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ORIGINAL COMMUNICATION
Influence of Female Hormones on Fascia
Elasticity: An Elastography Study
MARTIN VITA,
1
ZUZANA SEDLACKOVA ,
1
*MIROSLAV HERMAN,
1
TOMAS FURST,
1
DAVID SMEKAL,
2
AND ZDENEK CECH
3
1
Departments and faculties of Medicine and Dentistry, University Hospital Olomouc, Palacky University
Olomouc, Olomouc, Czech Republic
2
Departments and faculties of Physical Education, Palacky University Olomouc, Olomouc, Czech Republic
3
Second Faculty of Medicine, Department of Rehabilitation and Sports Medicine, Charles University
in Prague, Prague, Czech Republic
The aim of this study was to examine the influence of hormonal changes during
the menstrual cycle on deep fasciae. A total of 29 women, 17 users, and
12 nonusers of hormonal contraceptives were examined clinically and by ultra-
sound, 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
nonusers, and correlated with clinical data. There were statistically significant
differences between users and nonusers of hormonal contraceptives: the
thoracolumbar fascia was thicker in nonusers (P= 0.011), and nonusers had
higher maximal and mean stiffnesses of the fascia lata (P= 0.01 and 0.0095,
respectively). Generally, nonusers had a higher body mass index (BMI). The elas-
ticity 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 nonusers of hormonal contracep-
tives. The results of this pilot study suggest that deep fasciae can be evaluated by
shear wave elastography. Nonusers of contraceptives had greater stiffness of the
fascia lata and higher BMI. Clin. Anat. 32:941–947, 2019. © 2019 Wiley Periodicals, Inc.
Key words: elasticity imaging techniques; estrogens; fascia; fascialata;
lumbar fascia
INTRODUCTION
Fasciae have recently become a topic for discussion
and the subject of an increasing number of publications
(Condino et al., 2015; Fede et al., 2016; Petrofsky and
Lee, 2015; Stecco et al., 2019). International confer-
ences and courses have been dedicated to them
(International Fascia Research Congress and others
listed by Fascia Research Society). Fascial Man-
ipulation
®
, established by Luigi Stecco, focuses primarily
on deep fasciae. This method is justified by the view that
the condition of the deep fasciae projects into posture,
proprioception, and myofascial system pathologies.
Changes in connective tissue elasticity can affect, for
example, hypermobility, which is related to inadequate
joint stabilization and increases the risk of musculoskel-
etal injury (Balko et al., 2014). Several factors can
potentially affect the connective tissue elasticity. Sex
hormones appear to have significant effects in women
(Russek, 1999), the key hormones being estrogen,
*Correspondence to: Zuzana Sedlackova, Departments and facul-
ties of Medicine and Dentistry, University Hospital Olomouc,
Palacky University Olomouc, I. P. Pavlova 6, 775 20 Olomouc,
Czech Republic. E-mail: zuzana.sedlackova@fnol.cz
Received 27 April 2019; Revised 19 June 2019; Accepted 8
July 2019
Published online 25 July 2019 in Wiley Online Library
(wileyonlinelibrary.com). DOI: 10.1002/ca.23428
© 2019 Wiley Periodicals, Inc.
Clinical Anatomy 32:941–947 (2019)