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Fitness niggles and injuries, begone!

From knee strains to pelvic floor dysfunction. There are a host of injuries that affect sporty women more than men. Here are the culprits and how best to tackle them

You’ve bought the gorgeous workout gear and whizzy fitness gadgets, but is that niggling knee, twingey hip or sore shin getting between you and that glowing vision of health and fitness that you want to be? You’re not alone. Whether you’re a weekend cycling warrior, triathlete junkie or a potter-round-the-village-green sort, there are a host of injuries that trouble active women way more than men.  

Women have less muscle mass, less bone mass, and a higher percentage of body fat than men (whaaaat?) as well as a different physiological make up including wider hips. And don’t get us started on hormones. Between these various factors, there are certain injuries that afflict women, especially as we get older. 

The number of women participating in sport has shot up in the last 20 years. We’ve all been inspired by the stellar British successes in hockey, netball, football and cricket, and have been signing up to local teams, engaging trainers and setting new sports-related goals. Coupled with this are the stories of athletes such as Jessica-Ennis-Hill and Serena Williams who have returned to top level sport after having kids. Where once a gentle aerobics or pilates class was the reserve of women post childbirth, athletes like Helen Glover show that’s no longer the case.

But alongside the good stuff that comes from sport (fitness, energy levels, mood boost), come the injuries, says Dr Kate Hutchings, Sports and Exercise Medicine Consultant, who is part of a medical team looking after Olympic athletes as well as treating active women in the Berkshire/Oxfordshire area. She welcomes the rise in numbers of active women, but has seen an increase in certain types of injuries in her clinic. As a result she has set up The Active Women’s Clinic alongside Physiotherapist Ros Cooke, with a view to injury prevention strategies as well as diagnosis and rehabilitation. 

She told Muddy about the most common injuries affecting active women:

Knee injuries

So many of us know someone who has suffered an ACL (anterior cruciate ligament) injury. The ACL is a flexible band of tissue that runs diagonally over the knee and when it is overstretched it can sprain or tear. 

There are a host of reasons why it’s more common in women – in general women have a wider pelvis and different angle on their thigh bones as well as a narrower groove for the ACL to fit in. This can cause some women to bend their knees towards the midline of their body, placing additional stress on the ACL. 

Women also have more elastic ligaments which are more prone to overstretching and can result in injuries in women’s knee, ankle and elbow joints. This elastic quality is especially prevalent during pregnancy due to hormonal changes that allow women’s bodies to accommodate a growing baby. It can still be hanging around in the body months after pregnancy, leading to ligament problems for women who get back to sport after a baby.

While this strain can be avoided through targeted strength training and exercises, if it comes to an ACL injury, this is addressed through scans,  physiotherapy rehabilitation and in some people, key hole surgery. 

REDS and bone stress injuries

A condition that has only formerly been recognised in the last ten years is Relative Energy Deficiency in Sport (REDS). It’s caused by not eating  enough or “under fuelling” for your level of exercise. When we undertake any physical activity, our bodies require the correct amount of nutritional input to provide fuel for not only our exercise, but for the body’s metabolism. 

It sounds perverse as many women undertake exercise to lose weight or maintain a healthy weight, but if this is done in excess, REDS becomes a serious illness with lifelong health consequences. 

Exercising with insufficient nutrition leads to an abnormal metabolic/hormonal state. Periods can become irregular and eventually stop altogether as the body tries to conserve energy. This then leads to lower bone density as well as weight loss, changes in mood, reduced immune function with prevalence to respiratory infections, a decrease in sporting performance and increased recovery time from injury. 

When it was first recognised, it was so markedly more common in women that it was called ‘female athlete triad’. The best way to address this is through getting clinical advice on the nutrition/training balance.

Bone stress and soft tissue injuries

As a result of REDS, women can suffer bone stress injuries which can progress to stress fractures if left unrecognized. 

Bone stress injuries can also affect peri- and menopausal women. As women age, their oestrogen levels naturally decrease which can lead to reduced bone density, and inclination to injury. 

Some women address the issue of low oestrogen with hormone treatment, but it comes with its own side effects and so isn’t for everyone. The lesson to learn is that the exercise we did in our 20s has a different effect on our bodies as the same exercise in our 40s and 50s. A good physio or PT can put together a training plan that’s right for your age. 

Pelvic floor dysfunction

One of the biggest barriers to women being active across their lifespan is urinary leakage. It’s thought to affect nearly a third of exercising women and yet we remain squeamish about it. Less than half of all women suffering from incontinence seek medical help. 

It affects women for a number of reasons including age, pregnancy and childbirth or just a low performing pelvic floor which can be brought on by repeated high impact exercise. 

Addressing pelvic floor issues starts with the pelvic floor exercises that will be familiar to any woman who’s been to a pregnancy yoga class (elevator analogy ringing any bells?). While more severe cases tend to be addressed with muscle rehabilitation.

While the pitfalls are there, the overwhelming benefits of exercise win out. It’s just a case of acting your age, not your trainer size.

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