An article to shed light on the osteoarticular problems of the woman runner , on anatomical and physiological particularities that can favor some types of injuries, as well as specific local problems for bones and joints.
Osteoarticular problems of the knee
The valgus of the knee, the weakness of the vastus medialis, the malalignment of the extensor apparatus with “deviation” of the patellar tendon towards the outside, the high patella, the ligamentous laxite, are typical factors of women who they favor injuries. I remember that in flexion-extension movements the patella has a good stability in flexion. While in the extension its stability is only dynamic, that is due to the muscular and ligament structures.
In particular, the strength of the vastus medialis and the alar ligament are of great importance. We have patellar instability when the tissues are so weak and loose that the patella regardless of its “alignment” can move in and out, until it becomes dislocated as a result of traumatic factors. The stress that the patellar femoral joint bears can lead to cartilage wear which is an extremely serious problem for the future of every athlete.
This is why the strengthening of the vastus medialis is the cornerstone of the conservative therapy of patellar problems. The iliotibial band syndrome, on the other hand, has a lower incidence in women due to the female anatomical characteristics, ie the prevalence of the valgus knee, the less prominence of the external femoral condyle and the greater ligamentous laxity.
Osteoarticular problems of the feet
Hallux valgus, hammer toes, metatarsalgia, greatly disturb the activity of our athletes. Women have a very broad forefoot and a narrower rear foot than men. The use of inadequate shoes , with high heels and narrow forefoot, can favor the onset of osteoarticular problems. It takes years, of course, but many of the problems of some ladies are due precisely to the use of footwear that does not respect the anatomy of the foot. Instead, the habit of wearing ballet flats or low sneakers has dramatically increased plantar fasciitis.
We must not overlook, however, that the athletic shoes used by women rarely respect the anatomy of the female foot or only do so in some models. In fact, in most cases, they are too narrow in the forefoot and too wide in the rear foot. In these cases, pain due to hallux valgus can worsen or bursitis can develop in the head of the first metatarsal.
Every woman must be very careful in purchasing the shoe, selecting the model that minimizes stress and best respects the shape of the foot. A quality shoe always combines cushioning and stability in the best possible way. However, women who have a hollow and rigid foot should prefer shoes that are able to give the best in cushioning. Women who, on the other hand, have a flexible foot with a tendency to exaggerated pronation, must favor the stability of the shoe.
Stress fracturesthey are much more frequent among women than men. This injury is the result of the imbalance between bearable load (e.g. km of running) and bone resistance. All bones can be affected, but those of the pelvis and lower limbs such as the tibia, fibula, metatarsals, or small bones of the tarsus are affected. The main contributing factor is the hormonal imbalance that leads to alterations in the menstrual cycle in athletes.
The relationship between amenorrhea and stress fracture can be explained by the “female triad”: amenorrhea, osteoporosis and eating disorders. The low levels of estrogen present in marathon runners cause demineralization of cortical and trabecular bone, so much so that some 20-year-old athletes with amenorrhea and low estrogen values have a lower bone density than 50-year-old women in menopause. Obviously, even a woman with osteoporosis risks with an exaggerated physical activity to incur a stress fracture and osteoarticular problems .
In women with eating disorders and amenorrhea for more than 6 months it is indicated to check the BMD (bone mineral density) with the MOC. In addition to carrying out a gynecological examination. The main etiological factor underlying the triad is the energy deficit (RED-S), i.e. an inadequate caloric intake to withstand physical activity. Athletes who train with low caloric intake run into iron deficiency anemia, stress fractures, chronic fatigue, infections and performance deficits.
Prevention is based on the intake of calcium (1500 IU / day), vitamin D, vitamin C, collagen, glucosamine and iron. But above all on a correct diet that brings at least 45 Kcal / kg / day. The technicians must receive adequate information to correctly address the relationship between diet, weight, eating disorders and performance of their athletes.
The incidence of anterior cruciate injuries in women, especially those involved in sports such as volleyball and basketball, appears to be much higher in women than in men. The etiology is unclear, involving intrinsic factors (constitutional ligament laxite, ligament size, shape of the femoral condyles, hip width) and extrinsic factors (degree of athleticism, muscle strength, coordination). However, it is a rare injury in running and possibly possible in mountain running due to an accidental fall. Ankle sprains
are much more frequentwhere the greater ligamentous laxite of women is a sure favoring factor. Prevention is achieved with a careful choice of terrain (avoid uneven terrain), proprioceptive re-education, strengthening of the peroneal muscles and above all with adequate therapy of all distorting facts, particularly of the first episodes.