The effects of menstrual cycle on the knee joint position sense: preliminary study

Comparison of the validity and reliability of three different methods used for wrist proprioception measurement

BACKGROUND

ː Early detection of loss of proprioception is essential to prevent injury and maintain professional work activities. However, although many different methods are present for wrist proprioception measurement, these methods' validity and reliability studies are quite limited.

OBJECTIVE

To compare the validity and reliability of the goniometer, inclinometer, and joint position sense goniometer methods used in measuring wrist active joint position sense (AJPS).

METHODS

ː Thirty-two volunteer healthy participants (64 wrists) between the ages of 19-31 (mean age:23,34 ± 3,84) were included in the study. Wrist AJPS was assessed with an isokinetic dynamometer as a reference standard in addition to an inclinometer, goniometer, and joint position sense goniometer (JPSG). Spearman's Correlation Coefficient was used for validity analysis, and Intraclass Correlation Coefficient (ICC3,1) was used to analyze test-retest reliability.

RESULTS

ː It was found that the goniometer (p < 0.001, r = 0.529) is a moderately valid method to assess active wrist joint position sense. The JPSG (p < 0.001, r = 0.432) and inclinometer (p = 0.005, r = 0.350) have weak validity. According to the results of ICC3,1 analysis, the goniometer (p < 0.001, ICC3,1 = 0.422) and JPSG (p < 0.001, ICC3,1 = 0.369) were found to have poor reliability in assessing wrist AJPS, and the inclinometer (p = 0,183, ICC3,1 = 0,114) was not found as a reliable method.

CONCLUSIONS

ː Our results suggest that the JPSG and inclinometer should not be used in the wrist active joint position sense evaluation because of weak validity and poor reliability. The goniometer can be used in clinics and academic research to evaluate wrist joint position sense if the rater lacks a reliable and valid measurement tool.

Motor Control and Regularity of Menstrual Cycle in Ankle and Knee Injuries of Female Basketball Players: A Cohort Study

Inadequate motor control facilitates ankle and knee injuries in female basketball. Although biomechanical analysis could help to detect it, aspects such as irregular menstruation make these associations controversial. We aimed to evaluate associations between 2D biomechanics during landing and proprioception with ankle and knee injuries of female basketball players, considering their menstruation regularity. Seventy-one players participated in this study. In the preseason, participants performed a drop-jump to obtain biomechanics during landing and a weight-bearing proprioception test. During the competitive season, all the non-contact ankle and knee injuries were registered. Data showed that 16% of players sustained an ankle or knee injury, being more frequent in players with irregular menstruation compared to regulars (22% vs. 13%, χ² = 6.009, p = 0.050, d = 0.6). Players who sustained a left-side injury displayed higher left-side dynamic valgus during landing than uninjured players (χ² = 25.88, p = 0.006, d = 1.5). The rest of the variables did not show any significant difference (p > 0.05). Monitoring 2D dynamic valgus from a drop-jump could help to detect inadequate motor control that may facilitate ankle or knee injuries of female basketball players, mainly for those with irregular menstruation. Proprioception seems not to be related to injuries.

Sex Differences in Lower Limb Proprioception and Mechanical Function Among Healthy Adults

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.

Influence of Menstrual Cycle Phases on Neural Excitability in the Primary Somatosensory Cortex and Ankle Joint Position Sense

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.

Comparison of some intrinsic risk factors of shoulder injury in three phases of menstrual cycle in collegiate female athletes

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.

Changes in Knee Vastii Muscle Activity in Women with Patellofemoral Pain Syndrome During the Menstrual Cycle

BACKGROUND

Changes in hormonal levels during the menstrual cycle are known to affect muscle electromyographic (EMG) activity, but no studies have investigated the effect of hormonal changes on the EMG activity of muscles around the knee in patients with patellofemoral pain syndrome (PFPS).

OBJECTIVE

To evaluate the EMG activity of the vastus medialis obliquus (VMO) and vastus lateralis (VL) muscles during toe rise and heel rock tasks in different phases of the menstrual cycle in women with PFPS.

DESIGN

Cross sectional study.

SETTING

Rehabilitation Research Center at the School of Rehabilitation Sciences of Shiraz University of Medical Sciences.

PARTICIPANTS

Ten women with PFPS between 18 and 40 years of age.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

The VL/VMO amplitude ratio and differences between onset (onset VL-onset VMO) of vastii muscle activity were measured in the affected limb during rise and rock tasks in the follicular and ovulatory phases of the menstrual cycle. The signals were analyzed with MATLAB software.

RESULTS

During both tasks, there were no significant changes in onset differences in vastii muscles between the ovulatory and follicular phases. However, the amplitude ratio (VL/VMO) was significantly lower in the ovulatory phase compared to the follicular phase (P = .035 for rise tasks and .010 for rock tasks).

CONCLUSION

The menstrual cycle may affect some EMG parameters. These factors can be taken into account when planning sports and rehabilitation training programs.

Inter- and intrarater reliability of two proprioception tests using clinical applicable measurement tools in subjects with and without knee osteoarthritis

BACKGROUND

The therapeutic value of proprioceptive-based exercises in knee osteoarthritis (KOA) management warrants investigation of proprioceptive testing methods easily accessible in clinical practice.

OBJECTIVE

To estimate inter- and intrarater reliability of the knee joint position sense (KJPS) test and knee force sense (KFS) test in subjects with and without KOA.

DESIGN

Cross-sectional test-retest design.

METHOD

Two blinded raters performed independently repeated measures of the KJPS and KFS test, using an analogue inclinometer and handheld dynamometer, respectively, in eight KOA patients (12 symptomatic knees) and 26 healthy controls (52 asymptomatic knees). Intraclass correlation coefficients (ICCs; model 2,1), standard error of measurement (SEM) and minimal detectable change with 95% confidence bounds (MDC₉₅) were calculated.

RESULTS

For KJPS, results showed good to excellent test-retest agreement (ICCs 0.70-0.95 in KOA patients; ICCs 0.65-0.85 in healthy controls). A 2° measurement error (SEM 1°) was reported when measuring KJPS in multiple test positions and calculating mean repositioning error. Testing KOA patients pre and post therapy a repositioning error larger than 4° (MDC₉₅) is needed to consider true change. Measuring KFS using handheld dynamometry showed poor to fair interrater and poor to excellent intrarater reliability in subjects with and without KOA.

CONCLUSIONS

Measuring KJPS in multiple test positions using an analogue inclinometer and calculating mean repositioning error is reliable and can be used in clinical practice. We do not recommend the use of the KFS test to clinicians. Further research is required to establish diagnostic accuracy and validity of our KJPS test in larger knee pain populations.

Constant performance in balance and proprioception tests across the menstrual cycle - a pilot study in well trained female ice hockey players on hormonal contraception

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.

Influência das fases do ciclo menstrual no desempenho funcional de mulheres jovens e saudáveis

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.

Menstrual cycle and knee joint position sense in healthy female athletes

PURPOSE

The aim of this study was to investigate the effect of menstrual cycle on knee joint position sense (JPS) in healthy female athletes.

METHODS

Sixteen healthy female athletes participated in this study. Serum estrogen and progesterone levels were collected during the three phases of menstrual cycle. The knee JPS was also measured during the same phases using a system comprise of skin markers, digital photography, and AutoCAD software. Absolute angular errors were calculated as well as changes in hormone levels between the three phases.

RESULTS

Serum estrogen concentration was significantly higher during the mid-luteal (179.5 Pg/ml) and mid-follicular (125.6 Pg/ml) phases as compared with the early-follicular (menses) (22.8 Pg/ml) phase (P = 0.0001). Also serum progesterone concentration was significantly higher during the mid-luteal phase (7.35 Ng/ml) as compared with the menses (0.58 Ng/ml) and mid-follicular (0.5 Ng/ml) phases (P = 0.0001). The greatest amount of mean (SD) value of absolute error was at menses (4.2°), and the least amount of it was at mid-luteal (2.5°) phase. Also, a significant difference was observed within three phases of menstrual cycle (P = 0.025).

CONCLUSION

The result of this study suggests that healthy female athletes have different levels of knee JPS across a menstrual cycle. JPS accuracy decreases in menses, when circulating sex-hormones levels are low. Therefore, female athletes are at higher risk of injury at menses and improving their awareness regarding the knee injury risk factors can be a fundamental step toward preventing injuries.

LEVEL OF EVIDENCE

Case series, Level IV.

Effects of cold water immersion on knee joint position sense in healthy volunteers

The purpose of this study was to determine the effects of cryotherapy, in the form of cold water immersion, on knee joint position sense. Fourteen healthy volunteers, with no previous knee injury or pre-existing clinical condition, participated in this randomized cross-over trial. The intervention consisted of a 30-min immersion, to the level of the umbilicus, in either cold (14 ± 1 °C) or tepid water (28 ± 1 °C). Approximately one week later, in a randomized fashion, the volunteers completed the remaining immersion. Active ipsilateral limb repositioning sense of the right knee was measured, using weight-bearing and non-weight-bearing assessments, employing video-recorded 3D motion analysis. These assessments were conducted immediately before and after a cold and tepid water immersion. No significant differences were found between treatments for the absolute (P = 0.29), relative (P = 0.21) or variable error (P = 0.86). The average effect size of the outcome measures was modest (range -0.49 to 0.9) and all the associated 95% confidence intervals for these effect sizes crossed zero. These results indicate that there is no evidence of an enhanced risk of injury, following a return to sporting activity, after cold water immersion.