Female Performance Training

By Ollie Martin & Gemma Pilkington


Some Benefits of High Performance Training

  • Improved sports performance 
  • Better posture 
  • Optimal/healthy weight
  • Improved bone density
  • Better pelvic floor 
  • Better body image
  • Increased self confidence
  • Fun and social

However, many of the high performance training protocols having been developed for men.


Forward head posture & shoulder girdle

Female heads are on average same weight as a man’s but with 8% less bodyweight (plus potentially more hair).  For every inch the head moves forward there is three times the load on the neck extensors.  

Rounded shoulders are often adopted in puberty to hide developing breasts and exacerbated from sport specific muscle imbalances and too much sitting.  Steeper first rib angle causes excessive ligament strain.  This leads to thoracic outlet syndrome, where compression of blood vessels and nerves between the collar bone and first rib angle cause pain in shoulders/neck and numbness in fingers.   Also respiratory muscles can be overloaded.

Cascade effect:

  • Forward head posture
  • Steep first rib angle 
  • Increased lordosis in lumbar spine
  • Increased pelvic tilt
  • Hyperextended knees

Increased pelvic tilt

Associated with altered length tension relationships in the back and abdominals which, coupled with femoral anteversion (thigh bone turning inward) leads to lower extremity pronation injury.


Wider hips

To support child bearing wider hips create a wider Q angle.  Increased Q angle is associated with increased orthopaedic dysfunction at the hip (IT band, femoral anteversion and pronation) and knee (patellar lateral subluxation and chronic tracking dysfunction).

Stabiliser dysfunction

Woman are thought to develop faulty motor engrams related to gait during a two year period starting between 13-15 years of age in preparation for childbirth.  When this happens there is a tendency to to hang off the passive support structures and not use stabiliser muscles of the pelvic girdle effectively.

Most injuries are in the frontal and transverse plane whereas, most training programmes are in the saggital plane.  A good female performance programme will spend more time activating the stabilising muscles in the three planes of motion.  Athletes should not use fixed weight resistance machines as they do not train the stabilising muscles. 

Menstrual cycle

It is not just about periods, it is about the whole cycle. This is because the primary female hormones, oestrogen and progesterone, rise and fall throughout the entire menstrual cycle. As these hormones travel in the blood, they can affect everything from how athletes respond to training to how they recover and even to how their bodies metabolise or breakdown food for energy.

For example, in the first half of the cycle, as oestrogen rises, females are more likely to get the most benefit from a strength or high-intensity training session as the repair of muscle tissue is thought to be better at this time, and energy and strength levels rise to a peak. This changes in the second half of the cycle when progesterone levels start to ramp up, affecting other things like core body temperature, muscle breakdown, resting heart rate, breathing rate and insulin resistance.

Lowering injury risk 

Research indicates that there are certain points in the menstrual cycle where the risk of soft tissue injuries may be increased due to the effects of hormone fluctuations on ligaments, muscles and tendons. For example, the time most associated with an increase in risk of anterior cruciate ligament (ACL) injuries, the key stabilising ligament in the knee, is when oestrogen levels peak, just prior to ovulation.

This is because high oestrogen levels are linked with increases in joint laxity and changes in neuromuscular control. This means that the stability of the knee may alter and the muscles surrounding them may activate differently. It does not mean that an athlete should stop training, but, instead, by tracking and monitoring their cycle, they can adapt their preparation, training and nutrition in advance to lower the risk of ACL injuries during this window. There are many free menstrual cycle tracking apps available (Clue, Fitrwoman and Flo to name a few) where an athlete can simply note the day they start bleeding, how long for and any associated symptoms such as pain, mood changes, energy levels or sleep quality etc. This information is extremely useful to discover how an athletes menstrual cycle affect them and how they can adapt their training around it.

A barrier to performance

Female athletes:

  • 74% reported their menstrual cycle negatively affected their performance
  • 75% had never discussed their menstrual cycle with their coach
  • 72% received no education regarding exercise and their menstrual cycle

The lack of discussion in the wider domain and the lingering sense of taboo and embarrassment around what is, in fact, a natural process is often driven by the fact that there is very little education available on how the menstrual cycle relates to exercise and well-being.

Rough guidance for a menstrual cycle training schedule:

Based on a ‘typical cycle’ of 28 days.  Be sure to adapt this according to your cycle.

Phase 1 – 1st to last day of your period (e.g. days 1-5)

Oestrogen and progesterone are at their lowest during your period.  Inflammatory response affecting your recovery from exercise, a higher illness risk and higher blood pressure.  Greater cognitive function so an ideal time to learn a new coordination skill.  Focus on high intensity training and strength training.  The release of endorphins will help you relieve tension and feel happier.

Phase 2 – From end of your period until just before ovulation (e.g. days 6-14)

Oestrogen levels peak while progesterone levels stay low.  You’ll feel good, have energy, have a higher pain threshold and recover quicker.  Go large on your training! High intensity strength and power training.  Go for personal bests.  Watch out for increased joint laxity (too flexible).  Higher risk of ACL injury.  Blood sugar levels should be balanced, so you’ll find it easier to eat well (less sugar, instant energy foods).

Phase 3 – From ovulation until your hormones start to drop, usually lasts 9 days (e.g. days 15-23)

Oestrogen levels drop off with ovulation, then both oestrogen and progesterone start to rise and remain high.  You may experience pain, reduced strength, increased heart rate, increased appetite, increased emotions, reduced immunity and increased body temperature.  Reduce training intensity, focus on endurance, aerobic capacity and flexibility  Focus more on eating proactively real food including fat and protein. Prioritise sleep.

Phase 4 – The days just before your period (e.g. days 24-28)

Oestrogen and progesterone levels decline to their lowest point.  Inflammation causes PMS symptoms and recovery might be compromised.  Appetite may increase and craving are likely so eat proactively and a higher protein and fat ratio.  Focus on stress reduction activities such as the Takeshape breathing recovery programme, yoga and pilates. All types of training are beneficial in this stage.  Exercise has anti-inflammatory and antioxidant properties which have been shown to reduce PMS and endorphins will boost mood. Prioritise sleep.


A regular menstrual cycle is a sign of good health, vital for high performance. Its regularity, quality and presence is often considered as one of your primary body functions along with heart rate, respiratory rate and temperature and is an outward sign that your body is working optimally.  Amenorrhea is not good for bone health, injury risk, hormones, psychological health.  If your periods stop it is a sign of something is not right.  The main cause is stress.  If you have never had a period before the age of 16 or if you have recently missed three or more periods in a row, you should talk to a doctor.


Females have a higher incidence of joint laxity associated with mechanical dysfunction of the key joints.  If you are tight you can use this to your advantage, especially in Phase 2, but too much stretching/Yoga and not enough strength and stability training can exacerbate joint laxity.  Stretching should rebalance the wheel, only stretching short, tight muscles and not the long weak ones.  A biomechanical assessment at Takeshape identifies which is which.


Never diet – each diet increase the number and size of fat storing cells (lipogenic) and decreases the number of fat burning cells (lipolytic).  Each diet makes it harder to restore normal basal metabolic rate – starvation insurance!  Females are designed to store more energy as body fat than males.

Eat enough protein for essential neurotransmitters and hormones.  There is a strong correlation between lack of protein and over-training symptoms.

Eat real food rather than processed/packaged food and personalise your diet to your unique needs.  Eat the equivalent of two cereal-sized bowls of fruits and vegetables a day.

Less than 13% body fat is not healthy.

Aerobic exercise

Careful with too much aerobic exercise as it often ‘drains’ the the body rather than ‘trains’ it.  If you are looking to reduce body fat aerobic exercise is an inefficient way of doing so, as the body adapts quickly to the stress, creating a law of diminishing returns.  This is especially key in the menopausal woman if the goal is to shift abdominal fat. Strength, power and bodyweight training are more efficient ways of reducing body fat.

Sports bras and sportswear

It is important to find a comfortable bra that offers support rather than compression and it may be worth considering getting personally fitted for your sports bra to ensure adequate support is offered for your chosen sport.  If too tight it will effect respiratory pattern.  If your bra leaves a mark on your skin when you take it off, it is too tight.  Supportive underwear or sportswear is also gaining in its popularity and may be worth considering for those returning to high impact exercise post-natally or those suffering from pelvic floor dysfunction or urinary/faecal incontinence, especially if used alongside specific pelvic floor physiotherapy.

High heeled shoes

Wearing high healed shoes changes the angle of the body which requires some compensation for the body to function.  But, these compensations come at a cost including hyperextension of the knees (induces increased anterior pelvic tilt), shortened calf muscles and kyphosis (rounded shoulders).

Careful with eccentric loading

Eccentric loading is focusing on the return phase (lengthening) of the muscle which results in greater strength gains or the recoil phase in plyometrics (jump training).  Females will reach eccentric fatigue sooner than males of the same level of conditioning.  A five day recovery is recommend rather than four for men.

Pelvic floor

1 in 3 women will have pelvic floor issues at some stage in their lifetime and may include symptoms of pelvic organ prolapse, urinary stress and urge incontinence, difficulty in controlling wind or faeces, bladder urgency or pelvic pain.  Pregnancy and childbirth are considered to be particular risk factors for pelvic floor dysfunction however are not the only causes, in fact far from it and the following can also be causative, regardless if you’ve had children or not:

  • Menopause
  • Constipation and straining
  • Chronic cough
  • Being overweight
  • Poor posture
  • Heavy lifting 

Other considerations that may affect how your pelvic floor functions are conditions such as endometriosis, interstitial cystitis or painful bladder syndrome and post gynaecological surgeries.

Some sources of pelvic floor dysfunction in high performance training are:

  • Poor posture (habit and training)
  • Poor pelvic floor activation/technique or abdominal control (no TVA activation)
  • Over activity of upper abdominal muscles in relation to the lower core
  • Poor breathing patterns or breath holding during exercise
  • Lack of thoracic (mid back) rotation and extension
  • Stabiliser weakness (multifidus, TVA, internal oblique, hip rotators, adductors)
  • Overuse of machine exercises
  • Poor cueing (muscle sequencing / activation)
  • Sacroiliac/coccyx/pelvic girdle or lumbar spine pain and dysfunction
  • Weight belts


Do you ever leak urine or faeces?

Do you ever feel the need to go to the toilet frequently, quickly or do you not make it to the toilet on time?

Do you ever feel a heaviness or dragging feeling in your vagina?

Do you have pain in your vagina or during sex or inserting a tampon?

Have you recently had a baby and are concerned about your recovery or not sure when best to return to exercise?

Are you post menopausal and noticing problems with leaking or prolapse?

Are you considering having a hysterectomy or vaginal repair or are post gynaecological surgery?

If you answer yes to any of these questions it would be advisable to see a women’s health physio such as Gemma.  Up to 70% improve with specialised physiotherapy including pelvic floor muscle exercises, bladder re-training, advice and more. Just because symptoms are incredibly common does not make them normal.  Get talking and make an appointment to get your pelvic health back on track.


Every athlete is individual and performance training is a careful balance of applying stress to the body and giving it nutrients and rest to recover and super-compensate.  A key aspect of success is careful monitoring of performance and overtraining symptoms in line with the Takeshape ‘whole athlete’ approach: physical, nutritional, mental and emotional.


Ollie Martin – Contact us for more information

Gemma Pilkington is a women’s health physiotherapist specialising in pelvic health.  For any queries, questions or interest in booking please visit www.gpphysiotherapy.co.uk.

2019-10-31T18:56:38+00:00 October Oct, 2019|