Training and the Female Athlete
Female athletics are increasing in popularity every day. Because of this, female athletes must prepare their bodies for the demands of their sport just like the male athletes. Strength development is especially important for females because they have an increased risk of ACL tears and knee problems due to their hip to knee “Q-angle.” A strong “core,” hips, quads, and hamstrings can drastically decrease stress on the knee joint when female athletes land from a jump or change direction on the athletic field.
Researchers found that unlike men, women typically don't gain size from strength training, because compared to men; women have 10 to 30 times less of the hormones that cause muscle hypertrophy. So, lifting heavier weights will develop functional strength without the expense of adding unwanted size. There is also a psychological benefit for females when developing strength. When a female athlete becomes stronger, they become more confident and their self-esteem increases.
Studies have shown that strength training (strength work) reduced depression symptoms and anxiety levels more successfully than standard counseling sessions. Newly released studies show that after a strength training session, endorphin levels are increased by more than 60 percent leaving you feeling rejuvenated and even euphoric.
Research has also shown an increase in musculoskeletal and joint injuries during a female’s menstrual cycle. This is due to increased relaxin levels and increased flexibility and elasticity of connective tissue, such as in articular joints. Strong muscles can act as a “support system” to the female’s structure during this time of susceptibility and joint laxity. Females also have an imbalance between their hamstrings and quadriceps. This imbalance is yet another contributor to their growing incidence of knee injuries. Correcting this imbalance with proper exercise selection is yet another way to drastically reduce a female’s risk.
There are multiple issues that arise when women compete in sports that are not a problem with men. These include the female athlete triad, increased risk of ACL injury, and pregnancy.
ACL ISSUES
Research has shown that females are at an increased risk for ACL injury. According to the National Collegiate Athletic Association (NCAA) report, female athletes are at a 6 time greater risk for ACL injury when compared to male athletes in the same sport. An estimated 15,000 debilitating knee injuries can be expected to occur in female intercollegiate athletes during any given year. Possible reasons cited for this increased risk are an imbalance between the left and right legs, an imbalance between quadriceps and hamstring strength, core stability, and an increased load on connective tissue as a result of weak muscles crossing the knee joint. Although an increased risk of ACL injury would occur with anyone who has these issues, regardless of gender, a coach should remain aware that they are typical in female athletes.
Research has indicated that those who have an ACL injury are statistically more likely to do it again, as well as have problems with pain and limited mobility later in life.
Differences which affect training and sport.
Women's ACL's are smaller
The connective tissue softens in relation to a female's menstrual cycle
An increased "Q" angle creates greater force at the knees
Many females lack development of the VMO muscle
Females tend to decelerate movement in a more risk-oriented manner
Females do not have the same lean muscle mass and strength as males
Overtraining causes mental and physical fatigue, reducing the neuromuscular system's ability to control the body
Because of biomechanical differences in ankle, hip, and spine orientation, females tend to be quad dominant and demonstrate a lower Hamstring to Quadricep ratio. This means females typically have weaker hamstrings compared to males. Females demonstrate different muscle activation patterns compared to males. Females are typically Quadricep dominant athletes. This means females use their strong Quadriceps muscles and do not use their weak hamstrings. The hamstring muscle group act to protect the Anterior Cruciate Ligament (ACL) and the Quadricep muscle group places stress on the ACL. Quadricep dominant muscle work demonstrated by females places excessive stress on the ACL. As female athletes get older, their quad:ham ratio actually became more and more skewed. While their hamstrings got somewhat stronger with age, the quads became disproportionately stronger resulting in even greater imbalances.
Females demonstrate strength weakness comparing one leg to the other. Studies show that 20-30% of female athletes have one leg significantly weaker than the other leg. If a female has a muscle weakness of 15% or greater from one leg to the other, they are 2.6 times more likely to suffer a leg injury.
Females demonstrate a slower speed of muscle contraction. The typical female takes 3 tenths of a second longer to generate maximum contraction of the hamstrings. Example: A sprinter spends less than a tenth of a second balancing on one foot before pushing off and landing on the other foot. If the hamstrings do not contract fast enough the ACL may be in jeopardy.
From a biomechanical standpoint, address the movement patterns of the way women decelerate. Improve the various components of the movement related to stability such as strength, coordination, balance, and power. This would suggest that a women's practice may have a specific component of injury prevention different from the boys. A famous study out of the Santa Monica Orthopedic and Sports Medicine Research Foundation found that with a specific protocol designed to address biomechanical and neuromuscular deficiencies in female soccer players, they were able to observe an overall injury reduction of 88%. Work on the things that are weak, you decrease injury.
Sports such as basketball, volleyball, and soccer allow for inordinate amounts of quad/adductor development, while never putting them in a position of deep knee or hip flexion resulting in a weak posterior chain. This leads to weak, ineffective and often-injured athletes.
Female athletes have a higher likelihood for injury during sport due to an inability to absorb force, an unfounded fear of gaining muscular size, and most of all, great potential to increase their athletic ability through a proper strength and conditioning program. Look for the knocked knees (valgus), "straight up" running posture, tight ankles, interiorly tilted pelvis, inability to use glute muscles, and straight legged stopping technique. Create a program for young female athletes that helps "un-knock" their knees, maintain a lower running stance, increase glute strength, and improve the movement pattern of deceleration. By improving their general coordination, strength and endurance, you can decrease the chances that they will encounter a force that is either too great a magnitude or too high in frequency for them to control.
Heavy weights performed at low reps, exactly the prescription for increasing relative strength, is the opposite of what is needed for an increase in muscle mass. In fact, light weights moved with high repetitions is exactly what bodybuilders do to make their muscles grow (and the opposite of a performance enhancing strength program).
As relative strength increases, the ability to decelerate or absorb force increases. The stronger the muscles, tendons, and ligaments of an athlete, the more efficient they are at decelerating. And this is where most ACL injuries occur. Now, technique is a critical component of this as well. It is not good enough to be strong but have poor movement mechanics. The key is to get strong the way the body is supposed to move. This is what a good strength program will be centered around.
Consider the fact that there are a lot of females in high school athletics, and especially those heading into the collegiate ranks are not very good "athletes". They may possess a high level of skill in particular area, but they are lacking the overall qualities which make up athleticism. Participating in a strength and conditioning program will go a long way toward developing those qualities and improving performance while decreasing the likelihood of injuries while participating in their sport of choice.
Contributing factors to ACL injuries in female athletes:
Q angle,
Intercondylar notch
Menstrual status
KNEE JOINT LAXITY DURING THE MENSTRUAL CYCLE
Different levels of laxity were shown at different stages of the reproductive cycle, although the stage of the reproductive cycle in which the knee ligaments were at their most lax differed between women. Most commonly, maximum knee joint laxity was found during ovulation. Knee joint laxity (when present) was shown to correspond to changes in knee mechanics during an athletic activity and increased forces through the knee joint. These forces could potentially be associated with knee injury, in particular anterior cruciate ligament injury.
Hormonal changes during the menstrual cycle appear to be related to increased laxity of the knee joint and this laxity appears to be related to increased forces through the knee joint when jumping, cutting and landing. These changes could contribute to the higher rate of anterior cruciate ligament injury that is seen in female athletes.
Women are nearly three times more likely to injure their ACL during ovulation (days 10 to 14 after the start of menstruation, which is when estrogen levels peak) than during other times of their cycle.
Just a small change in laxity has a large influence on the load of knee joint. A 1-mm change will influence 40% to 50% of loading of the knee joint.
Training Considerations for ACL Prevention
Active warm-up:
High knee walk
Butt kicks
Reverse lunge
Power/stability – eccentric strength = landing skills (plyometrics):
Learn how to land on one leg.
Jump: 2 legs to 2 legs
Hop: single leg to single leg (forward, medially, laterally)
Bound: right leg to left leg
Skips: 2 foot contacts per foot
Progression:
Jump/hop to a box – forward, medially, laterally and stick
Jump/hop over and object and stick.
Jump/hop over object and bounce.
Single leg strength development:
Bodyweight first
Single leg strength w/progressions
Knee dominant and hip dominate single leg progressions
Change of direction (stop/crossovers) – learning to decelerate/stop
Change of direction conditioning (shuttle, etc.)
Most injuries occur in the acceleration and deceleration.
FEMALE ATHLETE TRIAD
The female athlete triad consists of 3 interrelated problems that arise in the female athlete. The 3 components of the triad are disordered eating, menstrual problems, and bone density reduction. Female athletes often assume that a decrease in body fat will lead to performance enhancement, even though the decreased energy availability typically leads to decreases in immediate performance. Having low energy levels also causes the body to reduce energy expenditure on other processes. In the female athlete, this can lead to menstrual problems, particularly amenorrhea, or discontinuation of the menstrual cycle. It can also lead to decreased bone mineral density, as new bone tissue is not formed and tiny cracks in the bone are not healed and possibly lead to osteoporosis. This is not natural consequence of exercise as long as energy balance is maintained within acceptable limits. In fact, exercise has been shown to have positive effects on bone mineral density.
While genetics has a major role in the incidence of osteoporosis, physical activity also has an effect on bone mineral density. The inclusion of weight-bearing activities, particularly in the high school years, leads to increases in bone mineral density, which reduces the risk of osteoporosis. Improvements in bone mineral density will only occur in the regions of the body that are being trained. Progressive resistance is crucial to continued improvements in bone mineral density. An athlete can be eating more food than her sedentary peers, but still be at risk for the triad if she has increased her caloric expenditure to enhance endurance or drop body fat through cardiovascular training. A coach or trainer must stay attentive to changes in an athlete’s physical appearance more so than casually observing her food intake.
PHYSICAL AND PSYCHOLOGICAL STRESS
As strength coaches and trainers (and even women or female athletes who train themselves) it is important to be aware of the athlete's stress level and its impact on their training and sports program. Female athletes, especially in the high school and collegiate settings, typically face a high amount of psychological/emotional stress. This comes not only in the form of course work and exams but can also be tied to social stress -- making new friends, being away from home (for the collegiate athlete), relationship stress, body image stress, etc.
The last example, body image stress, can kick off the female athlete triad as extreme changes to diet and nutritional intake commonly follow a negative self-image. When nutritional intake is poor, energy imbalance may create a platform for amenorrhea (cessation of normal menstruation). As well, high amounts of stress can alter hormones which can also have negative implications on normal menstruation. A decrease in nutrients, such as vitamin D and calcium, and alterations in hormones, especially estrogen, can eventually create a loss of bone mineral density.
This example clearly shows the interrelatedness of the female athlete triad and if we had started the example with more of a physical stressor (intense training, competition, and eventual overtraining) the same type of interrelated connection would easily be seen.
Analyzing the training and competition schedules as well as how these schedules work in conjunction with the school schedule can be a proactive approach on the coach's part. Knowing when mid-terms and exams are, from a strength coach standpoint, will allow you to plan training accordingly, and back off the intensity/volume/frequency a little bit as the athletes at this time are facing high amounts of psychological stress and usually sleeping less, as they are increasing their time studying, both of which will lead to a decreased ability to recover from the training stress. Furthermore, manipulating the training program around periods of frequent competition (as well as paying special attention to year round training in three sport athletes) can be helpful in preventing overtraining and ensuring that the athletes have appropriate time to recover both physically and psychologically from the demands of game day.
The female athlete triad is a very serious issue and should be dealt with appropriately. Have good communication with your athletes and recognize when there is problem.
POSITIVE COACHING
Women and men are not alike in their psychology. Sure, some women are more like men than others, but for the most part, female athletes don't respond well to negative reinforcement coaching. Many females simply need a positive male role model to look up to. By teaching them the skills and discipline necessary to succeed in the weight room, you not only give them the opportunity to develop into a better athlete, but you give them skills they can use to stay in shape and feel good about themselves for the rest of their life.
MYTHS AND FACTS
Women do not have nearly as much testosterone as men.
Women have about 15 to 20 times less testosterone than men. Testosterone is the reason men are men and women are women. After men hit puberty they grow facial hair, their voice deepens, and they develop muscle mass. Because men have more testosterone they are much more equipped to gain muscle. Because women do not have very much testosterone in their bodies they will never be able to get as big as men.
For women, toning is what happens when the muscle is developed through training.
This is essentially bodybuilding without testosterone. Since the testosterone is not present in sufficient amounts, the muscle will develop, but will not gain a large amount of mass. The "toned" appearance comes from removing the fat that is covering a well-developed muscle.
Muscle bulk comes from a high volume of work.
The repetition range that most women would prefer to do (8-12) promotes hypertrophy (muscle growth). For example, a bodybuilding program will have 3 exercises per body part -- for the chest they will do flat bench for 3 sets of 12, incline for 3 sets of 12, and decline bench for 3 sets of 12. This adds up to 108 total repetitions. A high volume (108 reps) causes considerable muscle damage, which in turn, results in hypertrophy. The considerably lower volume (6-8 reps) will build more strength and cause minimal bulking.
Heavy weights will promote strength not size.
This has been proven time and time again. When lifting weights over 85%, the primary stress imposed upon the body is placed on the nervous system, not on the muscles. Therefore, strength will improve by a neurological effect while not increasing the size of the muscles. Women need to train with heavy weights not only to strengthen the muscles, but also to cause positive adaptations in the bones and connective tissues.
FEMALE ATHLETES AND DISTANCE RUNNING
Anatomy and physics are the two reasons why females are at a disadvantage for running long distances. The problem with most women and running comes down to the Q angle. Wider hips make for narrow knees. This angle of hip to knee creates problems. Problems are magnified based on number of steps. The average person gets about 1500 foot strikes per mile. You do the math on a 5-mile run. Running produces forces in the area of two to five times bodyweight per foot contact.
Look at the elite female runner. Look at her body. You will generally see two things. She has narrow hips and she has small breasts. Women with larger breasts and wider hips don't make good runners. Her wider knees cause her to develop foot problems or knee problems. Her greater bodyweight causes greater ground reaction forces. Greater ground reaction forces stress muscle tissue and breast tissue.
The female body type puts them at greater risk. You need to look at your goals or the goals of your client. Does distance running coincide with the stated goals? If the goal is to run a road race, then running is a necessity. If the goal is fat loss or increased conditioning, distance running may not be the first choice. It really comes down to choosing the right tool for the job. Distance running may be the wrong choice for most females if they are running for weight control or fitness.
Injury potential
Research (Jones et al) has shown that 6 out of 10 females who begin a distance running program will eventually be injured. In fact in the study abstract the researchers stated: "Recent military research confirms the finding that higher volumes of running are associated with higher rates of injury. Furthermore, the study of army recruits suggests that greater amounts of exercise not only result in greater risks of injury, but in some instances may also impart no additional increase in fitness, a finding consistent with an earlier study of civilian runners." On a typical women's basketball team this translates to 9 out of 15 athletes potentially injured by a program of distance running. Factor in the size and weight of the typical female collegiate basketball player and we can safely assume that this number goes up, not down. The key here may lie in the concept of Q angle with the female athlete. Simply described Q angle looks at the inclination of the femur relative to the pelvis. Increased Q angle, as seen in many female athletes, predisposes the female athlete to issues not found in male athletes. IT band issues, patella-femoral issues and plantar fascia issues can all be magnified by an increased Q angle however, the finding of increased injury through distance running holds true for both genders.
Keys for Developing Strength and Conditioning for Female Athletes
In the early pre-adolescent stages, training should focus on sport movement, sport strength and sport balance. Learn how to move efficiently within your sport. Work on basic movement skills and the fundamental skills in your sport. Learn how to stop and start, cut, twist or turn. Practice staying forward on the balls of the feet, taking lots of little steps. They stay in an athletic stance, ready to move, pivoting on the front of the foot, with the knees bent. It is also important to keep the knees in line with the toes. Emphasize lateral and rotational movement patterns. Perform agility drills to teach change of direction while staying low in an athletic stance with knees flexed. Strength training must be sport specific, whole-body and multi-joint. The hip, the foot, the trunk and the shoulders all control the knee. Start with body weight exercises before adding external resistance and balance training needs to be incorporated into the conditioning program.
At a young age, girls should learn how to jump and land to prevent injuries, in particular ACL knee injuries. It is extremely important to have controlled, quality landings and soft landings from a jump, land soft, not wobbly knees or hard, no loud landings. Land on the balls of the feet with knees flexed and ankles bent to absorb the force. It is important for coaches to teach and monitor how a girl handles a jump.
At a young age, girls should learn how to run properly. Coaches should teach the proper form, biomechanics and foot strike technique. This will contribute to a smooth, efficient motion and help prevent injuries in particular overuse injuries to the knee, hip, back, foot and ankle.
Stress the importance of wearing the proper shoes when strength training and in practices and games. Women are more flat-footed with knee valgus (knock-kneed) so it is critical their shoes or insoles address these issues.
It would be ideal for a young female to start a strength and conditioning program at least before their adolescent years if they plan to compete and be successful at the high school or college level in their sport. The training should be year round with the proper amount of rest periods incorporated into the yearly training cycle. Late adolescent (high school age) female athletes should be strength training year round.
A strength training and conditioning program should focus on exercises that strengthen the knee joint to help prevent ACL injuries. Strengthen the quadriceps (vastus medialis), and more importantly, the hamstrings, which is normally much weaker in strength in comparison to the quadriceps in women. Statistics show a higher injury rate to be associated with knee flexor or hip extensor imbalances of 15% or more on either side of the body.
Strengthen the core (chest, abdominals and upper and lower back and hip areas). These are problem areas for many female athletes. Train the core from a standing position, this is more functional and more sport specific.
If the sport requires a good deal of throwing motions, train the rotator cuff muscles in the shoulder joint. Also work the upper back muscles, the rhomboids, which help stabilize the scapula and takes stress off the shoulder joint and musculature.
Train in a functional manner. Most of the exercises in the training program should be closed chain, (standing, feet on the floor) which incorporates balance, coordination, agility and proprioception into each movement. Get off the machines and move freely with multi-joint and multi-planar exercises.
Stress proper nutrition and hydration at a young age. We are seeing osteoporosis in individuals at younger and younger ages each year.
When a female athlete is maturing (12-13 years of age), training emphasis should shift from training for athleticism as a youth, to training to enhance locomotion, level changes, push/pull movements and rotation. If an athlete has a strength training history and has developed a good strength and flexibility base, the athlete can then incorporate more advanced forms of training into their program. For example, more advanced plyometric training, training for speed, power and explosiveness and power training with the Olympic lifts.
SAFETY GUIDELINES
There are numerous resistance training exercises that can be used in a strength-training program. Listed below are just samples of exercises that can be performed. It is important to keep in mind the risk versus benefit of each exercise. You must weigh the goals and limitations of each client separately when prescribing exercises. Quality and not quantity is the key. Proper body alignment and stability should be your main focus when placing your client under resistance loads.
GENERAL SAFETY GUIDELINES
When performing power exercises, (deadlift, clean and jerk, snatch, power clean) if a repetition cannot be completed, push the bar forward to move the body away and let the weight fall to the floor. With this type of exercise, attempting to push through and save the repetition can result in serious injury.
When performing the power and explosive exercises, always use a rotating lock collar.
When performing an exercise from a squat or power rack (front and back squats), always step backwards in the beginning and forward to complete and rack the weight. Never rack the weight by stepping backwards.
Always use collars on all barbell exercises.
GENERAL LIFTING GUIDELINES
When lifting weight from the floor you must safely position your body to avoid excessive strain on the low back. Use a correct stance in relation to the bar or dumbbells:
Squat down behind the bar or between the dumbbells.
Place feet between hip and shoulder width apart.
When lifting a bar, place bar close to the shins and over the balls of the feet and grab the bar with a closed grip slightly wider than shoulder width.
When lifting dumbbells, stand between them and grab the handles and position the arms outside of the knees with the elbows extended.
These steps are also how the body should be positioned when performing power or explosive exercises:
Back is flat or slightly arched.
The trapezius is relaxed and slightly stretched, the chest is out and up and shoulders are retracted and depressed.
Head in line with spine or slightly hyper-extended.
Body weight is balanced between the middle and the balls of the feet with heels on the floor.
Shoulders are slightly over the bar.
The eyes are focused straight ahead or slightly upward.
BREATHING GUIDELINES
The guidelines for proper breathing during resistance exercise are:
Exhale: during the exertion phase.
Inhale: during the “return” phase.