Special considerations for female exercisers

By Judy Torel

Regular exercise is one of the most positive life habits a person can practice. Current science links all exercise – cardiovascular, muscular strengthening, and flexibility training – with positive health outcomes. Exercise is credited with decreased risk of heart disease, diabetes and cancer and of symptoms of depression and anxiety, as well as improved sleep and improved capacity for everyday activities and increased self-esteem.

But as with all things, there is a light and a dark side to exercise. With regular exercise there is increased potential for certain injuries. There are several injuries related to regular exercise that are more prevalent in women. But if an ounce of prevention is worth a pound of cure, then read on so that you can gain all the benefits of exercise while avoiding the potential pains!

The feet
Overuse injuries of the feet are more prevalent in females than males. These injuries include Achilles tendonitis (inflammation and tenderness of the back of the calf right above the heel), plantar fasciitis (an inflammation of the arch on the bottom of the foot), heel spurs (tiny bone growths that result from tendons and ligaments pulling from running, walking and jumping) and neuromas (a pinched nerve usually on the foot between the third and fourth toe that causes tissue to grow around it, resulting in pain).

Eighty percent of foot surgery patients are female and most of the injuries are related to women squeezing their feet into shoes that do not match the design of their feet, according to a 15-year study by Michael J. Coughlin, MD, an orthopedic surgeon in Boise, Idaho.

As women, we strive to be fashionable. The current fashion is high–heeled (very high–heeled!), narrow-toed, tight-fitting day and evening shoes. Wearing high heels can lead to a shortening of the Achilles tendon and plantar fasciitis. Wearing narrow–toed shoes can lead to the squeezing of the widest part of our forefoot and pinched nerves. Wearing ill-fitting shoes that are too tight can lead to all of the above, plus heel spurs.

The shoe habits of women set them up for more sports related injuries of the feet when exercising. Most active women who develop a foot injury look first to their sneakers when searching for a cause of the pain, but most likely the correction to daily footwear may be the most effective treatment.

Many women don’t realize that as we age, there is a decrease of the fat pads on the bottom of our feet and our feet splay, or get longer and wider. Without changing our shoe size or adding extra cushioning through the use of additional insoles, everyday shoes can be setting women up for more sports-related injuries of the feet.

In addition to changing everyday shoe habits, active women experiencing foot pain can take several other corrective or preventative steps. Purchase a pair of cushioned insoles, such as Sof Sole or Road Runner Sports, and put them into your workout shoes in place of the standard inserts that come in the sneakers. Take time every day to stretch the muscles of the calf by putting your toe against a wall while keeping your heel on the floor and leaning forward with your hands on the wall while keeping your knee straight. Use a tennis ball, rolling pin or soup can and roll your foot over it to stretch and release the tendons and ligaments of the bottom of the foot. Try doing the same with a frozen Dixie cup of ice and get the additional benefit of decreased inflammation. If your feet are stiff in the morning, run hot water over a towel and wrap your feet in it to stimulate blood flow and loosen tendons and ligaments that have stiffened overnight.

The knee
Active women are more prone to knee injuries than men. Specifically, women develop patellofemoral pain, chondromalacia and anterior cruciate strains and tears. Patellofemoral pain is pain that feels like it is right on, directly above or directly below the knee cap. Chondromalacia is a wearing down of cartilage on the underside of the knee cap that leads to a degeneration of the articular surfaces (ends of the bones) in the knee. This is diagnosed as osteo-arthritis or degenerative arthritis of the knee. The Anterior cruciate is the ligament that attaches the bones of the lower leg to the bones of the upper leg through the knee joint. When strained or torn, it leads to feelings of instability, like the knee will buckle from under you when taking a step.

All of the knee injuries described above are believed to result more in women due to looser joints stemming from estrogen levels, a tendency to land with locked knees when jumping or running and a wider hip/pelvis area resulting in a higher Q-angle (quadricept angle).

The Q-angle is measured by two intersecting lines: one coming from the top of the center of the patella (knee cap) to the anterior-superior iliac spine of the pelvis (top of the flat bone of the pelvis) and one from the patella to the tibial tubercle (bottom of the shin bone in the ankle). In women, this angle is wider and results in increased stress on the knee joint and a higher incidence of pronation (flat feet) in women.

There are several corrective and preventative steps that can be taken to compensate and correct for a wider Q-angle. Having custom-made orthotics or purchasing inserts designed to provide a more rigid arch support than that of standard-issue inserts in sneakers can help correct excessive pronation and decrease sheering forces in the knee. Strengthening the VMO (vastus medialis obliquus or inner quad muscle) can help stabilize the knee. Wall squats performed to 30-degree flexion is an exercise that can strengthen this muscle. Stretching of the muscles that get excessively tight at a higher Q-angle, such as the quads, hamstrings, gastrocnemuis (back calf) and iliotibial band, which runs down the outside of the thigh, will help reduce the unbalanced tracking of the knee cap due to a higher Q-angle. Regularly replacing running or workout shoes will help prevent knee pain. The life of a sneaker is estimated at an average of 300 miles of running. They may look great, but the bottoms have been pounded down and need to be replaced at this mileage.

Osteoporosis
Active women are more prone to osteoporosis than their male counterparts. This is due to the fact that when exercising excessively, the human body sweats out electrolytes, including calcium. In addition, women are driven to maintain thinner body weights, which leads to decreased consumption of foods containing high calcium such as dairy products. A combination of high levels of exercise, which decreases estrogen, and with reduced caloric intake due to a drive for thinness, can result in osteoporosis in extremely active women.

Active women can prevent osteoporosis by including strength training with their cardiovascular training program. Ingesting 1,000mg of calcium daily from foods such as yogurt, milk or calcium-enriched products like orange juice or by taking a calcium supplement with vitamin D, which helps absorption (such as Os-Cal) can help minimize osteoporosis risk. In addition, maintaining a healthy weight as determined by body composition (body fat and lean mass percentage vs. BMI or height–weight charts), will minimize risk.

Osteoporosis is one component of a complex known as the Female Athlete Triad, which also includes low body weight and amenorrhea (absence of menstrual cycle due to low estrogen from high levels of exercise). This can literally be a deadly combination if not addressed in a timely manner. If a women suspects that she may be at risk of the Female Athlete Triad, she should consult with her doctor in order to receive testing to assess bone density, estrogen levels and healthy lean mass levels.

Exercise is a positive habit and more women need to practice it for long-term health and highest quality of life. There are some potential risks; but with proper prevention, the benefits definitely outweigh the liabilities!

Judy Torel is a therapist/personal trainer with a Master’s degree in psychology. She is certified through the American College of Sports Medicine as a fitness trainer and works out of Planet Fitness and Deb's Sweat Shop Extension. She can be reached at JTOREL2263@yahoo.com