Published on www.stuff.co.nz on 6th of April 2022.<\/p>\n
A new study into how Kiwi women are recovering from knee surgery involves a groundbreaking rehab programme especially tailored to sync with a woman’s menstrual cycle.<\/p>\n
Knees are the bane of a sportswoman\u2019s career. Just ask netballers like Monica Falkner, Georgia Heffernan and Bailey Mes, Black Stick Kelsey Smith or Football Fern Hannah Wilkinson. And Black Ferns Ruahei Demant and Ariana Bayler, who\u2019ve both had their knees rebuilt three times. Each year, around 3000 New Zealanders undergo surgery on their anterior cruciate ligament, better known as ACL. Almost half of those knee reconstructions are on women. But the most worrying statistic is that it\u2019s happening more to teenage girls than any other age group. Research in 2019 showed over the past decade, there\u2019s been a 120 percent increase in the number of 15 to 19-year-old girls undergoing ACL surgery.<\/p>\n
There\u2019s also growing concern that females aren\u2019t recovering from their surgeries as well as males are. And a big part of that problem is, as most sport science has been dominated by male-based research, most rehabilitation programmes for ACL injuries are tailored for men. What hasn\u2019t been studied well is the role a woman\u2019s menstrual cycle can play in her recovery. So physiotherapist Emma O\u2019Loughlin has created a study as part of her PhD thesis at the Auckland University of Technology to better understand how the menstrual cycle affects rehabilitation after ACL surgery. With the help of physiotherapy professor Duncan Reid and renowned female athlete physiologist Dr Stacy Sims, she\u2019s designed a rehab programme specifically for women, now being trialled around New Zealand.<\/p>\n
\u201cWomen are more likely to not be doing as much activity after their surgery as men do, and are not as likely to return to sport afterwards,\u201d says O\u2019Loughlin, who’s also an ultra runner. \u201cAnd on a more simple level, they aren\u2019t as strong, so they don\u2019t have as much recovery of their muscle strength after surgery. \u201cSo that\u2019s what we\u2019re looking at. We\u2019re gathering women from all around the country, then working with surgeons and physios to give them a female-specific rehab programme. \u201cEvery woman who does her ACL – whether they\u2019re a sportswoman or a mum who\u2019s hurt her knee bouncing on the trampoline with her kids – should be engaging in high quality rehab. And that\u2019s what we\u2019re providing.\u201d It\u2019s a strengthening programme, working in combination with phases of a women\u2019s menstrual cycle.<\/p>\n
O\u2019Loughlin is still looking for women who are aged over 16 and have a regular menstrual cycle. Six weeks after their surgery, they engaged in the 12-week rehab programme through a physio. \u201cWe\u2019re working with their physiology to get them do strengthening exercises, measuring before the trial and after, then comparing them with people who are engaging in normal physiotherapy,\u201d she says. So far into the trial, the evidence points to women returning stronger having done their exercises timed with their menstrual cycle.<\/p>\n
\u201cFrom day 1 to 14 of your cycle, you\u2019re building levels of oestrogen \u2013 which is like a female version of testosterone, an anabolic that helps to build muscle. Once you release the egg, for the second half of your cycle, you\u2019re releasing progestin that opposes the oestrogen, and stops it working so well to build muscle,\u201d O\u2019Loughlin says. \u201cWhat the evidence says so far is that, by and large, if you carry out a lot of your resistance training \u2013 your squats, leg presses, lunges, knee extensions, bicep curls \u2013 in the first half of your cycle before you release your egg, and you repeatedly do that for three to four months, at the end of the trials women have an increased strength through menstrual cycle-based rehab training.<\/p>\n
\u201cThere are stages of our cycle where we feel better, or a bit grotty. It may be a good time based on how we\u2019re feeling to carry out those high intensity sessions between the first day of your period and ovulation. \u201cAlongside that, there\u2019s some evidence that it might increase lean body mass \u2013 actual muscle bulk.\u201d O\u2019Loughlin is quick to point out that cycle-based rehab isn\u2019t \u201cthe golden ticket\u201d that patient wants \u2013 a quicker rehabilitation. Most athletes take between nine and 12 months to return to sport. \u201cWe look at whether the injured leg has the same strength as the other leg, or if there\u2019s less than 10 percent difference around the six to nine-month mark. What we expect is women are better placed to pass the criteria tests at that time,\u201d O\u2019Loughlin says.<\/p>\n
Duncan Reid says O\u2019Loughlin\u2019s study is critical for developing rehab programmes that work for women. \u201cWomen are not only behind the eight ball because they\u2019re not as strong as men. The programmes developed for ACL rehab are all based on men, which is a problem,\u201d Reid says. \u201cAnd if you don\u2019t get the strength back in your knee even though you\u2019ve had it repaired, you\u2019re predisposing yourself to quite significant osteoporosis further down the track. \u201cWomen are going to be more likely to have a knee replacement at a younger age. You\u2019d expect women in their 70s, but I\u2019m seeing women in their 50s because of injuries they sustained as young people.\u201d<\/p>\n
Some sports, like netball, have developed injury prevention plans in partnership with ACC. NetballSmart, for example, has reduced the incidence and severity of injuries by getting players to do a 15-20 minute dynamic warm-up. \u201cNetball is really interesting because there\u2019s a lot of really good work being done to reduce the number of injuries,\u201d says Reid. \u201cBut netball is also the perfect storm for rupturing your ACL because you only take two steps and you twist and turn. Even with the best intentions, as you see at our elite levels, people will still rupture their cruciate. \u201cThe other part of this puzzle is the second rupture. If you\u2019ve done it once you\u2019re predisposed to the second one. But we\u2019re hoping across the world better designed rehab programmes will reduce the chance of having a second or third event.<\/p>\n
\u201cBecause they cost hugely \u2013 both financially and the personal cost. After nine to 12 months rehabbing with the first one, the thought of going through that for a second time is just depressing.\u201d In the study to help women return from knee surgery stronger, there\u2019s another hurdle facing both patients and physios – talking about periods. \u201cWhen we designed the trial, we learned physios see the menstrual cycle as something they don\u2019t know a lot about, but it\u2019s something they\u2019re super interested in learning about,\u201d O\u2019Loughlin says. Some cultures still consider it taboo to talk about menstruation, but technology is helping.<\/p>\n
\u201cA lot of the female athletes are now tracking their cycles through apps on their phone, like FITR Woman, Flo and Clue. A lot of the female physios are too,\u201d O\u2019Loughlin says. \u201cIt\u2019s become more normalised to talk about it in the last few years.\u201d There are now more than a dozen women involved in the trial, with numbers increasing in Auckland since sport and elective surgeries have returned, after been cut during the Covid lockdowns. O\u2019Loughlin hopes to have around 50 women rehabbing to their menstrual cycles by the end of the year.<\/p>\n","protected":false},"excerpt":{"rendered":"
Published on www.stuff.co.nz on 6th of April 2022. A new study into how Kiwi women are recovering from knee surgery involves a groundbreaking rehab programme especially tailored to sync with a woman’s menstrual cycle. Knees are the bane of a sportswoman\u2019s career. Just ask netballers like Monica Falkner, Georgia Heffernan and Bailey Mes, Black Stick […]<\/p>\n","protected":false},"author":2,"featured_media":2437,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[13,1],"tags":[],"yoast_head":"\n