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The role of proximal dynamic joint stability in the development of exertional medial tibial pain: a prospective study
  1. Ruth Verrelst1,
  2. Dirk De Clercq2,
  3. Jos Vanrenterghem3,
  4. Tine Willems4,
  5. Tanneke Palmans5,
  6. Erik Witvrouw6
  1. 1Rehabilitation Sciences and Physiotherapy Ghent, Ghent University, Ghent, Belgium
  2. 2Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
  3. 3Rehabilitation Sciences and Physiotherapy, School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
  4. 4Department of Orthopedic Surgery and Physical Medicine, Ghent University, Ghent, Belgium
  5. 5Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
  6. 6Department of Physiotherapy, Aspetar, Doha, Qatar
  1. Correspondence to Ruth Verrelst, Rehabilitation Sciences and Physiotherapy Ghent, Ghent University, De Pintelaan 185 3B3, Ghent 9000, Belgium; ruth.verrelst{at}


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.

  • Lower extremity injuries
  • Sporting injuries
  • Women in sport
  • Core stability/pelvis/hips, ribs

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