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Contralateral Risk Factors Associated with Exertional Medial Tibial Pain in Women


Medicine & Science in Sports & Exercise: August 2014 - Volume 46 - Issue 8 - p 1546–1553
doi: 10.1249/MSS.0000000000000280

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.

1Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, BELGIUM; 2Department of Movement and Sports Sciences, Ghent University, Ghent, BELGIUM; 3Department of Physical Medicine and Orthopaedic Surgery, Ghent University, Ghent, BELGIUM; and 4Department of Physiotherapy, Aspetar, Doha, QATAR

Address for correspondence: Ruth Verrelst, PhD, Department of Rehabilitation Sciences and Physiotherapy, Ghent University, De Pintelaan 185 3B3, 9000 Ghent, Belgium; E-mail:

Submitted for publication August 2013.

Accepted for publication January 2014.

© 2014 American College of Sports Medicine