When training women, specific considerations needed for them fall into three categories: biomechanical, behavioural and biological.

Part one of this article series highlighted some of the differences that exist between training men and women, centred predominantly around exercise selection, rest periods, volume and frequency.

In this instalment, we aim to delve a little deeper and dissect some of the biomechanical, behavioural and biological differences that women should consider.

If you’re a trainer, this will be useful information for training your female clients. However, the real value will come for women who want to understand their bodies better, see the why behind what we do at Ultimate Performance, and ultimately be able to apply it to their own training for better results.

1. Biomechanical Differences

One of the most glaring biomechanical differences between men and women is the quadriceps angle, or more commonly known as the Q angle.

Women display a larger Q angle, which can have various implications on the biomechanics and integrity of the patella-femoral region.

What is the Q angle?

The angle is derived when drawing two straight lines: from the anterior superior iliac spine (ASIS) to the centre of the patella, and from the tibial tubercle to the centre of the patella. Research seems to point to the wider pelvic structure possessed by females as being responsible for this difference. To understand this Q angle better, the diagram below helps to illustrate.


What problems may occur and how?

The most common implication for women with wide Q angles is the susceptibility to anterior cruciate ligament (ACL) injuries. Statistically, women have two to ten times more ACL injuries than men (the number varies on the type of activity). These injuries typically occur when changing direction rapidly, sudden stopping, incorrect landing or some form of direct contact.

Now for some quick anatomy before we proceed. If you’d rather just learn what to do about it, skip to the next heading…

The ACL is a cruciate ligament which is one of the four major ligaments of the knee. It lies and moves within the intercondylar notch between the two femoral condyles, connecting the femur and tibia together. The primary action of the ACL is to provide stability in the knee, through resisting excessive anterior displacement and medial rotation of the tibia, under the femur. For those who prefer visual aids, this can be seen in figure 2 below.

In women, this intercondylar notch is significantly smaller, meaning less room for movement of the ACL, and an increased risk of pinching from the femoral condyles when placed in vulnerable positions, such as twisting. This pinching of the ACL can eventually create a rupture.

Returning to the Q angle difference, a larger angle will increase the pressure and stretch on the ACL during movement. Due to the greater medial rotation of the knee with higher Q angles, the ACL will often be stretched and worked to the limit, especially in twisting or sudden movement changes.

Another related implication for wider Q angles is the increased incidences of lateral and anterior knee pain. In a perfect world, the knee should track straight into the trochlear groove. However, in this case the quadriceps may create a lateral pull on the patella, increasing the stress around the knee joint and surrounding muscles, and pulling it out of correct alignment.

What can we do about this?

The good news is, everything we spoke about in our first instalment will apply directly here.

Lots of posterior chain and single leg work should form the basis of female programmes, especially when also prioritising knee health. By emphasising glute and hamstring strength, extra stability will be provided to the knee coupled with a greater resistance of knock-knee tendencies (associated with medial rotation of the knees).

Ultimate Performance - Female Training

If there was one exercise every woman should aim to progress to eventually is the glute ham raise (GHR). Unfortunately, it is one of the most difficult exercises to master with correct form.

Suitable progressions to build up the required strength to perform the exercise proficiently are Romanian deadlifts (RDL), pull-throughs, hip thrust variations and leg curl variations. Using slow eccentrics and easier variations of the GHR (like the Razor curl) can help provide a more specific approach to progression too.

A steady diet of single-leg exercise variations such as split squats, step-ups and single-leg RDLs can go a long way in ensuring optimal knee health. The extra frontal plane stability and activation will help strengthen the muscles surrounding the knee and posterior chain in different planes of movement.

Getting stronger can be a simple solution to most problems, and this is no exception. For women, this is especially important as they have less muscle mass in proportion to bone size, and therefore often lack stability at key joints. By improving muscle mass and strength in certain areas, they can use the muscles to stabilise their joints, instead of relying on ligaments and tendons, which can often lead to overuse and eventually injury.

2. Behavioural Differences

When we talk about behavioural differences, we refer to the various lifestyle choices women make.

Most relevant to the readers will be the (over) use of high heels, and the subsequent negative effects on posture and alignment in the body.

To examine the impact of high heels, let’s look at the body from bottom up.

Ankle

The first joint to be affected by the chronic overuse of high heels is the ankle joint, which responds by gradually reducing its ability to dorsiflex.

The body works as a whole, so when one joint along the kinetic chain becomes stiff or locked up, your body will compensate elsewhere to make up for it.

Restricted ankle mobility will lead to external rotation and pronation of the foot, and therefore internal rotation of both the lower and upper legs. The problem with internal rotation of the upper leg is the decreased ability to externally rotate the hip, which means the glutes will not be able to perform one of their key actions.

Ultimate Performance - Squat

To apply this with exercise, let’s take a squat as an example. One of the most common issues we see with the squat, especially in women, is valgus collapse (knees go inwards). This can be attributed to ankle dysfunction, whereby the consequent inability to externally rotate the hip can cause a lack of control in the tracking of the knee. Incorrect tracking can place a lot of unnecessary loading stress on the knee, and contribute to the anterior and lateral knee pain we discussed earlier.

Hips

If we take a look at the diagrams below, wearing high heels can mimic a half-seated position.

 

 

The hips and knees are flexed, and the back is in a hyper-extended position. If you’re in a state of hip flexion throughout the day, your hip flexor muscles, such as your psoas and rectus femoris, will be in a shortened position for a long time.

When these become too tight, it’s difficult for the hamstrings and glutes to fire effectively, leaving the back extensors to become prime movers on all hip extension movements (like deadlifts, hip thrusts, back extensions etc.).

If you were to then embark on a glute specialisation programme, these issues will only be exasperated, rather than shape your backside!

What can we do about this?

The simple fix to this problem is to stop wearing your heels so much!

Realistically this won’t happen, and instead, taking a damage limitation approach is the best option. The following steps will help off-set some of the postural dysfunctions that can develop over time from poor footwear choice. This routine should take 5-10 minutes max, and should be done 1-3x daily for best results.

  1. Release

The constricted position of the foot during high heel use will mean the feet, particularly the plantar fascia will be the key area to release.

To do so, stand on a small, hard ball and move in different directions slowly with varying amounts of pressure for a few minutes on each foot.

Another area you’ll want to focus on is the calf, which can be rolled on in a seated position with your leg outstretched in front of you.

While we could move up the chain, for chronic heel users, releasing the feet and calves will provide the most bang for your buck.

  1. Mobilise

Once we’ve released the feet and calves, mobilising the ankle joint is the next step.

To first get the feet moving, a great drill is to slowly draw the alphabet in the air with your feet, making each letter a very deliberate effort.

The next step would be to specifically improve dorsiflexion range with knee-break wall ankle mobilisations. The key points to remember when performing this is to ensure proper patella tracking over the foot, making sure the knees do not collapse in, and the feet do not evert out. To progress this exercise, you can add small weight plates under your toes.

Moving up the chain, the third exercise of choice would be the couch stretch, which will help open up the hip flexors, allowing the posterior chain to fire better, and to take load off the back.

To do this, assume a 90/90 position, like you’re at the bottom of a split squat. Instead of having the back leg on the floor, elevate the foot onto a bench, chair or sofa. This will stretch out not only the psoas, but the rectus femoris too, which gets chronically tight during heel use. When performing this stretch, keep a neutral spine with your abdominals braced, and the rear glute squeezed.

  1. Activations

The two key areas in need of activation are the glutes and the core.

To first activate the core, start with some low-level belly breathing drills to switch on the diaphragm and oblique muscles.

Once you’ve done this, move onto some abdominal activation drills such as ‘deadbugs’ (lie on your back, flatten your spine, lift legs up and bend knees, now lower towards ground maintaining a flat back and return) and leg raises done in a sub-maximal fashion.

Activating these muscles will help keep the pelvis in alignment, and reduce stress off the lower back.

To switch the glutes on, a bodyweight glute bridge is the easiest option. Performing these throughout the day and before training can really help with correct muscle firing patterns.

Glute Bridge

Lastly, if we revisit figure 3 again, wearing high heels creates a forward shift in the centre of mass, with increasing pressures on the forefoot with rising heel heights. While some of this pressure can be relieved through fascial release, what often happens is a loss of ‘normality’ when it comes to ‘feeling’ the ground and your own centre of mass.

The forward weight shift when in heels means spending as much time as possible barefoot and ‘feeling’ your bodyweight over your entire foot will help with engagement of correct muscles.

To help re-establish normality, balance on one leg for 30-60 seconds, while ensuring you can feel your centre of mass aligned with the middle of foot. It’s also important you avoid any eversion of the foot or valgus collapse of the knees.

3. Biological Differences

Biologically speaking, the main difference between women and men is a woman’s ability to reproduce.

The menstrual cycle is a highly intricate process which is controlled by the fluctuations and power of hormones. These hormones create changes in the body that must be considered when programming for females.

Female hormones like oestrogen and progesterone can increase laxity in connective tissues and allow for greater flexibility in muscles, tendons and ligaments during certain parts of the monthly cycle, specifically approaching ovulation and during menses.

The hormonal changes during the month are highly dynamic, so to precisely give a day would be irrelevant, as everyone’s hormonal balance is different. However, during a woman’s period may be the one time you should definitely proceed with some caution in regards to injury.

Role of Relaxin

Relaxin is a hormone produced by the corpus luteum in women and is most prominently released during menstruation and in pregnancy.

This hormone can lead to women experiencing ranging levels of pelvic girdle relaxation. The biological reason for this is to allow the pelvis to widen in order to provide enough space for the baby to come out during pregnancy.

However, with the relaxation of tendons and ligaments around the pelvis, it may create instability and possibly pelvic tilts which can offset movement patterns.

The degree to which women experience this varies. Feedback from our clients suggests some women notice no difference, whereas others feel a sense of instability and weakness in the core and pelvic region.

For this reason, you may want to avoid heavy squats and deadlifts, or at least lighten the loads. Although it’s worth bearing in mind many women actually lift personal bests during this time, so individual biofeedback is crucial.

Pregnancy

Relaxin is highest during the first trimester as the body begins to prepare for the forthcoming birth by ‘loosening’ the entire body’s system to create more room.

During this time, you want to take a more conservative approach to your training. Think maintenance work, not high-intensity training!

The stronger you are prior to pregnancy, the easier the process will be both leading up to and recovering from birth. For example, a strong posterior chain, abdominals and upper back will help counter the back and knee pain commonly found in pregnant women from the sudden increase in anterior loading from the fetus.

To conclude, the biomechanical, behavioural and biological differences women exhibit as opposed to men all centre around the knee for women to be very specific about their training approach, and perhaps more importantly, their ‘pre-hab’ methods.

The postural and anatomical changes that can occur as a result of the 3 B’s means women need to ensure they are stable, mobile and strong in the right places – notably the posterior chain and core.

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