Remember we spoke last week about the idea that hormones – namely estrogen and relaxin – may be implicated in the sensitization of fascial nociceptors, making females far more susceptible to myofascial pain than men?
Caterina Fede’s work with colleagues from the Anatomy Department of the University of Padua from 2016 can be extrapolated to highlight a difference between pre- and post-menopausal women. To quote, “it is well known that relaxin is a multifunctional factor which contributes to collagen tissue remodeling by inhibiting fibrosis and inflammatory activities” and that a deficiency of estrogen correlates with increased fibrosis. This is even seen in visceral organs such as the heart and liver.
Estrogen also inhibits TGBβ, a factor known to constrain fibrosis, as well as connective tissue growth factor and function. It also hinders the conversion of fibroblasts to myofibroblasts and retards the production of Types I and II collagen. So its role in fascial remodeling cannot be over-emphasized. Think on and the consequences for fascial stiffness and therefore the sensitization of nociceptors residing in that fascia (predisposing to stiffening of the underlying muscles) are undeniable.
Much to ponder, but this work is vital for us as Practitioners to bare in mind in addressing the issues of our female patient cohort to expand and complement our established manual therapy approaches.