Beware these five
Top five women-specific running injuries and how you can prevent them.
RESEARCH suggests that women get more running injuries than men. This has been attributed to a variety of anatomical and biomechanical factors.
Women have a wider pelvis than men and their femur is angled inwards more than men, rendering their knee less stable.
A difference in strength between the forward-facing thigh muscles (quadriceps) and the rear-facing thigh muscles (hamstrings) in women further predispose women to knee and lower leg injuries.
Hormonal changes associated with different phases of the menstrual cycle is also known to affect the integrity of ligaments, connective tissues and some aspects of neuromuscular control integral to running.
Dr Gowreeson Thevendran is an orthopaedic surgeon from Mount Elizabeth Novena Hospital in Singapore, who specialises in foot, ankle and sports injuries.
He shares with us some of the most common injuries suffered by women runners and how to avoid them.
Patellofemoral Pain Syndrome (PFPS)
This condition is caused by pain beneath the patella (knee cap) as it glides over the femoral notch (groove in the femur/thigh bone). This has been attributed in part to weak quadriceps muscles resulting in poor tracking of the patella over the femoral groove.
Women runners, in particular, have been shown to have weaker hip abductors and external rotator muscles that contribute to poor patella tracking and PFPS.
PFPS can be prevented with hip and quadriceps strengthening exercises (lying down sideways and lifting the leg away from midline, straight-leg raise exercise).
Icing after runs and using traditional or flexible athletic tapes on either side of the knee cap is also beneficial.
Stress fractures
Seemingly innocuous activities like running with repetitive loading can result in stress fractures as the strength of even normal bones is surpassed. Rather than gender inequality, stress fractures are more common in high-intensity female runners and those with biomechanically abnormal feet (high arched feet predisposes one to fifth metatarsal stress fractures and tight calf muscles may predispose to metatarsal stress fractures).
Constant and localised pain in the lower leg or foot should alert a runner to the possibility of a stress fracture. Consult an orthopaedic foot surgeon if in doubt.
Avoid running until the fracture has healed and support the injured foot with an orthotic (insole, wedge or heel cup) and supportive shoes is important.
Repeated stress fractures may be the result of a hormonal abnormality and should warrant further investigations in the way of blood tests and/or an MRI scan.
Iliotibial Band (ITB) Syndrome
The ITB is a strong band of tissue that extends sideways from the hip to the knee and helps to support the knee and leg when the foot first hits the ground when ambulating. It has been associated with running on uneven surfaces, poor footwear and sharp turns.
There is scientific evidence linking poor hip abductor and external rotator muscle strength with ITB syndrome in female runners.
Treating ITB syndrome requires changing your “running pattern” and strengthening the hip abductors (gluteus muscles) and external rotators (lying sideways on the ground and raising the leg away from the midline, or standing erect and crossing one leg in front of the other, hiking the hip up).
Performing these manoeuvres for 15 seconds each, three to four times per day is essential to improve hip strength and help resolve ITB syndrome.
Icing the ITB and massaging it with a roller bar after stretches also helps.
Medial Tibial Stress Syndrome or ‘shin splints’
Typically resulting in pain across the inside of the shin, this condition is classically associated with runners, with women having a slightly higher prevalence than men.
Less experienced runners are more prone to this condition as new scientific evidence shows that it is due to repeated stress across the front of the tibia, which gradually resolves as the bone thickens (remodels) once the beginner runner acclimatises to running.
Avoid running once the pain develops as persevering can result in stress syndromes/fractures. Build up a running routine and pace in a graduated fashion, allowing for the bone and muscles to condition itself.
Strengthening the calf and shin muscles helps reduce the impact on the bone as one runs and helps reduce the risk of shin splints.
There is weak evidence to suggest supportive shoes or running on a soft surface is truly protective.
Plantar fasciitis
This condition irks most runners due to its prevalence and stubborn nature.
Typically presenting as plantar heel pain, worst with the first step out of bed in the morning, it often persists for months or years before resolving.
Plantar fasciitis is commoner in those with flatfeet, overweight and those who have had the condition before. It is caused by degeneration of the foot arch-supporting band of tissue.
Best to avoid running for a short period. Utilise customised heel cups in shoes.
Stretching exercises are critical when treating plantar fasciitis, in particular calf stretches and plantar fascia stretches (flex the big toe up to accentuate the arch of your foot).
Stretching should be done at regular intervals during the day and it’s best to do it just before standing up when seated for prolonged periods or before getting out of bed.
Supportive shoes with an in-built arch and the use of night splints, even temporarily, is useful.
Finally, in refractory cases, shockwave therapy or key-hole surgery is recommended to release the tight plantar fascia. FitForLife KL 2017, with the theme “Get Fit. Live Great!” aims to inspire Malaysians to lead a healthy lifestyle by being physically and mentally fit. FitForLife KL 2017 is organised by Star Media Group Berhad with Great Eastern Life as exclusive event partner.
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