How to Prevent Female-Specific Training Issues

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While injury rates vary across the military branches, women can experience up to twice as many training injuries as men. Also, a woman's risk for more serious injuries — such as those leading to lost duty days — can be as much as two-and-a-half times greater than a man's. The following information can help you understand which injuries are most likely to affect female service members in training and how you can avoid them.

Some background

Physiological differences such as muscle size and bone mass may account for the greater rates of injury in female service members. In addition, women — often marching toward the back of the unit — frequently lengthen stride during marches to keep up with taller male service members marching near the front of the group. This puts added stress on the women's joints and limbs. Women's degree of physical fitness, particularly aerobic fitness, may also play a role.

Women in training often suffer injuries similar to those of female athletes, including lower limb injuries such as stress fractures, anterior cruciate ligament injuries and other knee problems and tendonitis.

Intrinsic training risk factors

General risk factors for training injuries for both women and men include age, previous injuries, (which may be reinjured), adverse health behaviors, such as smoking, and current and previous levels of physical fitness. People with a solid history of physical activity suffer fewer injuries than those with a history of limited physical activity.

Stress fractures

Stress fractures are very small cracks in a bone that happen as a result of intense, high-impact, frequent activity. They usually take time to develop, and typically occur in the lower leg and foot. Symptoms include redness, swelling, and pain during or after activity.

Anyone can suffer a stress fracture, but those at greatest risk include joggers, runners, gymnasts, dancers, and other athletes who put a great deal of strain on their legs and feet. Not surprisingly, military service members are also at risk for stress fractures. Women — both civilian and military — seem to be at greater risk than men. Several factors may contribute to the greater frequency of stress fractures in women. Overall greater bone width and muscle mass often allow men to absorb shock better than women. Hormonal influences, eating disorders, bone mineral density, menstrual irregularities and calcium intake may play a role in women's stress fractures as well.

Activities or sports that require a lot of running, particularly on hard surfaces, are most likely to cause a stress fracture. To prevent stress fractures, increase your level of exercise slowly, always warm up adequately and stretch before exercise. In addition, taking part in a cross-training program of high- and low-impact activities and using cushioned insoles can help prevent stress fractures.

Anterior cruciate ligament injuries

The anterior cruciate ligament — more commonly known as the ACL — is a ligament that connects the tibia to the femur. When the ACL is injured, the ligament stretches or tears to an extreme degree. These injuries are often associated with other injuries, such as the unhappy triad: tearing of the ACL, medial collateral ligament and lateral meniscus (one of the shock absorbing cartilages in the knee). Symptoms of ACL injury include pain, a popping or snapping sound from within your knee, a feeling that your knee is giving out and swelling.

Injuries to the ACL are two to eight times more common in female athletes than in men competing in the same sports. Service members in training, as well as individuals who play sports such as football, basketball, soccer and volleyball are at risk for ACL injuries. The increased risk in female athletes is thought to be due to both intrinsic factors (anatomical differences, increased joint laxity and flexibility and hormonal influences) and extrinsic causes (muscle imbalance between the quadriceps and hamstrings, neuromuscular control, knee stiffness, landing characteristics and posture control).

You can help prevent ACL injuries by:

  • Strengthening and using your hamstrings rather than stressing your quadriceps muscles when turning quickly
  • Learning to jump and land safely
  • Learning to bend at the knees and hips when pivoting
  • Working on proprioception — the ability to sense the orientation, position, location and movement of your body parts


Tendons are tough, flexible tissues that connect muscle to bone. Tendonitis occurs when tendons become inflamed and movement is painful. In addition to pain, symptoms often include irritation, swelling, warmth and redness. While tendonitis can affect any tendon, it typically affects the elbow, wrist, heel, hip or shoulder.

Anyone who performs frequent, repetitive motions of the arms or legs is susceptible to tendonitis. This means that runners, baseball players, swimmers, dancers and military personnel are at particular risk. Tendonitis is most commonly caused by overuse, but can also be due to the wear and tear of aging, direct injury or inflammatory diseases. Occasionally, a tendon sheath infection causes tendonitis.

You can help prevent tendonitis by:

  • Avoiding excessive stress on your tendons
  • Doing core stabilization exercises
  • Using proper stretching techniques
  • Alternating high- and low-impact activities
  • Warming up and cooling down properly

General prevention

There are general measures you can take to help protect your body from female-specific training injuries. They include:

  • Paying close attention to your body's signals
  • Eating a proper diet, including calcium-rich foods
  • Varying your physical activities

The American Academy of Orthopaedic Surgeons provides information on a variety of bone and joint disorders as well as injury prevention, safety, women's health, sports concerns and general exercise issues.

If at any time you experience pain or swelling, allow your body time to rest. Be sure to seek immediate medical attention if your symptoms do not improve or disappear.


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