Female Postural Issues

Female Postural Issues: Considerations for Personal Trainers and Strength & Conditioning Coaches

Females are faced with a number of unique postural challenges. These stem from a combination of physiological, genetic-structural, and psychosocial factors that influence movement patterns, joint alignment, and injury risk. A thorough understanding of these variables is essential for exercise prescription, injury prevention, and performance optimization.

1. Hyperextension of the Knees (Genu Recurvatum)

A common postural fault in females is hyperextension of the knees, often exacerbated by habitual wearing of high-heeled shoes. High heels shift the center of gravity forward, leading to compensatory posterior pelvic tilt, lumbar flattening or hyperlordosis, and increased stress on the knees in extension.

Implications for trainers:

  • Clients who regularly wear high heels may demonstrate tightness in the gastrocnemius-soleus complex, shortened hip flexors, and weakened gluteal musculature.

  • Avoid overstretching already lax posterior knee structures.

  • Incorporate glute and hamstring strengthening to promote posterior chain stability.

2. Pelvic Structure and the Q Angle

Females have a wider pelvis to support childbirth, which increases the Q angle (quadriceps angle)—the angle formed between the line from the anterior superior iliac spine (ASIS) to the center of the patella and the line from the center of the patella to the tibial tuberosity.

Q Angle Comparison Average Degrees
Males 11.2°
Females 15.8°

 

Ref: Muscle Testing and Function (4th Ed.), Kendell, McCreary & Provance.

A larger Q angle predisposes females to increased lateral tracking of the patella, contributing to patellofemoral pain syndrome (PFPS), chondromalacia patellae, and increased risk of patellar dislocation.

Key biomechanical consequences:

  • Increased tensile stress on the medial collateral ligament (MCL)

  • Increased compressive forces on the lateral patellofemoral joint

  • Greater genu valgum (knock-knees)

  • Lateral “bowstringing” effect on the patella

A study by Arendt & Dick (1995) reported recurrent patellar dislocations accounted for 58.4% of all dislocations in women, compared to 14% in men, highlighting the clinical relevance of gender-based structural differences.

Trainer action points:

  • Strengthen hip abductors and external rotators to counteract medial knee collapse.

  • Incorporate neuromuscular training to improve lower limb alignment during closed-chain activities (e.g., squats, lunges).

3. Joint Laxity and Hypermobility

Females generally exhibit greater joint laxity due to differences in connective tissue properties and hormonal influences (e.g., estrogen effects on collagen). Increased laxity predisposes to mechanical dysfunction in the shoulder, spine, pelvis, knee, ankle, and foot.

Use the Nine-Point Beighton Hypermobility Score to assess general joint hypermobility (see assessment section for test protocol).

Beighton Score Interpretation Clinical Significance
0–4 Normal flexibility
5–9 Generalized hypermobility

Training considerations:

  • Emphasize stabilization training targeting vulnerable joints (shoulder girdle, lumbar-pelvic complex, knees, ankles).

  • Limit excessive static stretching in hypermobile clients.

  • Focus on closed kinetic chain exercises to enhance joint proprioception and neuromuscular control.

4. Upper Body Strength and Stability Needs

Due to generally lower absolute upper body strength in females, targeted training is needed for:

  • Triceps brachii

  • Elbow flexors

  • Lower back extensors

  • Abdominal stabilizers

This is especially important for clients with elbow hyperextension, where strengthening elbow flexors helps resist posterior joint stress and provides dynamic stabilization.

5. Increased Injury Susceptibility

Females are at higher risk for injuries affecting the:

  • Thoracic outlet

  • Shoulder complex

  • Lumbar spine

  • Sacroiliac (SI) joints

  • Hips

  • Knees

  • Ankles

  • Feet

Contributing factors include:

  1. Lack of foundational conditioning

  2. Lower baseline muscle strength

  3. Underutilization of closed-chain functional exercises

  4. Hormonal influences affecting ligamentous integrity

  5. Insufficient nutrition and recovery practices

6. Pelvic Floor Dysfunction

Pelvic floor dysfunction (PFD) is significantly more common in females, with contributing factors including:

  1. Postural dysfunction

  2. Poor abdominal bracing techniques

  3. Deep core (stabilizer) muscle weakness

  4. Over-reliance on machine-based rather than functional exercises

  5. Sacroiliac joint dysfunction

  6. History of low back pain

  7. (Less commonly) use of weightlifting belts

Trainer strategies:

  • Incorporate pelvic floor activation cues (e.g., “lift and hold”) into core training.

  • Avoid excessive intra-abdominal pressure during heavy lifts in at-risk clients.

  • Include transversus abdominis and multifidus strengthening for spinal-pelvic stability.

Summary Table: Female-Specific Postural & Structural Considerations

Factor Impact Training Implication
Wider pelvis → ↑ Q angle Increased lateral patellar tracking, knee valgus Strengthen glutes, hips; neuromuscular retraining
Joint laxity Instability, higher injury risk Emphasize stabilization; avoid over-stretching
Hyperextension tendency Increased stress on ligaments, altered biomechanics Strengthen flexors; monitor joint alignment
Lower upper-body strength Weaker shoulder girdle, arms Prioritize triceps, back, and shoulder training
Pelvic floor dysfunction Urinary incontinence, core instability Integrate pelvic floor exercises, avoid excessive IAP

Conclusion

An evidence-informed approach to female training must account for structural, hormonal, and biomechanical differences that influence movement quality, injury risk, and adaptation. Trainers should incorporate individualized corrective strategies, focus on functional strength and stabilization, and prioritize injury prevention while promoting optimal performance.

References

  1. Kendall, F. P., McCreary, E. K., & Provance, P. G. (1993). Muscles: Testing and Function (4th ed.). Williams & Wilkins.

  2. Arendt, E. A., & Dick, R. (1995). Knee injury patterns among men and women in collegiate basketball and soccer. The American Journal of Sports Medicine, 23(6), 694–701.

  3. Powers, C. M. (2010). The influence of abnormal hip mechanics on knee injury: A biomechanical perspective. Journal of Orthopaedic & Sports Physical Therapy, 40(2), 42–51.

  4. Hewett, T. E., Myer, G. D., & Ford, K. R. (2006). Anterior cruciate ligament injuries in female athletes: Part 1, mechanisms and risk factors. The American Journal of Sports Medicine, 34(2), 299–311.

  5. Beighton, P., Solomon, L., & Soskolne, C. L. (1973). Articular mobility in an African population. Annals of the Rheumatic Diseases, 32(5), 413–418.

  6. Willson, J. D., Ireland, M. L., & Davis, I. (2006). Core strength and lower extremity alignment during single leg squats. Medicine & Science in Sports & Exercise, 38(5), 945–952.