This month I am going to highlight some areas of a woman’s body that are commonly painful, and that personal trainers will often assume are “tight” and in need of a stretch. We’ll then discuss common reasons WHY a woman might be sore, and what you need to consider before you decide whether or not to stretch, stabilise, mobilise, or strengthen (or whether you ignore it all together and meditate!!). A note before we start, this month I’m drawing off my 20+ years of training women, not any research papers, and the goal is just to get you thinking more broadly about the how and why this client may be sore, and to stop assuming they’re “tight”.
Firstly, we’re going to talk about the neck, specifically the traps.
Women are often sore in their necks, and we stretch them and stretch them, but they turn up sore again the next week. The question we have to ask is WHY they’re getting sore there in the first place! Questions like:
- What is their job?
- How old are their kids (and ascertain what their daily activities are like as a consequence of their time of life)?
- Their posture (women often develop upper cross syndrome in pregnancy and postpartum that can go on forever unresolved).
- Their mobility and stability (you can design your own tests for this!)
- Is there a tear or injury?
- Are the traps tight? Or are they chronically stretched, unstable, or long?
Only stretch their neck if:
- You can clearly see a shortening of the trap muscles (demo – posture assessment to screen for upper cross syndrome)
- You want to get them out of pain, you’re sure there’s no injury, and you also address the possible reasons for sore traps (eg. Tight chest, release anterior neck, unstable shoulder girdle, long rhomboids/strengthen back).
You do not have to diagnose the reason for their sore traps, simply try something, then run the posture assessment or stability test again to see if it makes a difference. If you do the posture assessment and decide they need to strength train their rhomboids, stretch and mobilise first to ensure them the best chance of actually targeting the preferred muscles (demo with upper cross syndrome and seated row).
If none of these strategies work, you’ve been consistent over 3mths, and worked with a physio, then consider sending them to a fascia specialist who can look at how the neck is interacting with the body – it might be a consequence of their c-section (for example, demo)!!
How about The Lower Back?
Mums get sore backs, a lot. I would take a stab and say women with kids get back pain more than anyone else, however, that doesn’t mean their lower back is tight and need stretching. Consider the video below…
When pushing a pram, the thoracic spine is immobilised, and the lower back must pivot to allow the legs to swing and walk… is it her thoracic that’s tight? Or her low back is unstable/overstretched? We don’t know – if you suspect try mobilising the thoracic and stabilising the low back and see what happens.
Or consider the posture changes that occur with a c-section (demonstrate), or sitting and breastfeeding. For some women this looks like a “tucked under” pelvis, in other words her low back is LONG and her abs are short – needing stretching!
Or consider the activities of daily life associated with child caring, the constant lifting and extending of the arms, carrying a baby on one hip, the uneven and wriggly loads…
Is her back sore because it’s had a heck of a workout? Does it need a REST?
What about pelvic floor dysfunction? This affects 30% of all women, and up to 76% of athletes depending on their sport… Pevic floor dysfunctions can cause or contribute to back pain, and they themselves be caused by too tight, too long, or uncoordinated muscles.
Assuming the back is sore because it’s tight is a mistake, particularly if your female client is a mum. Before stretching it, check her posture and alignment, consider her activities of daily life, and above all else – measure the changes!!
The Niggly ITB…
The illio-tibial band is a band of tissue that stretches from the hips to the knees and is often held responsible for hip and/or knee pain. It often feels tight, ropy, and inelastic – and stretching or “releasing” it is common for personal trainers. However, what they don’t often consider is the fact that women’s hips and pelvis’s are different to a mans hip and pelvis.
The Q-Angle, which is the angle of the femur as it connects the hips with the knees is up to 5 degrees greater in women that in men1. Combined with the fact that women generally have flatter feet, and you have a recipe for knees that collapse inwards. If you lengthen the ITB in these circumstances, you’ll likely be contributing to this propensity!
Some of us have been enlightened enough to know that the “balance” of the muscles around the knee is important, and for someone with a chronically sore ITB this usually means glute and VMO work; but this is not the whole solution. Women need to stretch their inner thigh to take the pressure off the ITB, which will also allow an improvement in alignment and more effective glute and VMO work.
Don’t just stretch the ITB because it’s sore! Again, look at your client’s posture, their stability versus mobility and go from there!
Between the Shoulder Blades
For similar reasons to the neck, the shoulder blades should be stretched with caution, and only after a thorough postural assessment. In addition, women have rounder rib cages and a different sternal angle to men (which is why they’re doing the massive back arch in weight lifting, to target the pecs which are located in a slightly different position to men’s!).
This combination means that it is easier for women to fall in to a Kyphotic posture, where the muscles between her shoulder blades are already stretched…. you go stretch them more and you contribute to her postural imbalances. Things to consider if she’s sore between the shoulder blades include:
- Rib mobility: can she twist and bend in both directions for a similar range?
- Breath mobility: when her lungs inflate, what moves? Her ribs? Her belly? Her neck?
- Head position: is it aligned over her shoulders?
- Hand position (and shoulder rotation): are they aligned at rest or rotated forwards?
- Mobility and flexibility generally: is she hypermobile, and does it take a lot of effort to hold an aligned posture as a result? Or does it take a lot of effort to stabilise than other clients? Is this something you could train?
- POSTURE: do you see evidence of upper or lower cross syndrome? Is her head aligned or tilted to one side? Her hips? Her shoulders?
Special mention: the hip flexors…
Trainers often stretch the hip flexors because a client is “short” in the lower back, however, the “hip flexors” as a group, attach to the spine in positions that can contribute to both a lordosis and an anterior hip tilt. Think about it honestly, has any of your clients ever had long term relief in pain or posture by stretching their hip flexors??
If you’re a trainer, who until now has automatically stretched the hip flexors in your female clients when they’ve reported lower back pain, or when you’ve see a lordosis, consider these options instead:
- Pelvic floor: stretch, mobility, co-ordination, synchronisation with breath
- Single leg stability: standing, 4-point, and prone positions. Forward and backwards, sideways, and circle movements.
- Diastasis and Abdominal strength versus length
- Short errector spinae (stretch those instead!)
We need to think differently when training female clients. As discussed, women are generally more mobile and less stable – which is not the same as saying ALL women are more mobile and less stable, there is an overlapping spectrum – however this needs to be taken in to consideration when prescribing stretches for female clients.
What works for men won’t necessarily work for women (and visa versa), and hopefully you now recognise that for women, painful places in her body are less likely to be tight, and more likely to be overstretched or unstable!