Greater Reduction of Balance as a Result of Increased Plantar Fascia Elasticity at Ovulation during the Menstrual Cycle

Myofascial induction technique changes plantar pressures variables compared to a simulated laser. A randomized clinical trial

BACKGROUND

The fascial system is made up of large number of mechanoreceptors and cells that regulate their tension, such as myofibroblasts, in addition to an extracellular matrix. The treatment of myofascial induction has shown in the static imprint in a quasi-experimental study comparing the effect before and after the technique, but there are no studies compared with a control with no real intervention. The objective of this research is to check the effects of the myofascial Induction technique, compared with a simulated Laser in plantar footprint variables in asymptomatic subjects.

METHODS

Thirty-six healthy participants were recruited to carry out a single-blind clinical study in randomizated two groups. Experimental intervention group performed a bilateral plantar fascia of Myofascial Induction technique. Control intervention group performed a simulated Laser. The time of application of the techniques were 5 min for both interventions. The variables recorded were Surface, mean pressure and maximum pressure for each region of the foot, rear foot, midfoot and fore foot.

RESULTS

Both groups were homogeneous prior to the interventions. The significant differences found later were in the forefoot surface variable (p = 0.026) where there was an increase in the area in the experimental group.

CONCLUSIONS

The myofascial induction technique shows effects on the static plantar footprint by increasing the surface of the forefoot compared to the application of a simulated laser. Registration in ClinicalTrial.gov (ID: NCT04628299) Registered in clinicalTrials.govhttps://clinicaltrials.gov/ct2/show/NCT04628299.

Evaluating the Effects of Sports Bra Design, Body Composition, Metabolic Markers, and Sex Hormones on Kinetic Measures of Postural Control in Full-Busted Women During Physical Activity

Due to inadequate commercial availability of sports bras designed with adequate breast support for full-busted women (cup size D and above), breast discomfort can be a significant barrier to exercise. In this study, postural characteristics during dynamic physical activities were evaluated for 20 full-busted women in 3 different sports bra conditions, 2 of which were bras designed specifically for full-busted women. Participants performed quiet standing, walking, jumping jacks, high knees, and running tasks on a force plate treadmill in each condition to collect postural measures associated with center of pressure (COP). COP measures were also evaluated with respect to body composition, metabolic health markers, and sex hormone profiles. COP measures were larger in high knees and jumping tasks with respect to quiet standing. Across running speeds, conventional bras were associated with the largest COP metrics. Analysis of covariance analysis indicated increased anthropometry measures such as mass and body fat percentage resulted in decreased COP area and favored mediolateral orientation. Luteinizing hormone, estradiol, progesterone, testosterone, and sex hormone-binding globulin were all found to impact statistical models, indicating the importance of incorporating a comprehensive hormone panel when considering the impact subject-level variations have on motor function.

Reproducibility of dynamic balance and anterior tibiofibular gap measurements in men and women: A menstrual cycle-based longitudinal study

BACKGROUND

The reproducibility of dynamic balance is an essential component of athletic performance and injury prevention, although it is affected by sex differences. This study aimed to confirm the reproducibility of repeated dynamic balance measurements and ultrasonography assessments of the anterior tibiofibular gap that may contribute to changes in dynamic balance for each sex.

METHODS

This was a longitudinal study involving 48 feet, with 12 men and 12 women. Measurements for men were obtained four times, approximately once a week, and for women, once during each of the four periods of the menstrual cycle (menstrual, follicular, ovulation, and luteal phases). The measures included dynamic balance in a single-leg jump with forward landing and the anterior tibiofibular gap measurement in standing and sitting positions; rate of change in the anterior tibiofibular gap was calculated from the values in standing and sitting positions.

RESULTS

The intraclass correlation coefficient for dynamic balance was excellent for men at 0.936 (0.881-0.969) and good for women at 0.843 (0.708-0.925). Regarding the anterior tibiofibular gap, the intraclass correlation coefficient for standing and sitting were 0.999 (0.997-0.999) and 0.998 (0.996-0.999), respectively, in men; and 0.976 (0.955-0.988) and 0.991 (0.984-0.996), respectively, in women, with excellent values for both sexes. Whereas no significant changes in dynamic balance and rate of change in the anterior tibiofibular gap were observed in the four measurements in men (p > 0.05), there was a significant variation in women (p < 0.05).

CONCLUSIONS

While reproducibility of dynamic balance and anterior tibiofibular gap measurements was high overall, it was lower in women than in men. Women exhibited variations in these measurements during each period of the menstrual cycle, peaking during ovulation. Recognizing these fluctuations could inform injury prevention strategies tailored to sex-specific differences in dynamic balance and ligament extensibility.

Physiological Changes in Women's Skin During the Menstrual Cycle: A Scoping Review

Multiple physiological changes occur during the menstrual cycle; many are attributed to fluctuations in estrogen, luteinizing hormone, follicle-stimulating hormone, and progesterone. These hormones differentially affect the menstrual cycle's follicular, ovulation, and luteal phases. Skin is one of the organs affected by changes in a woman's menstrual cycle. However, the understanding of the impact of these composite changes on skin biophysical and physiological parameters is limited. This scoping review was performed to help clarify the extent of physiological changes in the skin during a woman's menstrual cycle. Skin elasticity, hydration, temperature, blood flow, and sweating were the parameters assessed in this review. Embase, Ovid MEDLINE (Medical Literature Analysis and Retrieval System Online), and Web of Science databases were used to search for peer-reviewed articles in English relating to skin physiological changes during healthy women's menstrual cycles. The initial search yielded 666 unique articles that met the inclusion criteria. After critical appraisal, further screening produced 192 full texts that resulted in 26 articles that were investigated for skin elasticity, hydration, temperature, blood flow, and sweating during the menstrual cycle. The review clarifies the connection between female reproductive hormone fluctuations, phases of the menstrual cycle, and its subsequent impacts on the skin's physiological properties. An increase was seen in skin elasticity during ovulation compared to women in the follicular phase. No significant changes were seen in skin hydration across the three menstrual cycle phases. A higher basal skin temperature has been reported during the luteal phase than the follicular phase. A statistically significant increase in skin blood flow was also seen during the mid-luteal phase compared to the follicular phase. Lastly, an increased sweating rate was also observed in the luteal phase compared to the follicular phase for the parameter of sweating. However, higher sweating rates were also reported during the early follicular phase than in the mid-luteal phase. The overall findings of this review highlight how skin physiology varies within the menstrual cycle. This information can be useful in aligning treatment for women with abnormal menstrual cycles or possible maintenance of healthy menstrual flow. This review provides valuable information in a dermatological context to further explore how healthcare providers can apply personalized therapeutic approaches that align with certain phases of a woman's menstrual cycle, allowing for better skin condition management and improved patient care.

Hormonal Fluctuation and Ankle Instability in Women-Is There a Correlation?

Background

With higher incidences of ankle sprains and chronic ankle instability in women, it has been postulated that hormonal modulation and ligamentous laxity influences injury propensity. The purpose of this study is to investigate the impact of hormonal fluctuation on ankle stability and ligamentous laxity and their potential contribution to injury propensity in the female athlete.

Methods

In November 2023, a systematic review of the MEDLINE, Embase, and Cochrane Library databases was performed following PRISMA guidelines. Articles were included if they were published after the year 2000, evaluated outcomes related to the impact of hormones on ankle stability in healthy patients, and included menstrual tracking. The following search terms were used: "(sex or gender) AND (ankle stability)" and "(hormone) AND (ankle)."

Results

Thirteen articles were included, with 253 (76.4%) women at a weighted mean age of 21.9 ± 2.0 years (range, 20.0-25.9). Five studies evaluated postural sway and balance noting greater sway rates during ovulation compared with the follicular phase. Greater muscle tone (P < .001) was observed in the follicular phase than ovulation for the tibialis anterior, peroneus longus, and lateral gastrocnemius. Significantly higher ankle joint laxity was observed in ovulation (P = .016).

Conclusion

This review found that during ovulation, when estrogen peaks, subjects showed impaired balance with higher postural sway rates, greater ankle joint laxity, and decreased muscle and ligamentous tone and stiffness-an indicator of laxity. An underlying hormonally mediated etiology for the increased propensity to ankle instability in the female athlete is suggested. Syncing an athlete's workout type and intensity around menstrual cycle phase may be an advantageous strategy for injury prevention.

Changes in the mechanical properties of the thigh and lower leg muscle-tendon units during the early follicular and early luteal phases

Background

This study aimed to determine changes in the muscle and tendon stiffness of the thigh and lower leg muscle-tendon units during the early follicular and early luteal phases, and check for possible relations between muscle and tendon stiffness in each phase.

Methods

The sample consisted of 15 female university students with regular menstrual cycles. The basal body temperature method, ovulation kit, and salivary estradiol concentration measurement were used to estimate the early follicular and early luteal phases. A portable digital palpation device measured muscle-tendon stiffness in the early follicular and early luteal phases. The measurement sites were the rectus femoris (RF), vastus medialis (VM), patellar tendon (PT), medial head of gastrocnemius muscle, soleus muscle, and Achilles tendon.

Results

No statistically significant differences in the thigh and lower leg muscle-tendon unit stiffness were seen between the early follicular and early luteal phases. Significant positive correlations were found between the stiffness of the RF and PT (r = 0.608, p = 0.016) and between the VM and PT (r = 0.737, p = 0.002) during the early luteal phase.

Conclusion

The present results suggest that the stiffness of leg muscle-tendon units of the anterior thigh and posterior lower leg do not change between the early follicular and early luteal phases and that tendons may be stiffer in those women who have stiffer anterior thigh muscles during the early luteal phase.

Influence of the menstrual cycle on static and dynamic kinematics of the foot medial longitudinal arch

BACKGROUND

In women, the laxity of the plantar fascia increases during the ovulation phase of the menstrual cycle. Although it is possible that this increased laxity results in a decreased height of the foot in the medial longitudinal arch and exacerbates symptoms of several overuse injuries of the lower extremity, the influence of the menstrual cycle on static and dynamic kinematics of the medial longitudinal arch is unclear. The purpose of this study was to confirm that the medial longitudinal arch height during static standing, gait, and landing decrease during the menstrual cycle ovulation phase.

METHODS

Participants in this study were 16 female college students with normal menstrual cycles and 16 male college students. Navicular height in the static standing position was measured using a three-dimensional foot scanner. Kinematics of the medial longitudinal arch during gait and landing were measured using a three-dimensional motion capture system to determine the navicular height at initial contact, minimal navicular height, and dynamic navicular drop. In all measurements, female participants were tested twice during the course of one complete menstrual cycle: once during the follicular phase and once during the ovulation phase. Male participants were tested twice with an interval of ≥1 week and <2 weeks.

RESULTS

In women, navicular height in the static standing position significantly decreased during the ovulation phase compared with follicular phase (mean difference [95% confidence interval] = 2.1 [0.9-3.4] mm; p = 0.002), whereas men showed no statistical difference between the first and second measurements. In both men and women, no statistical differences were identified for the dynamic medial longitudinal arch kinematics measured during gait and landing.

CONCLUSIONS

Navicular height in the static standing position slightly decreased during the ovulation phase.

Investigation of postural sensory organization in women with and without primary dysmenorrhea in three phases of the menstrual cycle

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.

Potential role of physical labor and cultural views of menstruation in high incidence of pelvic organ prolapse in Nepalese women: a comparative study across the menstrual cycle

Introduction

Pelvic organ prolapse (POP) is a significant health concern for young Nepali women, with potential risk factors including pelvic floor trauma from vaginal delivery and heavy lifting. The prevalence of symptomatic POP (SPOP) among nulliparous women in Nepal is 6%, while the general population of Nepali women aged 15-49 years reports a prevalence of 7%. Surprisingly, the average age of SPOP onset in Nepal is 27 years, challenging the assumption that postmenopausal age and vaginal delivery are the sole risk factors. This study aims to investigate the influence of increased intra-abdominal pressure (IAP) during lifting tasks on pelvic organ descent in Nepali women across different menstrual cycle stages.

Methods

The study included 22 asymptomatic Nepali women aged 18-30 years who regularly engage in heavy lifting. Intra-abdominal pressure was measured intra-vaginally during typical and simulated lifting tasks, which encompassed various scenarios such as ballistic lifting, ramped lifting, and pre-contraction of pelvic floor muscles, as well as coughing, Valsalva maneuver, and pelvic floor contractions. Pelvic floor displacement was recorded using transperineal ultrasound during menstruation, ovulation, and the mid-luteal phase.

Results

Results indicated that pelvic floor displacement was greater during menstruation than ovulation when performing a simulated ballistic lifting task (6.0 ± 1.6 mm vs. 5.1 ± 1.5 mm, p = 0.03, d = 0.6). However, there was no significant difference in pelvic floor displacement during lifting when the pelvic muscles were pre-contracted.

Conclusion

These findings suggest that lifting heavy loads during menstruation may increase the risk of stretching and injuring pelvic floor supportive tissues, potentially contributing to SPOP in young Nepali women. Pre-contracting pelvic floor muscles during lifting tasks may offer a protective effect. Understanding these factors could aid in developing targeted preventive measures and raising awareness about the impact of heavy lifting on pelvic floor health among Nepali women.

Does Phase of the Menstrual Cycle Affect Balance and Postural Control?

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.

Effect of ovulation on postural sway in association with sex hormone variation across the menstrual cycle in college students: an observational study

Background

Poor balance associated with increased postural sway is a risk factor for the high incidence of injuries found during specific menstrual cycle phases. This fact led to the hypothesis that female reproductive hormones affect soft tissue and neuromuscular function, reducing postural balance and resulting in a high injury prevalence among female college students. So, the current study aimed to identify the influence of ovulation in association with sex hormone variation across the menstrual cycle on postural sway in college students.

Material and methods

Forty female college students were enrolled in this study. They were recruited among physical therapy students at Deraya University, New Minya, Egypt. They were aged from 17 to 22 years. They were allocated to a single group. Progesterone and estradiol blood levels were measured to detect the timing of the follicular and luteal phases, and a urine luteinizing hormone (LH) strip test was used to determine when ovulation occurred. The dynamic postural sway index was assessed by using the Biodex Balance system. All measurements were taken on the early follicular (1st–3rd) day, the ovulatory (11th–13th) day, and the mid-luteal phase (21st–23rd) day from the onset of menstruation.

Results

Statistical analysis showed that the anteroposterior, mediolateral, and overall sway index increased significantly during the ovulatory phase compared to the earlier follicular and mid-luteal menstrual cycle phases in female college students (P < 0.05). There was no significant variance between the early follicular and mid-luteal phases (P > 0.05).

Conclusions

It can be concluded that increased female sex hormones during ovulation affect postural sway, which may disturb balance and increase the risk of injuries in college students.

Postural sway is not affected by estrogen fluctuations during the menstrual cycle

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.

Relationship between Changes in Foot Arch and Sex Differences during the Menstrual Cycle

This study investigated the relationship between changes in foot characteristics and sex differences during the menstrual cycle in healthy male and female university students. We examined 10 female subjects and 14 male subjects. The menstrual cycle was divided into the three phases: the early follicular phase, ovulatory phase, and luteal phase via basal body temperature, an ovulation kit, and salivary estradiol and progesterone concentration measurements. Foot characteristics required for the calculation of the arch height index (AHI) were measured using a three-dimensional foot scanner under conditions of 10% and 50% weight-bearing loads. Arch height at 50% of foot length and truncated foot length were measured, and AHI was calculated by dividing arch height by truncated foot length. Arch height flexibility (AHF) was defined as the change in arch height from 10% weight-bearing load to 50% weight-bearing load. AHI was significantly lower in females than in males in the early follicular and ovulatory phases but did not differ significantly between males and females in each phase. AHF did not differ significantly between males and females in each phase. AHI and AHF showed no periodic fluctuation, suggesting that sex differences in AHF may be absent.

Assessing the differences in muscle stiffness measured with shear wave elastography and myotonometer during the menstrual cycle in young women

This study assessed the differences in muscle stiffness of the medial gastrocnemius (MG) and tibialis anterior (TA) muscles at rest and contraction during ovulation and follicular phase (menstruation) in women with regular menstrual cycle. Thirty-four young healthy women (mean age 21.3 ± 1.3 years) with regular menstrual cycles participated in this study. Stiffness of the TA and MG muscles at rest and voluntary contraction during ovulation and follicular phase in young women were measured using shear-wave elastography (SWE) and the handheld myotonometer MyotonPRO. The absolute stiffness difference between resting and contraction was expressed as the stiffness increase rate (SIR). The stiffness of the MG and TA at the resting position was not significantly different between the two phases of the menstrual cycle (p > .05). A significantly greater stiffness of both muscles measured using MyotonPRO in the follicular phase than during ovulation was found (p < .05), while stiffness measured by SWE showed a difference only in the TA muscle during contraction (p < .05). In addition, there were no significant differences in the SIR of both muscles between the two phases (p > .05). The results of our study showed a significantly greater stiffness of the MG and TA muscles at the follicular phase than at ovulation during contraction only. As muscle stiffness affects the risk of injury owing to reduced stability during sports activities, these changes in mechanical properties during the menstrual cycle should be noted, and training strategies should be used in female athletes. This article is protected by copyright. All rights reserved.

The Disturbing Effect of Neuromuscular Fatigue on Postural Control Is Accentuated in the Premenstrual Phase in Female Athletes

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 (CoP_LX) and antero-posterior (CoP_LY) 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, CoP_LX, and CoP_LY 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, CoP_LX, and CoP_LY 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.

The Specificities of Elite Female Athletes: A Multidisciplinary Approach

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.

A preliminary study exploring the change in ankle joint laxity and general joint laxity during the menstrual cycle in cis women

Background

The purpose of the present study was to examine the relationship between ankle joint laxity and general joint laxity (GJL) in relation to the menstrual cycle, which was divided into four phases based on basal body temperature and ovulation, assessed using an ovulation kit.

Methods

Participants were 14 female college students (21–22 years) with normal menstrual cycles (cis gender). Anterior drawer stress to a magnitude of 120 N was applied for all participants. Anterior talofibular ligament (ATFL) length was measured as the linear distance (mm) between its points of attachment on the lateral malleolus and talus using ultrasonography. Data on ATFL length from each subject were used to calculate each subject’s normalized length change with anterior drawer stress (AD%). The University of Tokyo method was used for evaluation of GJL. AD% and GJL were measured once in each menstrual phase.

Results

There was no statistically significant difference between AD% in each phase. GJL score was significantly higher in the ovulation and luteal phases compared with the early follicular phase. AD% and GJL showed a positive correlation with each other in the ovulation phase.

Conclusions

Although it is unclear whether estrogen receptors are present in the ATFL, the present study suggests that women with high GJL scores might be more sensitive to the effects of estrogen, resulting in ATFL length change in the ovulation phase.

Primary dysmenorrhea and postural control: Is it a problem only during menstruation?

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.

A Closer Look at the Cellular and Molecular Components of the Deep/Muscular Fasciae

The fascia can be defined as a dynamic highly complex connective tissue network composed of different types of cells embedded in the extracellular matrix and nervous fibers: each component plays a specific role in the fascial system changing and responding to stimuli in different ways. This review intends to discuss the various components of the fascia and their specific roles; this will be carried out in the effort to shed light on the mechanisms by which they affect the entire network and all body systems. A clear understanding of fascial anatomy from a microscopic viewpoint can further elucidate its physiological and pathological characteristics and facilitate the identification of appropriate treatment strategies.

Neuromuscular Control of Ankle-stabilizing Muscles-specific Effects of Sex and Menstrual Cycle

The purpose of this study was to examine the differences in neuromuscular control and mechanical properties of the ankle-stabilizing muscles between men and women, and during different phases of menstrual cycle in women. Fifteen women with regular menstrual cycles and 17 male counterparts were included in this study. Electromyographic signals were recorded from the peroneus longus (PL) and tibialis anterior (TA) muscles while performing three balance tasks. Muscle tone, stiffness, and elasticity of muscles were measured using a MyotonPRO in the resting position. Outcomes were measured twice (ovulation and early follicular phases) for women, while measurements were acquired only once for men. Significantly higher tibialis anterior-peroneus longus co-contraction (TA/PL ratio) was observed in all balance tasks in women than in men (p< 0.05); however, significant differences between phases of the menstrual cycle were noted only in the 2 most difficult tasks (p< 0.05). A similar pattern was observed in the postural sway. These results highlight the importance of sex-specific hormonal effects on neuromuscular control and mechanical properties, and as well as the differences during phases of the menstrual cycle. These insights assume significance in the context of developing neuromuscular strategies for the purpose of preventing lower extremity injuries during sports activities.

Greater Postural Sway and Tremor during Balance Tasks in Patients with Plantar Fasciitis Compared to Age-Matched Controls

Plantar fasciitis (PF) is a common condition found in men and women and can reoccur throughout life. PF is commonly diagnosed by prolonged foot pain lasting more than 3 months and a plantar fascia over 0.4 mm thick, as measured using ultrasound imaging. This study examined the ability to balance and the occurrence of muscle tremor during different balance tasks in patients with PF compared to their control counterparts. Fifty subjects (25 patients with PF and 25 control subjects) participated in this study. Subjective pain (measured with a visual analog scale (VAS)), pressure pain threshold (PPT), and postural sway and tremor during eight different balance tasks were measured. Postural sway was measured by a balance platform, while tremor was measured as the mechanical movement of the platform in the 8 Hz frequency range. Thickness of plantar fascia, subjective pain, and PPT were significantly greater in the PF group compared to the controls (p < 0.001). Postural sway and 8 Hz tremor were significantly greater in the PF group compared to the control group for all eight balance tasks (p < 0.01). These results indicate that the lack of plantar fascia elasticity is probably the cause of the reduced balance and increased muscle tremor.

Pressure and Traction Technique Improves Postural Control More Than Tactile Stimulation in Foot Plantar Fascia: A Randomized Single-Blind Trial

OBJECTIVE

To check the acute effects of manual pressure and traction technique on balance and plantar footprint variables.

DESIGN

A single-blind clinical study with 2 groups.

SETTING

Private practice.

PARTICIPANTS

Healthy participants (N=40; 28 female and 12 male) were recruited to carry out a single-blind study.

INTERVENTIONS

Experimental group performed a bilateral plantar fascia manual pressure and traction technique. Control group performed a tactile stimulation. The position of the participant, the therapist, and the time of application of the techniques (5min) were the same for both interventions.

MAIN OUTCOME MEASURES

We measured stabilometry variables and static footprint. The footprint variables were divided in rear, middle, and front foot areas.

RESULTS

Significant differences were found in stabilometry variables. There was an improvement in experimental group at X displacement with eyes open (P=.014) and surface eyes closed (P=.046) variables.

CONCLUSIONS

After technique the experimental group improved the stabilometry variables, specifically surface with eyes closed and X displacement with eyes open. The static footprint variables have not shown differences after the technique compared with the control group.

Acute effects of myofascial induction technique in plantar fascia complex in patients with myofascial pain syndrome on postural sway and plantar pressures: A quasi-experimental study

OBJECTIVES

The prevalence of myofascial pain syndrome varies from 21% 93%. Several studies have shown that myofascial induction is effective in treating myofascial pain syndrome. Although these techniques have shown some effectiveness in clinical practice, there have been little study into their effects, and have deep effects. The purpose of this study was to investigate if the application of a single myofascial induction technique for each foot, targeted to the plantar fascia resulted in changes in balance and footprint variables.

DESIGN

A quasi-experimental study.

SETTING

An outpatient clinic.

SUBJECTS

20 healthy participants (12 females and 8 males) were evaluated pre and post Myofascial induction technique for each foot in plantar fascia during 5 min.

METHODS

We measured static footprint and stabilometry variables in asymptomatic subjects. The footprint surface area was divided: bilateral rear foot, bilateral midfoot, bilateral fore foot.

RESULTS

We found differences in the footprint variables: maximun pressure in forefoot (p = 0.025), surface in forefoot (p = 0.03). The myofascial induction has no effects on stabilometry variables.

CONCLUSIONS

The immediate effects of the longitudinal technique of myofascial induction of the plantar fascia are the increase of surface and maximum pressure in fore foot.

Influence of female hormones on fascia elasticity: An elastography study

The aim of this study was to examine the influence of hormonal changes during the menstrual cycle on deep fasciae. A total of 29 women, 17 users, and 12 nonusers of hormonal contraceptives were examined clinically and by ultrasound, including shear wave elastography, at two phases of the menstrual cycle. The thickness and elasticity of the fascia lata, thoracolumbar fascia, and plantar fascia were measured, compared between hormonal contraceptive users and nonusers, and correlated with clinical data. There were statistically significant differences between users and nonusers of hormonal contraceptives: the thoracolumbar fascia was thicker in nonusers (P = 0.011), and nonusers had higher maximal and mean stiffnesses of the fascia lata (P = 0.01 and 0.0095, respectively). Generally, nonusers had a higher body mass index (BMI). The elasticity of the thoracolumbar and the plantar fasciae did not differ significantly between the groups. We found no correlation between thickness and elasticity in the fasciae. There were no statistically significant differences in hypermobility, cephalgia, or dysmenorrhea between users and nonusers of hormonal contraceptives. The results of this pilot study suggest that deep fasciae can be evaluated by shear wave elastography. Nonusers of contraceptives had greater stiffness of the fascia lata and higher BMI. Clin. Anat. 32:941-947, 2019. © 2019 Wiley Periodicals, Inc.

The influence of ageing and diabetic peripheral neuropathy on posture sway, tremor, and the time to achieve balance equilibrium

BACKGROUND

It is well recognized that ageing and diabetes are associated with reduced balance and impaired gait. However, one important factor may be not just balance, but how long it takes to achieve balance equilibrium after a balance challenge. This study examined the relationship between balance, tremor, and time to achieve balance after a challenge to stability in young and old individuals without and without diabetes.

METHODS

Twenty-four of the subjects were young controls, 22 were older controls, 23 were individuals with diabetes, and 21 were young people with diabetes. Posture sway, tremor, and time to achieve stability were assessed on a force plate during 8 progressively challenging balance tasks.

RESULTS

For postural sway, tremor and time to reach postural stability, there was a significant difference in all groups with the increased balance challenge of the 8 tests (P<0.01). However, ageing and diabetes made balance, tremor and time to reach stability worse. In general, the young group with diabetes, for example, had similar responses to the old group without diabetes.

CONCLUSIONS

In the subjects with diabetes, balance was poorer than the non-diabetes groups. The young subjects with diabetes showed similar results to the older subjects without diabetes. Diabetes subjects had more muscle tremor and a slower response time of the body to a balance challenge. This may account for increased falls in individuals with diabetes.

The influence of ovulation on postural stability (Biodex Balance System) in young female

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.

Controle postural de mulheres com dismenorreia primária em dois momentos do ciclo menstrual

RESUMO A dismenorreia primária (DP) é uma dor pélvica ou abdominal inferior relacionada à menstruação, associada a pontos dolorosos miofasciais, cuja presença é capaz de alterar a percepção somatossensorial e a ativação muscular, o que pode interferir no controle postural. O objetivo deste estudo foi verificar a influência da DP no controle postural estático de mulheres em dois momentos do ciclo menstrual, com e sem dor. Foram avaliadas 19 universitárias (22,4±3,0 anos) com DP por meio da escala visual analógica, algometria e plataforma de força. Os dados foram submetidos à estatística descritiva e verificados quanto à normalidade (Shapiro-Wilk) e às variáveis comparadas, utilizando-se o teste t de Student e o teste de Wilcoxon. O grupo avaliado apresentou uma dor considerada moderada (4,1±2,3), e os valores de limiar de dor à pressão foram menores no momento com dor quando comparado ao sem dor, na região do abdômen direito (p=0,04) e lombossacral bilateral (p<0,05), indicando maior sensibilidade local. Quanto ao controle postural, houve maior amplitude de deslocamento anteroposterior do centro de pressão, tanto na condição “olhos abertos” quanto “olhos fechados”, bem como na velocidade média e área da elipse do centro de pressão, na condição “olhos fechados”, durante o momento com DP. Essas alterações indicam maior necessidade de ajustes posturais na DP, possivelmente em virtude de uma interferência da dor sobre a propriocepção. Concluiu-se que houve maior sensibilidade dolorosa na fase menstrual do ciclo e que a dor interferiu sobre o controle postural deste grupo, eventos que foram intensificados pela ausência de visão.

Differences Between Men and Women in Balance and Tremor in Relation to Plantar Fascia Laxity During the Menstrual Cycle

CONTEXT

  Although much attention has been paid to the effect of estrogen on the knee ligaments, little has been done to examine the ligaments in the foot, such as the plantar fascia, and how they may be altered during the menstrual cycle.

OBJECTIVE

  To (1) examine sex differences in plantar fascia thickness and laxity and postural sway and (2) identify any menstrual cycle effects on plantar fascia laxity, postural sway, and neuromuscular tremor between menstruation and the ovulation phase.

DESIGN

  Case-control study.

SETTING

  Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

  Fifteen healthy women (age = 25.9 ± 1.8 years) and 15 healthy men (age = 27.3 ± 2.0 years) volunteered to participate in this study.

INTERVENTION(S)

  We asked participants to perform 8 balance tasks on a force platform while we assessed postural sway and tremor.

MAIN OUTCOME MEASURE(S)

  Plantar fascia length and thickness unloaded and loaded with body weight were measured via ultrasound. Postural sway and tremor were measured using a force platform.

RESULTS

  Plantar fascia length and thickness with pressure were greater in ovulating women compared with men ( P < .001), but no differences were found between women during menstruation and men. Postural sway and tremor were greater at ovulation than during menstruation ( P < .05), and men had less sway than ovulating women on the 3 most difficult balance tasks ( P < .01).

CONCLUSIONS

  Plantar fascia laxity was increased and postural sway and tremor were decreased at ovulation compared with menstruation in women. Postural sway and tremor in men were the same as in women during menstruation. These findings support the need to be aware of the effect of sex hormones on balance to prevent lower extremity injuries during sport activities.

Increased Postural Sway and Changes in the Neuromuscular Activities of the Ankle Stabilizing Muscles at Ovulation in Healthy Young Women

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.

Hormone receptor expression in human fascial tissue

Many epidemiologic, clinical, and experimental findings point to sex differences in myofascial pain in view of the fact that adult women tend to have more myofascial problems with respect to men. It is possible that one of the stimuli to sensitization of fascial nociceptors could come from hormonal factors such as estrogen and relaxin, that are involved in extracellular matrix and collagen remodeling and thus contribute to functions of myofascial tissue. Immunohistochemical and molecular investigations (real-time PCR analysis) of relaxin receptor 1 (RXFP1) and estrogen receptor-alpha (ERα) localization were carried out on samples of human fascia collected from 8 volunteers patients during orthopedic surgery (all females, between 42 and 70 yrs, divided into pre- and post-menopausal groups), and in fibroblasts isolated from deep fascia, to examine both protein and RNA expression levels. We can assume that the two sex hormone receptors analyzed are expressed in all the human fascial districts examined and in fascial fibroblasts culture cells, to a lesser degree in the post-menopausal with respect to the pre-menopausal women. Hormone receptor expression was concentrated in the fibroblasts, and RXFP1 was also evident in blood vessels and nerves. Our results are the first demonstrating that the fibroblasts located within different districts of the muscular fasciae express sex hormone receptors and can help to explain the link between hormonal factors and myofascial pain. It is known, in fact, that estrogen and relaxin play a key role in extracellular matrix remodeling by inhibiting fibrosis and inflammatory activities, both important factors affecting fascial stiffness and sensitization of fascial nociceptors.