Are Women More Prone to Running Injuries Than Men?

It is pretty well-known that women are more susceptible to running injuries than men.  The question of why is a bit murkier—is it body dimensions? Hormones? Different training?

This week, we’ll be taking a look at sex differences in running injuries from a scientific perspective.

The risk of running injuries in women

From looking at the scientific literature, we can see that women indeed do, on the whole, get injured more often than men do.  But the difference is not quite as drastic as popular wisdom might hold—a 2002 study of around two thousand patients at a Vancouver, Canada sports injury clinic found that women represented 54% of injuries, with men taking up the other 46%.  But among some specific injuries, women are at significantly higher risk.

In particular, the following injuries are 50% more common in women than men:

• Patellofemoral pain syndrome (PFPS or “runner’s knee)

• Iliotibial band (IT band) syndrome

• Stress fractures

• Medial tibial stress syndrome (“shin splints”)

• Achilles tendonitis

• Plantar fasciitis

So what is it about female runners that makes them more prone to injury overall, and specifically more prone to knee and shin injuries?

The answer must be some combination of training habits, running gait, and intrinsic body differences between men and women.  While there’s good evidence that higher training volumes are related to injury, women, if anything run slightly less than men at most levels of competition (perhaps because of injuries). So we are left to look for sex differences in running mechanics and properties of the body.

Reed Ferber, Irene Davis, and Dorsey Williams authored a 2003 study on the differences in running mechanics between men and women.  Using 20 male and 20 female recreational runners, Ferber, Davis, and Williams captured the gait of each subject in a biomechanics lab, then aggregated the data and compared the men to the women.

On the whole, the female runners exhibited greater hip adduction, hip internal rotation, and knee abduction than the men.

If you’ve read any of our articles on hip mechanics and knee injuries, you’ll know that these three factors are strongly related to knee injuries like PFPS and IT band syndrome.

So, the biomechanical differences in how men run vs. how women run might explain some of the variance in injury rates, but we are still left with some discrepancies in injuries that are not linked (at least not yet) to hip mechanics, like shin splints and stress fractures.

Biological differences between men and women

To explain the differences here, we’ll have to look to core biological differences between men and women.

Though runners traditionally chalk much of this up to hip width, waist size, or “Q angle” (the angle of the femur from the knee to the pelvis, relative to vertical), a very large prospective study of university students in Belgium found no link between Q angle and knee injuries.

As we just saw above, dynamic knee motion during activity is a more likely explanation than static measurements like hip width or Q angle.

Bone injuries

With regard to bone injuries, a 2000 study of male and female military recruits (who do a fair bit of running and sustain many of the same overuse injuries that runners do) by T.J. Beck and others highlighted one intrinsic difference between men and women.

• In male recruits, those who suffered from stress fractures to the tibia had bones that were narrower than the men who stayed healthy, but did not have any deficiencies in bone density.

• In female recruits, however, both bone geometry and bone density influenced the risk of a stress fracture.  There is also evidence for the same phenomenon in runners, as uncovered by a 2008 study by Melanie Franklyn and colleagues at Monash University in Australia.

Using CT scans of the tibia of  male and female athletes, Franklyn et al. demonstrated that bone geometry and bone injury are strongly linked, both in men and women.  Given that women have significantly different (and smaller) bone dimensions than men, and given that women are also predisposed to lower bone density, this may account for the variance seen between the sexes in bone injuries.

How to correct your hip mechanics and bone geometry

Fortunately, both hip mechanics and bone geometry are, to some extent, correctable.

• Exercises for hip strength and coordination can improve your hip mechanics and reduce your risk of knee injury

• Calf strengthening and an intelligent strength training program designed to progressively strengthen your legs will improve the strength of your bones.

Even though we can identify good explanations for many of the injury differences between men and women, there are still probably factors that we can’t account for.  Men and women differ biologically in a great number of ways, any number of which can impact running injuries.

Despite this, women can apply what we do  know to reduce their risk for injury.