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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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Bingzheng Z, Xinzhuo Z, Zhuo J, Xing Y, Bin L, Lunhao B. The effects of sex hormones during the menstrual cycle on knee kinematics. Front Bioeng Biotechnol 2023; 11:1209652. [PMID: 37744250 PMCID: PMC10512414 DOI: 10.3389/fbioe.2023.1209652] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/28/2023] [Indexed: 09/26/2023] Open
Abstract
The effects of the menstrual cycle and sex hormones on knee kinematics remain unclear. The purpose of the study was to investigate the effects of the menstrual cycle and serum sex hormone concentrations on knee kinematic parameters of the 90°cutting in female college soccer athletes. Three female college soccer teams (53 subjects) participated in the study. During the first menstrual cycle, a three-step method was used to exclude subjects with anovulatory and luteal phase-deficient (LPD) (12 subjects). The subjects' menstrual cycle was divided into the menstrual phase, late-follicular phase, ovulatory phase, and mid-luteal phase (group 1, 2, 3, 4). In each phase of the second menstrual cycle, we used a portable motion analysis system to enter the teams and tested the sex hormones concentrations and knee kinematics parameters in three universities in turn. We found that subjects had a lower maximum knee valgus in group 4 compared with other groups. This meant that subjects had a lower biomechanical risk of non-contact anterior cruciate ligament (ACL) injury in the mid-luteal phase. There was no significant correlation between serum estrogen, progesterone concentration, and knee kinematic parameters. This meant that sex hormones did not have a protective effect. Future studies need to incorporate more factors (such as neuromuscular control, etc.) to investigate.
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Affiliation(s)
- Zhou Bingzheng
- Department of Orthopaedic Surgery and Sports Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhao Xinzhuo
- Department of Biomedical Engineering, Shenyang University of Technology, Shenyang, Liaoning, China
| | - Jin Zhuo
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yang Xing
- Research Center for Universal Health, School of Public Health, China Medical University, Shenyang, China
| | - Li Bin
- Department of Orthopaedic Surgery and Sports Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bai Lunhao
- Department of Orthopaedic Surgery and Sports Medicine, Shengjing Hospital of China Medical University, Shenyang, China
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Dos’Santos T, Stebbings GK, Morse C, Shashidharan M, Daniels KAJ, Sanderson A. Effects of the menstrual cycle phase on anterior cruciate ligament neuromuscular and biomechanical injury risk surrogates in eumenorrheic and naturally menstruating women: A systematic review. PLoS One 2023; 18:e0280800. [PMID: 36701354 PMCID: PMC9879429 DOI: 10.1371/journal.pone.0280800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Eumenorrheic women experience cyclic variations in sex hormones attributed to the menstrual cycle (MC) which can impact anterior cruciate ligament (ACL) properties, knee laxity, and neuromuscular function. This systematic review aimed to examine the effects of the MC on ACL neuromuscular and biomechanical injury risk surrogates during dynamic tasks, to establish whether a particular MC phase predisposes women to greater ACL injury risk. METHODS PubMed, Medline, SPORTDiscus, and Web of Science were searched (May-July 2021) for studies that investigated the effects of the MC on ACL neuromuscular and biomechanical injury risk surrogates. Inclusion criteria were: 1) injury-free women (18-40 years); 2) verified MC phases via biochemical analysis and/or ovulation kits; 3) examined neuromuscular and/or biomechanical injury risk surrogates during dynamic tasks; 4) compared ≥1 outcome measure across ≥2 defined MC phases. RESULTS Seven of 418 articles were included. Four studies reported no significant differences in ACL injury risk surrogates between MC phases. Two studies showed evidence the mid-luteal phase may predispose women to greater risk of non-contact ACL injury. Three studies reported knee laxity fluctuated across the MC; two of which demonstrated MC attributed changes in knee laxity were associated with changes in knee joint loading (KJL). Study quality (Modified Downs and Black Checklist score: 7-9) and quality of evidence were low to very low (Grading of Recommendations Assessment Development and Evaluation: very low). CONCLUSION It is inconclusive whether a particular MC phase predisposes women to greater non-contact ACL injury risk based on neuromuscular and biomechanical surrogates. Practitioners should be cautious manipulating their physical preparation, injury mitigation, and screening practises based on current evidence. Although variable (i.e., magnitude and direction), MC attributed changes in knee laxity were associated with changes in potentially hazardous KJLs. Monitoring knee laxity could therefore be a viable strategy to infer possible ACL injury risk.
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Affiliation(s)
- Thomas Dos’Santos
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, United Kingdom
- Manchester Institute of Sport, Manchester Metropolitan University, Manchester, United Kingdom
- * E-mail:
| | - Georgina K. Stebbings
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, United Kingdom
- Manchester Institute of Sport, Manchester Metropolitan University, Manchester, United Kingdom
| | - Christopher Morse
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, United Kingdom
- Manchester Institute of Sport, Manchester Metropolitan University, Manchester, United Kingdom
| | - Medha Shashidharan
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, United Kingdom
- Manchester Institute of Sport, Manchester Metropolitan University, Manchester, United Kingdom
| | - Katherine A. J. Daniels
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, United Kingdom
- Manchester Institute of Sport, Manchester Metropolitan University, Manchester, United Kingdom
| | - Andy Sanderson
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, United Kingdom
- Manchester Institute of Sport, Manchester Metropolitan University, Manchester, United Kingdom
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Hagemeijer NC, Saengsin J, Chang SH, Waryasz GR, Kerkhoffs GMMJ, Guss D, DiGiovanni CW. Diagnosing syndesmotic instability with dynamic ultrasound - establishing the natural variations in normal motion. Injury 2020; 51:2703-2709. [PMID: 32741605 DOI: 10.1016/j.injury.2020.07.060] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/14/2020] [Accepted: 07/26/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Syndesmotic instability, when subtle, is challenging to diagnose and often requires visualization of the syndesmosis during applied stress. The primary aim was to assess normal distal tibiofibular motion in the sagittal plane using dynamic ultrasound under stress conditions. The secondary aim was to evaluate the reliability of dynamic stress ultrasonography. METHODS Twenty-eight participants without history of ankle injury were included. Sagittal fibular translation was generated by applying a manual force to the fibula from anterior to posterior and from posterior to anterior. Distance between the ultrasound probe and the fibula was taken at two predefined points: 1) no force applied and, 2) during maximum force application. Each participant was scanned twice by two independent examiners, and each scan was analysed by two independent examiners. Three participants were scanned a second time by the same examiner who analysed these films twice to assess for intraobserver agreement. Means of exam 1 versus exam 2 were compared using a mixed linear model. Agreement among observers was calculated using intraclass correlation coefficients (ICC) interpreted as 0.4, poor; 0.4 〈 ICC < 0.59, acceptable; 0.6 < ICC < 0.74, good; ICC 〉 0.74, excellent. RESULTS Fifty-six ankles were included in the study, including 16 (57%) males and 12 (42%) females. Average anterior to posterior fibular sagittal translation was 0.89 ± 0.6 mm and posterior to anterior fibular sagittal translation was 0.49 ± 1.1 mm. Anterior to posterior translation means of exam 1 versus exam 2 showed no significant differences, means of 0.81 mm [0.7-0.9] versus 0.77 mm [0.7-1.0], and posterior to anterior means [95% CI] of 0.42 mm [0.3-0.5] versus 0.44 mm [0.2-0.6] (p-values 0.416 and 0.758, respectively). Excellent Inter- and intraobserver agreement was found for all measurements taken. CONCLUSION Dynamic ultrasound allows one to effectively and readily evaluate sagittal translation of the distal tibiofibular joint. It is able to afford bilateral comparisons, which becomes critical as the amount of syndesmotic instability approaches greater degrees of subtlety.
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Affiliation(s)
- N C Hagemeijer
- Foot & Ankle Research and Innovation Laboratory Massachusetts General Hospital, Harvard Medical School, USA; Department of Orthopaedic Surgery Amsterdam Movement Sciences Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - J Saengsin
- Foot & Ankle Research and Innovation Laboratory Massachusetts General Hospital, Harvard Medical School, USA; Department of Orthopaedic Surgery Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Sri Phum subdistrict Mueang Chiang Mai District, Chiang Mai, 50200, Thailand
| | - S H Chang
- Foot & Ankle Research and Innovation Laboratory Massachusetts General Hospital, Harvard Medical School, USA; Department of Orthopaedic Surgery Faculty of Medicine, The University of Tokyo, 7 Chome-3-1 Hongo Bunkyo City, Tokyo, 113-8654, Japan
| | - G R Waryasz
- Foot & Ankle Research and Innovation Laboratory Massachusetts General Hospital, Harvard Medical School, USA; Foot & Ankle Service Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Building 55 Fruit St, Boston, MA, 02114, USA
| | - G M M J Kerkhoffs
- Department of Orthopaedic Surgery Amsterdam Movement Sciences Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands; Academic Center for Evidence based Sports medicine (ACES), Academic Medical Centre, Meibergdreef 9, 1105, AZ Amsterdam, the Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
| | - D Guss
- Foot & Ankle Research and Innovation Laboratory Massachusetts General Hospital, Harvard Medical School, USA; Foot & Ankle Service Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Building 55 Fruit St, Boston, MA, 02114, USA; Newton-Wellesley Hospital Harvard Medical School, Massachusetts General Hospital, Yawkey Building 55 Fruit St, Boston, MA, 02114, USA
| | - C W DiGiovanni
- Foot & Ankle Research and Innovation Laboratory Massachusetts General Hospital, Harvard Medical School, USA; Foot & Ankle Service Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Building 55 Fruit St, Boston, MA, 02114, USA; Newton-Wellesley Hospital Harvard Medical School, Massachusetts General Hospital, Yawkey Building 55 Fruit St, Boston, MA, 02114, USA
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