Greater Reduction of Balance as a Result of Increased Plantar Fascia Elasticity at Ovulation during the Menstrual Cycle

Abstract

One of the sexual hormones, estrogen, increases elasticity of human connective tissue such as the anterior cruciate ligament during the menstrual cycle in women. In the present investigation, the plantar fascia was investigated to see if there is a difference in elasticity with the menstrual cycle. Fifteen young healthy females in the age range of 18-35 years old with a regular menstrual cycle were tested twice throughout one full menstrual cycle; once during the early follicular phases and once at ovulation. Foot length, while standing on both feet and one foot were used to assess plantar fascia elasticity, ultrasound measured plantar fascia thickness while lying and standing, and posture sway and tremor using a balance platform during 8 different balance tests were assessed to see the impact of elasticity changes. Foot length increased significantly at ovulation compared to menstruation when standing on two feet (p = 0.03) and standing on one foot (p < 0.001). There was also a significant increase in plantar fascia in thinning per kilogram weight applied to the foot at ovulation compared to menstruation (p = 0.014). Associated with this increase in elasticity at ovulation, there was a reduction in balance in the most difficult balance tasks and an increase in tremor during ovulation (p < 0.05). Plantar fascia elasticity change during the menstrual cycle might have effects on posture sway and tremor, which could have a potential risk of falling. Therefore, healthy professionals working with young female adults should recognize these physiological effects.

Differences Between Men and Women in Balance and Tremor in Relation to Plantar Fascia Laxity During the Menstrual Cycle

“…8,18 Greater postural sway during ovulation than in the early follicular phase (menstruation) has been reported. 22 This could be explained by the complex interaction between knee and ankle laxity as noted earlier. Ericksen and Gribble 23 found less ankle stability in women than in men but reported no effects of the menstrual cycle.…”

“…The validity and reliability of this force platform were established in previous studies. 22,30 Four stainless steel bars, each with 4 strain gauges (model FLA-6, 350-17; Tokyo Sokki Kenkyujo Co, Ltd, Tokyo, Japan), were mounted at the 4 corners under the platform. The output of the 4 Wheatstone strain gauge bridges was amplified by a low-level biopotential amplifier (model M35; BIOPAC Systems, Inc, Goleta, CA) and digitized through a 24-bit A/D converter.…”

Increased Postural Sway and Changes in the Neuromuscular Activities of the Ankle Stabilizing Muscles at Ovulation in Healthy Young Women

“…However, only a few studies that provide evidence on ankle stability have been conducted (Hosea et al 2000;Trimble et al 2002;Petrofsky and Lee 2015;Silbernagel et al 2015).…”

Hormone receptor expression in human fascial tissue

“…To detect relaxin receptor 1 (RXFP1) and estrogen receptor-alpha (ERα), dewaxed sections were treated with Tris-EDTA pH 9.0 buffer for 15 min at 95°C, rinsed in water, and then washed in PBS. Isolated cells from fascia were plated (200 cells/mm 2 in 24-multiwells containing a glass coverslip) and allowed to attach for 48 h at 37°C. Cells were then washed in PBS, fixed for 10 min with 2% paraformaldehyde in PBS pH 7.4 and then washed three times in PBS.…”

“…1 demonstrated that type I collagen in the arcus tendineous fasciae pelvis decreased in post-menopausal women, possibly compromising the tissue’s tensile strength and increasing susceptibility to anterior vaginal wall prolapse. Petrofsky and Lee 2 demonstrated plantar fascia elasticity changes during the menstrual cycle, suggesting a possible role of the sexual hormones in increasing the elasticity of human connective tissue. In 1984, a prospective study by Möller-Nielsen and Hammar 3 showed that women soccer players were more susceptible to traumatic injuries during premenstrual and menstrual periods with respect to other periods of their menstrual cycle.…”