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Injury Risks for Female Runners

I enjoy running for exercise and sport and participate in half marathons. I am currently training for a full marathon. Are there specific issues that I should be aware of as a female runner? 

Although running offers extensive benefits, female runners, compared with male runners, have unique risks with respect to performance, repetitive stress, and acute injuries.  The risks and types of injuries change as women age.

Anatomical differences contribute to biomechanical differences that ultimately affect form and function. One fundamental difference between males and females is the pelvis. The shape of the pelvis controls the alignment of the hips and knees and is the basis for mechanical gender differences. A common alignment in women is to have increased internal rotation of the hips, a smaller quadriceps muscle and a “knock knee” pattern called genu valgum. This sets the stage for compensatory changes in the lower leg that creates excessive foot pronation and a slightly different heel strike. This alignment pattern can cause repetitive overuse injuries and is important for the female runner to address with strengthening exercises for the quadriceps and special attention to the alignment of the foot. Orthotics (shoe inserts) can be helpful in correcting foot alignment issues.

Other distinctions that affect performance are attributed to hormonal differences. During puberty, girls gain both fat mass and lean body mass because of rising levels of estrogen, whereas boys gain lean body mass and lose body fat under the influence of testosterone.  Men also have physiologically slightly higher oxygen-carrying capacity. However, even with these differences, studies have shown that women and men show the same physiological response to training and results in similar relative gains in strength.

Women are also at increased risk for stress fractures. Areas that are at particular risk to runners include the metatarsals (long bones of the foot), the tibia (lower leg bone), the femoral neck (hip), and the pelvis. Stress fractures may first appear as a slow onset, low-level pain that progresses and may become chronic. To prevent stress fractures from occurring, female runners should pay special attention to the factors that affect bone health such as adequate intake of calcium (1200-1500mg a day), vitamin D (400-800 IU a day), avoidance of carbonated beverages especially those with caffeine and appropriate calorie intake. Athletes who are involved in sports that focus on physical form and physical performance are at increased risk for jeopardizing nutritional requirements in the quest for the “ideal” body image. Runners fall within this category, and female runners in particular are at higher risk for eating disorders than their male counterparts.

Addressing the unique biomechanics of female runners is essential to rehabilitate athletes past symptom resolution and back into full activity. Prevention of injuries plays an important role in achieving the goal of participation in running and fitness activity throughout every stage of a women’s life.