By Dr Rami Hashish
The 2021 Tokyo Olympics will go down in history. And it may not be for the reason that you’re thinking…
For the first time EVER, there will be more women than men representing Great Britain, with an astounding 201 of the 376 athletes selected being female.
And it doesn’t matter the sport – women are dominating across the board. And that’s despite the myriad of roadblocks.
Like never before, women are taxing their bodies in pursuit of athletic excellence. But unfortunately, biases don’t lie just in the media or the workplace, but also, in scientific research. There’s an inordinate amount of research on optimal training and injury prevention strategies for male athletes, but far less for female athletes. As a result, it’s not all too uncommon for trainers, coaches, or female athletes themselves to adopt male-driven training and nutrition protocols. But because one size doesn’t fit all – or in this case, one gender – it can lead to a guessing game with regards to training.
So, let’s forget about the men, and break down how women need to train differently to achieve athletic excellence – often times, without the science men are afforded to guide their decision making.
- Managing their Menstrual Cycle
Women can be up to 3x more likely to sustain an injury to their knees or ankles depending on the phase they are in, in their menstrual cycle. Specifically, during the pre-ovulatory phase – i.e., the first 1-2 days of the menstrual cycle – ligaments become more lax, making them more likely to tear. As a result, during this phase, female athletes are more likely to sustain significant ligament injuries, such as ACL tears (which women are already more likely to tear than men). Accordingly, it’s commonly suggested that during this phase, women try to avoid high risk activities, like hard cutting (e.g., in soccer or basketball). However, choosing this route may lead to a loss of invaluable training days, which could be the difference between earning a medal or going home in defeat.
- Recovering Following Pregnancy
If you think it’s important to consider your hormones during menstruation, pregnancy takes it up a notch. During the first trimester of pregnancy, a hormone called Relaxin is released, which, among its roles, serves to help relax the ligaments in the pelvis to allow the growth of your baby. However, it may also lead to increases in pelvic width and reduced cartilage stiffness, increasing the potential for injury. Therefore, it may be advised that exercise consist predominantly of moderate to low-intensity activity, particularly during the latter stages of pregnancy, to limit injury potential to you and your baby.
Fortunately, there are science-driven guidelines regarding exercise during pregnancy. But no such guidelines – and very minimal evidence – exist with regards to how to return-to-sport following pregnancy. Let that sink in for a second. The incidence rate for an Achilles tear is about 10 for every 100,000 people, while it’s closer to 70 for every 100,000 people for an ACL tear. The birth rate, on the other hand, is closer to 6,000 for every 100,000 women. Yet while guidelines exist for return-to-sport following ACL and Achilles injuries, there are minimal, if any guidelines for return-to-sport following pregnancy. The lack of research is so dire that the IOC felt compelled to put together a series of expert recommendations.
Yet, despite the lack of science, women overcome – as they always do. Cyclist Laura Kenny (main pic), for instance, has been a mother since the Rio Olympics in 2016, and is already Great Britain’s most decorated female Olympian, while, Helen Glover, will become the first British rower to compete in the games after giving birth.
- Focusing on Postural Control
We all know that we need a strong core, but elite female athletes may need to it more than the rest of us. Women tend to have a larger Q-angle than men, which is characterized by one or both of the knees falling inwards. Q-angle also tends to increase with widening of the hips, such as what occurs during pregnancy. Strengthening the core helps maintain the integrity of the hips and control the posture of the legs.
While weakness and imbalance at the hips can certainly lead to hip problems, it’s how it affects the rest of the body that may be the bigger issue. For instance, larger q-angles are associated with a potential increase in stress, and chance of dislocation of your knee cap, as well as tearing of the ligaments in your knee. And if you have pain in your knee, you may compensate by walking, running, squatting, and jumping differently, potentially leading to problems in your back, ankles and feet. It should thus come as no surprise that a staple among female Olympian training regimens is core strength and stability.
- Adopting Gender-Specific Nutrition
Men and women both produce testosterone and estrogen, but because of increased levels of testosterone, men generally have larger muscle fibers. And due to increased levels of estrogen, females typically are less efficient at burning energy after eating. In fact, women are found to be worse than men at breaking down carbohydrates and protein, but better proportionally at breaking down fat. Such differences may be explanatory for why ideal body fat is about 7-8% higher for women than men. Yet despite the understood differences, nutritional recommendations have largely been based upon data collected from men.
Therefore, to optimise athletic performance, females oftentimes have to be innovative in their diet and associated training regimen. In doing so, however, they also have to be cognisant, and proactive in the prevention of the ‘female athlete triad.’ This set of three disorders – consisting of menstrual dysfunction, lower energy availability (potentially due to an eating disorder), and decreased bone mineral density – is commonly found in female athletes. The triad is caused by factors including psychosocial pressures, and an imbalance between training and nutrition, and can lead to an absence of menses, osteoporotic fractures, and permanent losses in bone mineral density.
They say that knowledge is power. Yet, many female athletes have been able to dominate, overcoming the relative lack of gender specific, research-driven training methods. It’s scary to think what will happen when there’s a more equal playing field. If there’s one thing for certain: men better watch out, because women are coming. Roadblocks be damned.
Dr. Rami is the Founder of the National Biomechanics Institute and the Chief Technological Officer of pareIT. He has been retained as an expert witness on more than 1,000 occasions, examining injuries in sports, the workplace, motor vehicle, and aviation accidents. Dr. Rami has consulted for various organisations and agencies, including the U.S. Airforce, the National Brain Injury Association, as well as pro sports team in the NBA and NFL.