There is no doubt that women are just different. This is a fact.
I’ll let you ponder on your own reasons why you might agree or disagree with me but for now I am going to stick with some good old physiological, biomechanical and hormonal facts.
These 2 things are just the beginning and an introduction into some tweaks you might want to make for your own prescribed training program (as a female), as a trainer or movement specialist for your female clients or whether you’re a bit of a “I watch insta and Facebook videos and mimic what I see on there” kind of girl.
Let’s get into it.
Women are governed by cycles – and their injury risk can be too.
The female ovulation cycle is an extremely intricate piece of hormonal and physiological machinery that can have some effects that some people have absolutely no idea about. One of the major aspects of this cycle involves a hormone called Relaxin.
Relaxin is a hormone secreted by females (yes men have it in their sperm but it has no direct reported link to connective tissue like it does in women) that negatively effects collagen (connective tissue) integrity and bone surface areas. It is directly related to the need for increased movement throughout the pelvis and birth canal during child birth. However In simple terms and for the everyday female it means your body is not necessarily operating at its peak and could be at a higher risk of injury when Relaxin is secreted in higher than normal doses.
The highest levels of Relaxin secretion is during the middle of the Luteal phase of menstruation which is day 20-23. Collagen is needed to connect bones to ligaments and the opposing bones, hence doing a very necessary job in holding joints together with a normal amount of laxity (minimal) and with the assistance of muscles of course. It also does the same with tendons that attach into muscular fascia (more connective tissue) and continues onto another tendon into another bone and so on.
Relaxin DECREASES the effectiveness of collagen which combined with directly relaxing the ligaments can have some pretty important influences on women's' training, weight loads (if going heavy) and movement selection during this period of time.
The secondary aspect of this is the direct correlation of Estrogen and Progesterone serum levels in the influence of injury rate. A study listed by the Journal of Athletic Training found that a high level of females who suffered an ACL injury were reportedly on days 1 or 2 of their menstrual cycle. Interesting right?
Take Home Note: Scientifically speaking, possibly take caution and be careful on days 1 and 2, and days 20-23 of your cycle to not strain yourself beyond a comfortable level or load yourself with a large weight especially for movements that involve hips, lower back, knees and ankles. We are looking forward to more research in the future regarding this topic.
2. Your pelvis width causes changes things more than you might realise. Wait for the kicker though..
Trust me, I am not the first person to tell you that because of having wider hips (designed for child birth for the majority) you might be at a higher risk of injury in certain areas than the average female. However there are more influences on your body due to your hips that you may be aware of. Let’s break them down.
2a) Have you heard of the rotator cuff of the hips?
The Q angle is the angle that your femur (long leg bone) from the hip down to your knee and the angle that they connect at. The reason this is so important is because it influences the loading you have through your knee, and further downstream in your feet and ankles. Every time you step and land, when you are running a marathon, twist and stride in hockey, and even side step playing footy; the influence between your hip, knee and ankle are controlling you and trying to make sure nothing gives way. The fact that your legs do not go straight down from the hips to the feet simply means you have another degree of necessary control.; not to make you paranoid or anything.
The dropping in of your knees towards each other is called Valgus; this is very important in human lower limb biomechanics and can seriously influence your long term performance, injury risk and possible pain. Valgus most commonly is a combination of the knee dropping in, and internal axial rotation (inward twist) of your femur. Did you know the muscles of the hip control this? Keep reading
Let’s look at the facts then break them down.
4-6 times more women will suffer an ACL (knee) injury than males. This indicates increased valgus (that knee drop in angle) is a major contributor to this issue prevalence.
Subjects with higher Valgus moments (biomechanics term meaning knee drop in angle) are more reliant on ligaments (ligaments connect bone to bone) to hold them together more than muscle as the alignment causes more strain through the ACL. (What’s actually happening – the internal axial rotation of your femur and drop in of your hips aren’t allowing your muscles to fire and communicate effectively with each other to assist your optimal joint control through specific muscle activation)
Higher rate of running based knee pain and ankle injuries. (What’s actually happening - the internal rotation of the femur and knee drop in causes the Tensor Fascia Latae muscle to act as a primary hip flexor instead of a synergistic (a little helper) one whilst loading up the outside aspect of your knee instead of the middle, this also causes the arch of your foot to be forced down which means your ankle will tend to drop in. Instead of your hip being stable and all muscles helping each other, they are fighting so hard and doing their very best to help your hip stay stable and your leg move in a controlled fashion which is more than they should be doing – they are compensating for other muscles which is not ideal.
So What Do We Do?
If you look at the issues above, two common things pop up – a link to Valgus angle – the knee drop in and an internal axial rotation of the femur (inward twist). We need to train our body to control this and reverse it when necessary.
What Do Most People/Practitioners Do and Why It Might Not Work As Well as It Could…Or sometimes at All
Usually we start with teaching people to turn their knees out when doing things like squatting or functional movements. Yes this is a good start to align the leg with the foot and assist some improved biomechanics however it is not axially externally rotating the femur outwards (spinning the long leg bone outwards) which means some very important muscles are not doing their job. Read HERE why this is important.
We love the Booty bands at the moment and can thank a lot of practitioners and girls with booties on Instagram plugging these things. To be honest, they do a good job to turn on some muscles and get things firing pretty well. This is a perfect step two for getting everything firing again HOWEVER as above you missed that little but important step one; learning how to twist your femurs and turn on more muscles. That TFL muscle I mentioned before, it also helps the leg come out sideways away from your body when you lift it, and if from what we said before is right it is probably a little overworked so doing the banded movements without twisting the leg out first can just hit this muscle even more. Try loosening if off with a ball or massage first so it can be a bit more relaxed before it activates again.
Most people do all of the rehab and alignment work in shoes – this is a no go zone. Get barefoot so your neuromuscular system is operating at its best. If you are going to do the work you want everything to be firing properly right? If you want to connect the foot to the rest of the body- then remove as much external influence as possible. You can read about this more in the future blog about your feet and ankles.
So What Is the Rotator Cuff of the Hip Then?
You have probably heard of the rotator cuff by now. It is a group of muscles in the shoulder that externally rotate the humerus and keep you shoulders and shoulder blades happy and operating properly. Did you know we pretty much have the exact same thing for our hips? And no the muscles aren’t glute medius and minimus which we love to give all the attention to. You can find the names of the 6 muscles below.
piriformis, gemellus superior, obturator internus, gemellus, inferior, obturator externus, and quadrates femoris
These muscles rotate the femur outwards and lock the femur in the capsule in a very healthy and controlled way – this is different to pushing the knees out. Turning the knees out is like simply putting the screw in your ikea set and leaving it there, using the muscles above is turning the screw tight so its nice and secure.
Learning how to combine these two things whilst taking the time to release off the muscles you have seriously been overloading for a while will give you a whole different and improved understanding of how well your body can operate.
So If I Do These Things then Then What Could/Might/Should Happen?
Your major hip flexors will start doing their job and the synergistic ones will go back to just helping out when they are meant to.
Muscle equilibrium and activation will become an actual thing your body does – which will minimise over-use injuries and continuously improve your strength
Your body will feel like a strong unit instead of different areas acting autonomously.
Your hip, knee and ankle pain could disappear over time and they will continue to become healthier and stronger together as they should be.
You could overcome your running, squat and all movement based personal records.
Your knee alignment and associated activation with the glute muscles will improve… a lot.
Remember this is just another step in the constant, fun and ever-changing battle to understand the way our body works. Remember, I am just one guy obsessed with movement and doing my best assisting people to move better.