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

Overview

Journal Foot Ankle Orthop

Publisher Sage Publications

Date 2024 Nov 29

PMID 39610646

Authors

Hayden Hartman

Shannon Fehr

Arianna L Gianakos

Affiliations

Soon will be listed here.

Abstract

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 ( < .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 ( = .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.

References

Gur H . Concentric and eccentric isokinetic measurements in knee muscles during the menstrual cycle: a special reference to reciprocal moment ratios. Arch Phys Med Rehabil. 1997; 78(5):501-5. DOI: 10.1016/s0003-9993(97)90164-7. View

Rozzi S, Lephart S, Gear W, Fu F . Knee joint laxity and neuromuscular characteristics of male and female soccer and basketball players. Am J Sports Med. 1999; 27(3):312-9. DOI: 10.1177/03635465990270030801. View

Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C . The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med. 2013; 44(1):123-40. DOI: 10.1007/s40279-013-0102-5. View

Shultz S, Sitler M, Tierney R, Hillstrom H, Song J . Consequences of pediatric obesity on the foot and ankle complex. J Am Podiatr Med Assoc. 2012; 102(1):5-12. DOI: 10.7547/1020005. View

Senol D, Ucar C, Toy S, Kisaoglu A, Ozbag D, Ersoy Y . Analysis of the effects of hypothalamic-pituitary-adrenal axis activity in menstrual cycle on ankle proprioception, dynamic balance scores and visual-auditory reaction times in healthy young women. J Musculoskelet Neuronal Interact. 2021; 21(1):85-92. PMC: 8020030. View

Emami F, Yoosefinejad A, Motealleh A . Comparison of static and dynamic balance during early follicular and ovulation phases in healthy women, using simple, clinical tests: a cross sectional study. Gynecol Endocrinol. 2018; 35(3):257-260. DOI: 10.1080/09513590.2018.1519788. View

Neugarten J, Acharya A, Lei J, Silbiger S . Selective estrogen receptor modulators suppress mesangial cell collagen synthesis. Am J Physiol Renal Physiol. 2000; 279(2):F309-18. DOI: 10.1152/ajprenal.2000.279.2.F309. View

Elliott K, Cable N, Reilly T, Diver M . Effect of menstrual cycle phase on the concentration of bioavailable 17-beta oestradiol and testosterone and muscle strength. Clin Sci (Lond). 2003; 105(6):663-9. DOI: 10.1042/CS20020360. View

Hewett T, Zazulak B, Myer G . Effects of the menstrual cycle on anterior cruciate ligament injury risk: a systematic review. Am J Sports Med. 2007; 35(4):659-68. DOI: 10.1177/0363546506295699. View

10.

Smith R, Reischl S . Treatment of ankle sprains in young athletes. Am J Sports Med. 1986; 14(6):465-71. DOI: 10.1177/036354658601400606. View

11.

Saeki J, Ikezoe T, Yoshimi S, Nakamura M, Ichihashi N . Menstrual cycle variation and gender difference in muscle stiffness of triceps surae. Clin Biomech (Bristol). 2019; 61:222-226. DOI: 10.1016/j.clinbiomech.2018.12.013. View

12.

Edama M, Ohya T, Maruyama S, Shagawa M, Sekine C, Hirabayashi R . Relationship between Changes in Foot Arch and Sex Differences during the Menstrual Cycle. Int J Environ Res Public Health. 2023; 20(1). PMC: 9819586. DOI: 10.3390/ijerph20010509. View

13.

Hansen M, Miller B, Holm L, Doessing S, Petersen S, Skovgaard D . Effect of administration of oral contraceptives in vivo on collagen synthesis in tendon and muscle connective tissue in young women. J Appl Physiol (1985). 2008; 106(4):1435-43. DOI: 10.1152/japplphysiol.90933.2008. View

14.

Peters J, Trevino S, Renstrom P . Chronic lateral ankle instability. Foot Ankle. 1991; 12(3):182-91. DOI: 10.1177/107110079101200310. View

15.

Burgess K, Pearson S, Onambele G . Menstrual cycle variations in oestradiol and progesterone have no impact on in vivo medial gastrocnemius tendon mechanical properties. Clin Biomech (Bristol). 2009; 24(6):504-9. DOI: 10.1016/j.clinbiomech.2009.03.011. View

16.

Park S, Stefanyshyn D, Ramage B, Hart D, Ronsky J . Alterations in knee joint laxity during the menstrual cycle in healthy women leads to increases in joint loads during selected athletic movements. Am J Sports Med. 2009; 37(6):1169-77. DOI: 10.1177/0363546508330146. View

17.

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View

18.

Arendt E, Agel J, Dick R . Anterior cruciate ligament injury patterns among collegiate men and women. J Athl Train. 2006; 34(2):86-92. PMC: 1322895. View

19.

Ericksen H, Gribble P . Sex differences, hormone fluctuations, ankle stability, and dynamic postural control. J Athl Train. 2012; 47(2):143-8. PMC: 3418125. DOI: 10.4085/1062-6050-47.2.143. View

20.

McNulty K, Elliott-Sale K, Dolan E, Swinton P, Ansdell P, Goodall S . The Effects of Menstrual Cycle Phase on Exercise Performance in Eumenorrheic Women: A Systematic Review and Meta-Analysis. Sports Med. 2020; 50(10):1813-1827. PMC: 7497427. DOI: 10.1007/s40279-020-01319-3. View