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Purpose/Background:
Medial shin pain (MSP) is a common complaint that may stop an athlete from running. No previous study has identified deficits in pelvic, hip or knee motion as potential contributing factors to MSP. The purpose of this study was to investigate the differences in kinematics during running between uninjured athletes and those with MSP. Secondary analyses investigated differences in limbs between groups and differences between sexes.
Methods:
This case-control study investigated fourteen runners aged 18–40 years old with a history of unilateral MSP and fourteen runner controls. Three dimensional lower quarter kinematics were captured as runners ran on a treadmill. Specifically, peak hip internal rotation (IR), frontal plane pelvic tilt (PT) excursion, and knee flexion were examined.
Results:
Groups were similar in age, mass, height, and training mileage. Subjects with a history of MSP demonstrated significantly greater frontal plane PT (P = 0.002, Effect size = 0.55) and peak hip IR (P = 0.004, Effect size = 0.51); and less knee flexion (P = 0.02, Effect size = 0.46) than the control group. No significant difference was found in kinematics of the MSP group during their involved side stance phase as compared to their non-involved side.
Conclusions:
Runners with MSP displayed greater PT excursion, peak hip IR, and decreased knee flexion while running as compared to a control group. These results should help guide treatment for the running athlete that experiences MSP.
OK, so we have internally placed hips and flexed knees reflecting a collapse in the corresponding closed chain feet either in the rearfoot/the forefoot/or both.
Do we treat the feet, the posture or both?
and can we discuss how we accomplish that?
Re: Proximal influences in medial tibial stress syndrome
The role of hip abductor and external rotator muscle strength in the development of exertional medial tibial pain: a prospective study
Ruth Verrelst, Tine Marieke Willems, Dirk De Clercq, Philip Roosen, Lennert Goossens, Erik Witvrouw Br J Sports Med doi:10.1136/bjsports-2012-091710
Quote:
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.
Re: Proximal influences in medial tibial stress syndrome
Quote:
Originally Posted by NewsBot
The role of hip abductor and external rotator muscle strength in the development of exertional medial tibial pain: a prospective study
Ruth Verrelst, Tine Marieke Willems, Dirk De Clercq, Philip Roosen, Lennert Goossens, Erik Witvrouw Br J Sports Med doi:10.1136/bjsports-2012-091710
OK, so we have internally placed hips (due to hip abductor weakness this time?) and flexed knees reflecting a collapse in the corresponding closed chain feet either in the rearfoot/the forefoot/or both.
Do we treat the feet, the posture or both?
and can we discuss how we accomplish that?
Re: Proximal influences in medial tibial stress syndrome
Hip Muscle Weakness As A Risk Factor For The Development Of Exertional Medial Tibial Pain: A Prospective Study
Ruth Verrelst, Tine Willems, Dirk De Clercq, Philip Roosen, Presented at 2013 ACSM Mtg
Quote:
Exertional medial tibial pain (EMTP) is a common and complex overuse problem among civilian, military and athletic populations and is usually induced by repetitive lower leg strain imposed by loading during weight-bearing activities. EMTP is characterised by exertional pain along the posteromedial border of the middle and distal thirds of the tibia and can include diagnostic entities of medial tibial stress syndrome (MTSS), tibial stress fracture, chronic exertional compartment syndrome and muscular an tendon injuries. The treatment of such an injury is often difficult, expensive and time-consuming. Hence, being injured can have a significant effect on a physically active lifestyle, and they can sometimes end activity-related careers entirely. The understanding of injury causation should therefore be of primary concern.
PURPOSE : 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 abductors, adductors, internal rotators and external rotators. The follow-up of the subjects was assessed using a weekly online questionnaire and a three-monthly retrospective control questionnaire. EMTP was diagnosed by an experienced M.D.. Cox regression analysis was used to identify the potential risk factors for the development of EMTP.
RESULTS: 21 subjects 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 female athletes. More specific, 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.
CONCLUSION: Hip abductor weakness is a significant predictor for EMTP. Preventive screening methods for EMTP should therefore include this proximal contributing factor.
Re: Proximal influences in medial tibial stress syndrome
Quote:
Originally Posted by NewsBot
Hip Muscle Weakness As A Risk Factor For The Development Of Exertional Medial Tibial Pain: A Prospective Study
Ruth Verrelst, Tine Willems, Dirk De Clercq, Philip Roosen, Presented at 2013 ACSM Mtg
Once again, if this proximal factor should be investigated and screened for, what treatment do you recommend once it is discovered to exist?
Re: Proximal influences in medial tibial stress syndrome
Quote:
Originally Posted by drsha
Once again, if this proximal factor should be investigated and screened for, what treatment do you recommend once it is discovered to exist?
Dennis
Dennis - if hip abductor weakness is shown to be a risk factor for a given pathology, and hip abductor weakness is 'discovered to exist' then what treatment do you think would be recommended??
Re: Proximal influences in medial tibial stress syndrome
Quote:
Originally Posted by Ian G
Dennis - if hip abductor weakness is shown to be a risk factor for a given pathology, and hip abductor weakness is 'discovered to exist' then what treatment do you think would be recommended??
Is there anyone else who didn't understand that I was asking for treatments for hip abductor weakness?
Proximal influences in medial tibial stress syndrome
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