her daughter must stop running and eat more when her weight seems healthy are the three concerns you will spend the most time addressing, and you address them with plain language and with the explanation of why resting and re-fuelling now gives her daughter the best chance of a full return. Do not launch into the plan before you have heard her. [9]

Explain the diagnosis in plain language, without jargon. Tell her that her daughter has been training harder than her body can fuel, and that the energy gap has caused two things — a small crack in the bone of her shin from the unaccustomed load, and the pause in her menstrual cycle because the body, short of energy, has switched off the reproductive system to protect the essential functions. Use the image of a bank account where the training is spending more than the food is depositing, so the body goes into deficit. Avoid the terms energy availability and functional hypothalamic amenorrhoea unless you translate them, and check her understanding by asking her to repeat back the key idea. The good news is that both the bone and the cycle recover when the energy balance is restored. [5] [9]