Abstract
Objectives: This study aimed to assess how menstrual cycle phase and extended menstrual cycle length influence the incidence of injuries in international footballers.Methods: Over a 4-year period, injuries from England international footballers at training camps or matches were recorded, alongside self-reported information on menstrual cycle characteristics at the point of injury. Injuries in eumenorrheic players were categorized into early follicular, late follicular, or luteal phase. Frequencies were also compared between injuries recorded during the typical cycle and those that occurred after the cycle would be expected to have finished. Injury incidence rates (per 1,000 person days) and injury incidence rate ratios were calculated for each phase for all injuries and injuries stratified by type.Results: One hundred fifty-six injuries from 113 players were eligible for analysis. Injury incidence rates per 1,000 person-days were 31.9 in the follicular, 46.8 in the late follicular, and 35.4 in the luteal phase, resulting in injury incidence rate ratios of 1.47 (Late follicular:Follicular), 1.11 (Luteal:Follicular), and 0.76 (Luteal:Late follicular). Injury incident rate ratios showed that muscle and tendon injury rates were 88% greater in the late follicular phase compared to the follicular phase, with muscle rupture/tear/strain/cramps and tendon injuries/ruptures occurring over twice as often during the late follicular phase compared to other phases 20% of injuries were reported as occurring when athletes were “overdue” menses.Conclusion: Muscle and tendon injuries occurred almost twice as often in the late follicular phase compared to the early follicular or luteal phase. Injury risk may be elevated in typically eumenorrheic women in the days after their next menstruation was expected to start.
Highlights
With the professionalization of women’s football, training, and match demands have significantly increased in recent years (Datson et al, 2014, 2017)
The injury incidence rate ratio showed the rate of injuries was 47% greater in the late follicular phase compared to the follicular phase and 24% lower in the luteal phase compared to the late follicular phase
Injury incident rate ratios showed that muscle and tendon injury rates were 88% greater in the late follicular phase compared to the follicular phase, with muscle rupture/tear/strain/cramps and tendon injuries/ruptures occurring over twice as often during the late follicular phase compared to other phases
Summary
With the professionalization of women’s football, training, and match demands have significantly increased in recent years (Datson et al, 2014, 2017). Several studies have identified a greater risk of ACL injury occurrence in the late follicular/ovulatory phase when estrogen concentrations are highest (e.g., Wojtys et al, 2002; Beynnon et al, 2006; Adachi et al, 2008; Ruedl et al, 2009), potentially due to increased ACL laxity (Chidi-Ogbolu and Baar, 2019). There is often discrepancy in the way that phases are defined and estimated: for example, some studies have only compared injury incidence in pre and post ovulatory phases (Möller-Nielsen and Hammar, 1989; Beynnon et al, 2006; Ruedl et al, 2009, 2011) which does not consider the ∼10-fold increase in estrogen concentrations from the early to late follicular phase (Stricker et al, 2006). Much of this research is in skiers (Beynnon et al, 2006; Ruedl et al, 2009, 2011; Lefevre et al, 2013) which may lack application to other sports
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