title: Contribution of a muscle fatigue protocol to a dynamic stability screening test for exertional medial tibial pain.
abstract: BACKGROUND
  Enhancing the accuracy of a risk factor screening test is an important element of sports injury prevention.
  
  
  OBJECTIVE
  To determine the effect of muscle fatigue on a screening tool for those at risk of exertional medial tibial pain (EMTP).
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Ruth Verrelst,Department of Rehabilitation Sciences and Physiotherapy, Ghent University, De Pintelaan 185, Ghent 9000, Belgium. ruth.verrelst@ugent.be.
authors.forename: Ruth
authors.initials: R
authors.lastname: Verrelst
authors.forename: Dirk
authors.initials: D
authors.lastname: De Clercq
authors.forename: Tine Marieke
authors.initials: TM
authors.lastname: Willems
authors.forename: Jan
authors.initials: J
authors.lastname: Victor
authors.forename: Erik
authors.initials: E
authors.lastname: Witvrouw
mesh_terms: D018771:Arthralgia / Q000503:physiopathology*; D016022:Case-Control Studies; D015331:Cohort Studies; D005080:Exercise Test; D005260:Female; D006621:Hip Joint / Q000502:physiology; D006801:Humans; D007719:Knee Joint / Q000502:physiology; D035002:Lower Extremity / Q000502:physiology; D018763:Muscle Fatigue / Q000502:physiology*; D010388:Pelvis / Q000502:physiology; D005082:Physical Exertion / Q000502:physiology*; D016059:Range of Motion, Articular / Q000502:physiology; D012044:Regression Analysis; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013909:Thorax / Q000502:physiology; D013977:Tibia / Q000503:physiopathology*; D055815:Young Adult
keywords: female athlete; injury prevention; overuse injury