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Influence of Female Hormones on Fascia Elasticity: An Elastography Study
Abstract
Aim:
To examine the influence of hormonal changes during the menstrual cycle on deep fasciae.
Methods:
A total of 29 women, 17 users and 12 non-users of hormonal contraceptives, were examined clinically and by ultrasound, including shear-wave elastography, at two phases of the menstrual cycle. The thickness and elasticity of the fascia lata, thoracolumbar fascia, and plantar fascia were measured, compared between hormonal contraceptive users and non-users, and correlated with clinical data.
Results:
There were statistically significant differences between users and non-users of hormonal contraceptives: the thoracolumbar fascia was thicker in non-users (p = 0.011), and non-users had higher maximal and mean stiffnesses of the fascia lata (p = 0.01 and p = 0.0095, respectively). Generally, non-users had a higher body mass index (BMI). The elasticity of the thoracolumbar and the plantar fasciae did not differ significantly between the groups. We found no correlation between thickness and elasticity in the fasciae. There were no statistically significant differences in hypermobility, cephalgia, or dysmenorrhea between users and non-users of hormonal contraceptives.
Conclusion:
The results of this pilot study suggest that deep fasciae can be evaluated by shear wave elastography. Non-users of contraceptives had greater stiffness of the fascia lata and higher BMI. This article is protected by copyright. All rights reserved.
... Consequently, efforts have been made to computationally predict the kinematics and kinetics of the PA during walking and running using motion capture and biomechanical modeling [11][12][13] . For this, previous studies attempted to capture the mechanical behaviors of the human PA in vitro using a tensile testing machine 14-16 , while recent studies captured the mechanical behaviors of the PA in vivo using ultrasound elasticity imaging [17][18][19][20][21][22][23][24][25][26][27][28][29] . Based on the measured mechanical properties, the PA is modeled as a single or a bundle of linear springs 11,13,30,31 . ...
... Such information on the mechanical properties of the PA contributes to the detailed biomechanical modeling of the human foot, leading to an improved understanding of the mechanical functions of the PA during movements, such as walking, running, and jump landing, and of the pathogenesis of the plantar fasciitis and plantar fibromatosis 23,36 . Our value of PA Young's modulus (SWV = 4.6 m/s) was lower than previously reported (SWV = 5.1-8.6 m/s) [17][18][19][20][21][23][24][25][26][27][28][29] . Although the exact cause of this discrepancy remains unclear, it might be attributable to the difference in the leg posture during measurement. ...
This study aimed to identify the stiffness and natural length of the human plantar aponeurosis (PA) during quiet standing using ultrasound shear wave elastography. The shear wave velocity (SWV) of the PA in young healthy males and females (10 participants each) was measured by placing a probe in a hole in the floor plate. The change in the SWV with the passive dorsiflexion of the metatarsophalangeal (MP) joint was measured. The Young’s modulus of the PA was estimated to be 64.7 ± 9.4 kPa, which exponentially increased with MP joint dorsiflexion. The PA was estimated to have the natural length when the MP joint was plantarflexed by 13.8°, indicating that the PA is stretched by arch compression during standing. However, the present study demonstrated that the estimated stiffness for the natural length in quiet standing was significantly larger than that in the unloaded condition, revealing that the PA during standing is stiffened by elongation and through the possible activation of intrinsic muscles. Such quantitative information possibly contributes to the detailed biomechanical modeling of the human foot, facilitating an improved understanding of the mechanical functions and pathogenetic mechanisms of the PA during movements.
... Moreover, the overweight aggravated by the long-standing in the kitchen or stressful activities rose a severe discomfort. Furthermore, the hormonal changes of their periods in this age group (40-49) years could worsen their suffering [8]. Moreover, morbid obesity is the cause of plantar fasciitis in all age groups. ...
Plantar fasciitis is a common complaint. This paper aimed to find the clinical characteristics of Al-Ramadi Women
who had Plantar fasciitis. A specialist rheumatologist in Al-Ramadi Teaching Hospital collected this prospective
report from 170 Iraqi women, aged (25-70) years, who had plantar fasciitis between 1st January 2019 to 1st January
2020. Our findings showed that the most common affected age was between (40-49) years among all women who
suffered from intense sharp painful heels at the start of walking. There were 66 women (38%) between (40-49)
years plus 32 women (18%) their BMI was between (30-34%). In the commonest age group, there were 37 women
(21.7%) who had Calcaneal spur and five women (0.2%) who had Diabetes Mellitus. Therefore, it can be clearly
said that Plantar Fasciitis is an evidence for obese due to the statistical analysis carried on the middle-aged Iraqi
women who had intense sharp painful heels at the start of walking plus calcaneal spur in the lateral X-ray
... Thickness values for each region are within those reported in the literature, although previous studies show a wide variation (distal range: 1.9e3.4 mm, middle range: 1.6e1.7 mm, proximal: 3.8 mm) (Goh et al., 2003;Gyaran et al., 2011;Khoury et al., 2018;Vita et al., 2019;Wang et al., 2008). The lack of power and small sample size precluded the inclusion of thickness as a covariate. ...
Objectives
To determine whether shear wave velocity (SWV) of the iliotibial band (ITB): i) increases with active and passive static tasks, and a dynamic task, ii) differs between ITB regions, iii) changes after exposure to running. Additionally, it aimed to determine the between-day reliability.
Design
Case series & test-retest.
Setting
Human movement unit laboratory.
Participants
Fifteen runners.
Main outcome measures
SWV was measured unilaterally in three regions of the ITB (proximal, middle and distal), during six tasks: rest and contraction (pre- and post- running), modified Ober test, standing, pelvic drop, and weight shift.
Results
Compared to rest, SWV was higher during contraction and Ober test in the distal and middle regions, and higher for the middle region in standing and pelvic drop. No differences were found between regions. A tendency of decreased SWV was observed after running. Compared to the start of the dynamic task, SWV was greater at the end of the movement. Reliability was moderate-to-good for the middle region in the standing tasks (ICCs=0.68 to 0.84).
Conclusion
SVW of the ITB was higher under passive or active tension. Comparisons between tasks/regions need to be considered in light of the small sample size and poor repeatability of some regions/conditions.
... These findings may explain some clinical differences detected in women of different age groups and why women tend to have different myofascial problems and myofascial pain after menopause [69]. When Vita et al. [70] analyzed the influence of hormonal changes on the deep fasciae during the menstrual cycle using ultrasound technology and shear wave elastography, they found statistically significant differences between the users and nonusers of hormonal contraceptives: the thoracolumbar fascia was thicker in the nonusers (p = 0.011), and the nonusers had higher maximal and mean stiffnesses of the fascia lata (p = 0.01 and 0.0095, respectively). Petrofsky and Lee [71] also demonstrated that plantar fascia elasticity modifications during the menstrual cycle can affect posture sway and tremor and lead to the potential risk of falling. ...
The fascia can be defined as a dynamic highly complex connective tissue network composed of different types of cells embedded in the extracellular matrix and nervous fibers: each component plays a specific role in the fascial system changing and responding to stimuli in different ways. This review intends to discuss the various components of the fascia and their specific roles; this will be carried out in the effort to shed light on the mechanisms by which they affect the entire network and all body systems. A clear understanding of fascial anatomy from a microscopic viewpoint can further elucidate its physiological and pathological characteristics and facilitate the identification of appropriate treatment strategies.
... In previous studies, the difference in age was a potential confounding factor, because aging affects the myofascial muscle tension by reducing the number of muscles fibers and their cross-sectional area 20 . Another potential factor was gender, and an increased in estrogen may lead to sagging of muscles and ligaments and thickening of TLF 21 . Hence, only healthy young men were selected in this study to rule out age-and gender-related problems; thus, the effect of age and gender differences on fascia stiffness cannot be assessed. ...
The objectives of this study were to examine the intra and inter-operator reliability of shear wave elastography (SWE) device in quantifying the shear modulus of thoracolumbar fascia (TLF) and the device’s abilities to examine the shear modulus of the TLF during upper body forward. Twenty healthy male subjects participated in this study (mean age: 18.4 ± 0.7 years). Two independent operators performed the shear modulus of TLF during upper body forward using SWE, and interclass correlation coefficient (ICC) and minimum detectable change (MDC) were calculated. The shear modulus of the TLF was quantified by operator A using SWE at upper body forward 60°. The intra-operator (ICC = 0.860–0.938) and inter-operator (ICC = 0.904–0.944) reliabilities for measuring the shear modulus of the TLF with the upper body forward 0° were rated as both excellent, and the MDC was 4.71 kPa. The TLF shear modulus of upper body forward 60°was increased 45.5% (L3) and 55.0% (L4) than that of upper body forward 0°. The results indicate that the SWE is a dependable tool to quantify the shear modulus of TLF and monitor its dynamic changes. Therefore, this device can be used for biomechanical study and intervention experiments of TLF.
... Significant decrease of stiffness and increase of elasticity in the dominant upper limb in this study may be the result of the state of these tissues "before therapy". It is worth to mention that various studies demonstrated the effect of the menstrual cycle and sex hormones on increasing FT elasticity (Lee and Petrofsky, 2018;Fede et al., 2019;Vita et al., 2019). Therefore, researchers should be aware of these physiological effects in young healthy women, which are mentioned in the limitations of the study. ...
Introduction: There are multiple theories surrounding the physiological impact of structural integration (SI) with little evidence or research corroborating any of these. The aim of the study was to assess the effectiveness of 10 sessions of SI on fascial tissue (FT) superficial blood perfusion, stiffness, and elasticity in 13 healthy women.
Methods: This was a prospective, interventional study. The primary outcome measures were FTs’ superficial blood perfusion, stiffness, and elasticity of bilateral selected FT points on the body. Data were collected before and after 10 sessions of SI intervention. Statistical analysis was performed using the non-parametric Wilcoxon test (intragroup comparison).
Results: The superficial blood perfusion increased significantly in the most selected FT points on the body (p < 0.05). SI interventions produced significant decreases in selected points (brachioradialis, biceps brachii, and trapezius; p < 0.05) of FT stiffness and significant increases in elasticity (brachioradialis, biceps brachii, triceps surae, and trapezius; p < 0.05), especially in the FT of the right (dominant) upper limb.
Conclusion: A 10-session of SI demonstrated positive effects on increasing superficial blood perfusion contributed to a decrease in FT stiffness and an increase in elasticity properties in the dominant upper limb. Data collection for this study is currently underway, and the trial is registered at ISRCTN.com with the identifier: ISRCTN46707309.
Objective:
To determine the reliability of shear-wave elastography (SWE)in assessing the stiffness of the nuchal fascia and the thickness of upper cervical muscles in neutral head posture (NHP) or forward head posture (FHP).
Methods:
Sixteen healthy adults (mean age: 21.69 ± 1.01years, 9 females) were included. SWE mode was chosen to measure the nuchal fascia shear modulus and muscle thickness was measured in B-mode. Measurements were collected by two independent investigators on two different days. The intraclass correlation coefficient (ICC) was used to measure the relative reliability, and the standard error of measurement (SEM) were used to measure the absolute reliability.
Results:
Intra‑rater (ICC = 0.63-0.89) and inter-rater (ICC = 00.54-0.82) reliability for the nuchal fascia shear modulus were moderate to excellent. Intra‑rater (ICC = 00.64-0.96) and inter-rater (ICC = 00.48-0.86) reliability for upper cervical muscles thickness were moderate to excellent. The SEM percentage oscillated from 3.27% to 13.55%. There were significant differences(P < 0.05) between NHP and FHP on nuchal fascia shear modulus, right side splenius capitis muscle thickness and left side semispinalis capitis muscle thickness, but no significant differences(P > 0.05) were observed between the right and left sides. The upper cervical muscles thickness of males was significantly thicker(P < 0.01) than females while no significant differences were observed (P > 0.05) on the nuchal fascia shear modulus.
Conclusions:
Ultrasound-based SWE may be a reliable tool for assessing the stiffness of the nuchal fascia and the thickness of upper cervical muscles in clinical practice.
Registration number:
ChiCTR2200055736.
Rationale and objectives:
Clinicians must precisely pinpoint the etiology of low back pain as the number of people suffering from it increases to provide targeted care. The purpose of this paper was to use MR imaging radiomics based on lumbar soft tissue to analyze changes in the lumbar fascia of patients with low back pain.
Materials and methods:
We retrospectively analyzed the lumbar MRI of 197 patients with low back pain. Patients were randomly assigned to either the training (n = 138) or validation (n = 59) cohorts. Multivariate logistic regression analysis was used to create radiomics model and combined nomogram model and their predictive performance were evaluated using receiver operating characteristic curves.
Results:
Seven radiomics features based on lumbar soft tissue MRI images were established, which performed well in distinguishing between low back pain patients with fascial changes and normal individuals demonstrated an excellent ability to identify differences, with an Area Under Curve (AUC) of 0.92 (95% CI, 0.88-0.96) in the training cohort and 0.84 (95% CI, 0.73-0.96) in the validation cohort, which performed better than the clinical model significantly only.
Conclusion:
The nomogram based on clinical features and radiomics features of MR images had a good predictive ability to differentiate fascial alterations in patients with low back pain from normal subjects. It had the potential to be used as a decision support tool to assist clinicians in determining the etiology of patients with lower back pain and managing patients promptly, particularly in the early stage of the fasciitis when significant abnormalities on imaging were difficult to detect.
Purpose
To assess the efficacy of shear-wave elastography (SWE) of the plantar fascia (PF) in identifying plantar fasciitis.
Methods
A literature search was conducted on the PubMed and Medline databases for articles published up to August 2022. The Newcastle–Ottawa scale was used to assess the risk of bias. We included original research studies in English dealing with the evaluation of patients with plantar fasciitis by means of SWE and including shear modulus (KPa) and/or shear-wave velocity (m/s). We compared healthy and pathologic PF stiffness using the standardised mean difference (SMD) in a random-effects model (95% CI).
Results
Five studies were included with a total of 158 pathologic PFs and 134 healthy PFs. No significant publication bias was detected. Studies were highly heterogeneous ( p < 0.00001; I ² = 97%). Pathologic PFs showed significantly lower stiffness, with an SMD of − 3.00 m/s (95% confidence interval: − 4.95 to − 1.06, p = 0.002), compared to healthy PF.
Conclusion
Pathologic PFs present significantly lower stiffness than healthy PFs. However, the analysed studies are highly heterogeneous.
Ultrasound examination is a broadly available method that can also be used in diagnosing locomotor system disorders. Elastography is one of the more recent ultrasound techniques that is currently most utilized in diagnosing pathologies of the liver, thyroid gland, breast, and prostate. Over the past several years, numerous studies have emerged in which the authors measured the elasticity of the locomotor system tissues. Both functional and structural disorders of the locomotor system are known to often cause changes in tissue stiffness that can vary depending on the current state. These changes could previously be detected only by palpation, which, opposed to elastography, did not provide objective data. There is still a lack of guidelines defining the methodol-ogy of examining particular structures in the locomotor system. Ultrasound elastography could contribute to better understanding of the function of the locomotor system, diagnosis of its pathologies, or the assessment of therapy efficacy, for example in rehabilitation. © 2020, Czech Medical Association J.E. Purkyne. All rights reserved.
Several data indicate that migraine, especially migraine with aura, is associated with an increased risk of ischemic stroke and other vascular events. Of concern is whether the risk of ischemic stroke in migraineurs is magnified by the use of hormonal contraceptives. As migraine prevalence is high in women of reproductive age, it is common to face the issue of migraine and hormonal contraceptive use in clinical practice. In this document, we systematically reviewed data about the association between migraine, ischemic stroke and hormonal contraceptive use. Thereafter a consensus procedure among international experts was done to develop statements to support clinical decision making, in terms of cardiovascular safety, for prescription of hormonal contraceptives to women with migraine. Overall, quality of current evidence regarding the risk of ischemic stroke in migraineurs associated with the use of hormonal contraceptives is low. Available data suggest that combined hormonal contraceptive may further increase the risk of ischemic stroke in those who have migraine, specifically migraine with aura. Thus, our current statements privilege safety and provide several suggestions to try to avoid possible risks. As the quality of available data is poor further research is needed on this topic to increase safe use of hormonal contraceptives in women with migraine.
Background
Women are at substantially greater risk for anterior cruciate ligament (ACL) injuries than are men.
Purpose
To conduct a systematic review and meta-analysis of the literature to clarify the effect of the menstrual cycle and contraceptives on the laxity of and noncontact injuries to the ACL.
Study Design
Systematic review; Level of evidence, 4.
Methods
Searches were conducted using MEDLINE (1946–August 2016), the Cochrane Library Database, clinical trial registries, and related reference lists. Search terms included athletic injuries, knee injuries, ligaments, joint instability, menstrual cycle, ovulation, hormones, and contraceptives. Investigators independently dually abstracted and reviewed study details and quality using predefined criteria and evaluated overall strength of evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria.
Results
Twenty-one studies totaling 68,758 participants were included: 5 on the menstrual cycle and ACL injury, 7 on hormonal contraceptives and ACL injury, as well as 13 on menstrual cycle and ligament laxity. Four of 5 studies of women not using hormonal contraception indicated that the luteal phase was the least associated with ACL injuries. The 2 largest and highest quality studies on hormonal contraceptives suggested that hormonal contraceptives may be protective against ACL injury. Six of 12 studies on ACL laxity provided quantitative data for meta-analysis, finding significantly increased laxity during the ovulatory phase compared with the follicular phase.
Conclusion
The literature suggests an association between hormonal fluctuations and ACL injury. Recent studies have suggested that oral contraceptives may offer up to a 20% reduction in risk of injury. The literature on ACL injuries and the menstrual cycle has more than doubled over the past decade, permitting quantitative analysis for the first time. However, the overall strength of this evidence is low. Promising potential directions for future research include long-term observational studies with ongoing hormonal assays and large interventional trials of follicular suppression, including newer hormonal methods.
Many epidemiologic, clinical, and experimental findings point to sex differences in myofascial pain in view of the fact that adult women tend to have more myofascial problems with respect to men. It is possible that one of the stimuli to sensitization of fascial nociceptors could come from hormonal factors such as estrogen and relaxin, that are involved in extracellular matrix and collagen remodeling and thus contribute to functions of myofascial tissue. Immunohistochemical and molecular investigations (real-time PCR analysis) of relaxin receptor 1 (RXFP1) and estrogen receptor-alpha (ERα) localization were carried out on sample of human fascia collected from 8 volunteers patients during orthopedic surgery (all females, between 42 and 70 yrs, divided into pre- and post-menopausal groups), and in fibroblasts isolated from deep fascia, to examine both protein and RNA expression levels. We can assume that the two sex hormone receptors analyzed are expressed in all the human fascial districts examined and in fascial fibroblasts culture cells, to a lesser degree in the post-menopausal with respect to the pre-menopausal women. Hormone receptor expression was concentrated in the fibroblasts, and RXFP1 was also evident in blood vessels and nerves. Our results are the first demonstrating that the fibroblasts located within different districts of the muscular fasciae express sex hormone receptors and can help to explain the link between hormonal factors and myofascial pain. It is known, in fact, that estrogen and relaxin play a key role in extracellular matrix remodeling by inhibiting fibrosis and inflammatory activities, both important factors affecting fascial stiffness and sensitization of fascial nociceptors.
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.
Ovulatory menstrual cycles are essential for women's fertility and needed to prevent bone loss. There is a medical/cultural expectation that clinically normal menstrual cycles are inevitably ovulatory. Currently within the general population it is unknown the proportion of regular, normal-length menstrual cycles that are ovulatory. Thus, the objective of this study was to determine the population point prevalence of ovulation in premenopausal, normally menstruating women. The null hypothesis was that such cycles are ovulatory.
This is a single-cycle, cross-sectional, population-based study-a sub-study of the HUNT3 health study in the semi-rural county (Nord Trøndelag) in mid-Norway. Participants included >3,700 spontaneously (no hormonal contraception) menstruating women, primarily Caucasian, ages 20-49.9 from that county. Participation rate was 51.9%. All reported the date previous flow started. A single, random serum progesterone level was considered ovulatory if ≥9.54 nmol/L on cycle days 14 to -3 days before usual cycle length (CL).
Ovulation was assessed in 3,168 women mean age 41.7 (interquartile range, [IQR] 36.8 to 45.5), cycle length 28 days (d) (IQR 28 to 28) and body mass index (BMI) 26.3 kg/m2 (95% CI 26.1 to 26.4). Parity was 95.6%, 30% smoked, 61.3% exercised regularly and 18% were obese. 1,545 women with a serum progesterone level on cycle days 14 to -3 were presumed to be in the luteal phase. Of these, 63.3% of women had an ovulatory cycle (n = 978) and 37% (n = 567) were anovulatory. Women with/ without ovulation did not differ in age, BMI, cycle day, menarche age, cigarette use, physical activity, % obesity or self-reported health. There were minimal differences in parity (96.7% vs. 94.5%, P = 0.04) and major differences in progesterone level (24.5 vs. 3.8 nmol/L, P = 0.001).
Anovulation in a random population occurs in over a third of clinically normal menstrual cycles.
Recently, there has been an increasing interest in the role of deep fascia mobility in musculoskeletal dynamics and chronic pain mechanisms; however, no strategies have been presented so far to study in vivo fascial motion in 3D. This paper presents a semiautomatic method, based on ultrasound (US) imaging, enabling a 3D evaluation of fascia mobility.
The proposed approach relies on the acquisition of 3D US datasets at rest and during a voluntary muscular contraction and consists of two phases: 3D US dataset analysis and generation of a displacement vector field using a block matching technique (Phase 1) and validation and filtering of the resulting displacement vector field for outliers removal (Phase 2). The accuracy and effectiveness of the proposed method were preliminarily tested on different 3D US datasets, undergoing either simulated (procedural) or real (muscular contraction) deformations.
As for the simulated deformation, estimated displacement vectors resulting from Phase 1 presented a mean magnitude percentage error of 8.05 % and a mean angular error of [Formula: see text] which, after Phase 2, were reduced by 69.44 and by 83.05 %, respectively. Tests on real deformations further validated the effectiveness of Phase 2 in the removal of outliers from the displacement vector field.
Obtained results preliminarily demonstrate the viability of the proposed algorithm for the analysis of fascia mobility. Such analysis can enable clinicians to better understand the fascia role in musculoskeletal dynamics and disorder. Further experiments are needed to optimize the method in consideration of the anatomical region to be studied.
Eighty-two percent of sexually active women aged 15-44 have used oral contraceptive pills (OCP) in the United States. The OCP, an exogenous source of synthetic forms of steroid hormones, prevents ovulation. Hormone changes during the menstrual cycle (MC) are believed to have an impact on anterior cruciate ligament (ACL) laxity due to estrogen. Because the estrogen receptor β resides on human connective tissue, OCP may have potential impact on tendon and ligament synthesis, structure, and biomechanical properties. Temperature has also been known to have an effect on tissue elasticity. Therefore, the purpose of this study was to investigate the differences in ACL elasticity, force to flex the knee (FFK), and knee flexion-extension hysteresis (KFEH) between OCP users and non-OCP users. To investigate these changes, two different knee temperatures were measured. Nineteen young females were divided into two groups: OCP users and non-OCP users. Blood for estradiol serum concentration (E2) was taken before beginning the tests. ACL elasticity, FFK, and KFEH were assessed both at ambient temperature (22 °C) and after 38 °C warming of the leg to stabilize tissue temperature. Assessments were performed four times during the MC. Throughout the MC, ACL elasticity, FFK, and KFEH fluctuated in non-OCP users, but not in OCP users. At ambient temperature, ACL elasticity was significantly lower and FFK and KFEH were significantly higher in OCP users than non-OCP users (p < 0.05). But, no significant differences in FFK and KFEH between the two groups were found after warming to 38 °C.
Background:
The role played by the thoracolumbar fascia in chronic low back pain (LBP) is poorly understood. The thoracolumbar fascia is composed of dense connective tissue layers separated by layers of loose connective tissue that normally allow the dense layers to glide past one another during trunk motion. The goal of this study was to quantify shear plane motion within the thoracolumbar fascia using ultrasound elasticity imaging in human subjects with and without chronic low back pain (LBP).
Methods:
We tested 121 human subjects, 50 without LBP and 71 with LBP of greater than 12 months duration. In each subject, an ultrasound cine-recording was acquired on the right and left sides of the back during passive trunk flexion using a motorized articulated table with the hinge point of the table at L4-5 and the ultrasound probe located longitudinally 2 cm lateral to the midline at the level of the L2-3 interspace. Tissue displacement within the thoracolumbar fascia was calculated using cross correlation techniques and shear strain was derived from this displacement data. Additional measures included standard range of motion and physical performance evaluations as well as ultrasound measurement of perimuscular connective tissue thickness and echogenicity.
Results:
Thoracolumbar fascia shear strain was reduced in the LBP group compared with the No-LBP group (56.4% ± 3.1% vs. 70.2% ± 3.6% respectively, p < .01). There was no evidence that this difference was sex-specific (group by sex interaction p = .09), although overall, males had significantly lower shear strain than females (p = .02). Significant correlations were found in male subjects between thoracolumbar fascia shear strain and the following variables: perimuscular connective tissue thickness (r = -0.45, p <.001), echogenicity (r = -0.28, p < .05), trunk flexion range of motion (r = 0.36, p < .01), trunk extension range of motion (r = 0.41, p < .01), repeated forward bend task duration (r = -0.54, p < .0001) and repeated sit-to-stand task duration (r = -0.45, p < .001).
Conclusion:
Thoracolumbar fascia shear strain was ~20% lower in human subjects with chronic low back pain. This reduction of shear plane motion may be due to abnormal trunk movement patterns and/or intrinsic connective tissue pathology. There appears to be some sex-related differences in thoracolumbar fascia shear strain that may also play a role in altered connective tissue function.
The female anterior cruciate ligament may be more susceptible to injury than the male anterior cruciate ligament because of the gender-specific expression of receptors for relaxin, a collagenolytic hormone that promotes remodeling of the anterior cruciate ligament.
This study was undertaken to investigate whether collegiate female athletes with elevated serum relaxin concentrations (SRC) sustain anterior cruciate ligament tears at an increased rate compared with those with lower SRC.
Cohort study (prognosis); Level of evidence, 2.
From 2005 to 2010, 143 Division I female athletes from 2 universities participating in sports at high risk for anterior cruciate ligament tears (basketball, lacrosse, field hockey, soccer, gymnastics, and volleyball) were recruited to participate. Questionnaires and urine luteinizing hormone (LH) tests were used to determine participants' anterior cruciate ligament injury and menstrual history and to identify their mid-luteal phase or projected cycle days 21 to 24. Serum samples were obtained for progesterone and relaxin ELISA (enzyme-linked immunosorbent assay) analysis. Participants were monitored for anterior cruciate ligament injury over their 4-year National Collegiate Athletic Association athletic career.
A total of 128 participants completed the study and were eligible for data analysis. The cumulative incidence of complete anterior cruciate ligament tear over the 4-year study period was 21.9%, and varied significantly by sport (P < .001). The mean SRC for athletes with anterior cruciate ligament tears (6.0 ± 8.1 pg/mL) was significantly higher than that for those without anterior cruciate ligament tears (1.8 ± 3.4 pg/mL; P = .013). In subgroup analysis of the 46 athletes who had detectable SRC, the cumulative incidence of anterior cruciate ligament tear was 14 of 46 (30.4%); the mean SRC among athletes with anterior cruciate ligament tears (14 of 46) was 12.1 ± 7.7 pg/mL and without anterior cruciate ligament tears (32 of 46), 5.7 ± 3.6 pg/mL (P = .002). When 6.0 pg/mL was set as the SRC cutoff for screening athletes for risk of anterior cruciate ligament tear in the subgroup with detectable relaxin levels, the test had 71% sensitivity, 69% specificity, 52% positive predictive value, 88% negative predictive value, and a relative risk of 4.4. These values were significant by χ(2) test (P = .003) and receiver operating characteristic analysis (P = .002).
Elite female athletes with anterior cruciate ligament tears have higher SRC than those without tears. Those with an SRC greater than 6.0 pg/mL had over 4 times increased risk for a tear.
Females with higher serum relaxin levels may be at increased risk for anterior cruciate ligament tears. Further investigation of the clinical utility of SRC testing is warranted.
Hypermobility syndrome was recognized as a distinct pathology by Kirk et al in 1967. Since then, the syndrome has been identified by a variety of names: 'hypermobility syndrome (HMS),' 'joint hypermobility syndrome,' 'hypermobile joint syndrome,' and 'benign hypermobile joint syndrome.' Other reports do not recognize this disorder as a syndrome, but refer to the manifestations of joint hyperlaxity, joint hypermobility, or articular hypermobility. In the International Nosology of Heritable Disorders of Connective Tissue, Beighton et al identified this syndrome as 'familial articular hypermobility syndrome.' Beighton et al excluded genetic diseases that include joint hypermobility as an associated finding, such as Ehlers- Danlos syndrome, osteogenesis imperfecta, and Marfan syndrome. Despite the proliferation of names, HMS has been given relatively little attention in the literature. Most reports are in the rheumatology literature, with virtually none in the orthopedic or physical therapy literature. This lack of reports may be due to several reasons. First, individuals with HMS are often seen by orthopedic physicians and physical therapists as a result of an acute or chronic disorder, which may be treated without the health care provider acknowledging the underlying HMS. Second, the diagnostic criteria for HMS are not well-defined and have not been consistent among research reports. In particular, patients with HMS lack laboratory or radiological findings that could identify HMS, unlike many other rheumatologic or orthopedic conditions. The diagnosis, therefore, is frequently made through exclusion of other disorders. Third, individuals with HMS often do not have the decreased mobility seen with many chronic conditions, nor do they always have the inflammation seen with many acute conditions. Finally, because HMS lacks a definitive pharmacological or surgical treatment, physicians may have perceived little benefit in its diagnosis.
Although plantar fascial thickening is a sonographic criterion for the diagnosis of plantar fasciitis, the effect of local loading and structural factors on fascial morphology are unknown. The purposes of this study were to compare sonographic measures of fascial thickness and radiographic measures of arch shape and regional loading of the foot during gait in individuals with and without unilateral plantar fasciitis and to investigate potential relationships between these loading and structural factors and the morphology of the plantar fascia in individuals with and without heel pain.
The participants were 10 subjects with unilateral plantar fasciitis and 10 matched asymptomatic controls.
Heel pain on weight bearing was measured by a visual analog scale. Fascial thickness and static arch angle were determined from bilateral sagittal sonograms and weight-bearing lateral foot roentgenograms. Regional plantar loading was estimated from a pressure plate.
On average, the plantar fascia of the symptomatic limb was thicker than the plantar fascia of the asymptomatic limb (6.1+/-1.4 mm versus 4.2+/-0.5 mm), which, in turn, was thicker than the fascia of the matched control limbs (3.4+/-0.5 mm and 3.5+/-0.6 mm). Pain was correlated with fascial thickness, arch angle, and midfoot loading in the symptomatic foot. Fascial thickness, in turn, was positively correlated with arch angle in symptomatic and asymptomatic feet and with peak regional loading of the midfoot in the symptomatic limb.
The findings indicate that fascial thickness and pain in plantar fasciitis are associated with the regional loading and static shape of the arch.
Increased knowledge of the rich innervation of the deep fascia and its anatomical organization indicates the need to re‐evaluate maps of the dermatome according to the new findings. The authors present a distinction between dermatome and fasciatome, basing their approach to the literature on nerve root stimulation and comparing dermatomeric and myomeric maps. The former represents the portion of tissue composed of skin, hypodermis, and superficial fascia supplied by all the cutaneous branches of an individual spinal nerve; the latter includes the portion of deep fascia supplied by the same nerve root and organized according to force lines to emphasize the main directions of movement. The dermatome is important for esteroception, whereas the fasciatome is important for proprioception. If they are altered, the dermatome shows clearly‐localized pain and the fasciatome irradiating pain according to the organization of the fascial anatomy.
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Case scenario: Ana: Anastasia (Ana), a 22-year-old editor for a publishing company, attends a community sexual health service for advice regarding virtually constant vaginal bleeding for the previous 6 months in association with the use of hormonal contraception. This started when she was first prescribed hormonal contraception – initially a progestogen-only pill and then a combined oral contraceptive pill. She has no other symptoms. She is currently using condoms for contraception, although a recent condom accident has highlighted that this is not a reliable method. She is in her first sexual relationship and finds the constant bleeding annoying and embarrassing. Ana's aunt died from cervical cancer in her early 30s and this has increased her anxiety regarding the vaginal bleeding she is experiencing. This chapter will focus on the non-oral combined hormonal contraceptive options, including the patch and more specifically the vaginal ring, which are underused in the UK and Australia. These options are widely used in many European countries and the USA. 1. Which investigations should be undertaken in women complaining of unscheduled (breakthrough) bleeding? 2. The challenge of facilitating a contraceptive choice consultation with a woman who has had a bad experience, which may have resulted in a negative perception of hormonal contraception. She may be unaware that there remain many choices available to her, even within the method categories, which she has already tried, e.g., the progestogen-only pill (POP) and the combined oral contraceptive pill (COC). 3. The opportunity provided in routine consultations to discuss benefits and risks of hormonal contraception. 4. Unplanned pregnancy and abortion are significant in women between the ages of 20 and 24.
The purpose of this study was to conduct a systematic review regarding the purported differences in anterior cruciate ligament (ACL) laxity throughout the course of the menstrual cycle.
A systematic review was performed by searching electronic databases, along with hand-searching of journals and reference tracking for any study that assessed ACL integrity throughout the menstrual cycle from 1998 until 2011. Studies that met the pre-defined inclusion criteria were evaluated using the Modified Sackett Score (MSS) instrument that assessed their methodological quality.
Thirteen articles out of a possible 28 met the inclusion criteria.
This systematic review found 13 clinical trials investigating the effect of the menstrual cycle on ACL laxity. There is evidence to support the hypothesis that the ACL changes throughout the menstrual cycle, with it becoming more lax during the pre-ovulatory (luteal) phase. Overall, these reviews found statistically significant differences for variation in ACL laxity and injury throughout the menstrual cycle, especially during the pre-ovulatory phase. Female athletes may need to take precautions in order to reduce the likelihood of ACL injury. However, the quality of the assessments was low and the evidence is still very limited. More and better quality research is needed in this area.
1. vyd. Nad názvem: Univerzita Palackého v Olomouci, Fakulta tělesné kultury Určeno pro studenty a pracovníky v oblasti funkční antropologie a fyzioterapie
Oral contraceptive use and menstrual cycle phase are suggested to influence the risk of anterior cruciate ligament (ACL) injuries in female athletes. However, only few data are available for recreational sports. Therefore, female recreational skiers with a non-contact ACL injury and age-matched controls completed a self-reported questionnaire relating to menstrual history, oral contraceptive use and previous knee injuries. Menstrual history data were used to group subjects into either preovulatory or postovulatory phases of menstrual cycle. Our findings suggest that oral contraceptive use did not show any protective effect against ACL injuries nor did self-reported previous knee injuries show any association with ACL injury rate in recreational alpine skiing. Analysis of menstrual history data revealed that recreational skiers in the preovulatory phase were significantly more likely to sustain an ACL injury than were skiers in the postovulatory phase.
Injury to the anterior cruciate ligament (ACL) often requires surgery and extensive rehabilitation. Women who participate in collegiate sports and military drills are more likely to injure their ACL than are men participating in similar activities. The influence of the normal fluctuation of sex hormones on the physical properties of the ACL is one potential cause for this disparity. The purpose of this study was to report the correlation between estradiol, estrone, estriol, progesterone, and sex hormone binding globulin (SHBG) and ACL stiffness during three phases of the menstrual cycle in normally cycling, healthy females.
We tested ACL stiffness and collected blood from 20 female subjects who were not using oral contraception during three phases of their menstrual cycle. Ligament stiffness was tested with the KT-2000 trade mark knee arthrometer (MEDmetric, San Diego, CA). Concentrations of estradiol and SHBG were assessed via radioimmunoassay (RIA). Progesterone, estriol, and estrone concentrations were determined via enzyme-linked immunoassay.
Spearman rank correlation analysis indicated a significant correlation between estradiol concentration and ACL stiffness (-0.70, p < 0.001) and estrone concentration and ACL stiffness near ovulation (0.46, p = 0.040). With the effects of the other variables controlled, there was a significant partial correlation between estradiol (-0.80, p < 0.001), estriol (0.70, p = 0.003), and progesterone (0.66, p = 0.005) and ACL stiffness near ovulation.
Our results indicate that there is a significant correlation between estradiol, estriol, and progesterone and ACL stiffness suggesting that fluctuating levels of sex hormones may influence the stiffness of the ACL near ovulation. Future studies that examine the relationship between sex hormones and the physical properties of the ACL should be focused near the ovulation phase of the menstrual cycle.
The high risk of anterior cruciate ligament (ACL) injuries in female athletes may be related to hormonal fluctuations resulting in an increased laxity of ligaments and muscles. This study examined changes in lower limb musculotendinous stiffness (MTS) and knee laxity over the course of the menstrual cycle and investigated the interaction of warm-up on MTS. Eleven female netball players aged 16-18 years who were not using hormonal contraceptives and demonstrated regular menstrual cycles participated in this study. Test-sessions were conducted at onset of menses, mid-follicular phase, ovulation and mid-luteal phase. ACL laxity was determined at each test-session using a KT2000 knee arthrometer. MTS was assessed prior to, and following a standardised warm-up. Repeated measures ANOVA revealed significant (P < 0.05) main effects of test-session and warm-up on MTS. MTS was found to significantly decrease by 4.2% following the warm-up intervention. MTS was significantly lower at week 3 (ovulatory phase) in contrast to weeks 1 and 2 (8.7 and 4.5%, respectively). For knee laxity measures, repeated measures ANOVA revealed no significant (P < 0.05) differences across the menstrual cycle. A reduction in MTS results in greater reliance on reflexive response from the contractile components of the muscle due to a decreased contribution from passive elastic structures and will also increase electromechanical delay. Given that extreme loads are applied to the knee joint within milliseconds, the contractile components cannot respond quickly enough to counteract these sudden and potentially damaging forces. These effects are augmented following a moderate warm-up. Oestrogen fluctuations had no significant effect on anterior knee laxity, however, the effects on MTS over the 28-day cycle were considerable. Future studies should use matched subjects who are using the monophasic oral contraceptive pill to investigate the effects of oestrogen supplementation on lower limb MTS.
Hypermobile joints by definition display a range of movement that is considered excessive, taking into consideration the age, gender and ethnic background of the individual. Joint hypermobility, when associated with symptoms is termed the joint hypermobility syndrome or hypermobility syndrome (JHS). JHS is an under recognised and poorly managed multi-systemic, hereditary connective tissue disorder, often resulting in a great deal of pain and suffering. The condition is more prevalent in females, with symptoms frequently commencing in childhood and continuing on into adult life. This paper provides an overview of JHS and suggested clinical guidelines for both the identification and management of the condition, based on research evidence and clinical experience. The Brighton Criteria and a simple 5-point questionnaire developed by Hakim and Grahame, are both valid tools that can be used clinically and for research to identify the condition. Management of JHS frequently includes; education and lifestyle advice, behaviour modification, manual therapy, taping and bracing, electrotherapy, exercise prescription, functional rehabilitation and collaborative working with a range of medical, health and fitness professionals. Progress is often slow and hampered by physical and emotional setbacks. However with a carefully considered management strategy, amelioration of symptoms and independent functional fitness can be achieved.
Ultrazvukováelastografie a jejívyužití v oblastihlavy a krku
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