Power Over Pain
No pregnancies. And no heels.
These are the main differences between women and men—at least when it comes to causes of common joint problems and muscle pain—according to Sabrina Strickland, MD, an assistant professor at New York City’s Hospital for Special Surgery. And Strickland would know: A 40-year-old orthopedic surgeon with three kids between the ages of 5 and 8, she also sees some 70 patients a week, 40 of whom are female, at her practice at the hospital’s Women’s Sports Medicine Center. “I have to work long hours, and when I’m home, I’m doing a zillion squats a day just taking care of my children,” she says. “Being female can be hard on you.” Whether it’s because of distinct dissimilarities in physiology, lifestyle habits, or the fact that women tend to care for children more than men, the two sexes really do differ when it comes to joint and muscle problems.
A recent American Podiatric Medical Association survey found that 87 percent of women suffer foot pain due to painful shoes, while a 2009 study from the Back Pain Research Group at the University of Sydney showed that working women are three times more likely than their male counterparts to incur neck pain. What’s more, osteoarthritis of the knee is twice as common in women as in men, and nine out of 10 bunions crop up on female feet.
It’s sometimes difficult, however, to pinpoint from a physiological standpoint exactly why women are more prone to certain aches and pains. In fact, researchers are conflicted about whether women are simply more sensitive to pain than men—or less. In the case of most multitasking female professionals and mothers, though, it’s a moot point. “I have so many things on my plate that I can’t get too caught up in pain. I just get over it,” says Strickland.
But fortunately, there are options. From t’ai chi and tension release to dumbbell exercises and acupuncture, you can find relief without resorting to cortisone injections or a handful of pharmaceuticals. Here’s a rundown of the latest research and most effective integrative therapies for everyday aches and pains.
Pregnancy, motherhood, anatomy, shoes: For some women, these factors all add up to rickety knees. And knee pain during your 30s and 40s can lead to arthritis in your 50s, 60s, and 70s. “When pregnant, we often gain weight quickly, many of us don’t exercise, and our weight is carried forward, stressing the knees,” says Strickland. (Pain under the kneecap, called patellofemoral pain syndrome, is more than twice as common in women than in men.) If you’ve ever been a baby-lifting, toddler-toting mother, you’ve performed actions your body’s not used to—like getting up off the floor over and over again—at a time when you may have lost fitness. Whether you’re pregnant or not, shoes with heels, even wide, stable ones, can place up to 26 percent more pressure on the knee. “It’s these years of pressure that end up causing osteoarthritis,” says Casey Kerrigan, MD, former chairwoman of the Department of Physical Medicine and Rehabilitation at the University of Virginia. Plus, because the Q-angle—the angle the femur (thigh bone) forms with the tibia (lower leg bone)—is greater in women than men, female athletes are up to eight times more likely to tear their ACL, a crucial ligament in the knee. A greater Q-angle can also cause the quadriceps to pull on the kneecap, moving it out of its usual track. As a result, women generally experience more wear on the lower-body joints.
While many studies have demonstrated that glucosamine and chondroitin supplements can help restore connective tissue, 2009 research published in Arthroscopy found that their effectiveness was inconsistent. That said, both supplements are very safe—and may help some people, says Strickland, who recommends taking 1,500 mg of glucosamine and 1,200 mg of chondroitin sulfate three times daily. “It costs a dollar a day, so I often tell my patients to try it for three months to see if they notice a difference,” she says. The same goes for avocado-soybean unsaponifiables, available in soft gels or pills, which were shown in a 2008 paper published in Osteoarthritis Cartilage to lessen pain and stiffness in people with knee or hip osteoarthritis who took 300 mg daily for three or more months. There’s also promising research that doing t’ai chi twice a week reduces knee pain, as does strengthening your hips with conditioning exercises. Losing weight is equally important. Carrying around an extra 5 pounds increases the load on the knees tenfold, so even lightening up a little can make a big difference.
It isn’t too difficult to fathom that 3-inch stiletto heels can wreak havoc on a female foot. Walking on your tippy toes causes twisting in the knee and can lead to metatarsalgia—tenderness under the ball of the foot. Morton’s neuroma, a painful condition caused by tissue thickening around a nerve between the third and fourth toes, is 10 times more common in women than in men, in part because of the pressure high heels place on the forefoot. Plantar fasciitis, irritation and inflammation of the heel and arch, is also more than twice as likely to occur in women. Thanks to the narrow toe boxes of most ladies’ shoes, more than half of women in the US have bunions—abnormal bony growths at the base of the big toe. And we’re not just talking Louboutins here: Most footwear is bad for you, says Kerrigan. “The classic design of shoes—with some heel and a stiff arch—comes from the old days of cobblers,” she says. “There’s no good reason for it. It’s as if shoe structures assume that a woman’s body is made wrong.”
Kerrigan was so frustrated by her footwear options that she left academia to develop her own shoe. “After writing a billion papers about this, I got to the point where it wasn’t changing anything,” she says. “Without better footwear, the research is worthless.” She’s now the chairwoman of JKM Technologies and OESH shoes, and her women’s walking shoe—with physiologically compliant cantilevers that are designed to move and flex with a woman’s body movements rather than against them—will roll out this fall.
In the meantime, save those party shoes for special occasions, and if you have to wear heels, keep ’em low. A 2009 study published in Foot & Ankle International suggests capping heels at 2 centimeters (about three-quarters of an inch) and placing a thin metatarsal pad (available at some pharmacies and specialty footwear stores) beneath the ball of the foot to relieve pressure and help thwart potential foot problems. Got bunions? Choose a shoe with plenty of room around your toes and no overlying stitching that might constrict natural movement and swelling. If heel pain such as plantar fasciitis is your problem, try physical therapy. Research shows that noninvasive therapies utilizing heat, massage, strengthening, and stretching treat joint and muscle problems more effectively than cortisone injections. And, as is true of most joint problems, losing a little weight when you’re heavy makes those hundreds of millions of steps you take over a lifetime that much easier on your body.
A 2007 study of 2,954 adults published in the Archives of Physical Medicine and Rehabilitation found that 23.5 percent of women experience greater trochanteric pain syndrome—tenderness or pain near the top of the thigh where the femur (thigh bone) meets the hip—compared to only 8.5 percent of men. According to lead author Neil Segal, MD, director of the Clinical Osteoarthritis Research Program at the University of Iowa, the reason could be anatomical—women’s wider pelvises change the angle of pull on the iliotibial (IT) band, the fibrous tissue that connects the hip muscles to the outer knee. Or it could be that the muscles that attach to the outer hip are weaker. Likewise, hormones could affect how the hip bursa, a fluid-filled sac that helps cushion the bones and joints, responds to ligament stress. Exercise is also a culprit: “The hips generally start hurting from overuse activities like running, not from day-to-day activities,” Strickland says.
Aside from experiencing hip pain during and after childbirth, women don’t have more hip problems than men per se—although weaker hips can cause pain that creeps down the leg. A February review from the Journal of Orthopaedic & Sports Physical Therapy (JOSPT) found that women with patellofemoral pain have weaker hip muscles, while IT band syndrome may be exacerbated when hip muscles are underdeveloped or the pelvis is out of balance.
What keeps your pelvic area from flexing and rotating too much? Your gluteal muscles. A weak butt can mean unstable hips, and unstable hips can cause leg injuries and knee pain. Strengthen them by doing abductions (lie on your side, legs straight, and lift the top leg) and alternating arm-leg raises (kneel on your hands and knees, lift and straighten one arm while lifting and straightening the opposite leg, hold for five seconds, then switch sides). Traditional squats and lunges work well, too, says Christopher Powers, PhD, author of the JOSPT review and codirector of the Musculoskeletal Biomechanics Research Lab at the University of Southern California.
To stretch your IT band, stand upright, cross your left foot in front of your right, then raise your right arm and gradually lean to the left (you should feel a slight pull at the top of your right hip). Whether you’re getting back into your exercise routine post-baby or post-injury—or simply ramping up the intensity of any sport—take it slow, cautions Strickland.
Back pain is the leading cause of disability in Americans under the age of 45 and affects as much as 85 percent of the population, according to some studies. In fact, a third of all visits to complementary medicine practitioners are to treat back or neck pain, a far higher percentage than for any other condition. A study published in the Clinical Journal of Pain confirmed that women are more affected by low back pain than men, and their prognosis tends to be worse. Researchers aren’t exactly sure why because women often lead healthier lifestyles, are less overweight, and (very generally, of course) have less physically straining jobs than men. Once again, pregnancy may be the culprit. “There’s nothing worse for core strength than being or having been pregnant,” says Strickland, adding that a weak core leaves women’s backs more vulnerable. Not only that, ligaments stay lax when you have to lift car seats and other kids, which can lead to aches, pulls, and other painful problems.
Short-term trials have shown that 50 mg of devil’s claw extract and 240 mg of salicin-rich willow bark extract can lead to improvements in back pain better than a placebo. More striking, however, is the evidence supporting acupuncture. Of 638 patients with chronic low back pain at Seattle’s Group Health Center for Health Studies, 60 percent who received acupuncture twice a week for three weeks, then once a week for four weeks, reported significant improvement—compared with only 39 percent of the control group, which took traditional pain meds and received physical therapy. A year later, up to 65 percent of the acupuncture group still reported improvements.
Not ready for needles? A 2008 study published in the British Medical Journal found that six one-on-one lessons in the Alexander Technique—which teaches better posture, ease of mobility, and tension release in everyday movements—combined with exercise treated back pain more effectively than massage, while 24 lessons reduced subjects’ number of days with pain by up to 85 percent. “Most people don’t pay attention to how they clench their jaws, stiffen their legs, and slouch throughout the day,” says Los Angeles–based Alexander Technique teacher Sharon Jakubecy. “Alexander Technique teachers can help heighten the sense of where you are in space, and you realize how little effort is actually required to sit, stand, lift grocery bags, and get into your car. A lot of people feel both lighter and more grounded after a few lessons in the technique.” To find an acupuncturist or other specialist in your area, visit naturalsolutionsmag.com and click on “Find a Health Practitioner.”
Neck and Shoulders
Julia Hush, PhD, a musculoskeletal physiotherapy expert and researcher for the Back Pain Research Group at the University of Sydney, discovered that female office workers incur neck pain three times more often than their male colleagues. And an ongoing study in Denmark found that more than 50 percent of female office workers have frequent neck pain. Of those, two-thirds suffer from trapezius myalgia—tension and aches in the large muscle that spans the neck, shoulder, and upper back. The possible causes of neck and shoulder pain include sitting at a computer for long periods of time, general stress (which more than doubles the likelihood of neck pain), and even carrying heavy handbags. “When your purse is really heavy—more than 10 percent of your body weight—you tend to shrug to keep it from sliding off,” says Strickland. “That leads to a lot of stiffness.” When seated at a desk, most people hunch over, then hyperextend their necks in order to look forward. Some research has also focused on reduced blood flow to neck and shoulder muscles—those with pain seem to have less vigorous circulation to the area. If you notice shoulder pain on the side where you use a computer mouse, you may have what’s sometimes called “mouse shoulder,” caused by having to reach too far forward or to the side of a wide keyboard to click. Not surprisingly, research has also shown that tense muscles have a reduced ability to rest and relax.
The good news is that there are many ways to remedy annoying neck and shoulder cricks. Hush found that those who performed general exercise at least three times a week—and whose necks were more flexible—were less likely to experience neck and shoulder pain. “I recommend doing neck movements like gently looking up, down, and side to side, and touching your ear to your shoulder to improve flexibility,” she says. And targeted neck-strengthening exercises are even better. According to the Danish researchers, five dumbbell exercises—reverse fly, one-arm row, shoulder abduction, shoulder elevation, and upright row, done three times a week—reduced women’s neck pain levels by half. For more immediate relief, try Traumeel, a homeopathic ointment packed with anti-inflammatory herbs like arnica, chamomile, and echinacea. In a 2008 study published in the Journal of Alternative and Complementary Medicine, Traumeel was just as effective as conventional meds in managing the pain of mild to moderate injuries. At the office, reduce “mouse shoulder” by placing your entire forearm on your desk, chair, or even in your lap, using the mouse from the top of your thigh. If nothing else, says Strickland, when you’re about town, carry in your purse only what you need, and divide your shopping loads into two bags—one for each shoulder.
Evelyn Spence is a freelance writer in Brooklyn, New York, whose work has appeared in Women’s Health, Backpacker, Runner’s World, and Men’s Journal.