We are in an age where ‘girl power’ and strong business women abound and female athletic performances are rapidly closing the gap on male performance. Should we, therefore, be training males and females the same in the gym environment? Are their goals the same? In many cases ‘Yes!’  Both sexes, generally want to lose body fat and increase muscle tone and definition. Yet there are still physical differences that should be catered for whilst training.

The most obvious difference is that males have broad shoulders and a narrower pelvis, whilst females have a broad pelvis and narrower shoulders. The broader female pelvis results in a larger quadriceps angle (q-angle). This is measured as the angle between the patella-tibial tuberosity to the patella-ASIS (anterior superior iliac spine).

It is well documented that females have a larger q-angle than males, averaging 12.7˚ vs. 10.2˚ 1, 2. This has often been postulated as being the reason why female athletes suffer a greater number of non-contact anterior cruciate ligament (ACL) tears than their male counterparts 3. However, to single out q-angle as being the lone culprit doesn’t sit easy with me, since a broader pelvis is how God intended women to be. It seems harsh that nature would deal females a biomechanical disadvantage at the knee as a compensation for a wider pelvis to bear children. One extensive scientific review could not identify any research to support increased q-angle as the reason for increased ACL tears in females 4.

However, a recent study did find females had an average anterior pelvic tilt of 3.5˚ compared to males who averaged 1.5˚, as well as greater pronation of the foot 4. Both these indicators were found to be significant factors in ACL rupture. It was noted that increased anterior tilt of the pelvis and pronation of the foot increased the likelihood of ACL injuries in either gender. The incidence of these factors combining was found to be more common in females which may play a role in explaining increased knee injuries.

The increased anterior tilt and pronation seen in females could be related to the wearing of high heeled shoes which increase anterior tilt and can adaptively shorten the calf muscles. Similarly, pregnancy can also increase anterior tilt by reducing the efficiency of the inner unit muscles and dragging centre of gravity forward. Whatever the causes, anterior tilt and pronation creates greater internal rotation of the knee. As a result, women rely less on the quadriceps, and more on ligaments to decelerate movements at the knee during running, jumping, twisting and turning 1, thereby placing greater stress on these ligaments.

So how does this information provide us with a sensible training platform for female exercisers? Increased pronation is associated with a hypertonic calf complex and a lack of dorsiflexion at the ankle. This is often paired with a hypertonic iliopsoas on the same side, which plays a role in creating the anterior pelvic tilt. Usually the over active calf and iliopsoas have had no choice but to take greater load throughout the kinetic chain as a compensation for under active gluteals. The bottom line is females need greater emphasis on improving their dorsiflexion and performing exercises that encourage the gluteals and quadriceps to fire more effectively! A progressive set of exercise examples include:

1. 3 plane single leg clock squat

2. Frontal plane dumbbell lunge with a low reach

3. Sagittal jumping lunge with med ball rotation over lead leg

If females need to emphasize certain exercises to encourage functional efficiency and prevent injury it would be reasonable to assume that they may also have some different needs when it comes to their nutrition. It is clear that female nutrient requirements will be driven by their ability to reproduce and carry a baby to full term. Whether or not a woman wishes to have children, she will feel healthiest when she has regular, smooth, pain-free reproductive cycles. Nutrient needs should focus around oestrogen balance, pre-menstrual tension (PMT), essential fatty acid (EFA) requirements and body fat levels.

In order for a woman to experience optimal health her body needs to be producing the right balance of hormones. Oestrogen levels continually rise from the first day of the menstrual cycle and then drop sharply between days 12 – 14 in preparation for ovulation. Following ovulation, often on day 15, oestrogen remains low whilst progesterone levels rise rapidly, subsequently dropping towards the end of the 28 day cycle to allow for the removal of the uterine lining.

This delicate cycle can be easily upset in our modern world where other sources of oestrogen are sneaking into the body undetected. High oestrogen has been associated with PMT, fluid retention, weight gain, and exacerbation of allergies and asthma 8.

• Our food, especially commercially produced fruits and vegetables are laden with herbicides and pesticides from farming and petrochemical residues from the plastics they are packed in. These compounds have oestrogen like effects and disrupt the fragile balance of our hormones, abnormally boosting levels above where they should be.

• Many women today take the contraceptive pill, some without a full understanding of how it prevents pregnancy. It keeps oestrogen levels abnormally high in the second half of the menstrual cycle so that conditions in the uterus will not allow the egg to survive in the uterus.

• Some studies have shown that plant sources of phytoestrogens, like soy, can cause hormonal disruption 5 and have the potential to cause infertility, hypothyroidism 6 and even breast cancer 7.

The body has two systems to regulate and detoxify excess oestrogen using enzymes in the liver. One system, the 2-OH end product, is non-toxic and even beneficial, but the 16-OH end product is carcinogenic and has been linked to cancers of the breast, uterus and cervix 8. Many of these oestrogen mimicking compounds push the body towards the more toxic 16-OH pathway. Food intake needs to support oestrogen balance, support the beneficial 2-OH pathway, promote good health, but also to alleviate PMT, reduce fluid retention and decrease body fat levels particularly around the hips, thighs and breasts.

A successful dietary approach would encourage the removal of typical craving foods that create further imbalance, such as coffee, tea, alcohol, chocolate and refined sugars. This would be supported by the inclusion of foods that provide adequate amounts of vitamins A, E and B6, calcium, magnesium and EFA’s 9. These should be obtained within the diet from reliable, naturally reared, organic produce where possible so as to guarantee no harmful chemicals, (see the table below). These natural foods will support the body to maintain homeostasis by correctly regulating oestrogen and allow the ebb and flow of a regular, healthy reproductive cycle. Fluid retention will ease and an appropriate body fat level will more easily be obtained. Moods will also become more stable across the cycle, which will lead to happier women and in turn happier men!

References:

1. www.pponline.co.uk, Raphael Brandon, Peak Performance, The knees of female athletes are very vulnerable to injury, especially ACL tears. Here’s what to do about it.

2. Hertel et al. (2004), Lower extremity malalignments and anterior cruciate ligament injury history. Journal of Sports Science and Medicine 3, 220-225

3. Arendt, E A and Dick, R. (1995), Knee injury patterns among men and women in collegiate basketball and soccer: NCAA data and review of literature. American Journal of Sports Medicine 23, 694-701.

4. Murphy et al. (2003), Risk factors for lower extremity injury: a review of the literature. British Journal of Sports Medicine 37, 13-29.

5. Makela S, Poutanen M Lehtimaki J Kostian ML, Santti R, Vihko R. (1995 Jan) Estogen-specific 17 beta-hydroxysteroid oxidoreductase type 1 (E.C.1.1.1.62) as a possible target for the action of phytoestrogens. Proc Soc Exp Biol Med;208(1):51-9.

6. Ishizuki Y, Hirooka Y, Murata T, Togashi K. (1991 May) [The effects on the thyroid gland of soybeans administered experimentally in healthy subjects]. [Article in Japanese] Nippon Naibunpi Gakkai Zasshi.  20;67(5):622-9.

7. Hilakivi-Clarke L, Cho E, Clarke R. (1998 Jun) Maternal genistein exposure mimics the effects of estrogen on mammary gland development in female mouse offspring. Oncol Rep 1998;5(3):609-16.

8. Foster J. (2000) A Natural Protection Against Estrogen Overload. Wise Traditions in Food, Farming and the Healing Arts. Winter edition

9. Enig M G. (2000) Fatty Acid Requirements for Women. Wise Traditions in Food, Farming and the Healing Arts. Winter edition