So imagine me, a big hunk of man tissue, standing in front of a group of women and trying to tell them about their ovarian cycle and what it means to their low back pain and core strength. I can imagine standing in front of a firing squad being less intimidating, but I’m a champ, so I sucked it up yesterday and gave a group of ladies in Calgary a rousing rendition of manliness.
So here’s a question: why is it people are still squeamish about talking menstrual function, ovarian cycle and all the fun hi-jinx that go along with them? The puritan society we inherited says it’s “not polite” to talk about such things, but they also said that about farting in public, and if you’ve ever read my blog, you know I don’t hold back on many topics, especially those that relate to health. So let’s get good and comfortable with it today. Let’s roll up our sleeves, get our hands dirty, and talk about a little PMS, shall we? (Note: I probably could have used a better build-up, and for those of you with graphic imaginations, you all sicken me).
Here’s an interesting stat for you: Half of the population are women.
Did you hear that? That was the sound of the doors being blown off your entire world right there. THAT JUST HAPPENED!! What’s even more interesting is that women don’t respond to exercise in the same way that men do. Think about their internal hormonal environment: they don’t have nearly as much testosterone in their circulation, meaning making significant gains in muscle mass is difficult (sorry gals, weights won’t “bulk you up” like commonly believed, unless you’re hittin it bodybuilder style for a few years), they have monthly variations in hormones that affect pretty much everything, INCLUDING ligamental laxity, joint stability and core muscle function. Betcha didn’t know that now smarty-pants??
The four main phases of the ovarian cycle are the proliferative phase (1st 10 days after menstruation uterine lining is thickening, no spikes in hormones, no problems with exercise, the villagers are happy), the ovulatory phase (thickened uterus, dilation of birth canal pressing on pelvic floor, limited activation of pelvic floor muscles, core recruitment is less than optimal, villagers have impending sense of dread surrounding them), Luteal phase (pre-menstrual, hormones are at their peak, uterine lining is thickest, inflammation begins, hormones cause reduced stability through SI area and lumbar spine, core function is moderately impaired, the villagers are TERRIFIED), and finished with menstruation (lining sloughs off uterus, inflammation causes pain and tenderness in abdomen and low back, lax ligaments give higher risk of SI joint and low back injury, tenderness reduces ability to activate core properly, the villagers are fleeing the township, ready to set up shop in a new part of the world).
So now that you know the basic phases, what does this mean for exercise? Well, young grasshopper, it means you have to change your workouts based on the stage of the ovarian cycle. For the proliferative phase, you can crank up the intensity, hit some box jumps, work on crazy spinal loading exercises and all that sheeeiit as much as you want, because there’s no adverse level of hormones causing joint problems. Tear it up, baby!!!
For the ovulatory phase, the mild core dysfunction found can be retrained with balance work, specific core training, and a hell of a lotta spinal stability exercises. Things like this series here would work well:
For the luteal phase, you’ll need a lead-lined barracks with some ground-to-air missiles, a steady dosage of chocolate and kleenex, as well as making sure the spine stays in neutral with no shear forces or rotation of the spine at all. Any core work will have to be done with full spinal bracing, trying to avoid doing any isolated ab work. Since the core is having trouble contracting due to inflammation, tenderness and pressure on the pelvic floor, doing only TVA activation exercises will actually create a core dysfunction, so making sure full ab activation is achieved will be the goal, but a difficult one to shoot for.
In the menstrual phase, the low back will commonly be tender and movement will be painful, so avoiding a lot of aggressive spinal movement will be necessary, as well as avoiding a lot of unilateral impact (like running, jumping), especially if the back is tender. On top of this, core temperature tends to increase by up to 1 degree celsius, meaning they have a greater chance of becoming dehydrated in this stage. The ligamental laxity isn’t just relegated to the spine and pelvis. Park et al (2009) found that the female ACL injury had a mild correlation to the stage of the ovarian cycle, and that circulating hormones played a role in creating an ACL laxity and reduction in overall resiliency.
Women who only run all month-long, and don’t fluctuate their programs on a weekly basis, will eventually develop knee, back and hip issues as a result of their cyclic laxity and the results of highly repetitive impact activities.
Training a female on a straight linear program that doesn’t take into account fluctuations in hormones, physical abilities, and joint mechanics will ultimately reduce the effectiveness of the training program. With pretty much all of my female clients I’ll ask if they are in the pre-, post-, or during-phase of their monthly cycle, and change a workout up if necessary base don how they’re feeling, what level of discomfort (if any) they may have in their low backs and hips, and stomach. A lot of ladies are uncomfortable telling someone what stage they are in, especially a jacked diesel dude like me, but by knowing why each stage produces different responses in the body that will directly affect their ability to workout and the gains they will make, it usually break the ice and lets them feel more comfortable with it. That and the fact I have a calm, soothing radio host voice that melts the hearts of puppies.