Tag Archives: gender

Runner’s Knee: Knee Pain Isn’t Just for Old People

Don’t knee problems only plague old people or people who have run for a lifetime? I questioned this when, for the seventh time in a row, my knee was hurting only a mile and a half into my run. I’m too young for this! However, a plethora of information suggests that knee pain is perhaps not so uncommon in younger runners and athletes as I thought.

The American Family Physican published an article detailing one form of knee injury informally called “Runner’s Knee”. A shockingly high number, between 16 and 25 percent, of running related injuries fall into this categorization. Medically termed patellofemoral pain syndrome (PFPS), the ailment manifests in pain or stiffness in the knee, particularly when bent in load-bearing scenarios such as walking, running, jumping, or squatting. The patellar region experiences shocking loads even in the day to day: in walking alone the region experiences up to a half the person’s body weight while in an activity like squatting it can experience up to seven times one’s body weight. Often the pain is hard to pinpoint but occurs in or around the front of the knee within a circular range. It can inhibit or put a stop to training, however, if addressed early on, can often be healed or corrected much more quickly.

an animated image of a runner mid-stride with the pain region for patellofemoral pain syndrome highlighted
Photo by www.scientificanimations.com from Wikimedia Commons

In PFPS, the patella (the kneecap) moves abnormally within the groove on the end of the femur (called the femoral trochlear groove) due to imbalanced or unusual loads on the joint. This results in over-stressing the joint and causing pain. Several possible causes exist for PFPS; here, I will focus on three of most commonly cited: increased intensity of activity, weak hip muscles, and overpronation.

an image of the muscular and skeletal structure of the knee, including the patella
Photo by BruceBlaus on Wikimedia Commons

Increased Activity

One review explored that women are more likely to suffer from PFPS. In this study they saw that women of higher activity levels were not necessarily more likely to experience pain due to PFPS than women who had a lower activity level. Rather, a substantial increase in activity level seemed to be the cause of pain. Therefore, more than overuse of muscles or joints, PFPS often develops with increased amounts of activity, or temporary overuse, such that the body is not prepared to handle the increased and repetitive forces on the knee.

Weakness in Hip Muscle Strength 

This study shows that lower extremity mechanics and motion can be affected by hip strength. For example, inward rotation of the hip can be lessened through strengthening of hip muscles that counteract that rotation. With less internal hip rotation, the knee abduction moment (the tendency of the knee, due to reaction forces from the ground, to rotate  inward and away from the balanced midline of the knee joint) decreased which often resulted in less stress in the knee. Therefore, the review suggests that strengthening hip muscles can lower the patellofemoral joint stress and help treat PFPS. 

Overpronation

Pronation refers to the natural movement of one’s foot and ankle slightly inward while stepping. When the ankle rotates too far inwards, it is called overpronation. Overpronation can lead to further improper structural alignment in the lower body as the tibia rotates improperly in response to the ankle rotation. The tibia’s rotation then disrupts the natural movement of the patellar joint and can contribute to PFPS. In many cases, overpronation can be corrected through use of orthotic shoe inserts that prevent the over-rotation of the foot and ankle.

In conclusion, while we may often associate knee problems with older people or arthritis, PFPS affects many athletes, particularly runners, at any age. Often, proper training programs that do not accelerate activity too quickly, strengthening exercises that focus on the hip muscles, and proper, overpronation-correcting footwear can treat or prevent an individual from being affected by PFPS. Check out some strengthening exercises here.

Women in Endurance Athletics: The Further, the Faster

In the majority of athletic events, men have long outperformed women. This is due to a combination of factors including physiological differences, societal norms, and legislation. But in the last few decades, there has been a noticeable swing in the realm of endurance athletics. Now more than ever, women are closing the gap with respect to their male counterparts in ultra-long distance races, including running, biking and swimming. In some cases, women are even outperforming men at the elite level, winning a number of top-tier events. So what are the reasons for this changing of the guard, and why is it happening now?

A woman fights up a steep hill in a mountain biking raceImage courtesy of Pixabay

One of the major reasons for this transition in endurance athletics performance boils down to athletics becoming more inclusive. Since the passing of Title IX in 1972, the number of women participating in a wide array of athletics has increased dramatically. Before Title IX, only about 300,000 girls participated in high school sports, whereas now that number has climbed to around 3.3 million annually. Many experts believe that about a third of the difference in performance between male and female athletes can be attributed to the door opening for more women to compete. But why does this effect endurance athletics the most?

In endurance athletics, there are five major factors that contribute to an athlete’s performance: heart size, VO2 max (the efficiency of oxygen delivery to muscle), lean muscle mass, central drive, and movement economy. Men are typically better suited than women when it comes to the first three. But central drive, or how well the nervous system can send continued signals to maintain muscle performance over time, and movement economy, or efficiency of form, allow women to close the gap. These two factors can be improved through practice with monumental results. In ultra-long-distance swimming, where efficient body control is perhaps most critical to building speed and saving energy, women perform better than men in two out of the three most elite races in the world.

Woman swimming in open water
Image courtesy of Free-Photos on Pixabay

There are a number of other physiological advantages for women at long distances. Women’s muscles tend to be smaller than men’s, but over long distances this means that they do not tire as quickly since their hearts do not have to work as hard to pump as much blood. Women have been found to recover faster than men, utilize fat stores for energy more efficiently than men, and hold a consistent pace nearly 20% better than men. All of these things add up over the length of high endurance races of all kinds, allowing women to perform better compared to men than they do at shorter distances.

There are still many factors in this area of biomechanics research which are unsure, but one thing is sure. As more women continue to participate in athletics and especially high endurance athletics, there is no telling the limit to how fast and how far they may go.

 

More information can be found at Outside Online and Active

 

Female Athletes Compete Against Higher Risk of ACL Injuries Than Males

Female athletes face a greater rate of anterior cruciate ligament (ACL) rupture than males. According to Dr. Karen Sutton and Dr. James Bullock from the Department of Orthopaedics and Rehabilitation at Yale University, female athletes are 2 to 8 times more likely to tear their ACL than male athletes. The majority of these injuries (more than two-thirds) are from non-contact situations. A variety of anatomical, biomechanical, and hormonal factors attempt to explain this difference.

Female soccer player stretching her leg
Photo by rawpixel on Unsplash
Differences between female and male lower-body anatomy show the disparity in Q-Angle that results
Taken from Desrosiers, Soccer Nation 2018

Some anatomical factors that help stabilize the knee joint and may be linked to ACL injuries include: the quadriceps angle (Q angle), tibial slope, and intercondylar notch. The Q angle is the angle formed between the upper leg at the hip joint and the lower leg at the knee joint. This angle tends to be 3.4-4.9 degrees greater in females than males when measured in a standing position. The figure at right shows the Q angle difference between men and women that is caused by anatomical differences including a wider pelvis in females. A greater Q angle causes more strain on the quadriceps muscle away from the centerline of the body, which can affect the position of the ACL to be more prone to rupture.

Tibial slope is a quantity used to describe the position of the tibia relative to the femur. When the tibia is positioned more forward than the femur there is a greater posterior tibial slope and therefore increased ACL strain. On average, females have shown to have a greater tibial slope, which may contribute to the higher incidence of ACL injuries. The figure below illustrates the biomechanics of posterior tibial slope: the effect of the knee joint compressive load (down arrow) and the force of the quadriceps (up arrow) result in an anterior shear force, causing anterior translation of the tibia relative to the femur (right-directional arrow) .

Biomechanical force diagram describing posterior tibial slope
Modified from Sutton and Bullock, JAAOS 2013

In terms of biomechanical differences between men and women, women have greater natural muscle contractions for movement away from the centerline of the body. This translates to a difference in landing positions for women compared to men – females tend to land more straight, creating more force on the knee joint, while males absorb the impact better by naturally flexing their knees upon landing. The hamstring to quadriceps ratio (H:Q ratio) is the functional strength of the hamstring muscles (peak torque) relative to the strength of the quadriceps in motion. Poor muscle strength has been linked to higher risk of lower extremity injury. Males have the ability to increase their H:Q ratio during sport motion, but females fail to do so. Women have also shown greater internal rotation laxity – slackness or lack of tension in a ligament – than men. Generalized laxity was also significantly greater among individuals who suffered a noncontact ACL injury compared to an uninjured control group.

Hormonal factors are an additional consideration that researchers have explored, but the results have been inconclusive in making a direct link between hormone levels and the rate of ACL injury.

Additional reading on this topic can be found at VeryWellHealth and SoccerNation. The following video shows some advice for female ACL injury prevention.