Where exactly does your knee hurt? Your doctor may have asked you that question at some time. Knee problems are common among Americans of all ages, and women are particularly vulnerable. Young women who take up physical sports such as soccer, basketball, volleyball and hockey sustain knee injuries at a rate that some sports medicine specialists call “alarming.”
Women participating in recreational activities such as running, cycling, dancing, tennis and walking are vulnerable to overuse injuries–also at a higher rate than their male counterparts. And women who are relatively inactive–particularly those carrying excess pounds–are likely to suffer from arthritic pain around the knee.
One major reason that women have knee problems is the way the female body is designed. The wider pelvis that makes childbirth possible increases the angle at which the thighbone meets the knee, placing inward pressure on the joint and increased stress on ligaments and tendons. For some women, this quadriceps- or Q-angle is particularly extreme.
Women also tend to have narrower intercondylar notches. This is the space at the bottom of the thighbone through which one of the major ligaments of the knee, the anterior cruciate ligament (ACL) is threaded. When the passageway is narrow, any cutting or jumping motion can lead to wearing out the ligament. Another reason that females are susceptible to knee injuries is related to the sex hormones, estrogen and progesterone. Some believe that these hormones make ligaments more lax and susceptible to over-stretching.
ACL INJURIES: Over the past several decades, women have participated at a higher level in sports such as basketball, soccer and volleyball. According to the NCAA, women basketball players suffer ACL injuries nearly four times more often than their male counterparts. In soccer, women have two and a half times more ACL injuries.
While not always associated with physical contact, these injuries are more common with high-intensity activity, and they are more likely to occur during a game rather than a practice session.
The injury typically occurs with a move that the athlete performs frequently–a jump, a quick change of direction or slowing down, some athletes report feeling a pop, followed by swelling within a few hours. Less severe injuries may go unnoticed, but the athlete may feel that the knee is less stable and likely to give way with certain movements.
For prevention, some specialists call for more strength training–combined with appropriate stretching. A University of Michigan study concluded that women, more than men, tend to rely on their quadriceps muscles (in the front of the thigh) rather than the stronger hamstrings (at the rear) to keep the knee stable. Training, according to these researchers, should stress “activities that increase the quickness of the hamstring response.”
OVERUSE SYNDROME: For the vast majority of women, physical activity means recreational exercise–running, cycling, stair stepping or walking. With such activities, the increased Q-angle may create misalignment that can, over time, lead to irritation and pain, usually at the front of the knee.
Do not let that scare you away from exercise. One recent long-term study concluded that vigorous physical activity benefits healthy knees. If you have had injuries in the past or your knees are aching because of poor alignment, you need to protect them by choosing the right activities and shoes that are appropriate for your walk.
OSTEOARTHRITIS is a major cause of chronic knee pain, stiffness and eventual disability, particularly in middle aged and older women. The condition is characterized by worsening damage of cartilage. Osteoarthritis often occurs rather early in young adults who fail to treat knee injuries properly. It can also occur in sedentary persons who are carrying excess weight.
Sore knees are no fun and put a serious crimp in daily activities. As a woman, it is important to understand why you might be vulnerable to knee injuries and what you can do to protect yourself.
By: Kerri Musselman, Pharm.D.
