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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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Kordi Yoosefinejad A, Khademi S, Vosoughi AR. Consequences of extensile lateral approach to the calcaneal fractures on balance and isokinetic strength of muscle groups crossing the ankle joint. Foot Ankle Surg 2022; 28:732-737. [PMID: 34511327 DOI: 10.1016/j.fas.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/30/2021] [Accepted: 09/01/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Inherent characteristics of extensile lateral approach (ELA) for fixation of displaced intraarticular calcaneal fractures together with delayed or probably insufficient physical therapy programs may lead to weakness of the muscle groups crossing the ankle joint. Peroneal tendons might be involved more than others because of possible postoperative adhesions. The aim of this study was to evaluate the isokinetic strength of the muscle groups crossing the ankle joint and also to assess balance and functional ability in this group of patients. METHODS Based on a pilot study, 23 patients undergone open reduction and internal fixation (ORIF) via ELA and 22 healthy subjects as the control group participated in this observational cross-sectional study. Patients more than 20 years of age with at least 12 months passed their unilateral closed intraarticular calcaneal fracture fixation without any postoperative complications like infection or wound dehiscence were included. Patients with history of concomitant lower extremity injury, spine trauma or surgery, cases underwent removal of calcaneal plates, and cases with neuromuscular or vestibular dysfunction were excluded. The outcome was assessed by isokinetic parameters such as peak torque, peak torque normalized to body weight, mean power and total work modified star excursion balance test, triple hop for distance test, and evertor-to-invertor (E/I) strength ratio. Isokinetic tests were performed at 60 and 120°/s. RESULTS Greater strength was observed in all muscles in the control group at 60°/s (p < 0.05). Evertors and invertors were weaker in the operated group at 120°/s in comparison to the dorsiflexors and plantarflexors. Modified star excursion (p: 0.003) and triple hop tests (p: 0.001) were lower in the operated group. E/I ratio was not statistically significant between the two groups at 60°/s (p: 0.44) and 120°/s (p: 0.62). CONCLUSIONS Strength deficit in all muscle groups crossing the ankle joint, and not evertors in isolation, in addition to balance and functional impairments would be seen one year following ORIF of calcaneal fracture via ELA. A long-term rehabilitation program emphasizing different kinds of contraction at low and high speeds and balance training in these patients is highly recommended.
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Affiliation(s)
- Amin Kordi Yoosefinejad
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sahar Khademi
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Amir Reza Vosoughi
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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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: 9] [Impact Index Per Article: 4.5] [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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Rocha-Rodrigues S, Sousa M, Lourenço Reis P, Leão C, Cardoso-Marinho B, Massada M, Afonso J. Bidirectional Interactions between the Menstrual Cycle, Exercise Training, and Macronutrient Intake in Women: A Review. Nutrients 2021; 13:438. [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] [MESH Headings] [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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Affiliation(s)
- Sílvia Rocha-Rodrigues
- Escola Superior de Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Álvares, 4900-347 Viana do Castelo, Portugal;
- Research Centre in Sports Sciences, Health Sciences and Human Development (CIDESD), Quinta de Prados, Edifício Ciências de Desporto, 5001-801 Vila Real, Portugal
- Tumor & Microenvironment Interactions Group, i3S, Rua Alfredo Allen, 208 4200-135 Porto, Portugal
| | - Mónica Sousa
- Nutrition & Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 1169-056 Lisboa, Portugal;
- CINTESIS, NOVA Medical School, NMS, Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 1169-056 Lisboa, Portugal
| | - Patrícia Lourenço Reis
- Hospital da Luz Arrábida, Luz Saúde, Praceta Henrique Moreira, 150, 4400-346 Vila Nova de Gaia, Portugal;
| | - César Leão
- Escola Superior de Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Álvares, 4900-347 Viana do Castelo, Portugal;
- Research Centre in Sports Sciences, Health Sciences and Human Development (CIDESD), Quinta de Prados, Edifício Ciências de Desporto, 5001-801 Vila Real, Portugal
| | | | - Marta Massada
- Centre for Research, Education, Innovation and Intervention in Sport, Faculty of Sport of the University of Porto. Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal; (M.M.); (J.A.)
- St. Mary’s Hospital of Porto, Rua de Camões, 906, 4049-025 Porto, Portugal
| | - José Afonso
- Centre for Research, Education, Innovation and Intervention in Sport, Faculty of Sport of the University of Porto. Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal; (M.M.); (J.A.)
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Ateş Y, Ünlüer NÖ. The relationship of pain, anxiety, and fatigue with knee position sense, balance, and dual task performance during menstrual cycle in females with multiple sclerosis. Somatosens Mot Res 2020; 37:307-312. [DOI: 10.1080/08990220.2020.1828057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Yasemin Ateş
- Faculty of Health Science, Physiotherapy and Rehabilitation, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Nezehat Özgül Ünlüer
- Faculty of Health Science, Physiotherapy and Rehabilitation, Ankara Yildirim Beyazit University, Ankara, Turkey
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Samani M, Kordi Yoosefinejad A, Campos MH, de Lira CAB, Motealleh A. Changes in Knee Vastii Muscle Activity in Women with Patellofemoral Pain Syndrome During the Menstrual Cycle. PM R 2019; 12:382-390. [PMID: 31408276 DOI: 10.1002/pmrj.12239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/29/2019] [Indexed: 11/12/2022]
Abstract
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.
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Affiliation(s)
- Mahbobeh Samani
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Kordi Yoosefinejad
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mario H Campos
- Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil
| | - Claudio A B de Lira
- Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil
| | - Alireza Motealleh
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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