Ruth Verrelst

The role of hip abductor and external rotator muscle strength in the development of exertional medial tibial pain: a prospective study

Objective To prospectively identify proximal risk factors contributing to the development of exertional medial tibial pain (EMTP). Methods Data were prospectively collected on healthy female students in physical education, who were freshmen in 2010–2011 and 2011–2012. 95 female students, aged 18.15±0.84, were tested at the beginning of their first academic year. Testing included isokinetic hip strength measurements of the abductors, adductors, internal rotators and external rotators. The follow-up of the individulas was assessed using a weekly online questionnaire and a 3-monthly retrospective control questionnaire. EMTP was diagnosed by an experienced MD (Doctor of Medicine). Cox regression analysis was used to identify the potential risk factors for the development of EMTP. Results 21 individuals were diagnosed with EMTP during follow-up. The results of this study identified that decreased hip abductor concentric strength is a predictive parameter for the development of EMTP in females. More specifically, total work (p=0.010) and average power (p=0.045) for concentric abduction strength were found to be significant predictors for this lower leg overuse injury. Conclusions Hip abductor weakness is a significant predictor for EMTP in women. Preventive screening methods for EMTP should therefore include this proximal contributing factor.

The role of proximal dynamic joint stability in the development of exertional medial tibial pain: a prospective study

Objective To prospectively determine risk factors contributing to the development of exertional medial tibial pain (EMTP). Methods Data were prospectively collected on healthy female students in physical education, who were freshmen in 2010–2011 and 2011–2012. Eighty-six female students aged 19.38±0.85 years, were tested at the beginning of their first academic year. Kinematic parameters in the frontal and transverse plane were measured during a single-leg drop jump (SLDJ). For further analysis, the SLDJ task was divided in two phases: touchdown until maximal knee flexion (MKF) and then MKF until take-off, representing landing and push-off phase, respectively. The injury follow-up of the students was assessed using a weekly online questionnaire and a 3-monthly retrospective control questionnaire. EMTP was diagnosed by an experienced medical doctor. Cox regression analysis was used to identify the potential risk factors for the development of EMTP. Results During injury follow-up (1–2 years), 22 participants were diagnosed with EMTP. The results of this study identified that increased range of motion (ROM) in the transverse plane of hip and thorax during landing (p=0.010 and 0.026, respectively) and during push off (p=0.019 and 0.045, respectively) are predictive parameters for the development of EMTP in women. Conclusions Increased ROM values of hip and thorax in the transverse plane, which can be interpreted as impaired ability to maintain dynamic joint stability resulting in increased accessory movements, are significant contributors to the development of EMTP in women.

Contribution of a Muscle Fatigue Protocol to a Dynamic Stability Screening Test for Exertional Medial Tibial Pain

Background: Enhancing the accuracy of a risk factor screening test is an important element of sports injury prevention. Purpose: To determine the effect of muscle fatigue on a screening tool for those at risk of exertional medial tibial pain (EMTP). Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: Sixty-nine female students in a physical education program with a mean age of 19.24 ± 0.86 years were tested at the beginning of their first academic year and followed for 1 to 2 years. Participants completed an online questionnaire every week and a retrospective control questionnaire every 3 months, which were used to assess injury follow-up. A diagnosis of EMTP was made by an experienced medical doctor. A Cox regression analysis was used to identify the potential risk factors by comparing prefatigue and postfatigue data between uninjured participants and those with EMTP. Both the leg that developed EMTP and the contralateral leg were compared with legs of a matched control group. Results: During injury follow-up, 21 female participants were diagnosed with EMTP. Results of the comparison between uninjured versus EMTP participants, respectively, are as follows: For the leg at risk in the nonfatigued state, only increased range of motion in the transverse plane (ROMT) of the hip during landing could be identified as a risk factor (8.44° ± 2.94° vs 11.69° ± 3.41°; P = .002). In the fatigued state, increased ROMT of the hip and pelvis during landing (hip: 8.04° ± 2.34° vs 9.36° ± 3.22°; P = .038; pelvis: 6.99° ± 2.20° vs 8.58° ± 3.13°; P = .040) and increased ROMT of the thorax during pushoff (8.83° ± 2.74° vs 10.69° ± 3.20°; P = .036) could be identified. For the leg not at risk for EMTP, increased ROMT of the knee during landing (10.96° ± 3.12° vs 14.07° ± 4.88°; P = .023) and decreased ROMT of the pelvis during pushoff (8.16° ± 3.48° vs 6.47° ± 2.47°; P = .034) were identified in the nonfatigued state but were not significant in the fatigued state. Conclusion: Adding a muscle fatigue protocol to the single-legged drop jump as a screening test for EMTP risk factors may enhance the possibility of identifying the leg at risk in a predisposed athlete and might determine the proximal risk factors for that leg at risk more thoroughly.

Contralateral risk factors associated with exertional medial tibial pain in women.

PURPOSE This study aimed to prospectively analyze the role of factors on the contralateral side of the kinetic chain in the development of exertional medial tibial pain (EMTP). METHODS Eighty-one female physical education students were tested at the beginning of their first academic year. Within the testing protocol, contralateral isokinetic hip muscle strength and full-body kinematic parameters during a single-leg drop jump were evaluated. Online questionnaires were administered weekly, and personal interviews were conducted every 3 months to assess injury follow-up. EMTP was diagnosed by an experienced medical doctor. Cox regression analysis was used to identify the potential risk factors for the development of EMTP. RESULTS After exclusion of subjects with diagnosed bilateral EMTP, 11 subjects were included in the EMTP group. Fifty-three subjects did not develop any lower extremity overuse injury and were included in the control group. The leg not at risk within subjects who developed EMTP was compared with an uninjured leg of those in the control group. Increased transverse plane motion for the contralateral lower leg segment during landing phase was found to be a significant predictor (P = 0.012) for EMTP. Analysis of the isokinetic data did not reveal altered hip muscle strength parameters for the leg not at risk within the EMTP group. CONCLUSIONS Impaired dynamic joint stability or accessory movements were found in the transverse plane of the contralateral lower leg segment of EMTP subjects. This contralateral instability might have contributed to altered movement patterns within the kinetic chain function of EMTP subjects. No contralateral hip muscle strength parameters were found to predict EMTP in this study.

THE CONTRIBUTION OF A FATIGUE PROTOCOL TO A DYNAMIC STABILITY SCREENING TEST FOR EXERTIONAL MEDIAL TIBIAL PAIN

Background The development of accurate measurement techniques to detect risk factors for common injuries should be of concern to health care professionals. Objective To determine the contribution of a fatigue protocol to a risk factor screening test for the development of exertional medial tibial pain(EMTP). Design 3D kinematic parameters were prospectively evaluated during a single leg drop jump (SLDJ) in both non-fatigued and fatigued state. Setting: Female students in physical education were tested at the beginning of their first academic year and followed throughout 1–2 years. Participants 69 healthy female students were included in the study. Risk factor assessment Cox regression analysis was used to identify the potential risk of dynamic joint instability in the development of EMTP. Main outcome measurements It was hypothesized that dynamic joint instability in frontal and transverse plane might play a role in the development of EMTP. Results 21 subjects were diagnosed with EMTP. The results identified that for the leg at risk in non-fatigued state, only increased range of motion in the transverse plane (ROMT) of the hip during landing (P=.002) could be identified. In the fatigued state, increased ROMT of hip (P=.038) and pelvis (P=.040) during landing and increased ROMT of thorax (P=0036) during push-off could be determined. For the leg not at risk for EMTP, increased ROMT for the knee (P=.023) during landing and decreased ROMT for the pelvis (P=.034) during push-off were determined. These significant parameters could no longer be determined in the fatigued state. Conclusions It can be concluded that adding a fatigue protocol to the SLDJ enhances the possibility to identify the leg at risk in a predisposed female athlete and determine the proximal risk factors for that leg at risk more thoroughly.

Kinematic chain related risk factors in the development of lower extremity injuries in women: A prospective study

The link between dynamic range of motion (dROM) parameters within the kinematic chain and the development of lower extremity (LE) injury has gained attention; however, very few longitudinal studies have been conducted. Therefore, we wanted to prospectively determine dROM‐related risk factors for the development of LE injury. Within this study, 90 female physical education students aged 19.33±0.87 years were tested. Full‐body kinematic and vertical ground reaction force (VGRF) parameters were measured during a triple hop jump (THJ). Cox regression analysis was used to identify potential risk factors for the development of LE injury. The injury follow‐up was assessed using a weekly online questionnaire and a tri‐monthly retrospective control questionnaire. Lower extremity injury was diagnosed by an experienced medical doctor. During the follow‐up, 39 percent of the participants were diagnosed with a LE injury. Decreased dROM of the pelvic segment (P=.043) and increased dROM of the knee and ankle joint (P=.041 and P=.028, respectively) in the sagittal plane during landing phase were identified as predictive parameters for the development of LE injury in women. No VGRF parameters were identified as predictive variables. It can be concluded that an altered dROM within the LE kinematic chain was observed within the group at risk for LE injury. More specifically, this group showed reduced proximal dROM that was coupled with increased dROM in the distal segments during a THJ. The THJ can be seen as a practical screening tool for LE injury.

Injury prevention in physical education teacher education students: lessons from sports. A systematic review

Sports injuries are a considerable problem in physical education teacher education (PETE) students. They have important consequences and might affect the attitude that PETE students have towards sports and physical activity. Up to now, several efficacious injury prevention programmes have been developed for various sports disciplines. There is a high probability that several components of those prevention programmes are transferable to the PETE environment. A systematic review was conducted to identify intrinsic components that are potentially applicable in PETE programmes. The databases PubMed and Web of Science were searched for articles published between 1974 and 1 February 2015. The systematic study selection resulted in the inclusion of 59 studies. Seventeen studies were rated as having a low risk of bias. Efficacy of the applied programme was proven in 11 of these. Analysis led to guidelines for an injury prevention programme for PETE students. A multiple preventive intervention should include an awareness programme, functional strength training, stretching, warm-up, core stability and dynamic stability exercises of the lower limbs. This multiple preventive intervention preferably has a gradual build-up, makes use of no or only simple materials and is executed around three times per week.

KINETIC CHAIN RELATED RISK FACTORS FOR THE DEVELOPMENT OF LOWER EXTREMITY INJURIES IN WOMEN: A PROSPECTIVE STUDY

Background Attention has turned to the role of the overall kinetic chain function within the development of lower extremity (LE) injury, however few longitudinal studies have been conducted so far. Objective To prospectively determine kinetic chain related risk factors for the development of lower extremity (LE) injury in women. Design Prospective cohort design. Setting Department of Physical Education at the University of Ghent, Belgium. Participants Ninety healthy, female physical education students aged 19.33±0.87 years were tested. Assessment of Risk Factors Kinematic and VGRF parameters were measured during a triple hop jump (THJ). Cox regression analysis was used to identify the kinetic chain related risk factors for the development of LE injury. Main Outcome Measurements The LE injury follow-up was assessed using a weekly online questionnaire and a three-monthly retrospective control questionnaire. LE injury was diagnosed by an experienced medical doctor. Results Thirty-five participants were diagnosed with a LE injury. The results of this study identified that in the sagittal plane, decreased dynamic range of motion (ROM) of the pelvis segment (P=0.043) and increased dynamic ROM of the knee and ankle joint (P=0.041 and P=0.028 respectively) during landing phase are predictive parameters for the development of LE injury in females. No VGRF parameters were found to be of predictive value. Conclusions The pattern of decreased ROM of the pelvis segment in the sagittal plane combined with increased ROM of knee and ankle joint in the sagittal plane during landing phase, can be seen as decreased ability of equally absorbing forces throughout the kinetic chain during the landing phase of the THJ, which might lead to LE injury.

DECREASED AVERAGE POWER OF THE HIP EXTERNAL MUSCLES AS A RISK FACTOR FOR THE DEVELOPMENT OF LOWER EXTREMITY INJURY IN WOMEN: A PROSPECTIVE STUDY

Background Attention has turned into the role of proximal risk factors in the development of lower extremity (LE) injury. Objective To prospectively identify hip strength associated risk factors contributing to the development of LE injury. Design Prospective cohort design. Setting Department of Physical Education at the University of Ghent, Belgium. Participants Ninety-four healthy, female physical education students aged 19.53±1.07 years were tested. Assessment of Risk Factors Testing included isokinetic hip strength measurements of abductors, adductors, internal rotators and external rotators. Main Outcome Measurements The LE injury follow-up of the subjects was assessed using a weekly online questionnaire and a three-monthly retrospective control questionnaire. Lower extremity injury was diagnosed by an experienced M.D. (Doctor of Medicine). Cox regression analysis was used to identify the potential risk factors for the development of LE injury. Results Thirty-four subjects were diagnosed with LE injury during follow-up. The results of this study identified that decreased average power (AVP) (P=0.031) for concentric external rotation strength was found to be a significant risk factor for LE injury. No other hip strength parameters were found to be significant contributors to the development of LE injury. Conclusions Decreased AVP of the hip external muscles was identified as a significant predictor for LE injury in females, whereas no peak torque parameters were found to be of predictive value. A stabilizing muscle group such as the gluteal muscle group might be more challenged in a functional outcome measure then in a peak outcome measure. AVP might be therefore be considered as a more accurate parameter to evaluate strength of stabilizing muscles.

EXPLORATION OF CONTRALATERAL RISK FACTORS ASSOCIATED WITH THE DEVELOPMENT OF EXERTIONAL MEDIAL TIBIAL PAIN IN WOMEN

Background There is a significant lack of studies looking into the role of contralateral factors in the kinetic chain of subjects predisposed to exertional medial tibial pain (EMTP). Design Hip muscle strength and 3D kinematic parameters during a single leg drop jump (SLDJ) were prospectively evaluated. Setting Subjects were tested at the beginning of their first academic year and followed throughout one or two years. Participants 81 healthy female physical education students, were tested at the beginning of their first academic year and followed throughout 1 or 2 years. Risk factor assessment Cox regression analysis was used to identify the potential risk factors for the development of EMTP. Main outcome measurements It was hypothesized that in a subject predisposed to EMTP, differences in contralateral factors can be determined when compared to subjects not predisposed to EMTP. Results After exclusion of subjects with diagnosed bilateral EMTP, 11 subjects were included in the EMTP-group. The leg not at risk for EMTP within EMTP-predisposed subjects was compared with an uninjured leg of the control group. Analysis of the isokinetic data did not reveal altered hip muscle strength parameters for the leg not at risk within EMTP-subjects. However, increased accessory movement in the transverse plane for the contralateral knee during landing phase, was found to be a significant predictor (P=.012) for EMTP. Conclusions Impaired DJS or accessory movement was found in the transverse plane of the contralateral lower leg of subjects who developed EMTP, which may speculate that this factor contributed to altered movement patterns within the kinetic chain function of the subjects who developed EMTP. No contralateral decreased isokinetic hip muscle strength was found to be a significant predictor for EMTP in this study.