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Women Specific Running Injuries . . . Do They Exist?
By Barbara Fallon WallaceMay/June 2010
For the Washington Running Report
As a runner, it would be great to have a crystal ball that foresees how training and race performances will unfold, what injuries might be encountered, and of course, how fate can be altered to stay healthy. We can all keep dreaming, right?
Overuse injuries are not uncommon in the running arena. The key is to determine what causes them and avoid it at all costs. Some variables are controllable such as mileage, intensity of training, and recovery, but one has to wonder if there are some forces of nature that are out of our control . . . such as gender?
As a physical therapist, I evaluate and treat a myriad of runners, male and female, who all struggle with the same common overuse injuries. I have found a few types of injuries, however, that appear more prevalent in women runners.
This is not caused by any "weakness," but primarily is attributable to varying anatomical and biomechanical differences between the genders that predispose one to injury. Below are a few "women specific" injuries I encounter in the clinic along with some differences between the genders that cause bias toward particular injuries.
Stress Fractures of the pelvic bones (hip, femur, pubic ramus) are not widespread in the running community, but not uncommon in the competitive female distance runner. [Note to men: do not stop reading here because you are not immune!] Preeminent distance runner Meb Keflezighi sustained a hip stress fracture and could only muster an eighth-place finish in 2:15:09 at the U.S. Olympic Marathon Trials in 2007. Stress fractures are small cracks that develop because of the inability of the bone to withstand repetitive forces.
Women are primary targets for stress fractures for several reasons. In general, women have less muscle mass than men, which means that the excess stress of exercise is often borne by the bone. Additionally, women often have an overall weaker bone structure because of hormonal influences, possible menstrual irregularities, and mineral and nutritional deficiencies.
The best means to combat stress fractures is to develop a good strength program to build lean muscle mass, a smart training regimen to avoid overtraining, and a proper nutrition program to ensure adequate nutrients for bone growth and development.
Patellofemoral Pain Syndrome, popularly known as "runner's knee," is extremely common in female runners of all levels. Patellofemoral pain is a generic descriptor for anterior knee pain that increases with repetitive loading of the joint while running, aggravated with climbing or descending stairs, and prolonged sitting.
Patellofemoral pain often is an irritation caused by abnormal tracking of the patella and not actually associated with damage within the knee joint itself. Certain biomechanical factors contribute to this dysfunction: tightness of the vastus lateralis muscle (outside quadriceps) and illiotibial band; weakness of the vastus medialis oblique muscle (VMO); and an increased Q-angle (defined as the angle between the quadriceps muscles and the patellar tendon).
Women have a Q-angle larger than men because of the wider design of the hips. Knee pain is not unique to women, but the larger Q-angle places undue stress on the bones of the pelvis which can translate down the kinetic chain into knee pain. That's right ladies---knee pain often times stems from the hips! A stretching program focused on the IT band and the quadriceps along with a complete strengthening and stabilization program to include the hip musculature and VMO are advised to help keep knee pain at bay!
Plantar Fasciitis (PF) is a common cause of heel pain in runners. PF is an inflammatory reaction along the plantar fascia, a thick fibrous band on the bottom of the foot that runs from the heel to toes. Often, runners note stiffness in the beginning of the run that subsides after warming up; only to find it reoccurs more intensely later in the day.
Women are particularly susceptible to PF due to their footwear selection during the workday. High-heel shoes look great but can wreak havoc on the lower legs and feet! Improper footwear can cause calf muscles to tighten and the Achilles tendon to shorten, which in turn places undue stress on the PF. Conversely, cute ballet flats offer no foot support and can create arch and plantar irritation as well.
The best measures to avoid heel pain are to perform strengthening exercises for the muscles that support the arch of the foot, maintain flexibility in the calves, and most importantly select supportive footwear---that can still look great but keep your feet happy!
Barb Fallon Wallace, MSPT, DPT holds a Masters and Doctorate in physical therapy. She is a local competitive runner and practices at Capitol Rehab in Arlington, VA. For more information: www.capitolrehab.com or 703-527-5492.