20.JAN.2017 6 MIN READ | 6 MIN READ

Women are more prone to certain sports injuries than men, particularly when it comes to knee and lower leg problems.

Scientific literature suggests women get more running injuries than men, due to various factors regarding the structure and mechanics of women’s bodies. 

Dr Gowreeson Thevendran, orthopaedic surgeon at Mount Elizabeth Novena Hospital, explains the most common injuries women runners suffer, and how to avoid them.

Patellofemoral pain syndrome (PFPS)

This condition is characterised by pain beneath the knee cap (patella). It is caused by the contact of the back of the knee cap with the thigh bone. Women runners, in particular, have been shown to have weaker hip abductors and external rotator muscles that contribute to poor knee cap tracking and PFPS.

How to avoid injury: PFPS can be prevented with hip and quadriceps strengthening exercises (lying down sideways and lifting leg away from midline, straight-leg raise exercise, and side-lying clamshell exercise). 

Icing after runs and using traditional or flexible athletic tapes on either side of the knee cap is also beneficial.

Stress fractures

A seemingly innocuous activity like running can result in stress fractures, as its repetitive loading can surpass the strength of even normal bones. Stress fractures are more common in high-intensity female runners and those with high arched feet or tight calf muscles.

How to avoid injury: Constant and localised pain in the lower leg or foot should alert a runner to the possibility of a stress fracture. 

Consult an orthopaedic foot surgeon if in doubt. It is important to avoid running until the fracture has healed, support the injured foot with an orthotic (insole, wedge or heel cup) and wear supportive shoes. Repeated stress fractures may be the result of a hormonal abnormality (female athletes triad) and warrant further investigations via blood tests and/or an MRI scan.

Iliotibial band syndrome (ITB syndrome)

The IT band is a strong band of tissue that extends sideways from the hip to the knee. It helps to support the knee and leg when the foot first hits the ground while moving about. 

ITB syndrome has been associated with running on uneven surfaces, poor footwear and sharp turns. 

There is scientific evidence linking poor hip abductor and external rotator muscle strength with ITB syndrome in female runners.

How to avoid injury: Treating ITB syndrome requires changing your ‘running pattern’ and strengthening the hip abductors (glutes) and external rotators (lying sideways on the ground and raising the leg away from the midline, standing erect and crossing one leg in front of the other, hiking the hip) 

Icing the IT band and massaging the IT band with a roller bar after stretches also helps.

Medial tibial stress syndrome or ‘shin splints’

Typically resulting in pain across the inside of the shin, this condition is classically associated with runners, with women having a slightly higher prevalence than men.

Less experienced runners are more prone. New scientific evidence now explain this condition to be due to repeated stress across the front of the tibia which gradually resolves as the bone thickens once the beginner runner gets more used to running.

How to avoid injury: Avoid running once the pain develops as persevering can result in stress syndromes / fractures. Build up a running routine and pace gradually, allowing the bone and muscles to condition itself.  

Strengthening the calf and shin muscles helps reduce the impact on the bone as you run, and helps reduce the risk of shin splints. There is weak evidence to suggest supportive shoes or running on a soft surface is truly protective.

Plantar fasciitis

This condition irks most runners due to its prevalence and stubborn nature. 

It typically causes pain in the bottom of the heel, worse with the first step out of bed in the morning and can often persist for months or years before resolving. 

Plantar fasciitis is more in those with flat feet, those who are overweight and those who have had the condition before. It is caused by degeneration of the foot’s arch-supporting band of tissue.

How to avoid injury: Avoid running for a short period. Use customised heel cups in shoes. Stretching exercises are critical when treating plantar fasciitis, in particular calf stretches and plantar fascia stretches (flex the big toe up to accentuate the arch of your foot).

Stretching should be done at regular intervals during the day and it is best to do them just before standing up when seated for prolonged periods or before getting out of bed. 

Supportive shoes with an in-built arch and the use of night splints, even temporarily, are useful. If the condition persists, shockwave therapy or key-hole surgery is recommended to release the tight plantar fascia.

Gowreeson Thevendran
Orthopaedic Surgeon
Mount Elizabeth Hospital

Dr Gowreeson is an orthopaedic surgeon practising at Mount Elizabeth Hospitals and Gleneagles Hospital, Singapore. His subspecialty interests are foot and ankle surgery, trauma/fracture surgery and the treatment of lower extremity sports injuries. He is particularly skilled in minimally invasive foot and ankle surgery.