Moving Forward Together

By Megan James

Although we’re still technically in winter, the days are getting longer and the snow is starting to melt – and it’s time to celebrate our female athletes with two special days! Did you know: National Girls & Women in Sports Day began in 1987 and celebrated this year on February 5. International Women’s Day began in 1911 and celebrated every year on March 8. Both of these days are meant to celebrate the accomplishments and achievements for and by women, and to bring attention to some of the challenges that women face in sports, business, and life. March is also Women’s History Month and this year’s theme is Moving Forward Together, designed to recognize the contributions of the many women before us as the foundation for the continual advancement of today’s women. 

Women account for a large number of participants in endurance sports: 65% of women globally are running according to the 2023 ASICS report, Closing the Gender Gap. Women are underrepresented in research: only 22% of the participants in the 2024 Garmin RunSAFE injury study were women. Now, keep in mind that these are only two studies, and research always has some element of bias, so take the exact numbers with a grain of salt; regardless, the disparity of participation vs. representation in research is quite astounding, if you ask me! 

For many decades, female athletes have been excluded from sport-related research, because they were “too complicated” – hormonal variations (with associated physical and mental changes) added elements of complexity that researchers did not know what to do with. In an effort to keep things straightforward, women were simply left out. As a result women have been coached and trained according to research on male athletes and expected the same results. Unfortunately, this method falls short because it neglects to incorporate the female physiology into, well, physiology, which is a primary pillar of sport performance and training. It is unreasonable to expect that female athletes see the same results of certain sport-related strategies when the research has not included them and their unique needs.

While our body of research on women in sports is still quite small, the great news is that it is growing! Researchers are beginning to delve into the effects of hormone fluctuations, pregnancy and post-partum, mental health, societal barriers to activity, and more. Already we are seeing the benefits of this new research – just look at the huge presence of moms competing in the 2024 Olympics, to start! In honor of female athletes, and in conjunction with peak training for those of us preparing for spring races, here are a few recovery strategies and injury considerations that I utilize on a regular basis as a physical therapist and coach. Again, our research database specific to women is limited, however, professional clinical experience and patient values are the other equally-important pillars of evidence based practice. So let’s dive in…

Recovery strategy #1: Sleep – The most important component of your training and recovery is sleep, so much so that you could even consider it a performance enhancing drug – minus the drug part. When we sleep, our body repairs the tissue damage induced by our daily activities, including exercise. In particular, non-REM (deep) sleep is where the majority of this repair occurs. The current recommendation is for 1.5-2 hours of deep sleep on average per night; some smartwatches and fitness trackers can give you this data. Getting enough quality sleep can be incredibly challenging, but the rewards are plentiful. 

In addition to juggling the normal “adulting” things like work, family and athletics, women have the added challenges of sleep disruption at a few key points in life: pregnancy, postpartum, pre-menstrual/luteal phase (every month!), and menopause. While there is debate on whether you can “bank” sleep (similar to trying to “bank time” in an endurance event…), my general advice for athletes is to follow a consistent bedtime routine and timeline as much as possible, recognizing that we will never achieve perfection. 

Recovery Strategy #2: Nutrition – One of the most common barriers to athletic success is underfueling. This can be intentional, as related to restrictive eating habits, excessive energy output (exercise is only one avenue for this), or an eating disorder; these situations often require extensive interdisciplinary medical intervention. Underfueling can also be unintentional, as is often the case of someone who simply does not realize how much they should be consuming to match their energy output. When we exercise, our body releases cortisol to pull nutrients out of storage (our body’s “ATM”); when we are done exercising, we want to shut down that cortisol so it doesn’t keep withdrawing from the ATM. How do we do that? By eating! Taking in a combination of carbs, proteins and fats within 30-45 minutes of finishing our activity will stop the cortisol cascade and replenish our ATM balance. Then, follow up your 30 minute snack with a full, balanced meal within one to two hours. 

There is a lot of talk about high-protein diets these days. While women do probably take in less than a daily recommended amount of protein, they are also well under the recommendation for carbohydrates as well, and it’s the carbs that are primarily responsible for fueling our brain, muscles and bones to do their jobs! For women specifically, our carbohydrate stores are harder to access in the luteal phase of our cycle (between ovulation and menstruation), so it becomes even more important to take in carbs from food when you are in this phase. Having adequate nutritional intake is imperative to your body’s ability to tolerate training and perform at any level, which includes the training itself and the recovery process. 

Recovery Strategy #3: Rest – Remember this saying: “stress plus rest equals growth.” After a training input, we immediately see a deficit (i.e., we feel tired), and once we recover, we become stronger; this is called supercompensation. If we time the stimuli and recovery appropriately, our baseline gradually gets higher and we see our performance improving! “Rest” does not mean you lie on the couch for three days after a hard workout; it means you are doing something relatively less demanding, such as cycling with lower resistance, doing yoga, or running at a conversational pace or shorter distance. 

Again, we should consider the phase of our menstrual cycle: women tend to recover more slowly from high training stimuli in the luteal phase, so the relative rest days and attention to timing are critical to avoid an overload, burnout, or simply frustration that you aren’t hitting paces as prescribed. One method I sometimes suggest for female athletes is to schedule an eight or nine day “week” – in this model, you fit all of your weekly training sessions into eight or nine days instead of a standard seven. This allows for extra recovery time so the training can really take its effect rather than just bog you down. And yes, rest also incorporates sleep and nutrition – all of these elements are essential to helping you become a stronger, faster, fitter, more durable athlete. 

Injury Considerations – To put it simply, an injury occurs when load exceeds capacity. This may occur in a traumatic event: you fall off your bike and break your arm as you try to brace yourself. This can also occur more gradually, which is more often the case with endurance events. We can increase our capacity by incorporating cross-training and strength training, optimizing our sleep, nutrition and recovery strategies, and managing external stressors; load is determined by things like our training volume and intensity, age, sex, and other external factors. 

With regard to bone injuries, the point of load exceeding capacity (in other words, when you start to feel pain) typically occurs six to eight weeks after a significant change or increase in activity – it’s the cumulative damage over time that leads to a failure in the bone. Soft tissue injuries can go from a minor niggle to a major time-out when we ignore the early warning signs or try to “test the waters” too much or too soon. Generally speaking, women tend to incur more bone stress injuries, knee pain and ligament injuries, while men report more foot/ankle and Achilles pain. Three things that warrant a medical evaluation are: pain that wakes you up at night; pain that alters your stride/stroke/cadence; or pain that does not return to baseline within 24 hours after an activity. In some cases, complete rest may not be best and could be detrimental to your recovery, but that would likely be the safest route until you can be evaluated by an appropriately qualified medical professional. 

One fairly recent major update to our injury research is that the use of NSAIDS (e.g., ibuprofen) and potentially ice/cryotherapy can disrupt healing, especially with bone-related injuries; we actually need inflammation in order to heal and taking that away can impair what our body is already designed to take care of on its own! 

The end of winter signals us to come out of hibernation here in the Northeast. Hopefully with these recovery strategies, you can stay healthy and maximize your training for your upcoming events. If you run into trouble, double-down on your recovery and consider consulting a medical professional to guide you down the best path. For my fellow female athletes, know that you are not just a “down-sized male” and have unique needs, so be sure to advocate for yourself to get the best care and best training possible! Happy Women’s History Month and safe training!

Megan James (megan@ptimmersion.net) of Charlton is a running specialist physical therapist and certified running coach. She is an avid runner, with special interest in 15K to half marathon distances, and loves tempo runs! Learn more: ptimmersion.net.