The Relationship between Tibial IR ROM and Knee

The Relationship between Tibial IR ROM and Knee and Hip Joint Angles in Female Soccer Players During Pivot-Turn Maneuver Nils-Otto Jaasko, ATC/L, SPT; Jacob Alexsuk, SPT Dr. Arie van Duijn, Ed. D, PT, OCS; Dr. Rob Sillevis, PT, DPT, Ph. D, OCS, FAAOMPT, MTC Florida Gulf Coast University, Department of Rehabilitation Sciences, Fort Myers, FL, USA Introduction Results • Injuries to the anterior cruciate ligament (ACL) are common with 70% of the incidences occurring as noncontact injuries and females 2 -8 times more susceptible to injury. 1 • Kinematic phenomenon such as knee valgus, knee rotation, hip internal rotation, and hip adduction and abduction during cutting and landing have been associated to ACL injury. 2 -9 • No research to our knowledge has explored the relationship between tibial internal rotation (IR) range of motion (ROM) and knee valgus, hip IR, and/or hip adduction related joint angles during cutting • The mean left tibial internal range of motion was 18. 833 degrees (SD= ± 9. 829), mean left hip IR joint angle was -3. 591 degrees (SD= ± 5. 133), mean left hip adduction joint angle was -12. 600 degrees (SD= ± 9. 161), and mean left knee valgus joint angle was 1. 397 degrees (SD= ± 8. 369) in our sample. • The mean right tibial IR range of motion was 20. 944 degrees (SD= ± 11. 603), right hip IR joint angle was -. 893 degrees (SD= ± 6. 854), right hip adduction joint angle was -15. 341 degrees (SD= ± 3. 933), and right knee valgus joint angle was 1. 482 degrees (SD= ± 3. 632 in our sample. • No statistically significant correlations were found between left tibial IR range of motion and left hip internal rotation joint angle (r=. 638, P=. 086), left hip adduction joint angle (r= -. 231 P=. 329), or left knee valgus joint angle (r= -. 293 P=. 288). • No statistically significant correlations were found between right tibial IR range of motion and right hip IR joint angle (r= -. 243, P=. 322), right hip adduction joint angle (r= -. 432, P=. 196), or right knee valgus joint angle (r=. 160, P=. 381). Objectives • The purpose: Is tibial IR ROM is inversely correlated to knee valgus, hip IR, and/or hip adduction related joint angles in female soccer players between 18 -25 years-old during the pivot turn maneuver. • Hypothesis: Tibial IR ROM will be inversely correlated to knee valgus, hip IR, and hip adduction joint angles within female soccer players between the ages of 18 to 25 years. Methods • Research design: cross-sectional observational pilot motion analysis study examining the correlation between tibial IR ROM and knee valgus, hip IR, and/or hip adduction related joint angles in female soccer players between 18 -25 years-old during motion analysis capture of the pivot turn maneuver. • Sampling: six FGCU female NCAA and Club soccer team athletes who met the inclusion and exclusion criteria using convenience quota sampling were included. • Procedure: the participants performed a standardized warm-up followed by tibial IR ROM measurements and Qualisys marker set placement • Three mock trials followed by 3 recorded trials of the 90 degree pivot-turn maneuver toward the right and left were performed. Data Analysis • Mean, standard deviation, variance, and range was determined for the sample. • Three separate Pearson correlation tests per leg were performed to test for correlation and significance of the correlation between tibial IR and hip adduction, hip IR, and knee valgus Discussion • Large variance, range, and inconsistent differences between the sides were noted in tibial IR range of motion and joint angle data. • Side-to-side differences related to leg dominance and plant mechanics and small sample size may explain this phenomenon. 12, 13 • Subjects planted in mean hip abduction and external rotation, and knee valgus as has been seen in the literature regarding normal planting mechanics. 3, 10, 11 • No statistically significant correlations between tibial IR ROM and hip and knee kinematic joint angles associated to increased risk of ACL injury existed in our population. • Inconsistent trends were noted between tibial IR ROM and hip and knee joint kinematic data. • Small sample size, heterogeneity (i. e. , level of play) of the sample, and leg dominance may explain these findings, as suggested in previous research. 12, 13 • Limitations: sample size, heterogeneity of the sample, controlled environment, reliability of marker placement, reliability and validity of ROM measurements, variance in the pivot-turn parameters such as intensity and mechanics. Conclusions • No statistically significant correlations were found. • Inconsistent trends existed between tibial IR range of motion and hip adduction, hip IR, and knee valgus joint angles. • A larger, more homogenous sample is required to appropriately determine potential correlations between tibial IR range of motion and hip adduction, hip IR, and knee valgus joint angles during the 90 -degree pivot-turn maneuver References: See Handout with Reference List

Introduction • Injuries to the anterior cruciate ligament (ACL) are common with 70% of the incidences occurring as non-contact injuries and females 2 -8 times more 1 susceptible to injury. • Kinematic phenomenon such as knee valgus, knee rotation, hip internal rotation, and hip adduction and abduction during cutting and landing have 2 -9 been associated to ACL injury. • No research to our knowledge has explored the relationship between tibial internal rotation (IR) range of motion (ROM) and knee valgus, hip IR, and/or hip adduction related joint angles during cutting

Objectives • The purpose: Is tibial IR ROM is inversely correlated to knee valgus, hip IR, and/or hip adduction related joint angles in female soccer players between 1825 years-old during the pivot turn maneuver. • Hypothesis: Tibial IR ROM will be inversely correlated to knee valgus, hip IR, and hip adduction joint angles within female soccer players between the ages of 18 to 25 years.

Methods • Research design: cross-sectional observational pilot motion analysis study examining the correlation between tibial IR ROM and knee valgus, hip IR, and/or hip adduction related joint angles in female soccer players between 1825 years-old during motion analysis capture of the pivot turn maneuver. • Sampling: six FGCU female NCAA and Club soccer team athletes who met the inclusion and exclusion criteria using convenience quota sampling were included. • Procedure: the participants performed a standardized warm-up followed by tibial IR ROM measurements and Qualisys marker set placement • Three mock trials followed by 3 recorded trials of the 90 -degree pivot-turn maneuver toward the right and left were performed.

Data Analysis • Mean, standard deviation, variance, and range was determined for the sample. • Three separate Pearson correlation tests per leg were performed to test for correlation and significance of the correlation between tibial IR and hip adduction, hip IR, and knee valgus

Results • The mean left tibial internal range of motion was 18. 833 degrees (SD= ± 9. 829), mean left hip IR joint angle was -3. 591 degrees (SD= ± 5. 133), mean left hip adduction joint angle was -12. 600 degrees (SD= ± 9. 161), and mean left knee valgus joint angle was 1. 397 degrees (SD= ± 8. 369) in our sample. • The mean right tibial IR range of motion was 20. 944 degrees (SD= ± 11. 603), right hip IR joint angle was -. 893 degrees (SD= ± 6. 854), right hip adduction joint angle was -15. 341 degrees (SD= ± 3. 933), and right knee valgus joint angle was 1. 482 degrees (SD= ± 3. 632 in our sample. • No statistically significant correlations were found between left tibial IR range of motion and left hip internal rotation joint angle (r=. 638, P=. 086), left hip adduction joint angle (r= -. 231 P=. 329), or left knee valgus joint angle (r=. 293 P=. 288). • No statistically significant correlations were found between right tibial IR range of motion and right hip IR joint angle (r= -. 243, P=. 322), right hip adduction joint angle (r= -. 432, P=. 196), or right knee valgus joint angle (r=. 160, P=. 381).

Results- Cont’d

Discussion • Large variance, range, and inconsistent differences between the sides were noted in tibial IR range of motion and joint angle data • Side-to-side differences related to leg dominance and plant mechanics and 12, 13 small sample size may explain this phenomenon • Subjects planted in mean hip abduction and external rotation, and knee valgus 3, 10, 11 as has been seen in the literature regarding normal planting mechanics. • No statistically significant correlations between tibial IR ROM and hip and knee kinematic joint angles associated to increased risk of ACL injury existed in our population.

Discussion- Cont’d • Inconsistent trends were noted between tibial IR ROM and hip and knee joint kinematic data. • Small sample size, heterogeneity (i. e. , level of play) of the sample, and leg dominance 12, 13 may explain these findings, as suggested in previous research. • Limitations: sample size, heterogeneity of the sample, controlled environment, reliability of marker placement, reliability and validity of ROM measurements, variance in the pivot-turn parameters such as intensity and mechanics.

Conclusion • No statistically significant correlations were found • Inconsistent trends existed between tibial IR range of motion and hip adduction, hip IR, and knee valgus joint angles. • A larger, more homogenous sample is required to appropriately determine potential correlations between tibial IR range of motion and hip adduction, hip IR, and knee valgus joint angles during the 90 -degree pivot-turn maneuver

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