To The Female Runner& How To Prevent Them
by Dr. Jeffrey Ross, D.P.M., F.A.C.F.A.S.
Clinical Assistant Professor, Baylor College of Medicine
Fellow, American College of Foot and Ankle Surgeons
bad news for the female runner is
that she is more likely than her male counterpart
to suffer certain types of injuries. The good
news is that, with proper education and the
right tips on injury prevention, she can minimize
such injuries or eliminate them altogether.
As a sports medicine podiatrist who treats a large
number of female patients, I am often asked why
women experience so many mal-alignment and overuse
injuries. The answer lies in the female's physical
development anatomy. When the female enters puberty
and her hips broaden relative to her waist and
shoulders, her pelvis begins to widen and a change
at the hip occurs. This creates an accompanying
change of the knees, often referred to as "knock
knees". The more "knock", the greater the quadriceps
pull. As a result, sports medicine doctors see
many overuse injuries affecting the hip, knee,
shin and ankle of the female runner.
I have identified five injuries common to the
female runner - scoliosis, foot type and deformities,
Achilles tendonitis, knee injuries and stress fractures
- and suggested how to deal with them.
This curvature of the spine is most prevalent
in female adolescents, occurring 85 percent of
the time. It can contribute to the lower back and
hip pain with running. It can also cause a pelvic
tilt, where one limb acts longer than the other.
This almost always develops into an overuse injury
to the shorter limb.
Recommended prevention: Measure the shorter
limb and equalize it to the other limb to reduce
the potential for overuse injuries. This can be
accomplished either by using a prescription orthotic
ora heel lift.
Foot Type & Deformity
If a woman has a flat foot or pronates
excessively and had ligamentous laxity, she had
a greater chance of developing a bunion of hammertoes.
Unfortunatley the problem is often compounded by
shoewear designed primarily for the male foot.
The female forefoot is wider and her hind foot
narrrower, requiring a differently shaped shoe.
Recommended prevention: A running shoe
designed for motion control and stability. If necessary
see a sports medicine doctor to get a prescription
orthotic that will control the excessive pronation.
In addition to placing pressure on the
ball of the foot and causing pain on the metatarsal
head bones, sesamoiditis, and Morton's neuroma
(nerve entrapment), women who wear high-heeled
shoes tend to shorten the Achilles tendon. This
can lead to a typical overuse injury such as chronic
Achilles tendonitits or a behind-the-heel spur
Recommended prevention: Plenty of stretching
performing correctly and without bouncing, holding
the stretch 20-30 seconds. Good suggestions: wall-calf/Achilles
stretches and step-heel/calfdecline stretches.
As we noted earlier, because a women's
pelvis is wider than a man's, her hips rotate inward
and downward, causing and accompanying change of
the knees, often referred to as "knock knees".
The more "knock", the greater the quadriceps pull,
and the greater the chance of injury to the knee.
A weak quadricep muscle or mal-alignment of the
knee cap can often lead to overuse "runner's knee" injury.
Recommended prevention: Shoes that have
motion control prevent the knees pendulum swing.
A prescription orthotic may also help. Quadricep
muscle strengthening is often beneficial.
Seen most often in females who do not menstruate
and/or suffer from osteoporosis due to a decrease
in bone mineral density, stress fractures can result
from extreme biomechanical stress on a weakended
bone. Activity, training and intensity increase
the incidence of stress fractures in amenorrheic
(non-menstruating) women. The prevalence of such
an injury increases dramaticially as the weekly
running mileage exceeds 20 miles.
With the more common incidence of eating disorders
in women, improper nutrition is another factor
that can lead to stress fractures. Anorexia nervosa
and bulimia nervosa are two eating disorders that
can contribute to injury and even death.
Recommended prevention: It goes without
saying that a proper diet, medical attention for
amenorrhea and appropriate hormone therapy will
address the problem of demineralization of the
bone. In addition, a greatly reduced mileage schedule
or complete cessation of running may be necessary
to allow for complete healing and prevent recurrent
Patient education is a must to prevent "down time".
Eating disorder, amenorrhea and osteoporosis must
be addressed early and have a team approach to
care. Proper diagnosis and treatment, in addition
to psychological counseling, may be immperative.
Understanding causes of injuries, together with
video taping of a runner's gait, can often illustrate
the nature of an injury. Muscle strengthening,
flexibility, biomechanical and other evaluation
can prove very helpful in preventing many of these
The female anatomy, physiology and even her psychology
require specific understanding, particularly in
cases of pregnancy and hormonal shifts. With patient
education and the tips mentioned on injury prevention,
the female runner can minimize or eliminate potential
Dr. Ross is a Podiatrist, M.D.
in private practice in Houston, TX. To book
an appointment with Dr. Ross or find out about
his services he can be reached at 713.791.9521.