When it comes to athletics, men and women are equal on many levels. But there’s one area where women take the clear lead: injuries. Female athletes are two to six times more likely to suffer an injury than men, depending on the sport. In particular, women are more prone to knee injuries.
Women are more likely to develop patellofemoral pain syndrome (“runner’s knee”), the degeneration of the shock-absorbing cartilage under the kneecap that can occur in many kinds of sports and activities. And they’re especially susceptible to a debilitating rupture of the anterior cruciate ligament (ACL), which helps stabilize the knee joint. Injuries to weight-bearing joints like the knee, as well as the ankle and hip, increase the risk of osteoarthritis.
Why the gender inequality?
A combination of anatomical, biomechanical and other factors are to blame. Women tend to have smaller, weaker muscles supporting their knees, as well as more lax ligaments. They tend to have a wider pelvis than men, and their thigh bones angle inward more sharply from hip to knee (this is called the Q angle, see "The Q Angle," below), making their knees less stable. Plus, they tend to have a relatively greater imbalance between quadriceps and hamstring muscles (with the quads being stronger), which can contribute to knee injuries. There are also biomechanical differences between the way men and women land on their feet, as in running or jumping.
Because hormones may affect ligaments, connective tissue and neuromuscular control, women may also be more prone to injury during certain phases of their menstrual cycles—though more research is needed. On top of all that, training programs for women are generally based on those developed for men and do not take these anatomical and biological differences into account.
The Q Angle
The, Q, or quadriceps, angle is the angle between two lines—one connecting a point on the front of the hip bone and the center of the kneecap (patella), the other connecting the kneecap and a point on the upper shinbone (tibial tubercle). An angle greater than normal increases your risk of
You can’t change anatomical or biological factors, but you can learn to compensate for them to reduce your risk of injury. If you exercise a lot or play a sport, you may want to work with a physical therapist or trainer, especially if you have already had an injury.
- Do exercises that increase core stability, agility, flexibility and balance. Include strength training, plyometrics (which involves first stretching a muscle and then contracting it rapidly) and activities that improve proprioception (your sense of position), such as using a balance board. See "Slow-Walking Lunge" and "Plyometric Squat Jump," below, for examples of two good exercises.
- Practice dynamic warmups— which are very active, as opposed to slow stretching. A website from Duke University (tinyurl.com/warmup4women) presents video examples of dynamic warm-ups—for example, how to use exercise bands around both ankles while doing various walking maneuvers (forward, backward, to the side and variations on normal walking), as well as exercises where you hop back and forth on one leg, run zigzag, skip forward and backward by crossing one leg over the other, and run backwards.
Walking slowly, take a big step forward with your right leg; land softly on your heel before planting your whole foot down. Then, lower your body into a lunge, with your right thigh parallel to the ground, your back heel lifted and your weight on the front heel and back toe.
- Learn how to jump and land properly. When women jump, they tend to land in an upright position that allows the knee to move more side-to-side and rotate. This reduces shock absorption, thereby increasing the risk of leg injuries. Instead, your hips, knees and ankles should be flexed when you land in order to absorb the force of the landing.
- The 20-minute PEP (Prevent injury and Enhance Performance) program, developed by the Santa Monica Sports Medicine Foundation, addresses deficits most common in women athletes. It includes warm-up, strengthening, stretching, plyometrics and agility exercises that can help you prevent knee injuries if you engage in high-intensity sports or activities that involve jumping or side-to-side motion, such as soccer, downhill skiing, tennis or vigorous dancing. A study in the American Journal of Sports Medicine in 2008 found that female college soccer players who performed the program three times a week had a significant reduction in ACL injuries compared to a control group. You can download it at smsmf.org/pep-program.
Plyometric Squat Jump
Stand with your feet shoulder-width apart and your fingers interlocked behind your head. Squat halfway (keeping your knees in line with your toes) and then jump straight up as high as you can, pulling in your abs. Land in the original half-squat position. Repeat 30 times, pausing after each set of
- Wear proper footwear and work out on appropriate (not very hard) surfaces. Insoles may help if your feet overpronate (roll inwards). Don’t suddenly intensify or lengthen your workouts. Lose weight if you’re overweight—excess weight puts increased stress on knees. Don’t wear high heels, except on special occasions.
- If you have knee problems or are predisposed to them, avoid the following: leg extensions with heavy weights and locked knees; full squats unless advised by a physical therapist; running downhill; cycling with the seat low and in high gear; taking large steps on stairs or stair machines.