Variation in knee joint position sense during different menstrual phases in healthy female basketball athletes – a longitudinal study.

Variation in knee joint position sense during different menstrual phases in healthy female basketball athletes – a longitudinal study.

Introduction

A period, or menstruation, is the shedding of the endometrium - the lining of the uterus. Menstruation is part of normal sexual health for women during reproductive age. Women have a period approximately every 28 days; however, there is some variation in this cycle, ranging from a 24-day to a 35-day cycle. Dr. Puala Hillard,(2016) said: "The menstrual cycle is a window into the general health and well-being of women and not just a reproductive event."

There is evidence that females are more prone for exercise- related musculoskeletal injuries than males. Sex differences in injury rates are apparent in some connective tissues such as ligaments. Although girls and boys have an equal chance of ligament injuries prior to adolescence, girls have a higher rate immediately after maturation (Tursz et al., 1986). Female athletes participating in cutting, jumping and pivoting sports have a 4-6 times greater chance of ACL tearing than their male counterparts (Arendt et al., 1999).Female basketball players are two to eight times more likelyto sustain an ACL tear while playing basketball than are their male counterparts.Long term exposure to highoestrogen levels has been shown to significantly decrease the collagen density of  tissue structures (Lee et al., 2004; Liu et al;1996; Miller et al., 2007)decreasing the stability of the joints which may expose them to risk of injuries of ligaments and other soft tissues because estrogen causes laxity at joints, ligaments.Hormone fluctuations in females have been identified as placing women at higher risks of injuries at certain times during the menstrual cycles as there is affection of joint position sense.Women have been shown to be more likely to injure their ACL during the pre-ovulatory phase of the menstrual cycle (Hewett et al., 2007; Shultz et al., (2010)

When female athletes are part of a  sport like Basketball, in which they cover almost 4000-5000m distance with intense and short lasting movements (Crisafulli et al,2000)such as jumping, pivoting, cutting, sprinting, sudden acceleration(Boon and Bourguis,2013), they are at high risk of getting  injured. In basketball, mostly injured joints are ankle and knee (Moira M. McCarthy, et al, AJSM, 2013). ACL injuries are very common with pivoting and cutting actions(Moira M. McCarthy, et.al, AJSM, 2013)

As per the studies done,the changes in the levels of these hormones have some effects on bones, soft tissues, central nervous system and connective.(Sedat Tolga Aydog˘ Zafer Hasc¸ elik H. Ali Demirel Onur Tetik Ece Aydog˘ Mahmut Nedim Doral, 2002)

Evidence suggest that menstruation can lead to changes in anterior knee laxity, jumping biomechanics, tibial torsion, neuromuscular control of the female athletes (Vivek Balachandar, Jan-Luigi Marciniak, Owen  Wall, Chandrika Balachandar, A systematic review, (2017)Neuromuscular control of the knee is defined as the unconscious response to an afferent signal concerning dynamic knee joint stability. These afferent signals are produced by Proprioception which refers specially to conscious and unconscious appreciation of joint position, kinesthesia (the sensation of joint motion or acceleration) and the perception of force (an ability to estimate joint loads). These signals are transmitted to the spinal cord via afferent (sensory) pathways.as Proprioception is an important part of neuromuscular performance, and can be deï¬ned as the individual’s awareness of his or her extremities’ position and motion in space.Rose Fouladi(2011)found out in his study that accuracy of joint position sense is reduced during menses. Sandra Schultz et al. (2012) , performed similar study which showed that knee joint position sense is affected in ovulatory phase.

Aim

To assess the Variations in knee joints position sense during different menstrual phases in healthy female basketball athletes.

Objectives-

1)     1. To assess static and dynamic (functional) Knee Joint Position Sensein

a.       Early follicular phase.

b.      Ovulatory phase.

c.       Late luteal phase.

2)      2. To compare variationin Knee Joint Position Sense, if any, between these three phases.

MMethodology-

1. Study design- Longitudinal study.

2. Sample size- 50

3SSampling technique- Convenient sampling.

4. Sample population- healthy female basketball athletes.

5. Study set-up- Basketball clubs in Pune.

AsAsessment tools- MB ruler software, Measuring tape,  Smartphone, Digital camera,     Skin markers .

Every participant will be assessed 3 times in a month for 2 concurrent months, with  joint position sense, vertical jump test and hop test. every test would be conducted three times and mean would be considered. data analysis would be done with ANOVA test.