Do Relaxin Levels Impact Hip Injury Incidence in Women? A Scoping Review

Parker, Emily Anne; Meyer, Alex M; Goetz, Jessica E.; Willey, Michael; Westermann, Robert W.

doi:10.3389/fendo.2022.827512

Cited by 8 publications

(4 citation statements)

References 77 publications

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“…Although the baseline serum level of relaxin is similar in both sexes, relaxin receptors are only found in the female ACL, putting female athletes at an increased risk of ACL rupture during the time of peak serum levels of relaxin, between days 21 and 24 of the cycle. 7 A higher average serum level of relaxin has been identified in elite female athletes with ACL ruptures compared with those without ruptures. Hence, it can be speculated that an increased serum level of relaxin is a risk factor for sustaining an ACL injury.…”

Section: Endogenous Hormones and The Anterior Cruciate Ligamentmentioning

confidence: 98%

The impact of the menstrual cycle on orthopaedic sports injuries in female athletes

Raj,

Fontalis,

Grandhi

et al. 2023

Bone Joint J

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There is a disparity in sport-related injuries between sexes, with females sustaining non-contact musculoskeletal injuries at a higher rate. Anterior cruciate ligament ruptures are between two and eight times more common than in males, and females also have a higher incidence of ankle sprains, patellofemoral pain, and bone stress injuries. The sequelae of such injuries can be devastating to an athlete, resulting in time out of sport, surgery, and the early onset of osteoarthritis. It is important to identify the causes of this disparity and introduce prevention programmes to reduce the incidence of these injuries. A natural difference reflects the effect of reproductive hormones in females, which have receptors in certain musculoskeletal tissues. Relaxin increases ligamentous laxity. Oestrogen decreases the synthesis of collagen and progesterone does the opposite. Insufficient diet and intensive training can lead to menstrual irregularities, which are common in female athletes and result in injury, whereas oral contraception may have a protective effect against certain injuries. It is important for coaches, physiotherapists, nutritionists, doctors, and athletes to be aware of these issues and to implement preventive measures. This annotation explores the relationship between the menstrual cycle and orthopaedic sports injuries in pre-menopausal females, and proposes recommendations to mitigate the risk of sustaining these injuries.Cite this article: Bone Joint J 2023;105-B(7):723–728.

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Section: Endogenous Hormones and The Anterior Cruciate Ligamentmentioning

confidence: 98%

The impact of the menstrual cycle on orthopaedic sports injuries in female athletes

Raj,

Fontalis,

Grandhi

et al. 2023

Bone Joint J

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“… 17 It has also been suggested that hormonal fluctuations in other hormones, such as relaxin, may increase the risk of ACL rupture. 17 , 23 The ACL of female patients has been shown to have concentrations of relaxin receptors, and the levels of relaxin have been shown to peak during the luteal phase of the menstrual cycle. This may increase laxity in the ACL and increase the risk of rupture.…”

Section: Introductionmentioning

confidence: 99%

Anterior cruciate ligament injuries in female athletes: risk factors and strategies for prevention

Mancino,

Kayani,

Gabr

et al. 2024

Bone Jt Open

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Anterior cruciate ligament (ACL) injuries are among the most common and debilitating knee injuries in professional athletes with an incidence in females up to eight-times higher than their male counterparts. ACL injuries can be career-threatening and are associated with increased risk of developing knee osteoarthritis in future life. The increased risk of ACL injury in females has been attributed to various anatomical, developmental, neuromuscular, and hormonal factors. Anatomical and hormonal factors have been identified and investigated as significant contributors including osseous anatomy, ligament laxity, and hamstring muscular recruitment. Postural stability and impact absorption are associated with the stabilizing effort and stress on the ACL during sport activity, increasing the risk of noncontact pivot injury. Female patients have smaller diameter hamstring autografts than males, which may predispose to increased risk of re-rupture following ACL reconstruction and to an increased risk of chondral and meniscal injuries. The addition of an extra-articular tenodesis can reduce the risk of failure; therefore, it should routinely be considered in young elite athletes. Prevention programs target key aspects of training including plyometrics, strengthening, balance, endurance and stability, and neuromuscular training, reducing the risk of ACL injuries in female athletes by up to 90%. Sex disparities in access to training facilities may also play an important role in the risk of ACL injuries between males and females. Similarly, football boots, pitches quality, and football size and weight should be considered and tailored around females’ characteristics. Finally, high levels of personal and sport-related stress have been shown to increase the risk of ACL injury which may be related to alterations in attention and coordination, together with increased muscular tension, and compromise the return to sport after ACL injury. Further investigations are still necessary to better understand and address the risk factors involved in ACL injuries in female athletes.Cite this article: Bone Jt Open 2024;5(2):94–100.

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“…Whilst some studies find greater joint laxity in the ovulatory phase compared to the other two phases [10][11][12], other studies have found no impact of MCP on tendon biomechanical properties [13,14], tendon fibril characteristics, or collagen cross-linking (8). A recent scoping review also describes that not only are menstrual cycle peaks of relaxin associated with matrix metalloproteinases (MMPs) activation and, hence, local collagen and gelatine degradation, but also, women have relaxin receptors in multiple joints, such that high relaxin levels correlate with greater joint laxity and a higher incidence of musculoskeletal injuries [15]. The inconsistency in findings between studies might result from varying measurement methods (e.g., validity of criterion outcome such as referring to tendon stiffness when joint laxity was assessed, measurement of serum vs. saliva hormone levels) and the timing of measurements (i.e., relative to menstrual cycle phase duration, which phases of the menstrual cycle have been contrasted, or whether sufficient delay has been allowed for any measurable hormonal impact).…”

Section: Introductionmentioning

confidence: 99%

Musculoskeletal Morphology and Joint Flexibility-Associated Functional Characteristics across Three Time Points during the Menstrual Cycle in Female Contemporary Dancers

Pessali-Marques,

Burden,

Morse

et al. 2024

JFMK

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Findings are inconsistent with regards to whether menstrual cycle phase-associated changes in physical functioning exist. It is possible that such discrepancies are due to varying rigour in experimental approaches. The current study aimed to systematically evaluate any effect of carefully tracked menstrual cycle phase on precisely measured muscle structure and function in a physically active group (contemporary dancers). Eleven women aged (M [SD]) 23.5 [2.94] years, undergoing 10.5 [1.73] hours of contemporary dance practice and 6.12 [2.36] hours of other physical activity per week, were recruited. Sex hormone level (enzyme-linked immunosorbent assays (ELISA), skin temperature and ovulation kits), physical pain assessments (Ice Water Test, Visual Analogue Scale, The Physical Activity Readiness Questionnaire, Self-Estimated Functional Inability Because of Pain Questionnaire, and Pain Anxiety Symptoms Scale), muscle architecture measurement (B-mode ultrasonography), and physical functioning (dynamometry, force-platform and electromyography) on both lower limbs were measured at three time points during one cycle, following three months of menstrual cycle monitoring. There was no difference in musculoskeletal flexibility variables between follicular, ovulatory, or luteal phases. Nonetheless, oestrogen change was associated with variability in 11 musculoskeletal variables, progesterone change was associated with variability in 7, and relaxin change was associated with variability in 15. Negative correlations existed between progesterone and flexibility and between oestrogen and jump variables. Moreover, oestrogen and relaxin were associated with increased musculoskeletal compliance, whilst progesterone was associated with increased muscle stiffness. In short, in absolute sex hormone levels, ‘inter-individual’ variances appear more impactful than ‘intra-individual’ variances. Not only are oestrogen and progesterone associated with differing musculoskeletal outcomes, but relaxin is also associated with musculoskeletal compliance changes. These effects are anticipated to impact jump height and flexibility, and hence, they could be expected to affect overall physical performance, including dance.

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Do Relaxin Levels Impact Hip Injury Incidence in Women? A Scoping Review

Cited by 8 publications

References 77 publications

The impact of the menstrual cycle on orthopaedic sports injuries in female athletes

The impact of the menstrual cycle on orthopaedic sports injuries in female athletes

Anterior cruciate ligament injuries in female athletes: risk factors and strategies for prevention

Musculoskeletal Morphology and Joint Flexibility-Associated Functional Characteristics across Three Time Points during the Menstrual Cycle in Female Contemporary Dancers

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