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Comparing Effectiveness of Myofascial Release and Muscle Stretching on Pain, Disability and Cervical Range of Motion in Patients with Trapezius Myofascial Trigger Points

Authors:
  • Gurugram University
  • Delhi Pharmaceutical sciences and research university

Abstract and Figures

Myofascial Release and Muscle stretching are the two technique used in the treatment of active Myofascial trigger points of a muscle. There is limited evidence for the comparison of Myofascial Release and Muscle stretching in the treatment of active trigger points of Trapezius muscle. The purpose of the study was to compare the effect of Myofascial Release and Muscle stretching on pain, disability and cervical range of motion in patients with trapezius Myofascial trigger points.Total numbers of thirty two patients were randomly assigned to receive either Myofascial Release or Muscle stretching along with hot pack for 3 times/week for 2 weeks. Pain, neck disability index and range of motion were taken at baseline, 1week, 2 week and follow up (after 1 week) in both the groups. Data analysis was performed using SPSS software 12 version. In both the group significant improvement occurred in VAS score, ROM, and Neck disability index. Between groups analysis revealed that improvement in VAS score and Neck disability index was more in Group A than Group B. There was no significant difference found in ROM in between groups analysis. Myofascial Release is a better treatment technique compared to Ultrasound in the treatment of active Myofascial trigger point.
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S301
© 2024 Medical Journal of Dr. D.Y. Patil Vidyapeeth | Published by Wolters Kluwer - Medknow
Introduction: The MC’s phases have been shown to inuence various physiological
and psychological aspects, yet their potential impact on physical performance and
psychological well‑being remains less explored. This research study investigates
the intricate interplay between functional capacity, fatiguability, anxiety level,
and static and dynamic balance in young adult females across the MC’s early
follicular and mid‑luteal phases. Materials and Methods: A cross‑sectional
study where 46 healthy eumenorrheic females aged 19–24 years were recruited.
Participants underwent various tests (six‑minute walk test (6MWT), single leg
stance test, and lower quarter Y balance test) and scales (Zung self‑rating anxiety
scale and fatigue severity scale (FSS)) during both the follicular and luteal phases
in a single menstrual cycle (MC). Results: Preliminary ndings suggest that
functional capacity, fatiguability, anxiety levels, and static and dynamic balance
show statistically signicant dierences (P < 0.01), exhibiting improvement
in the mid‑luteal phase as compared to the early follicular phase. A signicant
negative correlation exists between FSS score and 6MWT distance in the early
follicular (r = ‑0.441, P < 0.001) and mid‑luteal phase (r = ‑0.439, P < 0.01).
There is a signicant positive correlation between FSS score and SAS score
during the early follicular (r = 0.479, P < 0.001) and mid‑luteal phase (r = 0.496,
P < 0.01). Conclusion: The relationship between these parameters during the MC
holds implications for optimizing training regimens, injury prevention strategies,
and psychological support tailored to the unique needs of female athletes and
active individuals.
 Anxiety, dynamic balance, fatigue, follicular phase, functional
capacity, luteal phase, menstrual cycle, static balance
Relationship between Functional Capacity, Fatiguability, Anxiety Level,
Static, and Dynamic Balance in Young Adult Females During Follicular
and Luteal Phase of Menstrual Cycle
Gauri Sharma, Neha Kumari, Richa H. Rai, Sheetal Kalra, Kashika Bhatia, Tabassum Saher
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DOI:
10.4103/mjdrdypu.mjdrdypu_680_23
Address for correspondence: Prof. Richa H. Rai,
School of Physiotherapy, Delhi Pharmaceutical Sciences and
Research University, Delhi, India.
E‑mail: richarai@dpsru.edu.in
be attributed to a range of factors, including anatomical,
physiological, endocrinological, and psychological
elements. Among these, the menstrual cycle (MC)
holds particular prominence in understanding these
distinctions.
There is a dierence in physical health and health
tness status of females during dierent phases of
Original Article

The participation of women in various sports
activities, whether at amateur or professional levels,
has witnessed an increase. According to the International
Olympic Committee (2023), women’s participation in
sports has grown over the years from just over 13%
at the 1964 Games in Tokyo to more than 48% female
athletes at 2020 Games in Tokyo. As the involvement of
women in sports continues to grow, the exploration of
gender‑related distinctions in exercise performance and
progression has gained signicance. Dierences in the
physical performances of male and female athletes can
School of Physiotherapy,
Delhi Pharmaceutical
Sciences and Research
University, Delhi, India

How to cite this article: Sharma G, Kumari N, Rai RH, Kalra S, Bhatia K, Saher T.
Relationship between functional capacity, fatiguability, anxiety level, static,
and dynamic balance in young adult females during follicular and luteal phase
of menstrual cycle. Med J DY Patil Vidyapeeth 2024;17:S301-7.
This is an open access journal, and arcles are distributed under the terms of the Creave
Commons Aribuon‑NonCommercial‑ShareAlike 4.0 License, which allows others to
remix, tweak, and build upon the work non‑commercially, as long as appropriate credit is
given and the new creaons are licensed under the idencal terms.
For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com
Submission: 21‑08‑2023,
Decision: 29‑12‑2023,
Acceptance: 01‑01‑2024,
Web Publication: 27‑11‑2024
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Sharma, et al.: Functional capacity, fatigability, anxiety and balance during phases of menstrual cycle
S302 Medical Journal of Dr. D.Y. Patil Vidyapeeth ¦ Volume 17 ¦ Supplement 2 ¦ November 2024
MC. Because of the inuence of distinct hormones
across various phases of the MC, females are prone to
experiencing uctuations in their exercise performance
capabilities across these phases.[1] Several studies have
reported dierences in performance,[2,3] while others
have reported that exercise performance did not dier
during the phases of the MC.[4,5]
Cardiorespiratory tness holds a signicant position
in maintaining overall health and is integral to the
execution of functional tasks. The uctuation in physical
performance throughout the MC is believed to arise from
diverse mechanisms including, altered kinesthetic chain
activation and muscle work, endocrine‑metabolic milieu
of the body. Variations in concentrations of female sex
hormones could potentially account for shifts in force
generation, potentially impacting muscle strength and
power.[6]
Emotional and physical changes have a huge impact
on the activities of daily living of females. In contrast
to men, women tend to report a higher occurrence of
fatigue and chronic fatigue syndrome. Additionally, they
have a heightened likelihood—up to twice as much—
of encountering psychiatric disorders characterized by
fatigue, including conditions like generalized anxiety
disorder.[7] It is reasonable to consider that self‑reported
fatigue could vary throughout the MC. Furthermore,
the alteration of anxiety symptoms in relation to the
MC remains a relatively unexplored phenomenon,
emphasizing the necessity for additional research in this
area.[8]
It is possible to view MC as a signicant variable
that could impact postural control. Static and dynamic
balance along with the feedback and feedforward
physiological responses in the body help to initiate and
complete the tasks during activities of daily livings.
Both static and dynamic postural control are essential
for successfully performing tasks in daily activities. To
date, only a limited number of studies have investigated
the inuence of female gonadal hormone concentrations
on static and dynamic balance across various phases of
the MC.[9]
Based on this argument, MC may in fact inuence
exercise performance and functional outcomes in the
female population. However, research on the impact of
MC on exercise performance has produced a variety of
contradictory ndings.
If results show aection for quality of life, it can be
recommended to the healthcare policymakers to provide
health tness during that phase of the MC and create
awareness. If there is a signicant change in functional
capacity, fatiguability, static and dynamic balance,
as well as anxiety levels of females during follicular
and luteal phases of MC, it is important to take into
consideration while prescribing exercise regimens
for healthy women or when they engage in sport and
recreational activities.
It is crucial to understand whether these cyclical
variations brought on by hormonal inuences have any
impact on a woman’s day‑to‑day activities, i.e. physical
work capacity, in order to prevent any potential negative
repercussions. So, the present study intends to evaluate
various physical and psychological factors like functional
capacity, fatiguability, anxiety level, static and dynamic
balance during the early follicular and mid‑luteal phases
of the MC. In addition, the majority of research studies
that investigate the eect of MC on performance use
athletes as the sample population. For this purpose, this
study aimed to determine the relationship of MC phases
on physical health tness and psychological health
parameters in healthy non‑athletic young adult females.

Participants, setting, and study design
A cross‑sectional study was approved by DPSRU’s
Research Review Development Committee (10/801/
PT/DPSRU/2022/20319) and was conducted between
March and June 2023 in Delhi Pharmaceutical Sciences
and Research University, New Delhi, using a sample
of 46 females, who were recruited using convenience
sampling. Participants were selected on the basis of
an inclusion criteria of being non‑athletic healthy
eumenorrheic females aged 19–24 years and exclusion
criteria of subjects being: use of oral contraceptive pills
in the last six months, history of pregnancy in the past
six months, history of a major surgery that may hamper
with the physical tness of the subject, having no major
neurological or cardiovascular event in the past year,
any known psychological disorder, and smoking, alcohol
consumption, and drug intake in the past six months.
Data collection
An informed consent was obtained from all subjects
before the commencement of the study. The length of the
MC for each participant was determined by averaging the
length of her last six MCs, which allowed us to dene
the phases of the MC. Then, dates for the follicular and
luteal phases of the upcoming MC for every participant
were calculated. Data was collected in the two phases,
that is, the early follicular phase (1st–5th day of the MC)
and the mid‑luteal phase (20th–24th day of the MC), of
the same MC.
Data was then collected using 6MWT (functional
capacity), fatigue severity scale (FSS) (fatiguability),
Zung self‑rating anxiety scale (anxiety levels), single leg
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S303
Medical Journal of Dr. D.Y. Patil Vidyapeeth ¦ Volume 17 ¦ Supplement 2 ¦ November 2024
stance test (static balance), and lower quarter Y balance
test (dynamic balance).
The six‑minute walk test (6MWT) was conducted in
accordance with the guidelines set out by the American
Thoracic Society. It consists of walking back and forth
on a 30 m course. The distance walked is rounded to the
nearest meter. FSS is a nine‑item scale that measures the
severity of fatigue and its eect on a person’s activities
and lifestyle.[10] Zung self‑rating anxiety scale (SAS)
is a self‑report scale whose 20 items cover a variety
of anxiety symptoms, both psychological and somatic
in nature.[11] Single leg stance test (SLS) consists of
standing barefoot and unassisted on one leg with eyes
open and hands on the hips. Test is measured in seconds
from the moment the non‑testing limb is lifted from the
ground until it touches the ground again or the arms
leave the hips. Lastly, in the lower quarter Y balance
test (YBT), participants are asked to stand barefoot
on the center of a Y (made with non‑transparent tape,
with the angles between the anterior stripe and both
posterior stripes being 135°, with 45° between the two
posterior stripes) where all the lines intersected.[12] Then
they maintain their balance on one leg while reaching
as far as possible with the contralateral leg in each
direction, i.e. right anterior (RA), left anterior (LA),
right posteromedial (RPM), left posteromedial (LPM),
right posterolateral (RPL), and left posterolateral (LPL),
with both the lower limbs, with hands placed rmly at
their hips.
Data analysis
The SPSS version 24.0 software (IBM SPSS, Inc.,
Chicago, IL, USA) was used for statistical analysis.
A paired t‑test analysis was used to compare the data
during the early follicular and mid‑luteal phases. The
P < 0.05 was considered as signicant.
Pearson’s correlation coecient was also calculated for
understanding the relationship of the outcome measures
within the phases.

The demographic characteristics are depicted in Table 1.
Normality was established, and correlation was
established between the outcome measures of within
subjects. The means and the standard deviations of
the variables and comparison of the variables in the
two phases, i.e., early follicular (eFP) and mid‑luteal
phases (mLP), are depicted in Table 2.
Statistically signicant dierence (P < 0.01) was seen
within the groups, i.e., between eFP and mLP for all the
variables under study as analyzed by using paired t‑test.
As seen in the correlation matrix Tables 3 and 4, the
study shows that there is a statistically signicant
and low negative correlation between FSS score and
6MWT distance in the early follicular phase (r = ‑0.441,
P < 0.001) and mid‑luteal phase (r = ‑0.439, P < 0.01).
This suggests that as FSS score reduces, the performance
on 6MWT would improve during the respective phases.
Also, there is a statistically signicant and low positive
correlation between FSS score and anxiety score during
the early follicular phase (r = 0.479, P < 0.001) and
mid‑luteal phase (r = 0.496, P < 0.01). This suggests
that as fatiguability increases, the anxiety of the subject
also increases during the respective phases.
The Y balance test score for right and left leg showed
positive correlation respectively as seen in the
correlation matrix Tables 3 and 4 in both the phases.
Also, posteromedial and posterolateral scores also
correlated positively and signicantly.

During the MC phases, there occur various changes in
the hormonal levels in the female body, the major ones
being estrogen and progesterone (low estrogen and
low progesterone in eFP and, high estrogen and high
progesterone in mLP). In this study, we have tried to
analyze if these hormonal changes in dierent phases of
the MC, eFP, and mLP, in particular, aect functional
capacity, fatiguability, anxiety levels, and static and
dynamic balance in young adult females.
While many previous studies report varying exercise
performance across MC phases, an equal number of
studies conclude that no such variation exists. The
present study which was done on untrained females
shows highly signicant variation (P < 0.001) in
physical and psychological health parameters between
the two phases of the MC.
A comprehensive review of 51 studies by
McNulty et al.[13] suggests that exercise performance
might slightly decrease during the eFP compared to
other phases. They propose several mechanisms through
which lower estrogen and progesterone levels during
the eFP might negatively impact exercise performance:
estrogen, known for its anabolic eects,[14] regulates
substrate metabolism, oers antioxidant and membrane
stabilizer properties,[15] and enhances voluntary
Table 1: Demographic data of the participants
Parameters Minimum Maximum Mean SD
Age (year) 19 24 21 1.193
Height (cm) 147 170 159.496 5.7081
Weight (kg) 40 87 54.837 11.1395
BMI (kg/m2) 14.7 34.2 21.494 3.8445
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Sharma, et al.: Functional capacity, fatigability, anxiety and balance during phases of menstrual cycle
S304 Medical Journal of Dr. D.Y. Patil Vidyapeeth ¦ Volume 17 ¦ Supplement 2 ¦ November 2024
activation.[16] These functions suggest that uctuations
in estrogen levels during dierent MC phases could
inuence muscular and exercise performance. Moreover,
progesterone’s anti‑estrogenic eects[17] might amplify
estrogen’s benets during the late follicular and
ovulatory phases when estrogen is high without the
interference of progesterone, compared to the mid‑luteal
phase when both estrogen and progesterone are high.
Functional capacity is dependent on the integrated
functioning of the pulmonary, cardiovascular, and skeletal
muscle systems, which is essential for activities requiring
prolonged aerobic metabolism.[18] The present study
observes a signicant increase in 6MWT distance during the
mLP, indicating improved functional capacity during that
phase as compared to eFP. McNulty et al. in their review,
concluded that aerobic capacity decreased minimally in the
eFP as compared to the other phases, which is consistent
with the results of this study. However, some studies
found no signicant eect of changing hormonal levels
on aerobic capacity.[19] Although there is conicting data
to date, the combined eects of the female sex steroid
hormones on substrate metabolism may theoretically alter
aerobic endurance. which can be attributed to higher levels
of muscle glycogen or lower blood lactate levels.[20]
Table 2: Comparison of the variables in eFP and mLP of MC in young adult females
Variables eFP Mean (SD) mLP Mean (SD)  tSig. (2‑tailed)
FSS 3.49 (1.22) 2.79 (1.07) 0.70 4.68 0.000
SAS 43.07 (9.42) 36.09 (9.12) 6.98 5.88 0.000
6MWT 496.54 (87.14) 543.65 (87.15) ‑47.11 ‑4.54 0.000
SLS 61.82 (34.84) 74.43 (38.76) ‑12.61 ‑5.53 0.000
YBT_RA 62.03 (6.52) 65.94 (6.86) ‑3.91 ‑6.13 0.000
YBT_LA 63.35 (6.56) 65.55 (6.73) ‑2.20 ‑3.83 0.000
YBT_RPM 73.22 (14.19) 81.73 (11.16) ‑8.51 ‑6.81 0.000
YBT_LPM 72.29 (13.21) 80.12 (10.60) ‑7.83 ‑5.72 0.000
YBT_RPL 84.04 (14.59) 87.35 (12.08) ‑3.30 ‑3.07 0.004
YBT_LPL 82.54 (14.34) 87.01 (11.46) ‑4.48 ‑4.44 0.000
Table 3: Correlation matrix table between variables in eFP
FSS_P1 SAS_
P1
6MWT_
P1
SLS_
P1
YBT_
RA_P1
YBT_
LA_P1
YBT_
RPM_P1
YBT_
LPM_P1
YBT_
RPL_P1
YBT_
LPL_P1
FSS_P1 1 0.479** ‑0.441** 0.108 0.181 0.051 0.174 0.133 0.260 0.373*
SAS_P1 1 ‑0.152 0.207 0.050 0.043 0.022 ‑0.028 0.024 0.069
6MWT_P1 1 0.248 ‑0.189 ‑0.154 ‑0.227 ‑0.226 ‑0.073 ‑0.072
SLS_P1 1 0.216 0.291* 0.186 0.121 0.230 0.202
YBT_RA_P1 1 0.897** 0.310* 0.332* 0.258 0.361*
YBT_LA_P1 1 0.262 0.328* 0.153 0.265
YBT_RPM_P1 1 0.886** 0.575** 0.616**
YBT_LPM_P1 1 0.491** 0.563**
YBT_RPL_P1 1 0.851**
YBT_LPL_P1 1
Table 4: Correlation matrix table between variables in mLP
FSS_
P2
SAS_
P2
6MWT_
P2
SLS_P2 YBT_
RA_P2
YBT_
LA_P2
YBT_
RPM_P2
YBT_
LPM_P2
YBT_
RPL_P2
YBT_
LPL_P2
FSS_P2 1 0.496** ‑0.439** 0.161 0.238 0.296* 0.292* 0.180 0.414** 0.329*
SAS_P2 1 ‑0.181 0.199 0.085 0.068 0.259 0.137 0.311* 0.094
6MWT_P2 1 0.217 ‑0.110 ‑0.140 ‑0.021 0.105 ‑0.003 0.085
SLS_P2 1 0.364* 0.251 0.334* 0.159 0.226 0.251
YBT_RA_P2 1 0.850** 0.243 0.220 0.286 0.276
YBT_LA_P2 1 0.313* 0.274 0.317* 0.339*
YBT_RPM_P2 1 0.815** 0.532** 0.485**
YBT_LPM_P2 1 0.492** 0.456**
YBT_RPL_P2 1 0.843**
YBT_LPL_P2 1
**Correlation is signicant at the 0.01 level (2‑tailed). *Correlation is signicant at the 0.05 level (2‑tailed)
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Medical Journal of Dr. D.Y. Patil Vidyapeeth ¦ Volume 17 ¦ Supplement 2 ¦ November 2024
Static and dynamic balance signicantly dier between
eFP and mLP in this study. Improved balance during
the mLP could be attributed to two factors. Firstly,
changes in central nervous system function due to
estrogen and progesterone uctuations during MC. The
homeostasis of labyrinthine uids may be compromised
by hormonal changes, which could aect the balance.[21]
Secondly, variations in connective tissue elasticity are
driven by hormonal changes.[22,23] The synthesis of
collagen during MC phases is inuenced by estrogen,
which may compromise joint laxity.[24] The result of the
current study is consistent with the previous literature;[25]
however, there are studies in which no change in static
and dynamic balance was observed during dierent
phases of the MC.[26,27]
Understanding the psychological impact of MC on
females is just as important as analyzing the dierent
ways they are aected physically. In the present study,
there was remarkable improvement noted in fatigue
severity scale (FSS) (fatigability), zung self rating anxiety
scale (anxiety levels) (SAS) during mLP in comparison
with eFP. Women commonly report more fatigue and
are more prone to conditions featuring fatigue.[7] In a
study conducted by Pallavi LC et al.,[28] the fatigue rate
expressed as a percentage was highest during the eFP
among other phases. The researchers attributed this to
the psychological makeup of the subjects, noting that
the subjects’ performance was negatively impacted by
the bleeding itself since they were predisposed to nd
it distressing. As blood loss may also have an impact on
the same, it can also be related to physical performance.
The researchers linked this to the psychological of the
subjects, noting that the subjects’ performance was
negatively impacted by the bleeding itself since they
were predisposed to nd it distressing. Since blood loss
may also have an impact on physical performance, it is
also relevant to that.
Sophie H Li et al.[29] stated that periods of low sex
hormones intensify anxious symptoms. The role of
estrogen in the metabolism of serotonin may be the
cause of heightened feelings of fatigue and anxiety
during the early follicular phase. A decreased estrogen
concentration facilitates higher serotonin metabolism,
and lower levels of serotonin therefore have a
detrimental eect.[30] This could contribute to increased
stress during phases of low estrogen levels. A study
on 13 healthy females found that decreased levels of
serotonin were associated with participants’ increased
perception of tension anxiety and fatigue in the late
luteal phase, suggesting that reduced estrogen levels
were accountable for this serotonin decrease.[31] It is
possible that serotonin levels and fatigue are elevated
during the early follicular phase since estrogen levels
remain relatively low during this time.
While the initial impression might lean towards
perceiving these outcomes as unfavorable, the
variations in reproductive hormones actually oer
signicant benets. The absence of a regular MC
can have detrimental eects on bone health, cortisol
levels, neuromuscular health, and cardiovascular risk.
Moreover, despite a higher occurrence of ACL ruptures
among females compared to males, they encounter fewer
muscular injuries.[32] To prevent injuries, female athletes
should incorporate stability exercises into their training
regimen, regardless of their MC phase.
Given the signicant variability in how the MC aects
physical and psychological health parameters among
individuals, it is crucial for each woman to monitor her
responses and document the times when she performs
optimally. Recognizing and comprehending the MC’s
impact can lead to optimized training strategies and
improved performance outcomes. Females should
be educated about the MC’s relation to performance
parameters and psychological well‑being, the
considerable individual variability, and the potential
therapeutic approaches. By tailoring training regimens
to align with these hormonal changes, females can
capitalize on their body’s natural tendencies and make
informed decisions about training intensity and recovery
strategies.
Limitations
In this study, evaluation of hormonal levels was not
done which would have signicantly enhanced the
dierentiation of various MC phases. Techniques like
serum tracking and proling, and ovulation kits, which
had demonstrated eectiveness in prior investigations,
might be better options for detecting the precise timing
of MC phases; but we could not use these techniques
due to the limited resources.
Future scope
Longitudinal studies with larger sample sizes that
incorporate hormonal measurements and tracking across
the cycle could provide a more nuanced understanding
of these dynamics. In future studies, it’s important that
the research follows the latest recommendations by
examining outcomes across three distinct phases: early
follicular, ovulatory, and mid‑luteal. These phases oer
distinct hormonal environments, increasing the chances
of spotting uctuations. Notably, there’s a lack of
research focused on untrained collegiate, elite athletes,
and eld‑based team sports. Thus, further research in
these groups could ll this gap in the literature. Other
gaps in the literature pertaining to the eectiveness of
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Sharma, et al.: Functional capacity, fatigability, anxiety and balance during phases of menstrual cycle
S306 Medical Journal of Dr. D.Y. Patil Vidyapeeth ¦ Volume 17 ¦ Supplement 2 ¦ November 2024
frequently employed ergogenic aids across the MC,
the impact of MC phases on agility performance, and
performance variations under diverse environmental
conditions.

This study underscores the interconnectedness of
physical and psychological well‑being across MC
phases. Interventions should address the eect of
hormonal uctuations on performance, tailoring
strategies to enhance functional capacity and alleviate
anxiety. Young women with higher fatiguability exhibit
elevated anxiety, suggesting a link between physical
fatigue and psychological distress. This connection
should inform interventions targeting endurance and
resilience. Notably, MC‑related changes can inuence
exercise performance, necessitating consideration in
training and rehabilitation. Women should be aware of
injury risks during specic MC phases in sports. While a
universal blueprint is unlikely due to individual variation,
understanding hormonal eects can guide personalized
exercise, psychological support, and wellness strategies
for optimized performance and mental well‑being.
Availability of data and materials
The datasets used and/or analyzed during the current
study are available from the corresponding author on
reasonable request.
Authors contributions
GS: conceptualization, data collection, methodology,
resources, roles/writing‑original draft, writing‑review,
and editing
NK and TS: conceptualization, original draft review
RR: statistical analysis, report writing and editing,
manuscript editing and review
SK: manuscript preparation and editing
KB: conceptualization, data collection, manuscript
review
All authors read and approved the nal manuscript
Acknowledgements
The authors acknowledge all the subjects for their
voluntary participation in the study.
Ethics approval and consent to participate
The DPSRU’s Research Review Development Committee
gave its approval to conduct the study (10/801/PT/
DPSRU/2022/20319). Informed consent was obtained
from the participants.
Financial support and sponsorship
Nil.
Conicts of interest
There are no conicts of interest.

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... The examination of the suitability of MTrPs release for shoulder muscles in patients with chronic shoulder pain of myofascial origin was investigated in previous research and the outcomes demonstrated a significant reduction in the pain of the shoulder and scores of dysfunction index [36]. In the current study, Myofascial Passive stretching showed improvement in UE functions outcomes scores for MESUPES as it was directed at stretching the over-shortened and spastic muscle fibers, as it involved slow prolonged stretch with suitable concentration and relaxation that inhibit the gamma spindle response [37], hence Myofascial Passive stretching involves stretching the muscle as far as possible for nearly 45 seconds of maintenance until the relaxation of the muscle, also stimulates the Golgi tendon organs that results in a reflex relaxation of the muscle within 60 seconds of static or prolonged stretches, for enabling the muscle to stretch through relaxation before reaching the extensibility limits [37]. ...
... The examination of the suitability of MTrPs release for shoulder muscles in patients with chronic shoulder pain of myofascial origin was investigated in previous research and the outcomes demonstrated a significant reduction in the pain of the shoulder and scores of dysfunction index [36]. In the current study, Myofascial Passive stretching showed improvement in UE functions outcomes scores for MESUPES as it was directed at stretching the over-shortened and spastic muscle fibers, as it involved slow prolonged stretch with suitable concentration and relaxation that inhibit the gamma spindle response [37], hence Myofascial Passive stretching involves stretching the muscle as far as possible for nearly 45 seconds of maintenance until the relaxation of the muscle, also stimulates the Golgi tendon organs that results in a reflex relaxation of the muscle within 60 seconds of static or prolonged stretches, for enabling the muscle to stretch through relaxation before reaching the extensibility limits [37]. ...
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Introduction To investigate the influence of Myofascial Trigger Points (MTrPs) release combined with shockwave therapy on pain and functions of the upper extremity with shoulder hand syndrome (SHS) in stroke patients with diabetic neuropathy. Methods Two groups of thirty stroke patients, divided equally into, the study group: which received MTrPs release with shockwave therapy and conventional physical therapy program, while the control group: received the conventional physical therapy program. All the patients were evaluated pre-and post-intervention by the severity score of the Complex Regional Pain Syndrome (CRPS), Motor Evaluation Scale Upper Extremity Stroke Patients (MESUPES), the figure of eight test for hand swelling, and the Visual Analogue Scale for pain (VAS-P). Results highly significant improvement of affected upper extremity functions, with a significant reduction of SHS symptoms, swelling, and pain of the study group compared to the control group ( p < 0.05), also there was a negative significant correlation between MESUPES- all-out score and VAS-P. Conclusions The combination of both MTrPs release with shockwave therapy had a significant improvement effect on upper extremity function and a significant reduction of both SHS symptoms and pain in stroke patients with diabetic neuropathy, which leads to improvement in stroke patients’ functional rehabilitation.
... When the central nervous system receives the change in fiber length, this triggers the stretch reflex. In a simple note, myofascial release allows the lengthening of the contracted sarcomeres by passively stretching while working directly on the trigger points (Pawaria & Kalra 2015). Law et al., (2008) performed a double-blinded, randomized controlled trial of the effects of massage on mechanical hyperalgesia (pressure pain thresholds, PPT) and perceived pain using delayed onset muscle soreness (DOMS) as an endogenous model of myalgia. ...
... Keys (2014) compared the effects of myofascial release versus static stretching on hamstring range of motion and found that compared to the myofascial release group (28.9%), acute stretching programs increased hamstring range of motion (33.2%) relatively. Slow stretching, relaxation and breathing in will prevent the gamma spindle response that causes the muscle to compress when rapidly stretched (Pawaria & Kalra 2015). ...
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Title: The Effectiveness of Myofascial Release over Stretching on Pain and Range of Motion among Female College Students with Piriformis Syndrome.Background & Aim: Piriformis syndrome is a painful neuromuscular disorder that occurs when the piriformis muscle irritates and/or compresses the proximal sciatic nerve. Prolonged sitting position is the foremost cause of piriformis tightness in sedentary population that may eventually leads to piriformis syndrome. The incidence of piriformis has been reported to be six times more prevalent in female than in males. Piriformis tightness will cause reduced in range of motion as well as limitations in walking, sitting and even running. Moreover, individuals will also feel pain at their butt muscles which could be frustrating. Thus, the aim of this study is to determine the effectiveness of myofascial release over stretching on pain and range of motion among female college students with piriformis syndrome.Methods: twenty subjects aged between 19 to 25 years old with tight piriformis muscle for 4 weeks will make a part of the study based on the inclusion and exclusion criteria. Subjects are divided and will undergo myofascial release and stretching treatment for 4 weeks twice in a week. At the beginning before the session the pain score and goniometer measurements will be recorded.Conclusion: Group 1 and Group 2 are beneficial in reducing pain and range of motion. Therefore, there are no significant effect of myofascial release over stretching between the two groups.Keywords: Myofascial release, college students, piriformis syndrome, stretching, goniometer, pain score.
... Hence it is concluded that MFR with a hot pack is an effective therapeutic option in treating active MTrPs in the UT muscle. (33)(34)(35) A study to determine the efficacy of PRT and therapeutic massage on pain, pain threshold, and muscle stiffness in patients with trigger points or tender points of the UT muscle concluded that, on comparing patients treated with PRT to those treated with therapeutic massage, they showed significant improvements in NPRS, PPT, and muscle stiffness. (36) The recruitment strategy, diagnosis, and eligibility criteria to be employed in the study are purely based on regular clinical practice and are compatible with the findings which patients usually report at the physiotherapy outpatient department. ...
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Background Myofascial trigger points are incredibly prevalent and are a painful aspect of almost everyone’s life at some point. Myofascial trigger point pain can be excruciating and severely impair the quality of life. Therefore, in patients with neck pain caused by upper trapezius trigger, this current clinical trial will demonstrate the effectiveness of myofascial release therapy and positional release therapy in improving the level of pain, neck impairment, pain threshold, and standard of life. Methods A double-blinded randomized clinical trial will be conducted. Fifty-two participants with active myofascial trigger points in the upper trapezius muscle will be recruited based on selection criteria. They will be randomly allocated into group A (conservative treatment + myofascial release technique) or group B (conservative treatment + positional release technique). Both groups will receive the intervention three times a week for 2 weeks. The study will use the Numeric Pain Rating Scale, pressure algometer, Neck Disability Index, and a 36-Item Short-form Questionnaire as outcome measures. Discussion This trial will help identify the effectiveness of the positional and myofascial release techniques in active upper trapezius muscle trigger points and their effect on physical parameters. Trial Registration This trial has been prospectively registered at the Clinical Trials Registry-India (CTRI/2023/07/055126) on 12 July 2023.
... Several studies have been conducted to assess the MFRT's effects on improving ROM and decreasing pain. Pawaria and Kalra [26] applied a comparison to examine which one of MFRT or stretching of muscle has an effect on disability, pain, and ROM in patients with upper trapezius MTrPs. Six sessions in total were applied, three times/week for two weeks, to 32 patients complaining of MPS in UTM using VAS and neck disability index (NDI) assessment. ...
... Stretching and manual therapy on cervical spines can be conducive to increases in a joint range of motion (ROM) and pain reduction as well as stretching muscles that are related to the entire cervical portion such as thoracic spine or therapies using myofascial release can be effective to the recovery of ROM and pain reduction in cervical portion compared to ultrasound therapy. However, few studies have been conducted on stretching that is applied only to suboccipital muscles in the upper cervical spine (Pawaria, 2015). ...
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Background: Complaints due to upper trapezius myofascial pain syndrome include spasm, pain, and limitations in functional motion of the neck and surrounding areas. One way to overcome this is myofascial release, but there is no review article about the effect of myofascial release on the functional neck of myofascial pain syndrome. This study is to analyze the effect of myofascial release on pain and functional neck myofascial pain syndrome in the upper trapezius muscle. Methods: systematic review with the PICO framework (Population, Intervention, Comparison, Outcomes). Identify articles using relevant databases (Googlescholar, PubMed, PeDro) with customized keywords. Article selection using PRISMA flowchart, article assessment using critical appraisal. Results: The number of articles from 3 databases contained 3684 articles. After screening the title and the relevance of the abstract, 10 articles were obtained that proved the effectiveness of myofascial release in reducing neck pain and disability. Conclusion: myofascial release technique in the condition of myofascial pain syndrome, upper trapezius muscle is effective for reducing pain and increasing functional motion in the neck.
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Purpose of Review Anxiety symptoms increase during the peri-menstrual phase of the menstrual cycle in people with anxiety disorders. Whether this reflects a heightened variant of normal menstrual-related changes in psychological states experienced by healthy (i.e. non-anxious) people is unknown. Moreover, menstrual-related change in anxiety symptoms is a poorly understood phenomenon, highlighting a need for pre-clinical models to aid mechanistic discovery. Here, we review recent evidence for menstrual effects on anxiety-like features in healthy humans as a counterpart to recent reviews that have focused on clinically anxious populations. We appraise the utility of rodent models to identify mechanisms of menstrual effects on anxiety and offer suggestions to harmonise methodological practices across species to advance knowledge in this field. Recent Findings Consistent with reports in clinical populations, some evidence indicates anxiety symptoms increase during the peri-menstrual period in healthy people, although null results have been reported, and these effects are heterogeneous across studies and individuals. Studies in rats show robust increases in anxiety during analogous phases of the oestrous cycle. Summary Studies in female rats are useful to identify the evolutionarily conserved biological mechanisms of menstrual-related changes in anxiety. Future experimental approaches in rats should model the heterogeneity observed in human studies to increase alignment across species and advance understanding of the individual factors that increase the propensity to experience menstrual-related changes in anxiety.
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Objective: To determine changes in flexibility, dynamic balance, agility, vertical jump, aerobic capacity, anaerobic capacity, and muscle strength performances in women in the early follicular and midluteal phases of the menstrual cycle. Material and Methods: The study included eumenorrheic women over 18 years of age. Ovulation was detected using LH urine kits. Physical activity levels were determined using the "International Physical Activity Questionnaire-Short Form". Flexibility was evaluated with the sit-and-reach test, dynamic balance with the Y balance test, agility with the hexagon agility test, anaerobic power with the vertical jump test, aerobic capacity with the 20-meter shuttle run test, anaerobic capacity with the Wingate test, and muscle strength with an isokinetic dynamometer. Results: Twenty women participated in the study. The average age was 22.4 ± 0.9 years, and the average level of physical activity was 1162.2 ± 189.1 MET-min/week. The average menstrual cycle was 30.3 ± 0.5 days. The ‘minimum power’ value in Wingate test was higher during the midluteal phase compared with the follicular phase (p=0.048). The remaining parameters were not statistically different for the two menstrual phases (p>0.05). Conclusion: We conclude that different phases of the menstrual cycle affect performance parameters minimally and do not cause a statistically significant difference. Nevertheless, instead of establishing these changes as ‘clinically non-significant’, each athlete should be evaluated on an individual basis to develop individual training programs by taking into account the phases of the menstrual cycle.
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Background: Zung's Self-rating Anxiety Scale (SAS) is a norm-referenced scale which enjoys widespread use a screener for anxiety disorders. However, recent research (Dunstan DA and Scott N, Depress Res Treat 2018:9250972, 2018) has questioned whether the existing cut-off for identifying the presence of a disorder might be lower than ideal. Method: The current study explored this issue by examining sensitivity and specificity figures against diagnoses made on the basis of the Patient Health Questionnaire (PHQ) in clinical and community samples. The community sample consisted of 210 participants recruited to be representative of the Australian adult population. The clinical sample consisted of a further 141 adults receiving treatment from a mental health professional for some form of anxiety disorder. Results: Mathematical formulas, including Youden's Index and the Receiver Operating Characteristics Curve, applied to positive PHQ diagnoses (presence of a disorder) from the clinical sample and negative PHQ diagnoses (absence of a disorder) from the community sample suggested that the ideal cut-off point lies between the current and original points recommended by Zung. Conclusions: Consideration of prevalence rates and of the potential costs of false negative and false positive diagnoses, suggests that, while the current cut-off of 36 might be appropriate in the context of clinical screening, the original raw score cut-off of 40 would be most appropriate when the SAS is used in research.
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This study aimed to investigate the fluctuations of muscle performance in the Smith machine half-squat exercise during three different phases of the menstrual cycle. Thirteen resistance-trained and eumenorrheic women volunteered to participate in the study (58.6 ± 7.8 kg, 31.1 ± 5.5 years). In a pre-experimental test, the half-squat one-repetition maximum (1RM) was measured. Body mass, tympanic temperature and urine concentration of the luteinizing hormone were estimated daily for ~30 days to determine the early follicular phase (EFP), the late follicular phase (LFP), and the mid-luteal phase (MLP) of the menstrual cycle. On the second day of each phase, performance of the Smith machine half-squats was assessed using 20, 40, 60 and 80% of one repetition maximum (1RM). In each load, force, velocity, and power output were measured during the concentric phase of the exercise by means of a rotatory encoder. The data were analyzed using one-way repeated measures ANOVA coupled with magnitude-based inferences. Overall, force, velocity and power output were very similar in all menstrual cycle phases with unclear differences in most of the pairwise comparisons and effect sizes >0.2. The results of this investigation suggest that eumenorrheic females have similar muscle strength and power performance in the Smith machine half-squat exercise during the EFP, LFP, and MLP phases of the menstrual cycle.
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The aim of this study was to evaluate the timed sit-to-stand (STS) test performances of healthy young adults and to investigate the relationship of timed STS tests with 6-minute walk test (6MWT). A cross-sectional study was performed. A total of 40 healthy volunteers (mean age: 21.7 ± 1.2 years) were evaluated with 10, 30, and 60 seconds STS tests and 6MWT. Fatigue and shortness of breath were rated using Borg category-ratio scale (CR10) before and after each test. Weekly energy expenditures of volunteers were calculated using International Physical Activity Questionnaire. 30 and 60 seconds STS tests were moderately (r = 0.611 and r = 0.647, respectively) (P < .001) and 10 seconds STS test was weakly (r = 0.344) (P = .028) correlated with 6MWT. Among correlations of each STS test with 6MWT, none of them was statistically stronger to one another (P > .05). Borg fatigue scores after 10, 30, and 60 seconds STS tests were weakly correlated with fatigue score after 6MWT (r = 0.321, r = 0.378, and r = 0.405, respectively) (P < .05). Weekly energy expenditure (MET-min/week) was moderately correlated with 10, 30, and 60 seconds STS tests and 6MWT (r = 0.533, r = 0.598, r = 0.598, and r = 0.547, respectively) (P < .001). Considering the statistically significant relationship between timed STS tests and 6MWT, any of the timed STS tests may be used for a quick and alternative measurement of physical performance and functional capacity in healthy young adults. Copyright
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Introduction: Some of the physiological factors and athletic performance might show variation along the phases of menstrual cycle. The alterations seen in these physiological parameters of various systems relating to oscillations in hormonal levels do affect the autonomic nervous system and metabolic functions. Former studies heave inconclusively about the influence of hormones on exercise performance, predominantly muscle strength and rate of fatigue during different phases of the menstrual cycle. Studies regarding influence of these variations during bleeding phase were not done. Aim: To evaluate the muscle strength variations and also the rate of fatigue during various phases of the menstrual cycle in young adults. Materials and methods: This was a prospective study conducted among 100 healthy adult female volunteers aged 18-24 years, with normal regular menstrual cycles persistent between 26- 32 days (average of 28 days), for a minimum of last 6 months. Muscle strength was assessed by calculating the work done and fatigue rate using Mosso's ergograph and by handgrip dynamometer strength. Each subject was evaluated consecutively for two menstrual cycles in all three phases which were classified as Phase 1- Menstrual phase, Phase 2- Follicular phase and Phase 3- Luteal phase. The data obtained was analysed by statistical tool One-way ANOVA followed by a post-hoc Tukeys test. A p-value of ≤ 0.05 was considered significant. Results: The amount of work done and handgrip strength was significantly higher in phase 2 (p<0.001) and relatively reduced in phase 1 and 3 (p<0.001) of menstrual cycle. In terms of fatigue rate percentage, phase 2 showed significantly lesser values (p<0.001) as compared to phase 1 and 3 of menstrual cycle. Conclusion: We conclude that the cyclical variation in endogenous reproductive hormones increases the muscle strength in follicular phase of the menstrual cycle. Thus provide support for the influence of these hormones in regulation of these parameters in the premenopausal age group.
Article
Purpose: This study investigated the effects of the menstrual cycle on running economy (RE). Method: Eleven eumenorrheic female athletes (mean age: 21.18 ± 3.65 years, height: 170.2 ± 6.6 cm, VO2max: 49.25 ± 9.15 mL·kg−1·min−1, and menstrual cycle: 29.8 ± 0.98 days) were tested for anthropometric variables, physiological responses (oxygen consumption [VO2], blood lactate [LA], heart rate [HR], and respiratory exchange ratio [RER]) at rest and while running. The RE was measured at speeds of 75%, 85%, and 95% of the lactate threshold at 3.5 mmol·L−1 during the follicular (FP) and luteal phases (LP) of the menstrual cycle. The RE was evaluated as oxygen consumption (mL·kg·min−1 [O2C_min], mL·kg−1·km−1 [O2C_km]) and caloric unit cost (kcal·kg−1·km−1 [EC]) during both phases. Results: There were no significant differences in body composition or resting physiological measurements between the LP and FP (p > .05). Physiological responses measured during RE tests were similar in both phases (p > .05). The RE measured as O2C_min, O2C_km, and EC was significantly lower during the LP than during the FP (p < .05). The RE defined as O2C_ min significantly increased with speed (p < .05), but RE defined as O2C_km and EC was unaffected by speed increment (p > .05). Conclusions: The RE is better in the LP than the FP and is independent of running speed when RE is evaluated as O2C_km and EC. The menstrual cycle had no effect on body composition and physiological variables measured at rest.
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