Overuse Injuries in Female Athletes: How to Stay in the Game

The human body has a tremendous capacity to adapt to physical stress. However, jumping into too much too soon can also cause the breakdown of muscle tissue, leading to overuse injuries. 

Acute injuries, like wrist fractures and ankle sprains, are usually the result of a single, traumatic blow, whereas overuse injuries are the result of repetitive micro-trauma to the tendons, bones, and joints. Stress fractures, tendonitis, bursitis, epicondylitis, and knee injuries are some of the most common overuse injuries seen in women.

So why do these injuries pose more of a threat to female athletes than to our male counterparts? 

The prevalence of overuse knee injuries in women is due to a number of gender-specific factors, including patellar tracking issues, decreased quad strength, and greater Q angles—the angle from our hips to our knees and from our knees to our ankles, which is greater/more pronounced in women due to our wider hips and flatter pelvises. 

Additionally, hormone levels may be involved in some women’s inflammatory response to exercise, and in comparison to men, women have looser ligaments in our joints and significantly lower levels of testosterone, a hormone that aids in muscle growth and development. When our muscles aren’t adequately prepared for the stress we place on our musculoskeletal systems during activity, we’re more likely to sustain overuse injuries. 

Women are particularly vulnerable to overuse injuries when they plunge into use following a period of nonuse, such as jumping into two-a-day practices after summer break. Men face similar vulnerabilities when going from use to nonuse, but due to their increased muscle mass and thicker bones, their risk of suffering an overuse injury is substantially lower than for women in the same circumstances.

To combat this lag in muscle development and the risk of overuse, it’s important to ease into activity. The 10-percent rule is a good standard to follow if you’re unsure just how gradual your transition to action should be. This rule encourages athletes to increase their training and intensity by no more than 10 percent per week. 

In addition to the 10-percent rule, I advise my active female patients to: 

• Focus on low-impact strength training (less weight, more reps)
• Graduate into the work load
• Target different muscle groups
• Break a sweat before any intense workouts, runs, or practices
• Consider an ice bath after any intense workouts, runs, or practices
• Use common sense—you don’t become a marathon runner in one week

To compete at your highest potential, it’s pivotal to value consistency, patience, and progress. Going from 0 to 100 right out of the blocks is a quick way to find yourself on the injured list.

For more training tips and women’s health advice, follow me on Twitter @MicheleSchulzMD!