Injuries All Women Runners Should Know About

women running issues

All runners are aware of injuries they must trat and avoid when training. But did you know that women runners often face a unique set of physical challenges? Here’s what you need to know as a fierce, female runner.


The female runner has unique risks with respect to repetitive stress, acute injuries and performance. The risks and types of injuries change as women age. Healthcare professionals must consider the anatomic, bio-mechanical, and hormonal factors that are unique to women when caring for the injured female runner.



As a female runner ages, different concerns that are unique to her emerge. Pre-pubertal female runners are similar to their male counterparts with regard to muscle mass, aerobic activity, strength, and overall sports performance. However, during puberty, female adolescent runners begin to experience changes in body composition and form secondary to the hormonal changes describes above. Athletes attempt to maintain their prepubescent physiques by challenging physiologically induced body habitus changes with caloric restriction and radical calorie use techniques. It is in this population that the female athlete triad of eating disorder, menstrual dysfunction, and osteoporosis is increasingly prevalent. A long-term consequence of the female athlete triad is lifelong decreased bone mineral density. Osteopenia may progress to osteoporosis as the female runner ages.


Patients who maintain an exercise program during
pregnancy benefit from reduced weight gain, improved muscle tone, improved self-esteem, decreased incidence of varicosities, decreased incidence of low back pain, and improved sleep hygiene. However, pregnant runners must use caution when exercising. The concerning consequences of intense exercise include the effect of elevated maternal temperature on the fetus, the altered blood flow to the fetus in response to exercise and hydration status, and decreased fetal mass. The American College of Obstetrics and Gynecologists published guidelines for exercise during pregnancy in January 2002 to address these concerns.

The following is a list of the guidelines:

  • Exercise should be at 65% to 85% of the maximum predicted heart rate
  • Exercise should occur at least 3 days a week for no more than 45 minutes at a time
  • Avoid the supine position (increased pressure on the inferior vena cava can inhibit blood flow to the placenta)
  • Keep core body temperature less than 38.7 degrees Celsius and monitor hydration status
  • Stop Exercise immediately for extreme shortness of breath, dizziness, headache, chest pain, or contractions
  • Women should not exercise when fatigued and not exercise to exhaustion
  • Any exercise with the potential for abdominal trauma should be avoided

The most important factor in the selection of a safe exercise program for pregnant runners is the pre-pregnancy fitness level. Pregnancy should not be a time to initiate a running program or increase a training schedule. Elite athletes have demonstrated the ability to train daily and rigorously until close to delivery without adverse consequence.

Many of the physiologic changes that occur in pregnancy last 4 to 6 weeks post-partum, but they can last longer in women who breastfeed. A gradual increase in activity is advised. Nursing mothers are recommended to breastfeed before activity to decrease the discomfort that is caused by engorged breasts and to limit the acidity of milk that is caused by elevated levels of lactic acid.


Runners of advanced age who have nonspecific pain complaints should be evaluated for osteopenia, osteoporosis, stress fractures, pathologic fractures, and arthritic conditions. Hypoestrogenic women who have decreased bone mass are at increased risk for stress fractures. Sites at particular risk to runners included the metatarsals, the medial tibia, the femoral neck and the pelvis. Insufficiency fractures may appear first as an insidious onset of low-level pain that progresses and the pain may become chronic. Osteopenic aging runners who have buttock pain should have a sacral insufficiency fracture ruled out. Referred pain may be the only presenting symptom. A common example is demonstrated by the runner who has refractory groin pain who eventually receives that diagnosis of femoral neck insufficiency fracture.

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