The reason why women are getting so many non-contact knee injuries in soccer is the same reason they get them in all other sports and in training.
Coach Kevin Don breaks down the principles of training for women, and how anatomical differences should play into your training plan.
Get-Fit Guy is hosted by Kevin Don. A transcript is available at Simplecast.
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Hi, I'm Kevin Don, the Get-Fit Guy, and this week, I would like to risk alienating 50% of the population by discussing the question: should women be training differently from men?
This is a topic that can be touchy, with literally no need. The goal of a coach or of a participant is to be armed with the best information. Men and women have different needs, and the best training plans take that into account. I’ll also note—in this episode, I’ll be focusing on cisgender athletes.
Earlier this week I read an article on BBC News titled: “Why are so many women footballers (soccer players for you Americans and Aussies) suffering ACL injuries?”
Now, this is something I actually have great insight into. I dated a professional soccer player who represents her country and has played at the Olympics as well as in the Champions League, and I have another good friend who also represents her country as a soccer player.
This may be beginning to sound a bit like a soccer-specific episode, but it's not, because the reason why women are getting so many non-contact knee injuries in soccer is the same reason they get them in all other sports and in training.
First off, let's be clear that there are MAJOR differences between men and women. Some are anatomical and some, unsurprisingly, are economic, especially in professional sports.
First up, we have anatomical differences. Women give birth. Men do not. This means the pelvis is shaped very differently. This difference in pelvis shape to allow childbirth means that the head of the femur (thighbone) is generally set out wider from the knee than in men. The angle formed is, on average, 16 degrees larger than in men. It’s called the angle of Q. This results in more uneven loading at the knee. As you can probably see, this is already a clue as to why women footballers have more non-contact knee injuries.
The next anatomical difference is intercondylar notch width. This sounds super fancy, but basically, if you drew a cartoon bone, you would very likely have two lumps on the end of a long bone. In men, those are larger and set further apart. In women, the notch between the two lumps is narrower, so the tendons and ligaments in there are in closer proximity and can get more easily inflamed. The smaller size means less surface area to spread impact across.
There have been some studies into the angle of Q and knee injury, but they have been underfunded and very small and therefore have low statistical weight. But just because a study hasn’t been funded doesn’t make it not the case. It just means no one funded a study.
Next up we have hormonal differences. This might be a surprise to my male listeners, but menstruation can have a large effect on the body. At each of the four phases of the menstrual cycle—menstruation, follicular, ovulation, and luteal—there are varying levels of different hormones in the bloodstream. Some of these make tendons and ligaments softer and more pliable. This is the case in the luteal phase, in the presence of more relaxin.
Now, what was interesting to me, was that my friend told me that her top-tier soccer team, who play in the Champions League, do take data on menstrual cycles. However, they don’t do anything with the data. This is pointless. The whole reason to acquire data is to be able to make decisions and take action based on the data.
Why wouldn’t a professional sports team take action on this data? Economics! A professional sports team needs to be successful. A place or two further down the league table means a huge difference in winnings at the season’s end. What are they going to do? Not play 3/4 of their best players because they are ovulating and at a high degree of risk for a tendon or ligament injury? Nope.
Furthermore, grass pitches are easier on the joints and astroturf is hard. The surface is less forgiving, and cleats get caught easier and joints take the stress and torque. However, grass pitches are more costly to maintain. In Scotland, where I am right now, all womens league matches are on astroturf. To me, this is crazy. We already know women get more non-contact knee injuries, why are we playing them on astro? Money.
So, what does this mean if you aren’t a professional sports player? Well, the same factors still apply. If we look at the most common workout out methods of HIIT, bootcamp, or functional fitness, we see a ton of movements like jumping lunges, single-leg squats, and so on. These are dynamic movements where knee collapse can occur due to an increased angle of Q. Hormonal differences still apply also. Would I prescribe my clients agility work, rebound work, or dynamic movements like snatch or clean during the luteal phase? Unlikely. I would be more inclined to go for tempo training there, slow and controlled to mitigate risk.
I could go into more specifics depending on sport or training goals, but those are the major points. If you’re a woman concerned about your training needs, please do send an email to email@example.com and let's chat about it!
In the meantime, enjoy the holidays and I’ll be back with more noticings in the New Year!