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Baran E, Yılmaz T. Investigation of postural sensory organization in women with and without primary dysmenorrhea in three phases of the menstrual cycle. Gait Posture 2024; 109:49-55. [PMID: 38277764 DOI: 10.1016/j.gaitpost.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 10/27/2023] [Accepted: 01/10/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND The effects of the menstrual cycle in women with and without primary dysmenorrhea on phase-related postural sensory organization are controversial. RESEARCH QUESTION This study was carried out to examine postural sensory organization in three phases of the menstrual cycle in women with and without primary dysmenorrhea and to evaluate whether there is a difference between women with/without primary dysmenorrhea in this regard. METHODS Women aged 18-30 years were divided into two groups as primary dysmenorrhea group (PDG, n = 14) and control group (CG, n = 15). Computerized dynamic posturography were applied to the participants on the follicular, ovulation, and luteal phases of the menstrual cycle. Outcome measures were antero-posterior and medio-lateral Sensory Organization Test (SOT-somatosensory, vestibular and visual scores) and Limits of Stability test (LoS). The findings obtained were analyzed with the two-factor ANOVA, paired samples t test, and independent samples t test. RESULTS In the PDG, follicular phase antero-posterior somatosensory scores were lower compared to luteal phase (p = 0.002). Follicular phase antero-posterior and medio-lateral vestibular scores were lower than ovulation (p = 0.003, p = 0.004, respectively) and luteal (p = 0.005, p = 0.001, respectively) phases. Follicular phase LoS scores were lower than ovulation (p = 0.001) and luteal (p = 0.002) phases. In the CG, ovulation phase antero-posterior somatosensory scores were lower than follicular phase (p = 0.003). Follicular phase LoS scores were lower than ovulation phase (p = 0.002). The PDG had lower follicular phase antero-posterior somatosensory (p = 0.019), vestibular (p = 0.031), and medio-lateral somatosensory (p = 0.019) scores than those of the CG. The PDG had lower luteal phase antero-posterior somatosensory scores than those of the CG (p = 0.029). The PDG showed lower follicular phase LoS scores than those of the CG (p = 0.009). SIGNIFICANCE This study revealed that primary dysmenorrhea impairs postural sensory organization. Decreased sensory organization may predispose women to injury. The risk of injury should be investigated and necessary precautions should be taken.
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Affiliation(s)
- Emine Baran
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hitit University, Çorum, Turkey.
| | - Tuğba Yılmaz
- Faculty of Health Sciences, Department of Audiology, Gülhane University of Health Sciences, Ankara, Turkey
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Pohle C, Becker L, Baumeister J. Alterations of postural control across the menstrual cycle - A systematic review. Gait Posture 2024; 107:72-82. [PMID: 37757596 DOI: 10.1016/j.gaitpost.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/09/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Postural control is a vital component of injury prevention and prediction and plays a critical role in sports performance. Its relationship with the phases of the menstrual cycle (MC) is not yet fully understood and requires further investigation. RESEARCH QUESTION Does postural control alter between high hormone and low hormone phases of the MC? METHODS Five electronic databases were searched by two reviewers between 30th November and 2nd December 2022. Included were studies that investigated the effects of the MC on static and dynamic postural control in naturally cycling (NC) women by comparing the early follicular phase (EFP) with at least one high hormone phase of the MC. Two reviewers conducted the literature search, selection of eligible studies, data extraction, methodological quality assessment utilizing a modified Downs and Black Checklist, GRADE guidelines and SIGN grading, and synthesis of results. RESULTS Nine studies examined the effects of the MC on static (n = 7), dynamic (n = 1), or both forms of postural control (n = 1) in 148 NC women. Included studies were of very low to moderate quality. Level of evidence was either 2 + (n = 1) or 2- (n = 8). Limited evidence of five very low-quality studies indicated decreased static postural control during the ovulatory phase of the MC, compared to the EFP. The decrements were present in balance tasks that altered sensory input of at least two sensory systems of postural control. SIGNIFICANCE This systematic review is the first compiling evidence on the effect of the MC on postural control. Evidence that the MC influences postural control is unclear. However, a trend towards decrements in postural control form EFP to OP was observed in balance tasks that eliminated or altered sensory input. Hence, compensatory strategies might be less effective during the OP.
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Affiliation(s)
- Carina Pohle
- Exercise Science & Neuroscience Unit, Department of Exercise & Health, Faculty of Science, Paderborn University, Warburger Straße 100, 33098 Paderborn, Germany.
| | - Linda Becker
- Exercise Science & Neuroscience Unit, Department of Exercise & Health, Faculty of Science, Paderborn University, Warburger Straße 100, 33098 Paderborn, Germany
| | - Jochen Baumeister
- Exercise Science & Neuroscience Unit, Department of Exercise & Health, Faculty of Science, Paderborn University, Warburger Straße 100, 33098 Paderborn, Germany
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Elvan A, Kirişçi S, Başer Seçer M, Çeliker Tosun Ö, Tosun G. Does Phase of the Menstrual Cycle Affect Balance and Postural Control? J Mot Behav 2023; 56:69-77. [PMID: 37517810 DOI: 10.1080/00222895.2023.2241403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/15/2023] [Accepted: 07/20/2023] [Indexed: 08/01/2023]
Abstract
The aim of the study is to examine the effects of menstrual cycle phases (MCP) on balance and postural control. The study was carried out with 63 volunteer women. Digital ovulation kits and, a Menstrual Cycle Regularity Questionnaire (MCRQ) to detect menstrual cycle regularity and duration, Premenstrual Syndrome Questionnaire (PMSQ) to question the presence of premenstrual syndrome, Menstruation Attitude Questionnaire (MAQ) to assess menstrual attitudes, International Physical Activity Questionnaire Short Form (IPAQ-SF) to question physical activity level was used. Balance and postural oscillation were evaluated with Balance Master balance and performance test device and Tekscan MatScan™ Pressure Mat System, respectively. All evaluations were repeated twice, in the preovulatory period and the postovulatory period. When the evaluations of the preovulatory period and the postovulatory period were compared, there was %3 increase in the percent weight-bearing of the non-dominant extremity (p = 0.01) and %2.5 decrease in the percent weight-bearing of the dominant limb in the postovulatory period (p = 0.01). %8 increase in functional reach distances was detected in the postovulatory period (p < 0.01). It was determined that there was %7.4 decrease in the oscillation rate of the center of gravity in the static stance with eyes open and %9 decrease in the static stance with eyes closed in the postovulatory period (p = 0.35, p = 0.18, respectively). It has been determined that the balance and postural control of young women are negatively affected in the preovulatory period and the function improved from the preovulatory period to the postovulatory period.
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Affiliation(s)
- Ata Elvan
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Selin Kirişçi
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Melda Başer Seçer
- Manisa Celal Bayar University Health Services Vocational School, Manisa, Turkey
| | - Özge Çeliker Tosun
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Gökhan Tosun
- Department of Obstetrics and Gynecology, University of Health Sciences, Tepecik Education and Research Hospital, Izmir, Turkey
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Reschechtko S, Nguyen TN, Tsang M, Giltvedt K, Kern M, Hooshmand S. Postural sway is not affected by estrogen fluctuations during the menstrual cycle. Physiol Rep 2023; 11:e15693. [PMID: 37217442 PMCID: PMC10202824 DOI: 10.14814/phy2.15693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/24/2023] Open
Abstract
When people stand still, they exhibit a phenomenon called postural sway, or spontaneous movement of the body's center of pressure, which is related to balance control. In general females show less sway than males, but this difference only begins to appear around puberty, pointing to different levels of sex hormones as one potential mechanism for sway sex differences. In this study, we followed cohorts of young females using oral contraceptives (n = 32) and not using oral contraceptives (n = 19), to investigate associations between estrogen availability and postural sway. All participants visited the lab four times over the putative 28-day menstrual cycle. At each visit, we performed blood draws to measure plasma estrogen (estradiol) levels, and tests of postural sway using a force plate. During late follicular and mid-luteal phase, estradiol levels were lower in participants using oral contraceptives (mean differences [95% CI], respectively: -231.33; [-800.44, 337.87]; -613.26; [-1333.60, 107.07] pmol/L; main effect p < 0.001), reflecting expected consequences of oral contraceptive use. Despite these differences, postural sway was not significantly different between participants who were using oral contraceptives and participants who were not (mean difference: 2.09 cm; 95% CI = [-1.05, 5.22]; p = 0.132). Overall, we found no significant effects of the estimated menstrual cycle phase-or absolute levels of estradiol-on postural sway.
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Affiliation(s)
- Sasha Reschechtko
- School of Exercise and Nutritional SciencesSan Diego State UniversitySan DiegoCaliforniaUSA
| | - Thuy Ngoc Nguyen
- School of Exercise and Nutritional SciencesSan Diego State UniversitySan DiegoCaliforniaUSA
| | - Michelle Tsang
- School of Exercise and Nutritional SciencesSan Diego State UniversitySan DiegoCaliforniaUSA
| | - Kristine Giltvedt
- School of Exercise and Nutritional SciencesSan Diego State UniversitySan DiegoCaliforniaUSA
| | - Mark Kern
- School of Exercise and Nutritional SciencesSan Diego State UniversitySan DiegoCaliforniaUSA
| | - Shirin Hooshmand
- School of Exercise and Nutritional SciencesSan Diego State UniversitySan DiegoCaliforniaUSA
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Ekenros L, von Rosen P, Solli GS, Sandbakk Ø, Holmberg HC, Hirschberg AL, Fridén C. Perceived impact of the menstrual cycle and hormonal contraceptives on physical exercise and performance in 1,086 athletes from 57 sports. Front Physiol 2022; 13:954760. [PMID: 36111164 PMCID: PMC9468598 DOI: 10.3389/fphys.2022.954760] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/02/2022] [Indexed: 11/25/2022] Open
Abstract
Female athletes train and compete under the potential influence of hormonal fluctuations during the menstrual cycle or during use of various hormonal contraceptives. Dysmenorrhea and premenstrual symptoms are common in the general population, as well as side effects of hormonal contraceptives. More detailed knowledge concerning prevalence and perceived impact of these symptoms on training and performance in different sports is required. The aim of the study was to 1) characterize perceptions of training and performance during the menstrual cycle phases and by hormonal contraceptive use in a large population of female athletes; 2) explore whether symptoms experienced are related to perceived performance; and 3) examine potential differences in these factors between athletes at different levels of performance. The study was based on self-reported data from 1,086 athletes from 57 sports at different performance levels via a web-based questionnaire. Thirty-seven percent (n = 407) of the athletes did not use hormonal contraceptives. In this group, menstrual cycle related symptoms were common across all athlete levels, particularly dysmenorrhea (74%, n = 300) and premenstrual symptoms (78%, n = 318), which also influenced perceived performance of aerobic fitness, muscle strength, mental sharpness, balance, and sleep quality. Sixty-three percent (n = 679) of the athletes used various hormonal contraceptives and 40% (n = 272) perceived a variety of side-effects. Physical performance was experienced equally independent of time-point of the pill-chart except for the period of inactive pills, which was associated with more negative impact. Nonetheless, only 18% (n = 191) of the athletes considered menstrual cycle or hormonal contraceptive issues when planning their training or competitions. These results indicate that greater focus is needed to identify and effectively treat different menstrual cycle and hormonal contraceptive related symptoms on an individual level.
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Affiliation(s)
- Linda Ekenros
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy Karolinska Institutet, Huddinge, Sweden
| | - Philip von Rosen
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy Karolinska Institutet, Huddinge, Sweden
| | - Guro Strøm Solli
- School of Sport Sciences, UiT, the Arctic University of Norway, Tromsø, Norway
- Department of Sports Science and Physical Education, Nord University, Bodø, Norway
| | - Øyvind Sandbakk
- School of Sport Sciences, UiT, the Arctic University of Norway, Tromsø, Norway
- Department of Neuromedicine and Movement Science, Centre for Elite Sports Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hans-Christer Holmberg
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
- Department of Physiology and Pharmacology, Biomedicum C5, Karolinska Institutet, Stockholm, Sweden
| | - Angelica Lindén Hirschberg
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Fridén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy Karolinska Institutet, Huddinge, Sweden
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Cecilia Fridén,
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Legerlotz K, Nobis T. Insights in the Effect of Fluctuating Female Hormones on Injury Risk—Challenge and Chance. Front Physiol 2022; 13:827726. [PMID: 35250631 PMCID: PMC8891628 DOI: 10.3389/fphys.2022.827726] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/26/2022] [Indexed: 11/25/2022] Open
Abstract
It is time to take on the challenge of investigating the complex effect of fluctuating female hormones on injury risk as this offers a chance to improve female athletes’ health and performance. During the recent decade, the body of knowledge on female hormones and injury risk has largely been increased. New insights have been offered regarding the association of certain phases of the menstrual cycle and injury prevalence as well as regarding relationships between hormone levels and musculoskeletal changes such as, for example, ligamentous stiffness and knee laxity. However, current research often follows the theme of a causal relationship between estrogen levels and musculoskeletal function or injury and thus—one might argue—further enhances a rather simplistic approach, instead of uncovering complex relationships which could help in establishing more nuanced ways of preventing female injuries. To uncover real effects and to truly understand the physiological responses, we suggest to reflect on potential bias regarding research questions and current approaches. It may enhance future studies to apply a more nuanced approach to causation, to include multidimensional perspectives and to implement an interdisciplinary methodology.
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Affiliation(s)
- Kirsten Legerlotz
- Movement Biomechanics, Institute of Sport Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- *Correspondence: Kirsten Legerlotz,
| | - Tina Nobis
- Berlin Institute for Integration and Migration Research, Humboldt-Universität zu Berlin, Berlin, Germany
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Kacem M, Borji R, Sahli S, Rebai H. The Disturbing Effect of Neuromuscular Fatigue on Postural Control Is Accentuated in the Premenstrual Phase in Female Athletes. Front Physiol 2021; 12:736211. [PMID: 34733175 PMCID: PMC8558460 DOI: 10.3389/fphys.2021.736211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 09/15/2021] [Indexed: 11/13/2022] Open
Abstract
This study explored the fatigue effect on postural control (PC) across menstrual cycle phases (MCPs) in female athletes. Isometric maximal voluntary contraction (IMVC), the center of pressure sway area (CoParea), CoP length in the medio-lateral (CoPLX) and antero-posterior (CoPLY) directions, and Y-balance test (YBT) were assessed before and after a fatiguing exercise during the follicular phase (FP), mid-luteal phase (LP), and premenstrual phase (PMP). Baseline normalized reach distances (NRDs) for the YBT were lower (p = 0.00) in the PMP compared to others MCPs, but the IMVC, CoParea, CoPLX, and CoPLY remained unchanged. After exercise, the IMVC and the NRD decrease was higher at PMP compared to FP (p = 0.00) and LP (p = 0.00). The CoParea, CoPLX, and CoPLY increase was higher in the PMP compared to FP (p = 0.00) and LP (p = 0.00). It was concluded that there is an accentuated PC impairment after exercise observed at PMP.
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Affiliation(s)
- Maissa Kacem
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Rihab Borji
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Sonia Sahli
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Haithem Rebai
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
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Castanier C, Bougault V, Teulier C, Jaffré C, Schiano-Lomoriello S, Vibarel-Rebot N, Villemain A, Rieth N, Le-Scanff C, Buisson C, Collomp K. The Specificities of Elite Female Athletes: A Multidisciplinary Approach. Life (Basel) 2021; 11:622. [PMID: 34206866 PMCID: PMC8303304 DOI: 10.3390/life11070622] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 12/19/2022] Open
Abstract
Female athletes have garnered considerable attention in the last few years as more and more women participate in sports events. However, despite the well-known repercussions of female sex hormones, few studies have investigated the specificities of elite female athletes. In this review, we present the current but still limited data on how normal menstrual phases, altered menstrual phases, and hormonal contraception affect both physical and cognitive performances in these elite athletes. To examine the implicated mechanisms, as well as the potential performances and health risks in this population, we then take a broader multidisciplinary approach and report on the causal/reciprocal relationships between hormonal status and mental and physical health in young (18-40 years) healthy females, both trained and untrained. We thus cover the research on both physiological and psychological variables, as well as on the Athlete Biological Passport used for anti-doping purposes. We consider the fairly frequent discrepancies and summarize the current knowledge in this new field of interest. Last, we conclude with some practical guidelines for eliciting improvements in physical and cognitive performance while minimizing the health risks for female athletes.
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Affiliation(s)
- Carole Castanier
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | | | - Caroline Teulier
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | | | - Sandrine Schiano-Lomoriello
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Nancy Vibarel-Rebot
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Aude Villemain
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Nathalie Rieth
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Christine Le-Scanff
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Corinne Buisson
- Département des Analyses, AFLD, 92290 Chatenay-Malabry, France;
| | - Katia Collomp
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
- Département des Analyses, AFLD, 92290 Chatenay-Malabry, France;
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Keklicek H, Sermenli Aydin N, Can HB, Dönmez Aydin D, Yilmazer Kayatekin AZ, Uluçam E. Primary dysmenorrhea and postural control: Is it a problem only during menstruation? Gait Posture 2021; 85:88-95. [PMID: 33517042 DOI: 10.1016/j.gaitpost.2021.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The effects of the menstrual cycle and primary dysmenorrhea (PD) on phase-related cognitive and physical functions are controversial. This study was carried out to examine whether women with PD showed a different physical function or dual-tasking response than women without PD at times other than menstruation. METHODS Women with or without PD were recruited for the study. Individuals assessed on the first day of the menstruation and the day they reported themselves as well being (feeling good day-FGD). Zebris © FDM Type Force Platform was used to evaluate postural stability. Individuals have were asked to perform to a 3-step balance test protocol; the first session: comfortable upright standing; the second session: standing with a motor task; the third session: standing with a cognitive task (counting backward). Correctly calculated numbers were also recorded. RESULTS The number of correct answers given by individuals during the cognitive dual-task was similar on the first day of menstruation and FGD (p > 0.05). In the control group, no difference was observed between the first days of menstruation and the evaluations on FGD days with dual-task (p > 0.05). In individuals with PD, there was no difference between the measurements at different times (p > 0.05). However, in the assessment with the motor dual-task on the first day of menstruation; postural sway increased (p < 0,05). In FDG measurement; distortion in postural stability was observed with the cognitive task (p < 0,05). In the assessments performed on the first day of menstruation, there was no difference in any parameters between the groups (p > 0.05). In the measurements made on FGD day with the cognitive task; there was a difference between the groups (p < 0,05). Individuals with PD had higher postural sway. SIGNIFICANCE This study showed that the primary dysmenorrhea is not only a problem for females during menstruation, primary dysmenorrhea causes impaired ability of the individual to perform dual-tasking and continuously affects postural stability.
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Affiliation(s)
- Hilal Keklicek
- Department of Physical Therapy and Rehabilitation, Trakya University, Faculty of Health Science, 22030 Edirne, Turkey.
| | - Nimet Sermenli Aydin
- Department of Physical Therapy and Rehabilitation, Trakya University, Faculty of Health Science, 22030 Edirne, Turkey; Department of Physical Therapy and Rehabilitation, Marmara University, Faculty of Health Science, 34854 İstanbul, Turkey.
| | - Hilal Başak Can
- Department of Physical Therapy and Rehabilitation, Trakya University, Faculty of Health Science, 22030 Edirne, Turkey; Department of Physical Therapy and Rehabilitation, Marmara University, Faculty of Health Science, 34854 İstanbul, Turkey.
| | - Didem Dönmez Aydin
- Department of Anatomy, Trakya University, Faculty of Medicine, 22030 Edirne, Turkey.
| | - Ayşe Zeynep Yilmazer Kayatekin
- Department of Anatomy, Trakya University, Faculty of Medicine, 22030 Edirne, Turkey; Department of Anatomy, Zonguldak Bülent Ecevit University Faculty of Medicine, 67600 Zonguldak, Turkey.
| | - Enis Uluçam
- Department of Anatomy, Trakya University, Faculty of Medicine, 22030 Edirne, Turkey.
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Bidirectional Interactions between the Menstrual Cycle, Exercise Training, and Macronutrient Intake in Women: A Review. Nutrients 2021; 13:nu13020438. [PMID: 33572821 PMCID: PMC7910908 DOI: 10.3390/nu13020438] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 02/08/2023] Open
Abstract
Women have a number of specificities that differentiate them from men. In particular, the role of sex steroid hormones and the menstrual cycle (MC) significantly impact women’s physiology. The literature has shown nonlinear relationships between MC, exercise, and nutritional intake. Notably, these relationships are bidirectional and less straightforward than one would suppose. For example, the theoretical implications of the MC’s phases on exercise performance do not always translate into relevant practical effects. There is often a disconnect between internal measures (e.g., levels of hormone concentrations) and external performance. Furthermore, it is not entirely clear how nutritional intake varies across the MC’s phases and whether these variations impact on exercise performance. Therefore, a thorough review of the existing knowledge could help in framing these complex relationships and potentially contribute to the optimization of exercise prescription and nutritional intake according to the naturally occurring phases of the MC. Throughout this review, an emerging trend is the lack of generalizability and the need to individualize interventions, since the consequences of the MC’s phases and their relationships with exercise and nutritional intake seem to vary greatly from person to person. In this sense, average data are probably not relevant and could potentially be misleading.
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11
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Sex Differences in Lower Limb Proprioception and Mechanical Function Among Healthy Adults. Motor Control 2020; 24:571-587. [PMID: 32866946 DOI: 10.1123/mc.2020-0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/01/2020] [Accepted: 06/05/2020] [Indexed: 11/18/2022]
Abstract
Twenty-four healthy adults, including 12 females and 12 males, participated in the study. Each female participant completed three trials in three different phases of one menstrual cycle, which included follicular, ovulatory, and luteal phases. The study aimed to investigate whether there is any difference in joint kinetic sense, neuromuscular coordination, and isokinetic muscle strength (a) between healthy males and females at different phases of the menstrual cycle and (b) between females at different phases of the menstrual cycle. The outcome measures included the number of jumps in the square-hop test and ankle and knee proprioception, which were assessed by an electric-driven movable frame rotated at 0.4 deg/s and isokinetic muscle strength measured by a computerized dynamometer (Biodex). For the square-hop test (p = .006), ankle dorsiflexion/plantar flexion (p < .05), knee flexion/extension (p < .05), the relative peak torque of the isokinetic muscle strength at the 60° and 180° knee flexion/extension (p < .001), and the 30° and 120° ankle plantar flexion/dorsiflexion (p < .05) between females and males showed significant differences. For the females at different phases of the menstrual cycle, significant differences were found on ankle dorsiflexion (p = .003), plantar flexion (p = .023), knee extension (p = .029), the square-hop test (p = .036), and relative peak torque of isokinetic muscle strength at 180° knee flexion (p = .029). This study demonstrated that there are sex differences in lower limb proprioception and mechanical function. Females at ovulatory and luteal phases have better lower limb proprioception than at the follicular phase.
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Ikarashi K, Iguchi K, Yamazaki Y, Yamashiro K, Baba Y, Sato D. Influence of Menstrual Cycle Phases on Neural Excitability in the Primary Somatosensory Cortex and Ankle Joint Position Sense. WOMEN'S HEALTH REPORTS 2020; 1:167-178. [PMID: 33786480 PMCID: PMC7784724 DOI: 10.1089/whr.2020.0061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/18/2020] [Indexed: 02/07/2023]
Abstract
Introduction: Ankle sprain (AS) is one of the most common injuries among women engaged in competitive sports and recreational activities. Many studies have shown that several factors contributing to AS are influenced by the menstrual cycle. Despite the finding that abnormal joint position sense (JPS) is one of the major risk factors of AS, the alteration of the JPS throughout the menstrual cycle and its associated neural mechanisms remain unclear. Objective: This study aimed to examine whether the menstrual cycle phases affect neural excitability in the primary somatosensory cortex (S1) and JPS. Methods: Fourteen right-footed women participated in this study. Somatosensory-evoked potential and paired-pulse inhibition (PPI) were measured to assess S1 excitatory and inhibitory functions. Ankle JPS was measured using an active joint position matching method. Menstrual syndrome was evaluated using the menstrual distress questionnaire. All assessments were conducted in the follicular, ovulatory, and luteal phases. Results: The two main findings of this study were as follows: First, PPI decreased in the ovulatory phase than in the follicular phase. This may have been the reason for estrogen altering the neural inhibition and facilitation balance throughout the menstrual cycle. Second, JPS was not changed during the menstrual cycle. Conclusion: In conclusion, phases of the menstrual cycle affect the neural excitability in S1 as shown by the decreased PPI in the ovulatory phase, and the ankle JPS was unchanged throughout the menstrual cycle.
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Affiliation(s)
- Koyuki Ikarashi
- Field of Health and Sports, Graduate School of Niigata University of Health and Welfare, Niigata, Niigata, Japan.,Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Niigata, Japan
| | - Kaho Iguchi
- Field of Health and Sports, Graduate School of Niigata University of Health and Welfare, Niigata, Niigata, Japan
| | - Yudai Yamazaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Niigata, Japan
| | - Koya Yamashiro
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Niigata, Japan.,Department of Health and Sports, Niigata University of Health and Welfare, Niigata, Niigata, Japan
| | - Yasuhiro Baba
- Department of Health and Sports, Niigata University of Health and Welfare, Niigata, Niigata, Japan
| | - Daisuke Sato
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Niigata, Japan.,Department of Health and Sports, Niigata University of Health and Welfare, Niigata, Niigata, Japan
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13
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Comparison of some intrinsic risk factors of shoulder injury in three phases of menstrual cycle in collegiate female athletes. Phys Ther Sport 2020; 43:195-203. [PMID: 32220759 DOI: 10.1016/j.ptsp.2020.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 02/21/2020] [Accepted: 02/22/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES present study aims to investigate the changes in the shoulder joint stability factors during the menstrual cycle. DESIGN cross-sectional study; SETTING: laboratory. PARTICIPANTS 15 healthy collegiate female athletes with normal menstrual cycles. MAIN OUTCOME MEASURES shoulder strength, proprioception, laxity and functional stability were the primary outcomes. Participants were assessed in three phases (mense, ovulation, midluteal (day 21) by 4 different categories of tests, each designed for a different factor. Shapiro-Wilk Test was used to determine normality of data, ANOVA and Friedman Test were used to compare results. Significance level and alpha were considered 95 percent and ≥0.05, respectively. Data shown a relation between proprioception, strength and menstrual cycle. RESULTS shoulder strength was significantly increased in ovulation phase compared to other phases (p < 0.5) (effect size >0.14). Proprioception was significantly decreased in luteal phase than in mense and ovulation phases (p < 0.5) (effect size >0.14). Finally, ligament laxity and functional stability showed no change in all phases (p < 0.5). CONCLUSION Menstrual cycle and sexual hormones affect muscle strength and proprioception of shoulder joint, but have no effect on ligament laxity and functional stability.
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Sung ES, Kim JH. The influence of ovulation on postural stability (Biodex Balance System) in young female. J Exerc Rehabil 2018; 14:638-642. [PMID: 30276186 PMCID: PMC6165977 DOI: 10.12965/jer.1836266.133] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/14/2018] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to examine the influence of ovulation (OV) on dynamic balance in young female. Thirty-two eumenorrheic healthy women participated in Biodex Balance System (BBS) test for postural stability and a limit of stability menstrual cycle. BBS was tested in the menses (MS), OV, and luteal phase (LP). The limits of stabilities (total, forward-left, forward-right, backward-left, and backward-right) were significantly higher in the OV (total, 61.44±14.77; forward-left, 67.50± 15.17; forward-right, 69.50±14.43; backward-left, 64.00±20.32; and back-ward-right, 69.06±13.59) than in the MS (total, 55.44±14.63; forward-left, 60.00±15.98; forward-right, 62.17±9.78; backward-left, 57.83±19.09; and backward-right, 57.28±13.73). Furthermore, the LP (65.11±13.79) was a significantly higher limit of stability than MS (57.28±13.73) during back-ward-right. The present study showed that estrogen negatively influences postural stability. The postural sway in limits of stabilities (total, forward-left, forward-right, backward-left, and backward-right) were significantly the greatest in the OV. Since there is a different postural stability between MS, OV, and LP, this should be taken into account when devising training programs to avoid risk factor of fall and joint injury.
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Affiliation(s)
- Eun-Sook Sung
- Department of Sports Rehabilitation, College of Health Welfare, Woosong University, Daejeon, Korea
| | - Jung-Hyun Kim
- Department of Physical Therapy, College of Health Welfare, Woosong University, Daejeon, Korea
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15
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Mucci V, Canceri JM, Brown R, Dai M, Yakushin SB, Watson S, Van Ombergen A, Jacquemyn Y, Fahey P, Van de Heyning PH, Wuyts F, Browne CJ. Mal de Debarquement Syndrome: A Retrospective Online Questionnaire on the Influences of Gonadal Hormones in Relation to Onset and Symptom Fluctuation. Front Neurol 2018; 9:362. [PMID: 29910765 PMCID: PMC5992375 DOI: 10.3389/fneur.2018.00362] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 05/04/2018] [Indexed: 12/19/2022] Open
Abstract
Introduction Mal de Debarquement Syndrome (MdDS) is a condition characterized by a persistent perception of self-motion, in most cases triggered from exposure to passive motion (e.g., boat travel, a car ride, flights). Patients whose onset was triggered in this way are categorized as Motion-Triggered (MT) subtype or onset group. However, the same syndrome can occur spontaneously or after non-motion events, such as childbirth, high stress, surgery, etc. Patients who were triggered in this way are categorized as being of the Spontaneous/Other (SO) subtype or onset group. The underlying pathophysiology of MdDS is unknown and there has been some speculation that the two onset groups are separate entities. However, despite the differences in onset between the subtypes, symptoms are parallel and a significant female predominance has been shown. To date, the role of gonadal hormones in MdDS pathophysiology has not been investigated. This study aimed to evaluate the hormonal profile of MdDS patients, the presence of hormonal conditions, the influence of hormones on symptomatology and to assess possible hormonal differences between onset groups. In addition, the prevalence of migraine and motion sickness and their relation to MdDS were assessed. Method Retrospective online surveys were performed in 370 MdDS patients from both onset groups. Data were analyzed using Fisher’s exact test or Fisher-Freeman-Hanlon exact test. When possible, data were compared with normative statistical data from the wider literature. Results From the data collected, it was evident that naturally cycling female respondents from the MT group were significantly more likely to report an aggravation of MdDS symptoms during menses and mid-cycle (p < 0.001). A few preliminary differences between the onset groups were highlighted such as in regular menstrual cycling (p = 0.028), reporting menses during onset (p < 0.016), and migraine susceptibility after onset (p = 0.044). Conclusion These results demonstrate a potential relation between hormone fluctuations and symptom aggravation in the MT group. This study is an important first step to suggest a hormonal involvement in the pathophysiology of MdDS and provides a base for further hormonal investigation. Future prospective studies should expand upon these results and explore the implications for treatment.
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Affiliation(s)
- Viviana Mucci
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Josephine M Canceri
- School of Science and Health, Western Sydney University, Sydney, NSW, Australia
| | - Rachael Brown
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Mingjia Dai
- Icahn School of Medicine, Mount Sinai Hospital, New York, NY, United States
| | - Sergei B Yakushin
- Icahn School of Medicine, Mount Sinai Hospital, New York, NY, United States
| | - Shaun Watson
- Institute of Neurological Sciences, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Angelique Van Ombergen
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium.,Department of Biomedical Physics, Faculty of Sciences, University of Antwerp, Antwerp, Belgium
| | - Yves Jacquemyn
- Department of Gynaecology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Paul Fahey
- School of Science and Health, Western Sydney University, Sydney, NSW, Australia
| | - Paul H Van de Heyning
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Floris Wuyts
- Department of Biomedical Physics, Faculty of Sciences, University of Antwerp, Antwerp, Belgium
| | - Cherylea J Browne
- School of Science and Health, Western Sydney University, Sydney, NSW, Australia.,Translational Neuroscience Facility, School of Medical Sciences, UNSW Sydney, Sydney, NSW, Australia
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16
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Legerlotz K, Bey ME, Götz S, Böhlke N. Constant performance in balance and proprioception tests across the menstrual cycle - a pilot study in well trained female ice hockey players on hormonal contraception. Health Sci Rep 2018; 1:e18. [PMID: 30623036 PMCID: PMC6266417 DOI: 10.1002/hsr2.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/04/2017] [Accepted: 10/16/2017] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION It has yet to be explained why female athletes appear to suffer more often from non-contact ligament injuries during the first half of the menstrual cycle. Fluctuations in balance, caused by impaired proprioception due to increased fluid retention, may be relevant factors contributing to this anomaly in distribution. The aim of this study was therefore to uncover relationships between dynamic stability, proprioception and fluid retention in association with the menstrual cycle as a possible explanation for the observed changes in injury rates. METHODS Nine healthy, female, well trained ice hockey players on hormonal contraception with regular cycles were tested at least twelve times during one menstrual cycle. Bioimpedance analysis was applied to investigate body composition and fluid distribution. A joint position sense test was performed to characterize changes in proprioception, while unexpected perturbations on a balance board were used to obtain measures for dynamic postural control. RESULTS No distinct changes in proprioception, dynamic stability and fluid retention were identified across the menstrual cycle in this population. Weak correlations were found between parameters for dynamic stability and proprioception. CONCLUSION Variations in proprioception, dynamic stability and fluid retention seem unlikely to be major contributors to injury risk peaks, at least in this population of healthy trained athletes using hormonal contraception.
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Affiliation(s)
- Kirsten Legerlotz
- Department of Training and Movement SciencesHumboldt UniversityBerlinGermany
| | - Marie Elena Bey
- Department of Training and Movement SciencesHumboldt UniversityBerlinGermany
| | - Susann Götz
- Division of Training and Movement ScienceUniversity of PotsdamPotsdamGermany
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17
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Kami AT, Vidigal CB, Macedo CDSG. Influência das fases do ciclo menstrual no desempenho funcional de mulheres jovens e saudáveis. FISIOTERAPIA E PESQUISA 2017. [DOI: 10.1590/1809-2950/16081424042017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
RESUMO Os hormônios sexuais femininos como estrogênio e progesterona têm relação com receptores específicos localizados em regiões cerebrais e podem influenciar o controle motor. Analisou-se o desempenho funcional nas diversas fases do ciclo menstrual em mulheres jovens e saudáveis. O estudo caracteriza-se como transversal e incluiu 13 mulheres saudáveis com ciclo menstrual regular e que não faziam uso de contraceptivo oral. Para a avaliação do desempenho funcional foram utilizados os testes Side Hop Test (SHT), Figure of Eight Hop Test (F8T) e Modified Star Excursion Balance Test (mSEBT) aplicados em três fases do ciclo menstrual (menstrual, ovulatória e lútea). Este estudo estabeleceu diferença significativa para os testes funcionais SHT e F8T entre as fases do ciclo menstrual, com piores resultados para a fase menstrual. O mSEBT não estabeleceu qualquer diferença. Concluiu-se que o desempenho funcional nos testes SHT e F8T foi significativamente pior na fase menstrual, quando comparado à ovulatória e lútea. Estes resultados podem ser considerados para avaliação e prescrição de condutas fisioterapêuticas para mulheres na fase menstrual, já que seu desempenho funcional pode estar comprometido.
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Affiliation(s)
| | | | - Christiane de Souza Guerino Macedo
- Universidade Estadual de Londrina, Brazil; Universidade Estadual de Londrina, Brazil; Universidade Norte do Paraná, Brazil; Universidade Estadual de Londrina, Brazil
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18
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Maged AM, Salah E, Kamel AM, Hussein AM, Saad H, Meshaal H, Kamal WM. Effect of oral contraceptives on balance in women: A randomized controlled trial. Taiwan J Obstet Gynecol 2017; 56:463-466. [PMID: 28805601 DOI: 10.1016/j.tjog.2017.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To detect the effect of combined oral contraceptive pills (COC) on dynamic postural balance in healthy middle aged women. MATERIALS AND METHODS A prospective randomized controlled study included 200 patients classified into two groups. Group I received COC containing 30 μg of EE and 3 mg of drospirenone for 12 consecutive cycles and Group II received no treatment. Overall, medio-lateral and antero-posterior stability were measured using Biodex system after 12 months. RESULTS There was a highly statistically significant difference between the 2 study groups regarding estradiol level (12.84 ± 1.96 vs. 38.86 ± 3.99, P value < 0.001) and progesterone level (0.52 ± 0.25 vs. 11.64 ± 4.53, P value < 0.001). There was a highly statistically significant difference between the 2 study groups regarding mediolateral stability (1.84 ± 0.23 vs. 2.40 ± 0.56, P value < 0.001), antereoposterior stability (1.91 ± 0.29 vs. 2.33 ± 0.61, P value < 0.001) or overall stability (2.42 ± 0.29 vs. 2.95 ± 0.53, P value < 0.001). CONCLUSION COC are effective method of contraception to improve postural balance and decrease risk of injury in normal and athletic women. NCT02855294.
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Affiliation(s)
- Ahmed M Maged
- Obstetrics and Gynecology Department, Cairo University, Egypt.
| | - Emad Salah
- Obstetrics and Gynecology Department, Cairo University, Egypt.
| | - Ahmed M Kamel
- Obstetrics and Gynecology Department, Cairo University, Egypt.
| | - Ahmed M Hussein
- Obstetrics and Gynecology Department, Cairo University, Egypt.
| | - Hany Saad
- Obstetrics and Gynecology Department, Cairo University, Egypt.
| | - Hadeer Meshaal
- Obstetrics and Gynecology Department, Cairo University, Egypt.
| | - Wafaa M Kamal
- Physical Therapy Department, Cairo University, Egypt.
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19
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Lee H, Yim J. Increased Postural Sway and Changes in the Neuromuscular Activities of the Ankle Stabilizing Muscles at Ovulation in Healthy Young Women. TOHOKU J EXP MED 2017; 240:287-294. [PMID: 27941275 DOI: 10.1620/tjem.240.287] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Lateral ankle sprains are one of the most common injuries among the physically active subjects. Ankle inversion-eversion laxity is greater and dynamic postural control is less in women compared with men. The purpose of this study was to examine differences in postural sway and its effects on the neuromuscular activities of the ankle stabilizing muscles during the menstrual cycle in young women. Fourteen young women with regular menstrual cycles participated in this experiment. Postural sway and electromyographic signals of the lateral gastrocnemius, peroneus longus (PL), and tibialis anterior (TA) were recorded while the participants performed eight different balance tasks at ovulation and early follicular phase during one full menstrual cycle. Significantly greater postural sway in the two most difficult balance tasks was observed at ovulation compared to that in the early follicular phase (p < 0.001). A similar pattern was also observed in terms of PL activity, while TA activity was significantly greater in the most difficult balance task at ovulation. In addition, TA-PL co-contraction (TA/PL ratio) was significantly higher at ovulation compared with that in the follicular phase in the two most difficult balance tasks (p < 0.01). Young women could benefit from increased understanding of the varying neuromuscular activation patterns throughout the menstrual cycle. The results of this study suggest that health professionals should be aware of the physiological effects and the shifts in neuromuscular strategies in each menstrual cycle phase in order to prevent increased risk of lower extremity injury.
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Affiliation(s)
- Haneul Lee
- Department of Physical Therapy, Gachon University
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20
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Ekenros L, Papoutsi Z, Fridén C, Dahlman Wright K, Lindén Hirschberg A. Expression of sex steroid hormone receptors in human skeletal muscle during the menstrual cycle. Acta Physiol (Oxf) 2017; 219:486-493. [PMID: 27438889 DOI: 10.1111/apha.12757] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/29/2016] [Accepted: 07/17/2016] [Indexed: 01/29/2023]
Abstract
AIM Variations in sex hormone levels during the menstrual cycle may affect neuromuscular performance and the risk of sustaining musculoskeletal injury in women. The aim of this study was to investigate mRNA and protein levels for sex steroid hormone receptors in skeletal muscle in three distinct phases of the menstrual cycle. METHODS Fifteen, healthy women with regular menstrual cycles participated in the study. Muscle biopsies from the vastus lateralis were obtained in three hormonally verified phases of the menstrual cycle for each individual, that is the follicular phase, the ovulatory phase and the luteal phase. mRNA and protein levels of oestrogen (ERα and ERβ), progesterone (PR) and androgen (AR) receptors were analysed. RESULTS There was an overall significant variation in mRNA and protein levels of ERα and PR across the menstrual cycle. mRNA and protein levels of ERα were highest in the follicular phase when oestradiol levels were low, whereas protein levels of PR were highest in the luteal phase when progesterone levels were high. mRNA levels of PR were highest in the ovulatory phase. No significant variation in AR levels was detected across the menstrual cycle. ERβ levels were very low in all three phases of the menstrual cycle. CONCLUSION Significant variations in mRNA and protein levels of ERα and PR were detected in skeletal muscle during three confirmed phases of the menstrual cycle. These results may have an impact on effects of muscular training and sports injuries in women.
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Affiliation(s)
- L. Ekenros
- Division of Physiotherapy; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Huddinge Sweden
| | - Z. Papoutsi
- Department of Biosciences and Nutrition; Karolinska Institutet; NOVUM; Huddinge Sweden
- Centre for Clinical Research Sörmland; Uppsala University; Uppsala Sweden
| | - C. Fridén
- Division of Physiotherapy; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Huddinge Sweden
- Academic Primary Health Care Center; St Erik Primary Health Care Center; Stockholm Sweden
| | - K. Dahlman Wright
- Department of Biosciences and Nutrition; Karolinska Institutet; NOVUM; Huddinge Sweden
| | - A. Lindén Hirschberg
- Division of Obstetrics and Gynecology; Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
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21
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Takeda T, Imoto Y, Nagasawa H, Takeshita A, Shiina M. Stress fracture and premenstrual syndrome in Japanese adolescent athletes: a cross-sectional study. BMJ Open 2016; 6:e013103. [PMID: 27798029 PMCID: PMC5073596 DOI: 10.1136/bmjopen-2016-013103] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To investigate the relationship between the occurrence of stress fracture and premenstrual syndrome (PMS)/premenstrual dysphoric disorder (PMDD) in Japanese adolescent athletes. DESIGN Cross-sectional study. SETTING Osaka, Japan. PARTICIPANTS A school-based survey on menstruation and school life was conducted using a sample of 1818 Japanese female students who belonged to two public high schools in Japan. Among them, we recruited 394 athletes who had regular menstrual cycles (25-38 days) and completed a questionnaire about their premenstrual symptoms and their competitive career. MAIN OUTCOME MEASURE Premenstrual symptoms and the occurrence of stress fracture. RESULTS The prevalences of moderate-to-severe PMS and PMDD were 8.9% and 1.3%, respectively, which were the same as in collegiate athletes in a previous study. Premenstrual symptoms disturbed 'Work efficiency or productivity, home responsibilities', 'Relationships with coworkers or family' and 'Athletic performance in training or competition' more severely than menstrual pain (p=0.031, p=0.004 and p<0.001, respectively). 66 athletes (16.8%) reported having experienced a stress fracture. The severity of 'Overeating or food cravings', 'Physical symptoms' and 'Performance in training or competition' in athletes with previous stress fractures were much higher than in those without a history of stress fractures (p=0.015, p=0.008 and p=0.006, respectively). In terms of premenstrual symptoms, 'Physical symptoms' was associated with an increased risk of stress fractures in athletes (OR 1.66, 95% CI 1.06 to 2.62). CONCLUSIONS The results from this study indicated that premenstrual symptoms may affect athletic performance and has the risk of stress fractures in adolescent athletes.
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Affiliation(s)
- Takashi Takeda
- Division of Women's Health, Research Institute of Traditional Asian Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Yoko Imoto
- Division of Women's Health, Research Institute of Traditional Asian Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Hiroyo Nagasawa
- Division of Women's Health, Research Institute of Traditional Asian Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Atsuko Takeshita
- Division of Women's Health, Research Institute of Traditional Asian Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Masami Shiina
- Division of Women's Health, Research Institute of Traditional Asian Medicine, Kindai University School of Medicine, Osaka, Japan
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22
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Micussi MT, Freitas RP, Varella L, Soares EM, Lemos TM, Maranhão TM. Relationship between pelvic floor muscle and hormone levels in polycystic ovary syndrome. Neurourol Urodyn 2015; 35:780-5. [PMID: 26288062 DOI: 10.1002/nau.22817] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 06/09/2015] [Indexed: 11/10/2022]
Abstract
AIMS To evaluate the electrical activity of the pelvic floor muscles (PFM) in women with polycystic ovary syndrome. METHODS Forty-two women with polycystic ovary syndrome (PCOS group) and 13 premenopausal women (control group) were recruited in this cross-sectional study. Total testosterone and estradiol were measured and muscle tone and maximum voluntary contraction (MVC) of PFM were determined by surface electromyography. RESULTS There was a difference in muscle tone (PCOS = 59.9 µV and Control group = 25.5 µV; P < 0.0001) and MVC (PCOS = 159.7 µV and Control group = 63.7 µV; P < 0.0002) between groups. The concentration of estradiol and testosterone showed a strong correlation with tone (r = 0.9, r = 0.8 respectively) and MVC (r = 0.9, r = 0.9 respectively) in women with PCOS. The control group exhibited a strong correlation between testosterone and muscle tone (r = 0.9) and MVC (r = 0.9). CONCLUSION Women with PCOS display higher electromyographic values than those in premenopause. Moreover, electrical activity showed a positive relation with estradiol and testosterone concentrations. Although PCOS is a heterogeneous disorder affecting young women, it is suggested that the hyperandrogenic state associated with PCOS is a protective factor for PFM. Neurourol. Urodynam. 35:780-785, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Maria Thereza Micussi
- Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Rodrigo Pegado Freitas
- Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Larissa Varella
- Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Elvira Maria Soares
- Maternidade-Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Telma Maria Lemos
- Department of Clinical Analysis, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Técia Maria Maranhão
- Department of Tocogynecology, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Khowailed IA, Petrofsky J, Lohman E, Daher N, Mohamed O. 17β-Estradiol Induced Effects on Anterior Cruciate Ligament Laxness and Neuromuscular Activation Patterns in Female Runners. J Womens Health (Larchmt) 2015; 24:670-80. [PMID: 26167943 DOI: 10.1089/jwh.2014.5184] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We investigate the effects of 17β-Estradiol across phases of menstrual cycle on the laxness of the anterior cruciate ligament (ACL) and the neuromuscular control patterns around the knee joint in female runners. METHODS Twelve healthy female runners who reported normal menstrual cycles for the previous 6 months were tested twice across one complete menstrual cycle for serum levels of 17β-estradiol, and knee joint laxity (KJL). Electromyographic (EMG) activity of the quadriceps and hamstrings muscles was also recorded during running on a treadmill. The changes in the EMG activity, KJL, and hormonal concentrations were recorded for each subject during the follicular and the ovulatory phases across the menstrual cycle. RESULTS An observed increase in KJL in response to peak estradiol during the ovulatory phase was associated with increased preactivity of the hamstring muscle before foot impact (p<0.001). A consistent pattern was also observed in the firing of the quadriceps muscle recruitment pattern throughout the follicular phase associated with decreased hamstring recruitment pattern during weight acceptance phase of running (p=0.02). Additionally, a low ratio of medial to lateral quadriceps recruitment was associated with a significant reduction of the quadriceps to hamstring co-contraction ratio during the follicular phase. CONCLUSIONS Changes in KJL during the menstrual cycle in response to 17β-estradiol fluctuations changes the neuromuscular control around the knee during running. Female runners utilize different neuromuscular control strategies during different phases of the menstrual cycle, which may contribute to increased ACL injury risk.
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Affiliation(s)
- Iman Akef Khowailed
- 1 Department of Physical Therapy, College of Health and Human Services, Touro University Nevada , Henderson, Nevada
| | - Jerrold Petrofsky
- 2 Department of Physical Therapy, School of Allied Health, Loma Linda University, Loma Linda, California
| | - Everett Lohman
- 2 Department of Physical Therapy, School of Allied Health, Loma Linda University, Loma Linda, California
| | - Noha Daher
- 2 Department of Physical Therapy, School of Allied Health, Loma Linda University, Loma Linda, California
| | - Olfat Mohamed
- 3 Department of Physical Therapy, California State University , Long Beach, California
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Casey E, Hameed F, Dhaher YY. The muscle stretch reflex throughout the menstrual cycle. Med Sci Sports Exerc 2014; 46:600-9. [PMID: 24091990 DOI: 10.1249/mss.0000000000000134] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The significant sex disparity in sports-related knee injuries may be due to underlying differences in motor control. Although the development of sex-specific movement patterns is likely multifactorial, this study specifically focuses on the potential modulatory role of sex hormones. PURPOSE This study aimed to investigate the muscle stretch reflex (MSR) across the menstrual cycle. We hypothesized that the MSR would fluctuate throughout the menstrual cycle and that the lowest response would correspond with peak concentrations of estrogen. METHODS Nineteen healthy women age 18-35 yr participated in this study: 8 eumenorrheic women and 11 women taking oral contraceptives. Serum estradiol and progesterone concentrations, anterior knee laxity (AKL), and the MSR response of the quadriceps muscles were measured three times during the menstrual cycle. RESULTS The MSR response of the rectus femoris (RF) varied significantly across the menstrual cycle in both groups. Specifically, the RF MSR response was 2.4 times lower during the periovulatory phase when compared with the luteal phase (P = 0.007). The same trend was seen in the vastus medialis, but this did not reach statistical significance (P = 0.070). The MSR response of the vastus lateralis did not change significantly across the menstrual cycle (P = 0.494). A mixed model comparison did not show an association between endogenous concentrations of estradiol and progesterone, exposure to hormonal contraceptives or AKL, and the MSR response for any muscle. CONCLUSIONS Our results demonstrate that the RF MSR response varies throughout the menstrual cycle with the lowest response around the time of ovulation. Additional research is needed to clarify the exact relationship between sex hormones, AKL, and MSR response and to determine the specific origin of the change along the monosynaptic reflex arc.
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Affiliation(s)
- Ellen Casey
- 1Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL; and 2Rehabilitation and Regenerative Medicine, New York Presbyterian Hospital, Columbia University Medical Center, Columbia University College of Physicians and Surgeons, New York, NY
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25
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Abstract
OBJECTIVE The primary aim of this study was to compare muscle strength in the upper and lower limb, as well as hop performance during oral contraceptive (OC) use with non-OC use in the same woman. A secondary aim was to compare muscle strength and hop performance within 3 specific phases of an OC cycle, as well as during a menstrual cycle of the corresponding cycle days (non-OC cycle). DESIGN Crossover. SETTING Research laboratory. PARTICIPANTS Seventeen moderate to highly recreationally active women participated in the study. INTERVENTION Observational study with no intervention. MAIN OUTCOME MEASURES Maximal isokinetic muscle strength of knee extensors, isometric handgrip strength, and 1-leg hop test for distance were measured during 1 OC cycle and 1 non-OC cycle at 3 specific phases, respectively, using a crossover design. RESULTS No significant differences were found in terms of muscle strength and hop performance between the OC cycle and the non-OC cycle. Furthermore, no significant difference in muscle strength and hop performance could be demonstrated within the OC cycle or within the phases of the menstrual cycle except from maximal isokinetic muscle strength in the knee extensors detected between the early follicular phase and the luteal phase. CONCLUSIONS We found no support for any significant influence of OC use on muscle strength and hop performance in healthy moderately active women.
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Ekenros L, Hirschberg AL, Bäckström T, Fridén C. Postural control in women with premenstrual symptoms during oral contraceptive treatment. Acta Obstet Gynecol Scand 2010; 90:97-102. [PMID: 21275922 DOI: 10.1111/j.1600-0412.2010.01021.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study investigates postural control among women with and without premenstrual symptoms (PMS) on oral contraceptive (OC) treatment. DESIGN Prospective repeated measures design. SETTING Women's health clinical research unit at a university hospital. POPULATION Fifteen women using low-dose monophasic oral contraceptives participated in the study. Depending on premenstrual symptoms, the women were divided into one PMS group and one non-PMS group. METHODS Postural control (displacement area) was measured using an AMTI(®) force platform during the active hormone phase (OC phase) and the hormone-free phase (non-OC phase) of the pill chart. Premenstrual symptoms were evaluated prospectively using the Cyclicity Diagnoser. MAIN OUTCOME MEASURES Displacement area as a measure of postural control. RESULTS Six of 15 women showed premenstrual symptoms (primarily negative mood symptoms) between the phases and were considered having premenstrual symptoms. When analyzing postural control, the PMS group displayed a significantly greater displacement area in the OC-phase compared to the non-OC phase. In contrast, the non-PMS group did not show any significant difference between the phases. Furthermore, the PMS group had significantly greater displacement area during the OC phase compared to the non-PMS group. CONCLUSIONS The present study shows that women with premenstrual symptoms have greater displacement area than those without premenstrual symptoms during the active phase of oral contraceptive treatment. Negative mood symptoms may affect the maintenance of postural control by central interactions. Further studies are needed to clarify the precise mechanism for altered postural control in women with premenstrual symptoms.
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Affiliation(s)
- Linda Ekenros
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institute, Huddinge, Sweden.
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27
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Estrogen-induced effects on the neuro-mechanics of hopping in humans. Eur J Appl Physiol 2010; 111:245-52. [DOI: 10.1007/s00421-010-1647-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2010] [Indexed: 10/19/2022]
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Burgess KE, Pearson SJ, Onambélé GL. Menstrual cycle variations in oestradiol and progesterone have no impact on in vivo medial gastrocnemius tendon mechanical properties. Clin Biomech (Bristol, Avon) 2009; 24:504-9. [PMID: 19398254 DOI: 10.1016/j.clinbiomech.2009.03.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 03/25/2009] [Accepted: 03/25/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Tendon tissue contains oestrogen receptors and is therefore likely to be responsive to female sex hormones. Here we examine any effect of levels of female sex hormones associated with the menstrual cycle phase on corresponding tendon mechanical properties. METHODS Fifteen healthy females aged 23 (SEM 1.0 years) underwent three assessments of medial gastrocnemius tendon mechanical properties. Assessments were carried out once during days 1-4, 12-14 and 20-23 (with day 1 being the first day of menstruation). Venous blood samples were taken on the same days as tendon properties assessments to quantify serum levels of oestradiol and progesterone. FINDINGS There was no significant difference in the stiffness of the medial gastrocnemius tendon over the course of the menstrual cycle (days 1-4, 65.08 (SEM 5.16 Nm m(-1)), days 12-14, 62.73 (SEM 5.82 Nm m(-1)), days 20-23, 66.74 (SEM 7.14 Nm m(-1))). There were also no significant differences in tendon length and cross-sectional area which led to no significant differences in Young's modulus values. No correlations were found between serum levels of oestradiol and/or progesterone and tendon stiffness and/or Young's modulus. INTERPRETATION Acute fluctuations in female sex hormones have no significant effect on medial gastrocnemius tendon mechanical properties. In a context where studies are often limited to selecting only oral contraceptive-users as participants in order to minimise potential noise related to the anticipated effects of menstrual cycle hormones on physical performance, our findings provide the basis for enabling the pooling of female tendon data, regardless of the phase of the menstrual cycle of individual participant.
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Affiliation(s)
- K E Burgess
- Centre for Rehabilitation and Human Performance Research, Directorate of Sport, University of Salford, Salford M66PU, Manchester, UK.
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Hoffman M, Harter RA, Hayes BT, Wojtys EM, Murtaugh P. The interrelationships among sex hormone concentrations, motoneuron excitability, and anterior tibial displacement in women and men. J Athl Train 2008; 43:364-72. [PMID: 18668169 DOI: 10.4085/1062-6050-43.4.364] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Sex hormone fluctuations have been implicated as a contributing factor to the high rates of noncontact injury to the anterior cruciate ligament in females. OBJECTIVE To determine the strength of the relationships among variables of sex hormone concentrations, motoneuron excitability, and anterior tibial displacement (ATD) in women and men and to determine if these relationships differ between the sexes. DESIGN Cohort study. SETTING Sports medicine laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty-eight regularly menstruating women (age = 22.4 +/- 3.4 years) and 15 men (age = 22.3 +/- 3.7 years) participated in the study. INTERVENTION(S) Fluctuations in sex hormones were determined for the participants. Female participants were tested every other day of their menstrual cycles, whereas male participants were tested every fourth day during the 28-day period. MAIN OUTCOME MEASURE(S) We measured Hoffmann reflexes (maximum Hoffmann reflex [H(max)] to maximum M-wave [M(max)] ratio in the soleus), ATD under a 134-N load, and saliva concentrations of estrogen and progesterone. The independent variable was sex. Pearson product moment correlation coefficients were calculated for each participant by pairing measurements made on the same day. Two-tailed independent-samples t tests were used to determine the difference between the male and female correlations for each variable. RESULTS Over the course of the study, the relationships between H(max)ratioM(max) and estrogen, H(max)ratioM(max) and progesterone, ATD and estrogen, and ATD and progesterone were not different between the sexes. However, the relationship between ATD and progesterone was different between the sexes (P = .036). CONCLUSIONS The observed correlations did not support our hypothesis that the relationships between sex hormone levels and reflex activity or between sex hormone levels and ATD would be different for women compared with men. If sex hormone concentrations significantly contribute to anterior cruciate ligament ruptures because of changes in laxity or in motoneuron excitability, their mechanism of action is likely multifactorial and complex.
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Affiliation(s)
- Mark Hoffman
- Sports Medicine Laboratory, Oregon State University, Corvallis, OR 97331-3303, USA.
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Mihalik JP, Ondrak KS, Guskiewicz KM, McMurray RG. The effects of menstrual cycle phase on clinical measures of concussion in healthy college-aged females. J Sci Med Sport 2008; 12:383-7. [PMID: 18771954 DOI: 10.1016/j.jsams.2008.05.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2007] [Revised: 02/10/2008] [Accepted: 05/24/2008] [Indexed: 11/29/2022]
Abstract
The management of concussion and mild traumatic brain injury is an area of clinical uncertainty for many sports medicine professionals. While recent studies suggest sex differences in neurocognitive function may exist, our understanding of the effects of menstrual cycle phase and oral contraceptive pill (OCP) use in healthy females is limited. The purpose of this study was to investigate whether there were changes in neurocognitive function, postural stability and self-reported symptoms between the early and late stages of the menstrual cycle, and also to identify whether performance across menstrual cycle would differ between females using OCP and eumenorrheic females not using OCP. Healthy college-aged females completed a standard concussion test battery including computerised assessment of neurocognitive function, postural stability and symptom status. Participants completed the counterbalanced testing design during the early and late phases of their menstrual cycle. No significant main effects or interactions for any neurocognitive function or postural stability outcome measure were observed. Eumenorrheic females endorsed a higher number of symptoms and reported an increased symptom severity score compared to females using OCP. Menstrual cycle phase had no effect on the total severity or the number of symptoms endorsed. These results suggest preseason neurocognitive and postural stability baseline tests are stable across the menstrual cycle, regardless of OCP use. Therefore, decreased performance on these measures following a suspected concussion is likely not attributable to menstrual cycle phase or use of OCP.
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Affiliation(s)
- Jason P Mihalik
- Department of Exercise and Sport Science and Curriculum in Human Movement Science, The University of North Carolina, Chapel Hill, NC 27599, USA
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Adachi N, Nawata K, Maeta M, Kurozawa Y. Relationship of the menstrual cycle phase to anterior cruciate ligament injuries in teenaged female athletes. Arch Orthop Trauma Surg 2008; 128:473-8. [PMID: 17909824 DOI: 10.1007/s00402-007-0461-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) injuries are more common among female athletes compared to male athletes. Several studies have been reported to explain the gender difference in ACL injury rates and several risk factors underlying gender disparity are believed to exist. Hormonal effects are considered to be one of the etiological factors for female non-contact ACL injuries. The objectives of this study were to determine if ACL injuries occurred randomly or correlated with a specific phase of the female menstrual cycle in teenaged female athletes and then to determine if pre-menstrual and menstrual dysfunctions influenced these ACL injuries. MATERIALS AND METHODS Eighteen of 37 consecutive female athletes, with ACL injuries, met the study criteria: teenage, with regular menstrual cycle, and non-contact injury. The menstrual history, athletic activity, and injury history were collected. RESULTS Seventy-two percent of the subjects had premenstrual symptoms and 83% had menstrual symptoms. The subjective activity level at the follicular phase was significantly lowest between the phases. A significant statistical association was found between the phase of the menstrual cycle and ACL injuries (P = 0.0002). There were more injuries in the ovulatory phase than expected, and fewer injuries occurred in the other phases. CONCLUSION The results showed a significant increase in non-contact ACL injuries in teenage female athletes during the ovulatory phase of the menstrual cycle and the subjective activity level and the premenstrual and menstrual symptoms might not affect the likelihood of the injuries. These findings suggest that sex hormones might play a role in the incidence of female non-contact ACL injuries.
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Affiliation(s)
- Noriko Adachi
- Department of Fundamental Nursing, School of Health Sciences, Faculty of Medicine, Tottori University, Yonago, Japan
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Field EF, Pellis SM. The brain as the engine of sex differences in the organization of movement in rats. ARCHIVES OF SEXUAL BEHAVIOR 2008; 37:30-42. [PMID: 18074218 DOI: 10.1007/s10508-007-9270-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Sex differences in the kinematic organization of non-reproductive behavior are often relegated to byproducts of sex differences in body morphology. We review evidence showing not only that male and female rats organize their posture and stepping differently during a variety of actions, but that these differences arise from sex differences in the organization of movement in the central nervous system (CNS). Indeed, the expression and choice of sex-typical patterns of movement can be altered by CNS injury. The pattern of hormonal regulation of these sex differences is also not organized as commonly held theory would predict. As expected, males castrated shortly after birth are female-typical in their motor organization. Females ovariectomized at birth, however, are male-typical in their patterns of movement. Thus, female-typical patterns of movement organization are not the default form, but rather are dependent on the effects of gonadal steroids to feminize the developing CNS. The implications of these findings are discussed with regards to our understanding of the evolution of sex differences in CNS anatomy and behavior both for animals and humans.
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Affiliation(s)
- Evelyn F Field
- Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta, Canada.
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Abt JP, Sell TC, Laudner KG, McCrory JL, Loucks TL, Berga SL, Lephart SM. Neuromuscular and biomechanical characteristics do not vary across the menstrual cycle. Knee Surg Sports Traumatol Arthrosc 2007; 15:901-7. [PMID: 17364205 DOI: 10.1007/s00167-007-0302-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2006] [Accepted: 01/26/2007] [Indexed: 11/30/2022]
Abstract
Research examining the menstrual cycle and its relationship to ACL injury has focused on determining the incidence of ACL injury during the different phases of the menstrual cycle and assessing the changes in neuromuscular and biomechanical characteristics between these phases. Conflicting results warrant further investigation to determine if neuromuscular and biomechanical characteristics respond in a similar pattern to the fluctuating estradiol and progesterone. The purpose of this study was to determine if changes in the levels of estradiol and progesterone significantly altered fine motor coordination, postural stability, knee strength, and knee joint kinematics and kinetics between the menses, post-ovulatory, and mid-luteal phases of the menstrual cycle. Ten healthy and physically active females (Age: 21.4 +/- 1.4 years, Height: 1.67 +/- 0.06 m, Mass: 59.9 +/- 7.4 kg), who did not use oral contraceptives, were recruited from the local university population. Single-leg postural stability, fine motor coordination, knee strength, knee biomechanics, and serum estradiol and progesterone were assessed at the menses, post-ovulatory, and mid-luteal phases of the menstrual cycle. Levels of estradiol were significantly higher during the post-ovulatory (P = 0.016) and mid-luteal phases (P < 0.001) compared to the menses phase. Levels of progesterone were significantly lower during the menses (P < 0.001) and post-ovulatory phases (P < 0.001) compared to the mid-luteal phase. No significant differences existed between phases of the menstrual cycle for fine motor coordination (P = 0.474), postural stability (P = 0.707), hamstring - quadriceps strength ratio at 60 degrees s(-1) (P = 0.748) or 180 degrees s(-1) (P = 0.789), knee flexion excursion (P = 0.6), knee valgus excursion (P = 0.899), peak proximal tibial anterior shear force (P = 0.797), flexion moment at peak proximal tibial anterior shear force (P = 0.698), or valgus moment at peak proximal tibial anterior shear force (P = 0.924). The results of the current study suggest neuromuscular and biomechanical characteristics are not influenced by estradiol and progesterone fluctuations. All neuromuscular and biomechanical characteristics remained invariable between testing sessions despite concentration changes in estradiol and progesterone.
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Affiliation(s)
- John P Abt
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, 3200 South Water Street, Pittsburgh, PA 15203, USA.
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Dedrick GS, Sizer PS, Merkle JN, Hounshell TR, Robert-McComb JJ, Sawyer SF, Brismée JM, Roger James C. Effect of sex hormones on neuromuscular control patterns during landing. J Electromyogr Kinesiol 2006; 18:68-78. [PMID: 17079166 DOI: 10.1016/j.jelekin.2006.09.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Revised: 09/05/2006] [Accepted: 09/07/2006] [Indexed: 12/01/2022] Open
Abstract
The purpose of the study was to investigate the effects of sex hormones across menstrual cycle phases on lower extremity neuromuscular control patterns during the landing phase of a drop jump. A repeated-measures design was utilized to examine sex hormone effects in 26 recreationally active eumenorrheic women. Varus/valgus knee angle and EMG activity from six lower extremity muscles were recorded during three drop jumps from a 50 cm platform in each phase of the menstrual cycle. Blood assays verified sex hormone levels and cycle phase. The semitendinosus muscle exhibited onset delays (p0.006) relative to ground contact during the luteal phase, and demonstrated a significant (p0.05) difference between early and late follicular phases. Muscle timing differences between the gluteus maximus and semitendinosus were decreased (p0.05) in the luteal compared to early follicular phases. These results suggest a different co-contractive behavior between the gluteus maximus and semitendinosus, signifying a shift in neuromuscular control patterns. It appears that female recreational athletes utilize a different neuromuscular control pattern for performing a drop jump sequence when estrogen levels are high (luteal phase) compared to when they are low (early follicular phase).
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Affiliation(s)
- Gregory S Dedrick
- Department of Rehabilitation Sciences, Texas Tech University Health Sciences Center, Doctor of Science in Physical Therapy Program, Center for Clinical Rehabilitation Research, Lubbock, TX 79430-6226, USA.
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Hertel J, Williams NI, Olmsted-Kramer LC, Leidy HJ, Putukian M. Neuromuscular performance and knee laxity do not change across the menstrual cycle in female athletes. Knee Surg Sports Traumatol Arthrosc 2006; 14:817-22. [PMID: 16470385 DOI: 10.1007/s00167-006-0047-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2004] [Accepted: 09/05/2005] [Indexed: 10/25/2022]
Abstract
Female athletes incur anterior cruciate ligament ruptures at a rate at least twice that of male athletes. Hypothesized factors for the increased injury risk in females include biomechanical, neuromuscular, and hormonal differences between genders. A wealth of literature exists examining these potential predispositions individually, but the interactions between these factors have not been examined extensively. Our purpose was to investigate changes in neuromuscular control and laxity at the knee across the menstrual cycle of healthy females. Fourteen female collegiate athletes with normal, documented ovulatory menstrual cycles, confirmed ovulation, and no history of serious knee injury participated. The presence and timing of ovulation was determined during a screening cycle with ovulation detection kits and during an experimental cycle with collection of daily urine samples and subsequent analysis of urinary estrone-3-glucuronide (E3G) and pregnanediol-3-glucoronide (PdG), which correlate with circulating estrogen and progesterone. Each subject had measures of knee neuromuscular performance and laxity once during the mid-follicular, ovulatory, and mid-luteal stages of her menstrual cycle. The test battery included assessments of knee flexion and extension peak torque, passive knee joint position sense, and postural control in single leg stance. Knee joint laxity was measured with an arthrometer. Analyses of variance revealed that E3G and PdG levels were significantly different across the three testing sessions, but there were no significant differences in the measures of strength, joint position sense, postural control, or laxity. No significant correlations were found between changes in E3G or PdG levels and changes in the performance and laxity measures between sessions. These results suggest that neuromuscular control and knee joint laxity do not change substantially across the menstrual cycle of females despite varying estrogen and progesterone levels.
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Affiliation(s)
- Jay Hertel
- University of Virginia, Charlottesville, VA 22904-4407, USA.
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Abstract
The female sex steroid hormones estrogen and progesterone have potential effects on exercise capacity and performance through numerous mechanisms, such as substrate metabolism, cardiorespiratory function, thermoregulation, psychologic factors, and injuries. Consequently, hormone level changes may theoretically lead to either improved or decreased performance at various times throughout the menstrual cycle. Numerous methodological issues and a paucity of studies have precluded evidence-based conclusions in almost every area of research in this field. In addition, there appears to be a great degree of inter- and intraindividual variability in these hormonal responses. Using oral contraceptives may be advantageous for female athletes who are negatively affected by their menstrual cycle, as they may provide a stable yet controllable hormonal milieu for training and competition.
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Affiliation(s)
- Naama W Constantini
- Department of Physiology, Tel-Aviv University-Sackler Faculty of Medicine, 4 Haarazim Street, Tel-Aviv, Israel.
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Fridén C, Hirschberg AL, Saartok T, Renström P. Knee joint kinaesthesia and neuromuscular coordination during three phases of the menstrual cycle in moderately active women. Knee Surg Sports Traumatol Arthrosc 2006; 14:383-9. [PMID: 15942744 DOI: 10.1007/s00167-005-0663-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2004] [Accepted: 03/01/2005] [Indexed: 11/27/2022]
Abstract
An increased incidence of sports related injuries in the premenstrual phase as well as in the menstrual phase of the menstrual cycle has been described. This may be explained by alterations in proprioception and neuromuscular coordination due to hormonal variations. Prospective, within women analysis of knee joint kinesthesia and neuromuscular coordination were performed by repeated measures analysis of variance in three hormonally verified phases of three consecutive menstrual cycles. Thirty-two healthy, moderately active female subjects volunteered to participate in the study. Twenty-five of the subjects performed at least one hormonally verified menstrual cycle. A specially designed device was used to investigate knee joint kinaesthesia and neuromuscular coordination was measured with the square hop test. These tests were carried out in the menstrual phase, ovulation phase and premenstrual phase determined by hormone analyses in three consecutive menstrual cycles. An impaired knee joint kinaesthesia was detected in the premenstrual phase and the performance of square hop test was significantly improved in the ovulation phase compared to the other two phases. The results of this study indicate that the variation of sex hormones in the menstrual cycle has an effect on performance of knee joint kinaesthesia and neuromuscular coordination.
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Affiliation(s)
- Cecilia Fridén
- Section of Sports Medicine M3 Research center, Division of Surgical Sciences, Karolinska Institutet, 171 76 Stockholm, Sweden.
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Aydoğ ST, Hasçelik Z, Demirel HA, Tetik O, Aydoğ E, Doral MN. The effects of menstrual cycle on the knee joint position sense: preliminary study. Knee Surg Sports Traumatol Arthrosc 2005; 13:649-53. [PMID: 15871012 DOI: 10.1007/s00167-004-0604-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2004] [Accepted: 10/16/2004] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to determine the effects of menstrual cycle on proprioception by using the active knee joint position sense test (JPST). The 19 healthy women (ages between 20 years and 27 years) who have normal regular menstrual cycle were included in the study. We applied JPSTs at two different directions throughout the three different phases of the menstrual cycle, i.e. menstrual, follicular, and early luteal in dominant knees. When we started from flexion (90 degrees ), target angles were 70 degrees , 50 degrees , and 30 degrees and we started from extension (0 degrees ), target angles were 20 degrees , 40 degrees and 60 degrees . The absolute reposition errors from the target angles have been evaluated. Results have shown that reposition errors from the target angle at 40 degrees , 50 degrees and 70 degrees of knee angles were higher in the menstrual phase than that of the follicular phase (P<0.05). In addition, higher value of reposition error from the target angle at 40 degrees was found in the menstrual phase compared to luteal phase (P<0.05). In conclusion, we have demonstrated that active JPST was significantly reduced in the menstruation period.
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Affiliation(s)
- Sedat Tolga Aydoğ
- Department of Sports Medicine, Hacettepe University, Sihhiye, Ankara, Turkey
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Abstract
BACKGROUND Gymnasts practise many hours a week, and symptoms from injuries do not seem to stop them from continuing with practice. They may even compete with symptoms from injuries, which could increase the risk of reinjury, or of the occurrence of a more severe injury. OBJECTIVES To investigate whether team gymnasts compete at high level in spite of symptoms from an injury. METHODS 188 male and female competitors participating in the Swedish Cup for juniors and seniors answered a questionnaire about symptoms from injuries on the day of the competition. RESULTS More than half the gymnasts (58%) competed despite having symptoms from an injury on the day of the competition. More seniors than juniors competed in spite of symptoms from an injury (p = 0.006). Two of three team gymnasts (65%) reported symptoms from the lower extremities and around one in five (22%) reported back symptoms. Fifty five per cent of the gymnasts reported recurrence of an injury at the same site (reinjury). CONCLUSIONS There was a high prevalence of symptoms from injuries on the day of competition. This did not stop the team gymnasts from competing.
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Fridén C, Ramsey DK, Backstrom T, Benoit DL, Saartok T, Lindén Hirschberg A. Altered postural control during the luteal phase in women with premenstrual symptoms. Neuroendocrinology 2005; 81:150-7. [PMID: 15985762 DOI: 10.1159/000086592] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2005] [Accepted: 03/24/2005] [Indexed: 11/19/2022]
Abstract
The purpose of this study was to investigate postural control in women with and without premenstrual symptoms (PMS) in three hormonally verified phases of the menstrual cycle. Thirty-two women were recruited to participate in the study and 25 of these women were included in the results. Menstrual cycle phases were determined by sex hormone analyses in serum and LH detection in urine. A prospective rating of PMS was used to divide the subjects into two groups: one with PMS (cyclic) and one without (non-cyclic). For measurement of postural control, subjects stood on a force platform (AMTI) in two-legged stance (eyes open and closed) and one-legged stance (eyes open and closed). There were no significant differences in the two-legged stance between the phases of the menstrual cycle or between groups. In one-legged stance with eyes open, there was a significant increase in postural displacement in the mid-luteal phase in the cyclic group, but no differences were detected between phases in the non-cyclic group. These findings may be related to the previously reported increased injury rate and psychomotor slowing in the luteal phase in women with PMS.
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Affiliation(s)
- Cecilia Fridén
- Section of Sports Medicine, Division of Surgical Sciences, Karolinska Institutet, Stockholm, Sweden.
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