This week, we’ll be examining which injuries men are most likely to get and explore some of the causal factors.
Running injuries men are most prone to
The best way to gauge which injuries men are disproportionately affected by is to do a large study of hundreds or even thousands of injured runners, categorizing them by injury location. This is exactly the kind of study conducted by J.E. Taunton and colleagues at the University of British Columbia.
Using data from all 2,002 of the running patients who visited a particular sports injury clinic from 1998-2000, Taunton et al. listed the most common running injuries, sorting by frequency and listing the relative incidence in men and women. While the two most common running injuries ( runner’s knee and IT band syndrome ) occurred more often in women, four out of the next five were substantially more common in men.
This does not mean that these injuries are necessarily the most common injuries that men get—rather, they are the injuries which are overrepresented among men and underrepresented among women.
Though these injuries are located throughout the lower body, a number of them are known to have similar biological roots.
The plantar fascia, the Achilles tendon, and the patellar tendon are all large, thick, fibrous structures that carry considerable loads during running. They act as conduits for large forces during impact with the ground but especially during the propulsion phase of running, as you drive yourself forward by pushing off the ground.
Excessive strain, either from impact or “active” forces, causes damage to the fibers of the tendons, which, if not allowed to heal, accumulates over time and becomes a chronic problem. When these tendons and fascia become injured, they all display the same degenerative, non-inflammatory damage that unfortunately makes them difficult to heal.
Possible causes based on observations
Unlike patellofemoral pain syndrome and IT band syndrome, which have fairly well-established biomechanical roots, less is known about the causes of the kinds of tendon and fascia injuries that men are most vulnerable to. High impact forces have been connected with plantar fasciitis, but only in women, and tightness in the calves and quadriceps have been implicated in plantar fasciitis and patellar tendonitis, respectively, but the evidence is far from definitive.
What is clear is that these injuries are related to excessive loading—this might account for why these injuries are more common in men, since men tend to weigh more and run faster in their daily workouts. Both of these would put more stress on the major load-bearing tendons and fascias of the body.
Indeed, another large survey of runners by J.G. Macintyre and others found that middle-distance runners had a greater incidence of Achilles injuries than did recreational or marathon runners, which the authors suggested was the result of the higher training speeds of the middle distance runners.
The other injuries more commonly suffered by males—calf strains, knee osteoarthritis, and meniscus tears—are all associated with older age, so their incidence in men might just be a result of there being more older male runners.
Unfortunately, Taunton et al. did not report on the age distribution of the men and women in their study, so it is difficult to say.
Men are also more likely to have participated in sports like soccer, football, hockey, and rugby, which can cause traumatic knee injuries linked to the development of knee osteoarthritis and meniscus tears. The root cause of calf strains, which become an increasingly common problem as runners get older, still remains largely unknown.
One of the most likely explanations is that men undergo inherently greater stress while running due to their tendency to run faster and weigh more, and participate in other activities that make them more likely to suffer these injuries.
While treatments are reasonably well established (and covered here at RunnersConnect in other articles!) for most of the injuries that disproportionately affect men, their root causes are less clear. Exactly why men are more likely to get Achilles tendonitis, plantar fasciitis, patellar tendonitis, calf strains, knee osteoarthritis, and meniscus injuries is unclear.
Plenty of other factors could account for the discrepancies in injuries between men and women. Until more is known about sex differences and running injuries, the best men can do is be aware of the injuries that they are more likely to get and modify their training and recovery accordingly.
1. Taunton, J.; Ryan, M.; Clement, D.; McKenzie, D.; Lloyd-Smith, D.; Zumbo, B., A retrospective case-control analysis of 2002 running injuries. British Journal of Sports Medicine 2002,36, 95-101.
2. Maffulli, N., Overuse tendon conditions: Time to change a confusing terminology. Arthroscopy: The Journal of Arthroscopic and Related Surgery 1998,14 (8), 840-843.
3. Powers, C. M., The Influence of Abnormal Hip Mechanics on Knee Injury: A Biomechanical Perspective. Journal of Orthopaedic and Sports Physical Therapy 2010.
4. Bowser, B.; Hamill, J.; Davis, I. In A prospective study of loading variables in female runners who develop plantar fasciitis, Annual Meeting of the American Society of Biomechanics, 2010.
5. van der Worp, H.; van Ark, M.; Roerink, S.; Pepping, G.; van der Akker-Scheek, I.; Zwerver, J., Risk factors for patellar tendinopathy: a systematic review of the literature. British Journal of Sports Medicine 2011,45 (5), 446-452.
6. Cole, C.; Seto, C.; Gazewood, J., Plantar Fasciitis: Evidence-Based Review of Diagnosis and Therapy. American Family Physician 2005,72 (11), 2237-2242.
7. Macintyre, J.; Taunton, J. E.; Clement, D.; Lloyd-Smith, D.; McKenzie, D.; Morrell, R., Running injuries: A clinical study of 4173 cases. Clinical Journal of Sports Medicine 1991,1, 81-87.