By Dr. Anthony J. Lombardi
Picture this: you’re at the gym preparing for an upcoming competition — it’s only eight weeks away. Today is leg day. You’re beginning with some light squats to warm up the muscles when you realize that you’re incredibly stiff and your lower back has started tightening like a vice. No, it’s not a disc injury; it’s not sciatica; it’s not even a pulled muscle. In fact, it’s really quite simple: you just got your period.
Painful menstruation, or dysmenorrhea, is estimated to affect up to 50 per cent of women, and of those, 10 per cent experience incapacitating pain for one or two days every single month — bad news for anyone, but for an athlete with a regular training schedule this disruption can seriously hinder growth and development.
“The most common problems that I’ve witnessed in my clients with dysmenorrhea are associated with lower-back and hip pain,” says Sarah Maduck, a fitness model, personal trainer, and the owner of Anytime Fitness in Warman, Saskatchewan. “If you’re in pain, the body tends to overcompensate in order to complete the exercise you’re trying to perform, which can create problems later on.”
The Science Behind The Pain
Thanks to something called the viscerosomatic reflex, the core muscles surrounding the uterus can experience spasms when uterine contractions occur during menstruation. These contractions trigger inflammation, which can cause the muscles of the pelvis, lower back, and hips to become much weaker.
Simply put, a viscerosomatic reflex is when something that’s happening in one bodily organ reflexively causes the neighbouring muscles to tighten. In this instance, the pain impulses from the uterus belong to the same nerve path as the muscles in the lower back and hips. This means when certain nerve impulses from the uterus reach the brain, they are misinterpreted as lower-back pain, which causes the hip flexors to tighten up, making squats and deadlifts nearly impossible.
This same viscerosomatic reflex also causes a phenomenon known as motor inhibition, which means that the pain coming from the uterus can actually cause the muscles around it to stop working. So the core muscles, hip flexors, and lower-back muscles take a vacation, preventing you from generating any strength, even on days when you feel fine and your menstrual pain has gone.
Diagnosing The Issue
Research published in The Clinical Journal Of Pain determined that motor inhibition prevents effective muscle retraining. So, if a muscle has shut off and stopped working, then trying to strengthen it would be ineffective because you would have to overcompensate by using other muscles.
Cue functional assessment, a chiropractic concept that allows therapists to locate the muscles that have been shut off and begin proper treatment. Dr. Sarah Hopkins, a chiropractor at the Hamilton Back Clinic, is an expert in treating injuries in athletic women.
Using the EXSTORE® system, Hopkins can locate muscle imbalances within a couple of minutes. “The EXSTORE system is an important diagnostic tool. The Clinical Journal Of Pain conclusion that motor inhibition prevents muscle re-training indirectly tells us that proper rehabilitation of our patients will not occur unless muscle weakness is found and corrected,” Hopkins explains.
Fixing The Problem
If you’re training for something specific and have a time sensitivity, then missing one or two workouts a month can be really detrimental. In a 2008 study in the American Journal of Obstetrics & Gynecology, German researchers found that electroacupuncture could reduce the amount of pain experienced by women who suffer from dysmenorrhea.
Hopkins uses this same approach to relieve pain and restore function in women who are slowed down by their menstrual cycle. “Electroacupuncture involves adding a light battery pulse to the acupuncture needle, which slows uterine contractions, relieving menstrual back pain and turning inhibited muscles back on. This helps athletes stay strong despite lower-back pain,” Hopkins shares.
Preventing The Pain
Ladies who lift, however, like to tough it out. “In my experience, women who have fitness goals usually continue to train through menstrual discomforts,” Maduck admits. “Research supports the idea that women who work out on a regular basis are less likely to suffer the same intense levels of discomfort as those who are inactive.”
However, Maduck does recommend that you modify your training routine during your cycle in order to avoid injuries. She also suggests making modifications in advance. “Women who have a regular menstrual cycle may choose to plan their workouts accordingly,” she explains. “Exchanging an upper-body workout for a lower- body workout, or considering a lighter leg and core workout is what I often suggest to my clients to help prevent that pattern of missed workouts.”
But changing up your routine may not be enough. Any athlete who routinely stresses their muscular system should seek regular treatments in order to maintain proper muscle function and prevent motor inhibition, and Maduck supports the idea that treatment is a vital part of injury prevention. “I am a testimony to the importance of receiving treatment in the form of active release techniques (ART) or muscle stimulation,” she shares. “Women who lift weights are subjecting their bodies to physical stress in the gym and therefore need to balance the maintenance and health of their muscles while lifting those weights.”
For those who experience extreme and continuous menstrual pain and physical discomfort, please consult your medical doctor or schedule an examination, particularly if the pain persists or gets worse over time. In some cases pain during your period can be an indication of a more serious condition, so be sure to get it assessed by a professional, just to be safe.