Injury Incidence Across the Menstrual Cycle in International Footballers

Abstract

Objectives: This study aimed to assess how menstrual cycle phase and extended menstrual cycle length influence the incidence of injuries in international footballers.Methods: Over a 4-year period, injuries from England international footballers at training camps or matches were recorded, alongside self-reported information on menstrual cycle characteristics at the point of injury. Injuries in eumenorrheic players were categorized into early follicular, late follicular, or luteal phase. Frequencies were also compared between injuries recorded during the typical cycle and those that occurred after the cycle would be expected to have finished. Injury incidence rates (per 1,000 person days) and injury incidence rate ratios were calculated for each phase for all injuries and injuries stratified by type.Results: One hundred fifty-six injuries from 113 players were eligible for analysis. Injury incidence rates per 1,000 person-days were 31.9 in the follicular, 46.8 in the late follicular, and 35.4 in the luteal phase, resulting in injury incidence rate ratios of 1.47 (Late follicular:Follicular), 1.11 (Luteal:Follicular), and 0.76 (Luteal:Late follicular). Injury incident rate ratios showed that muscle and tendon injury rates were 88% greater in the late follicular phase compared to the follicular phase, with muscle rupture/tear/strain/cramps and tendon injuries/ruptures occurring over twice as often during the late follicular phase compared to other phases 20% of injuries were reported as occurring when athletes were “overdue” menses.Conclusion: Muscle and tendon injuries occurred almost twice as often in the late follicular phase compared to the early follicular or luteal phase. Injury risk may be elevated in typically eumenorrheic women in the days after their next menstruation was expected to start.

Relationship between Muscle Flexibility and Characteristics of Muscle Contraction in Healthy Women during Different Menstrual Phases

“…It has been shown that the occurrence of musculoskeletal injuries differs according to the menstrual cycle [3][4][5][6]45,46) . Furthermore, it has been reported that the risk of ACL injury in women changes with the menstrual cycle 18,47,48) .…”

Players', head coaches and medical personnel knowledge, understandings and perceptions of injury and injury prevention in elite-level women’s football in Ireland.

“…Despite limited evidence to support their view [35,36], half of the study participants believed the hormonal changes associated with the menstrual cycle were a risk factor for injury. There is some preliminary evidence suggesting that the incidence rate and type of injuries may vary across the eumenorrheic menstrual cycle [35], and that symptoms associated with the menstrual cycle affect athletes' training and competition availability [37] but robust studies con rming the relationship between menstrual cycle phase and injury occurrence do not exist currently.…”

Factors influencing performance and injury risk in elite female Gaelic team sport players and future research directions: a narrative review

“…The effect of estrogen has been suggested as a possible injury mechanism for ACLs in female athletes [122], however there is a lack of agreement regarding the influence of sex hormones on ACL injury rates. It has been reported that female soccer players had an increased incident rate during the luteal phase of the MC [123] Martin et al [124] reported that injury rates were 47% and 32% greater in the late follicular phase in comparison to the early follicular and luteal phase. However, caution is needed in the interpretation of these studies as the methodological process (small sample size), ecological validity and terminology (phase definition and confirmation) may have affected the interpretation of the original results.…”