Why Rose Harvey Finishing The Olympic Marathon With A Femur Stress Fracture Is Not Something To Celebrate

Editor’s note: This article discusses Relative Energy Deficiency in Sport (RED-S), an increasingly common cause of stress fractures among endurance athletes. However, it does not imply that British runner Rose Harvey is experiencing RED-S. Neither Harvey nor her team has confirmed any such condition. It is entirely possible that Harvey is a healthy, well-balanced athlete who may have simply pushed her body slightly beyond its limits. Given the pressure and timing of the Olympic marathon, she may have inadvertently risked her health to compete, potentially exacerbating her injury.

Running the Olympic marathon already comes with many challenges: the hours of training and preparation, the hot weather, the grueling course, the immense pressure that comes with competing on that stage, the list goes on.

The last thing you’d want as an Olympic marathoner is to have to deal with a niggle, pain, or even worse, an injury.

British marathon runner Rose Harvey came into the Olympics with some tightness in her hip that she says she began to feel about three weeks before race day. Despite getting treatment before the Olympics, her injury wasn’t improving, and, against the advice of doctors and physiotherapists, she decided to start the marathon regardless.

What started as a tight hip was later revealed to be a stress fracture in her femur.

The 31-year-old said to BBC that it became obvious from early in the race, about two miles in, that continuing to run would be “really, pretty painful.”

“It was really tough,” Harvey told the BBC.

And, according to Harvey, the hills didn’t help at all: “The downhills were just agony, and it just got worse and worse.” By the halfway point in the race, she admitted that she knew that the rest of her Olympic marathon was going to be a brutally painful experience.

Although in “agony” throughout the race, Harvey finished, crossing the line in 78th with a time of 2:51:03, far from her qualifying time of 2:23:21 from the 2023 Chicago Marathon.

Although many have praised Harvey for battling through the pain, the harsh reality is that this is not something that should be celebrated.

RED-S: A Common Source Of Stress Fractures In Runners

While there are a number of causes for stress fractures, the most common among runners is a condition called Relative Energy Deficiency in Sports, or RED-S for short. RED-S results in a decline in athletic performance and overall health when athletes do not get enough fuel through food to meet the energy demands of their sports training and daily lives.

RED-S is most commonly seen in female athletes involved in endurance sports or sports that tie athletic success to a thin body, such as running. However, it can occur in any athlete regardless of gender, sport, or ability level.

Many athletes experience low energy availability, especially after long or intense training sessions or competitions.

However, through rest and a healthy diet, athletes can replenish their energy stores and continue training healthily. When an athlete continues to train and compete without refueling and allowing for rest, the energy deficit continues to grow, eventually negatively impacting endurance, strength, and overall health.

As the energy deficit grows, RED-S can disrupt several systems throughout the body:

• Reproductive Health: Abnormal or missed menstruation in women, low libido in men
• Bone Health: Increased risk of stress fractures due to decreased bone density, increased risk of osteopenia, and early onset osteoporosis
• Immune System: Decreased function of the immune system, leading to more infections, colds, and illness.
• Metabolic System: Decreased metabolic rate (body takes more time to convert food into energy)
• Cardiovascular System: Decreased heart rate leading to dizziness and increased risk of long-term heart damage, including atrophy
• Psychological System: Increased risk of depression and anxiety

Athletes can often find short-term success in the early stages of weight loss. This success, often accompanied by praise from coaches, results in many athletes continuing to push the bar until they find themselves in dangerous and unhealthy situations.

Because it is also a relatively unknown condition, many athletes or coaches may be unaware of the harm done when athletes lose weight rapidly.

‘It is still a relatively new condition,’ explains sports and eating disorder specialist dietitian Renee McGregor to Runners World. ‘It is a clinical condition within a sporting community, so only practitioners trained in both clinical and sports science/medicine will have a full understanding of it.’

Prioritizing Athlete Mental And Physical Health

Harvey and many other athletes who have had to compete while injured are often praised for “pushing through the pain” or for the “sacrifice” they’re willing to make for their country.

Harvey’s situation is similar to that of the famous Kerri Strugg gymnastics vault from the 1996 Olympic Games.

During the team final of the 1996 Olympic gymnastics team competition, the American needed to nail her vault to secure the first team gold medal for the U.S. However, on her first vault, she fell, injuring her ankle, which was later discovered to have broken.

Despite being unable to walk or stand without grimacing, her coaches were yelling and encouraging her to do her second vault.

Strugg completed her second vault, landing on one foot before falling to the floor and crawling off the mat, securing Team USA the gold medal.

However, years later, it was unveiled that these athletes were systemically abused with a “win at all costs” mindset instilled in them from a young age.

Realistically, Strugg didn’t have a choice to do the vault.

American runner Fiona O’Keefe was another Olympic athlete who encountered a similar situation during the 2024 Olympic marathon.

O’Keefe, the 2024 U.S. Olympic Marathon Trials winner, was hailed as a rising star coming into the Olympic marathon as the top American. However, less than 5K into the race, O’Keefe was seen hobbling out the back of the pack and, soon after, withdrew from the race.

The incident sparked controversy about whether external pressures from coaches, family, or friends may have led to her decision to start despite suffering pain and tightness in her hip the week before the race.

Of course, many people will say that Harvey, or any athlete in a similar situation, would want to push through the pain or the injury. And that’s probably true. However, many of these athletes have had the “win at all costs” mindset forced upon them from a young age.

We live in a world where there is a lineup of replacement athletes who are equally as talented and would jump at an opportunity to take Harvey’s Olympic spot. Because of this, athletes who aren’t willing to make these sacrifices or have the “Our success is more important than your well-being” mindset are easily replaced.

While nothing will change overnight, prioritizing athletes’ mental and physical health is crucial for longevity in sports. When we look at situations like Harvey or Strugg, our thoughts should not be to celebrate the sacrifices they’ve made but to question why they feel the need to push their bodies to the breaking point.