Interaction of hip and foot factors associated with anterior knee pain in mountain bikers

• Published in: Physical therapy in sport Vol. 55; pp. 139 - 145
• Main Authors: Branco, Guilherme R., Resende, Renan A., Bittencourt, Natalia F.N., Mendonça, Luciana D.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-05-2022; Elsevier Limited
• Subjects: Ankle; Bicycling; Cycling; Decision trees; Digital cameras; Injury; Knee; Pain; Physical therapy; Questionnaires; Range of motion; Software; Sports injuries; Sports medicine; Statistical analysis; Variables; United States > US; Japan; Knee; Cycling; Decision trees; Injury
• ISSN: 1466-853X; 1873-1600
• DOI: 10.1016/j.ptsp.2022.04.001

To investigate the association of interactions among trunk, hip, and foot/ankle musculoskeletal factors with the presence of anterior knee pain (AKP) in mountain bikers.
Cross-sectional study.
Private clinical setting.
Fifty professional and amateur cyclists, with and without AKP, were included.
Bridge test with unilateral knee extension, hip stability isometric test (HipSIT), passive hip internal rotation (IR) range of motion (ROM), shank-forefoot alignment (SFA), and ankle dorsiflexion ROM were analyzed by classification and regression tree (CART) to identify interactions with AKP presence. A receiver-operating characteristic (ROC) curve verified accuracy of the model. To investigate strength of associations, prevalence ratios were calculated for each terminal node of the CART model.
Interactions among passive hip IR ROM, HipSIT, ankle dorsiflexion ROM and SFA identified mountain bikers with and without AKP. The model achieved 76.9% sensitivity and 87.5% specificity. The area under the ROC curve was 0.86 (95% confidence interval: 0.75–0.97; standard error 0.05; p < 0.0001).
Presence of AKP in mountain bike cyclists was associated with interactions among passive hip IR ROM, HipSIT and ankle dorsiflexion ROM captured by CART, indicating that the contribution of one factor depends on the presence of other factors.
•Hip and ankle joint factors interacted composing risk profiles for AKP.•CART was able to identify an accurate model for AKP in MTB cyclists.•No single isolated factor could predict AKP in MTB cyclists.