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Back pain and
female hormones
During pregnancy, a woman's body secretes a hormone called relaxin which causes
ligaments to loosen in preperation for birth.
Ligament laxity is normal during
pregnancy.
Relaxin's effects include the production and remodeling of
collagen, increasing
the elasticity and relaxation of muscles,
tendons, and
ligaments. The point is
that relaxin has a direct negative effect on the strength of collagen. Relaxin
is secreted by all females, the highest levels being during the middle of the
luteal phase (ovulation) of the menstrual cycle (days 20-23).
Because of the double whammy of
estrogen and relaxin, women have increased
ligamentous laxity and flexibility compared to men. This excessive laxity is the
reason that there is an increased incidence of
patellar subluxations and
ligament sprains
seen in female athletes. This laxity is especially present during pregnancy when
the risk of
ankle sprains and ligamentous injuries is highest. If this was not bad enough,
articular cartilage (see also
Articular
Cartilage Growth)
also has estrogen receptors located on it. Like ligamentous
tissue, estrogen has a direct negative effect on cartilage growth and repair.
The net effect of all of this is that the joints of females, even females who
have no pain whatsoever, are not normal. They cannot possibly be normal because
of all the negative effects of estrogen as the prime instigator and relaxin as a
lessor instigator. The turnover time (or half-life) of ligaments and cartilage
is about one to two years. This means that about half of the cartilage or
ligaments is regenerated about every 300 to 700 days. This is a very, very slow
rate.
Fibroblastic cells, which make collagen, and
chondrocytes that make
cartilage tissue, are stable cells in the fact that they do not proliferate
easily. They need to be stimulated to proliferate. Injury to tissue stimulates
them to some degree, but
exercise does not noticeably change this rate. The
primary way to stimulate the
fibroblasts and
chondrocytes (see research paper) is by direct
proliferative therapy (Prolotherapy).
Prolotherapy injections
(watch where do Prolotherapy
injections go and do they hurt?) are given right
where the fibroblasts and chondrocytes are located-at the
fibro-osseous
junction. This is where ligaments attach to bone or directly on the outside of
the cartilage. This causes a massive stimulation of fibroblastic and chondrocyte
growth, with the net effect being ligament and cartilage growth. It is this
treatment that offers the only hope to women to not only get rid of their
chronic pain, but also cure their
sports injuries
Jan Brynhildsen and colleagues from the Department
of Obstetrics and Gynecology, Faculty of Health Sciences, University Hospital,
Linkoping, Sweden, sent questionnaires to 1,324 women who were in menopause.
This questionnaire included questions about current
hormone replacement
treatment, previous and current
back pain, medical care for back problems,
parity, exercise and smoking habits, and occupation. The questionnaire was
returned by 85 percent of the women. There was a significant positive
association between current use of hormone replacement treatment and
low back pain. Previous back problems during pregnancy was a strong risk factor for
current back pain, whereas neither current smoking nor regular physical exercise
was a risk factor (nor was exercise protective). Their conclusion was that women
receiving hormone replacement treatment had a significantly higher prevalence of
current
back pain than non-users, which could not be explained by differences in
occupation, smoking habits, or current physical activity. (Brynhildsen, J. Is
hormone replacement therapy a risk factor for low back pain among postmenopausal
women? Spine. 1998; 23:809-813.) They speculated that hormonal effects on joints
and ligaments may be involved.
Others have also speculated that oral contraceptive pills are a risk factor for
low back and
pelvic pain among women. The theory proposes that estrogen steroid
hormones affect joints and ligaments, leading to
pubic symphysis weakening and
low back pain. In our opinion, this is not theory, but fact. Estrogen negatively
affects collagen growth with only one result emerging, and that result is not
good. Many general practitioners, gynecologists,
orthopedists, midwives, and
physiotherapists (at least in Sweden) believe there is an association between
the use of these estrogen pills and the development of back problems.
Approximately one-fourth of the active professionals in Sweden recommend that
some women with back problems abandon their use of oral contraceptives. (Brynhildsen,
J. Oral contraceptives and low back pain: Attitudes among physicians, midwives
and physiotherapists. Acta. Obste. Gynecol. Scan. 1995; 74:714-717.) Many
believe the oral contraceptives increase the risk of back problems, just like
what occurs during pregnancy. As many as 50 percent of all women experience back
problems during pregnancy. Because back problems develop so early during
pregnancy, they cannot be explained as related only to the increased mechanical
stress from the weight gained in the front of the body; therefore, hormonal
factors have been proposed as the cause. Sex hormones are thought to affect
ligaments and increase flexibility in the pelvis. This increased flexibility, or
laxity, then leads to the low back pain.
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