Bristol City trying to find link between periods and injuries
Players to take part in menstrual cycle study Research could explain repeated ACL problems
Players at Bristol City Women are set to take part in a landmark menstrual cycle study in an attempt to understand why female footballers are so susceptible to anterior cruciate ligament injuries.
The knee injury has debilitated numerous players in the Women’s Super League this season, including three at Bristol, who sit bottom of the Women’s Super League. Meag Sargeant and Elise Hughes suffered ACL tears in the same match last month while playing for City, while forward Abi Harrison picked up the injury last November.
The study, which will begin at the end of this month, will determine how joint laxity and lower limb stiffness are influenced by different stages of the menstrual cycle. If successful, The Daily Telegraph understands it could play a pioneering role in critically managing injury prevention among elite female footballers.
Yesterday, this paper reported how Chelsea Women have tailored training programmes around players’ menstrual cycles in an attempt to enhance performance and reduce injuries by tracking monthly bleeds through the Fitrwoman app.
Bristol City told The Telegraph they have been collecting menstrual function data on a self-reporting basis for a number of years through daily wellness questionnaires, with players simply stating if they are menstruating on any given day. Since the start of this season, the club have expanded this to recording players’ symptom severity throughout their monthly cycles.
“When some players start their menstrual cycles, they tell me the pain is almost unbearable,” said Chris Difford, the club’s lead physical performance coach. “Some are visibly not able to do what we want them to. They’d say, ‘I’m really suffering from stomach pains because I’m on my period’. That was the light-bulb moment. We needed to know this before training because if they’re on a heavy loading day, they obviously can’t train the same.”
From knowing the start and end dates of every player’s monthly bleed, Difford has used arbitrary scores to alter players’ training loads, such as reducing the intensity on heavy training days. But this method has its limitations.
“Self-reporting is fine in some regards, but actually knowing the actual different phases of the menstrual cycle cannot be done through a self-report,” said Prof Mark De Ste Croix, a lecturer in sport and exercise science at the University of Gloucester, who is part of the team leading the study.
It is hoped the study will identify players who are at an increased risk of soft-tissue injuries throughout their cycles. This includes, but is not limited to, ACL injuries. Research linking ACL injuries and menstrual cycles remains sketchy, with both reproductive hormones and the alignment of a female’s hips thought to play a part.
“This study isn’t because we’ve had ACL injuries this year and it’s not as if the menstrual cycle is going to be a magic cure,” Difford said. “The ACL is a mechanism which is so multifactorial. It’s very difficult to pinpoint it on a particular thing.”
Each player will receive an ovulation kit complete with urinebased test strips. These are akin to pregnancy test strips and detect levels of luteinising hormone, which is released close to ovulation.
“We will ask each player to urinate on the stick every day throughout their cycle, for two consecutive cycles,” said De Ste Croix. “Players’ joint laxity will be measured at three different points throughout the cycle: pre, post and at peak ovulation. This will be done using a Lachmeter, a device which measures how much the knee joint can move. With this relatively new piece of equipment, we will be able to measure the amount of joint laxity in a given movement and see if there is a clear link between laxity and circulating hormones.”
Players’ limb stiffness will also be measured by hopping on both legs for 20 seconds. Hormone levels will be simultaneously measured from saliva samples taken from players at their suggested three test points in their cycles. This will be used as a sort of backup tool to support the predicted ovulating dates determined by the ovulation kit.
Depending on funding, these saliva samples will also be analysed to determine whether collagen, the structure that provides stability to a ligament, is affected during various points in the menstrual cycle.
“You can think of collagen like scaffolding,” De Ste Croix said. “It forms part of the ligament to make it strong which stops it from breaking. If there’s a point in the cycle when collagen uptake is particularly poor, do you say to a coach, ‘I don’t want this player to be doing lots of sidestepping and jumping today?’ You can imagine what a nightmare it would potentially be for a coach, because all these players are at different stages of their cycle.”
It is hoped the data will be recorded from each player by the end of the season, to identify early trends or patterns. The study will then become more embedded at the start of next season with a move to becoming part of the club’s permanent player profiling.
“What we’re expecting the players to do is getting more and more intensive,” Difford said. “The speed and the growth of the women’s game is something everyone is trying to catch up with.”