Walking Patterns and Hormonal Cycles in Females

Abstract

Concussion is a mild traumatic brain injury caused by direct or indirect biomechanical forces to the head or body, resulting in temporary disruption of brain function and a range of physical, cognitive, emotional, and sleep-related symptoms, often without structural abnormalities detectable on standard neuroimaging. Female athletes often experience prolonged symptoms and higher rates of secondary musculoskeletal (MSK) injuries following concussion compared to males, potentially due to hormonal fluctuations and physiological characteristics that influence neurological recovery and physical function. This thesis explores the relationship between menstrual cycle-related hormonal changes and gait alterations, and their potential implications for concussion outcomes, recurrent concussion, and secondary musculoskeletal injury susceptibility in females.

Despite growing evidence linking concussion-related hormonal disruption, menstrual cycle changes, and post-concussion gait alterations, limited research has examined how these factors interact. To address this gap, a scoping review was conducted to evaluate current evidence on the influence of menstrual cycle related hormonal changes and gait alterations on concussion outcomes their potential implications for secondary musculoskeletal injury and recurrent concussion in females. The literature review highlighted that fluctuations in oestrogen and progesterone may affect symptom severity and recovery, with injuries sustained during the luteal phase often associated with more pronounced symptoms. In addition, gait-related studies demonstrated persistent post-concussion impairments, particularly during dual-task conditions, including reduced walking speed, altered cadence, and impaired stability, which may increase vulnerability to secondary MSK injuries. However, no studies directly investigated the combined relationship between menstrual cycle-related hormonal changes and gait alterations.

To further explore this relationship, a prospective observational pilot case series study was conducted between 1 October 2025 and 15 March 2026. The study included 10 healthy female participants with no history of concussion or musculoskeletal injury, who attended multiple study visits (up to 12 sessions) over a three-month period. Participants completed questionnaires, performed single-task, dual-task, and head-turn walking assessments, and provided blood samples for hormonal analysis. Significant hormonal variations occurred across menstrual phases, particularly in oestradiol, progesterone, luteinising hormone, follicle-stimulating hormone, testosterone, thyroid-stimulating hormone, and dehydroepiandrosterone. However, no significant differences were identified in gait parameters across menstrual phases, with gait performance remaining stable despite hormonal fluctuations.

The findings contribute new insights into the relationship between menstrual cycle-related hormonal changes and gait alterations, suggesting that hormonal fluctuations alone may not substantially influence gait in healthy females. Although limited by the small sample size and absence of concussed participants, this study provides important feasibility data and methodological guidance for future research investigating the relationship between menstrual cycle-related hormonal changes and gait alterations, and their potential implications for secondary musculoskeletal injury and recurrent concussion in females recovering from concussion.