As she continues her rehabilitation Anna Boniface looks at the challenge of balancing rehab and recovery with an ever-present desire to train.

Dedicated. Focused. Determined. These are essential qualities for athletes to succeed. They’ve often been used when describing improvements in my own performance. I’ve heard many times people compliment my commitment to training and admire how hard I work.

There’s a fine line between dedication and addiction. It’s difficult to distinguish an athlete that is motivated to perform vs. an athlete that is addicted to training.

Obsessed. Compulsive. Addicted. The exercise addict is emotionally tied to training. They will continue to train regardless of injury or illness. They don’t take rest days, or they will manipulate some sort of exercise into a rest day.

They become very irritable if they cannot train. They are obsessed with complying to a training schedule or with exercising as a means of controlling weight. Complying to training is the priority above everything else, including performance. You can read more about RED-S and exercise addiction here.

Exercise addiction and eating disorders/disordered eating are a key competent to RED-S. The psychological overlay makes managing RED-S complex. Simply forcing the athlete to rest, relax and eat cake isn’t going to work. It takes negation, patience and an individualised approach.

The first barrier will be getting athlete “buy-in” and acceptance to the underlying problems causing the low energy availability. For me this has taken a long time.

Upon my diagnosis of RED-S, I was still fixated on doing the London Marathon. My rationale brain as a physiotherapist acknowledged my DEXA scan results, the years of no periods and the science behind how my actions were causing that. But my delusional thinking was more dominant.

RELATED: Anna Boniface: The ‘break’ in breakthrough

In the initial stages, my exercise was restricted. I was signed off work for six weeks. Without training or work, it left a huge void in my day. The break in routine was horrible.

Retrospectively complete rest during this phase would have helped my recovery enormously. However, I was not ready to do that.

The real challenges began when the boot came off and I started my rehabilitation plan.

Regardless of RED-S or not, rehab following a fracture is important. It includes strength work, proprioception and a gradual increase in bone loading.

Cross training plays a huge part in that. I opted for the traditional cycling and aqua jogging.

RELATED: Anna Boniface: cross-training faux pas

The main problem was that I wasn’t dealing with my irrationalities around exercise and food during a vulnerable time. Instead, I upped the stress in life and wallowed in self-pity about being injured. My coping strategy was to exercise more.

Patience and trust

When dealing with an athlete going through RED-S, it’s important to be patient, build trust and be mindful of psychological factors that may be influencing their behaviour.

I am very fortunate to have the patience of those working with me. I’ve been more honest about my compulsive behaviours and accepting my issues. We’ve now put better strategies in place to help me balance my rehab and recovery.

I love rules, plans and clear goals. I have an agreed weekly training budget. I take a complete rest day every week. I’m working with my dietician to implement small, gradual changes to get me out of my energy deficit state.

I certainly don’t expect my relationship with food and exercise to drastically change overnight, but significant changes are happening. With the support of some great friends (the running community is incredible), I’m “sucking it up” and moving forward.

Cutting out my compulsive junk exercise allows the training that matters to really count. I go into training sessions feeling good, not depleted or tired.

These little discoveries are doing wonders in helping shift my mindset and strive for being stronger. I’m not fully there yet, but I’m learning to embrace being stronger, heavier and healthier.

My recovery process is by no means a perfect example. However, it’s the reality and represents the challenges that other athletes go through. I’ve certainly made mistakes and probably still will. But I am finding the balance between rehab and recovery.

I don’t want to be an exercise addict. I don’t want to use training as an emotional outlet or as a means of controlling my body. I want to train to perform, to run fast and achieve goals. I don’t want to run because I feel guilty. I am a runner because it is something I love.

I came across this a while ago by Lauren Fleshman, which I’ve written on the front page of my training diary.

Athletic Assessment

Anyone can dream, are you committed?
Anyone can train hard, do you have the discipline to recover?
Anyone can follow a diet, can you make exceptions and remain confident?
Anyone can react to a move, can you be the one that makes it?
Anyone can show good sportsmanship, can you be genuinely happy for your competitors?
Anyone can fail, can you do so without feeling like a failure?
Anyone can talk, can you listen?

Anna Boniface features in the ‘Fast 10: class of 2018’ and will share her running journey every month. You can read Anna’s previous posts here and further information about the ‘class of 2018’ can be found here.

Whether it's the best running news, race round-ups or training and nutrition advice you are after, never miss a thing by following us on Twitter, Facebook and Instagram.