Menstrual cycles and increased injury risk?

Coffee chat takes a tangent!
 We have a weekly Friday team coffee as a quick catch up which normally involves your usual pre weekend chat, however sometimes the physio geek part in us comes out.
Last week it wasn't your usual work coffee chat, we started chatting about some research into menstrual cycles and the effects on female athletes- specifically for ACL knee ligament ruptures and strength gains.

So I thought we'd do a little summary about it below:

Hopefully you find it interesting and maybe even spread the word as the more people talk about this, the more it may help with general understanding and education on how the female body works when exercising.

Menstrual cycles and increased injury risk?

It's still very early stages in the research around this however there seems to be growing potential to monitor menstrual cycles to help identify periods (excuse the pun) of increased injury risk and adjust training accordingly.

The research hints at a correlation between hormone fluctuations throughout the menstrual cycle and the risk of ACL ruptures, particularly during the ovulatory phase when estrogen levels peak.

Why Estrogen?
Estrogen is primarily linked to the female reproductive system, but seems to influence ligament laxity, potentially making the ACL more vulnerable to injury during certain menstrual phases.

Apart from the obvious, why is it a specific concern for female athletes- especially knee ACL's?

Female athletes face a significantly higher risk of ACL rupture, with rates 4-8 times greater than men.

Particularly alarming is the fact that young female athletes, aged 15-19, are most prone to ACL injuries and ACL injury rates are on the rise.

While research points towards a connection between menstrual cycles and ACL injuries (with up to 75% of ACL ruptures in females occurring within the first two weeks of the menstrual cycle!), unraveling all the factors is tricky as you also need to add in biomechanical differences (bone and muscle shape and size), neuromuscular control (sometimes lacking in young female athletes), and individual variability all play significant roles in injury risk.

Fortunately, up to 70% of non-contact ACL injuries can be prevented through targeted injury prevention programs (such as the fifa 11+).

The greatest impact of these programs is often observed among athletes aged 14-18, given that this age group typically exhibits poorer strength, power, and movement control.

To effectively prevent ACL injuries, a comprehensive prevention program needs to be consistent and involve exercises that focus on balance, strength, agility, and plyometrics, alongside sport-specific skills and drills

Beginning the program in the pre-season allows athletes to reap the full benefits (which may take up to six weeks to materialize) and should commence early, with exercises incorporated into training routines from as young as 11-12 years of age, considering that the peak rate of female ACL rupture occurs in the mid-teens.

By implementing these proactive measures, maybe we can help prevent some of these serious injuries?

Are sports teams doing anything about it?

Teams are starting to incorporate some strategies around this, but there is still a long way to go.

Hopefully through more understanding and education teams (junior through to elite) will be able to tailor training programs to accommodate the menstrual cycle to maximize performance, minimize the risk of injury, and promote overall well-being among their teammates.

Some approaches to consider:

Communication and Support: Creating an open dialogue between coaches and athletes about menstrual health can only create a more supportive environment where athletes feel comfortable discussing any challenges they may face during different phases of their menstrual cycles. This communication may enable coaches/parents to provide personalized support and make adjustments as needed.

Understanding the Menstrual Cycle: Coaches/parents and athletes educate themselves about the phases of the menstrual cycle as each phase is associated with hormonal fluctuations that can affect energy levels, strength, and endurance.

Customized Training Plans: Athletes track their menstrual cycles to identify patterns in energy levels, mood, and physical symptoms. Based on this information, coaches can adjust training intensity, volume, and types of exercises to align with the physiological changes throughout the menstrual cycle.

Periodization: Coaches implement a periodized training approach that takes into account the fluctuations in hormone levels and adjusts the training load accordingly. For example, during the follicular phase when estrogen levels rise, athletes may focus on building strength and endurance. In contrast, during the luteal phase when progesterone levels increase, emphasis may be placed on recovery and lower-intensity workouts.

Nutritional Support: Coaches and nutritionists work together to develop dietary strategies that address the nutritional needs of athletes at different stages of the menstrual cycle, such as increasing iron intake during menstruation to compensate for blood loss.

Recovery and Rest: Recognizing the importance of rest and recovery, coaches encourage athletes to prioritize sleep and stress management techniques throughout the menstrual cycle. Adequate rest helps optimize recovery and performance while reducing the risk of overtraining and injury.

Where it can get complicated ( a couple of sticking points).....

1. engaging with young females athletes who may not want or be ready to understand/talk about this with there parents, let alone their coaches.
2. Injury fear around their cycle and the associated anxiety that they may then take into their game/performance......

As I said, it's still in early phase of research/knowledge and plenty of work to do and things to think about!

Meet Jen, our Pelvic health physio guru

Incase you haven't met her, here’s a little bit about Jen:

Jen has worked both in Auckland and London in the musculoskeletal and sports physio sphere, including a couple of seasons with Superleague Netball in the UK and travelling with NZ Athletics to Oceania's 2022. She has also started to specialise in pelvic health, and you'll find her talking about bladders, bowels, and the lack of pre/postnatal education without too much encouragement.

She's always been keen on sports, but more of a social all-rounder than a master of any one. You're most likely to find her involved if there's a cold drink after the final whistle.

She has a particular passion for treating the individual - finding out what makes people tick, and getting to the root of the issue to get them back to their best. 

Jen is always empathetic, ready for a laugh, and eager to push you to improve.