Effect of Corrective Exercises on Dynamic Knee Valgus

Effect of Corrective Exercises on Lower Extremity Biomechanics and Performance in Asymptomatic Dynamic Knee Valgus

Dynamic knee valgus (DKV) is a movement pattern of the lower limb potentially consisting of a combination of adduction and internal rotation of the femur, knee abduction, tibial anterior translation, tibial external rotation and ankle eversion. Average "normal" performance during a fall jump landing mission knee valgus angle should be in the range of 7-13 degrees in women and 3-8 degrees in men. This faulty movement pattern is a common dysfunction observed in the lower limb during dynamic activities. On the other hand, this is reported to be the underlying mechanism of knee injuries. Changes in knee valgus increase abnormal stresses on the tibiofemoral joint and increase the risk of injuries such as anterior cruciate ligament injuries, patellofemoral pain, iliotibial band syndrome, chronic ankle instability, acute lateral ankle sprains. The main cause of DKV is deficits in neuromuscular control and therefore injury prevention and rehabilitation strategies focus on improving neuromuscular control to avoid these injury mechanisms. There are conflicting results in the literature regarding which of the exercise approaches is superior for DKV, and there is a lack of studies evaluating 2D movement analysis, muscle mechanics and performance of corrective exercise training. Identifying individuals with abnormal movement patterns and those at risk is important to prevent future injuries. The aim of the study was to investigate the effect of corrective exercises on lower extremity biomechanics and performance in individuals with asymptomatic dynamic knee valgus.

Study Overview

• Status: Recruiting
• Conditions: Dynamic Knee Valgus; Frontal Plan Projection Angle; MyotonPRO; Motion Analysis; Corrective Exercise
• Intervention / Treatment: Other: Exercise; Other: Control

• Study Type: Interventional
• Enrollment (Estimated): 33
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Istanbul, Turkey
    • Recruiting
    • Istanbul Medipol University
    • Contact: İmge Nas; Phone Number: +90444 85 44; Email: i.nas@iku.edu.tr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Between 18 and 25 years of age
• Have asymptomatic dynamic knee valgus
• Being woman

Exclusion Criteria:

• BMI≥ 30 kg/cm2
• Lower extremity musculoskeletal pain
• Lower extremity injury in the past 1 year
• History of lower limb surgery
• Neurological condition that may affect balance and coordination during the test
• More than half an hour of intense exercise per week
• Those who exercise vigorously for more than half an hour per week

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Exercise group; Intervention includes corrective exercises for dynamic knee valgus	Other: Exercise; Education on activities of daily living will be provided. In addition, a program including muscle strengthening, neuromuscular control and flexibility exercises for lower extremity and trunk muscles will be performed. Exercise Program will be performed for 8 weeks, 2 sessions per week.
Active Comparator: Control group; The control group will be followed without intervention.	Other: Control; Education will be provided for activities of daily living. Individuals with dynamic knee valgus in the control group will not receive any intervention. Exercise program will be implemented after the end of the study.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Frontal plan projection angle evaluation	It will be evaluated with the Single Leg Drop Jump test. Kinovea® 2D motion two-dimensional video analysis software will be used to measure the knee-valgus/varus anterior plane projection angle (FPPA).	Before the intervention, up to 8 weeks
Single leg squat test	During the test, they will be asked to perform a single-leg squat from a static position to at least 60° knee flexion and then return to the starting position. Kinovea® 2D motion two-dimensional video analysis software will be used for the measurement.	Before the intervention, up to 8 weeks
Viscoelastic properties of muscle	The viscoelastic properties of the participants' muscle will be measured using a myotonometer (MyotonPRO, Tallinn, Estonia). It will be performed on the quadriceps, hamstring, gastrocnemius and hip adductor muscles. Individuals will be asked to contract the muscle and the center of the muscle mass will be identified and marked. The muscle will then be asked to relax. For the measurement, the probe is placed over the muscle, perpendicular to the skin surface, and mechanical force is applied to the subcutaneous tissue for a constant 15 milliseconds. The interval between each pulse is 8 ms and 5 pulses.	Before the intervention, up to 8 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Static Balance Measurement	Participants will be asked to stand on one foot and to stand on tiptoe with the instruction "rise" and stay in this position. The time will be recorded in seconds.	Before the intervention, up to 8 weeks
Dynamic Balance Measurement	It will be measured with the "Y balance test". Participants will start by standing on one foot at the midpoint of the linear line with a 120-degree angle between them. With the other foot, they will be asked to touch the anterior, possteromedial and posterolateral direction with their fingertip. The tests will be repeated three times. The distances will be averaged and recorded.	Before the intervention, up to 8 weeks
Single Leg Forward Jump Test	They will be asked to jump as far as possible with one leg.	Before the intervention, up to 8 weeks
Three Step Forward Jump Test	They will be asked to perform 3 consecutive maximal jumps forward. The distance from the starting line to the point where the heel touches the ground after completing the third jump will be recorded.	Before the intervention, up to 8 weeks
Vertical Jump Test	The participant will be asked to jump as far as possible with both feet. The vertical jump distance will be recorded in cm by finding the difference between the jump distance and the arm length.	Before the intervention, up to 8 weeks

Collaborators and Investigators

• Sponsor: Medipol University
• Collaborators: Istanbul Kültür University

Study record dates

Study Major Dates

• Study Start (Actual): October 11, 2024
• Primary Completion (Estimated): March 22, 2025
• Study Completion (Estimated): June 15, 2025

Study Registration Dates

• First Submitted: January 7, 2025
• First Submitted That Met QC Criteria: January 14, 2025
• First Posted (Actual): March 25, 2025

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: January 14, 2025
• Last Verified: January 1, 2025

More Information

Terms related to this study

• Other Study ID Numbers: İK-2024-03

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No