Q&A Time! What's Up with Loss of Tibial IR? | Modern Manual Therapy Blog

Q&A Time! What's Up with Loss of Tibial IR?

Want to guess which side has knee pain while running?

Since taking the SFMA a few years ago, I noticed the common loss of tibial IR in lower quarter dysfunction. So I mention it.... A LOT. As they say, common things happen commonly, actually one of my best friends who I mentored said they say that, even though I've never heard that saying myself until then.

Thanks to Dr. Luke Nelson for this question, that he really answered himself in a way...

"Hey Dr E, just wondering if you could help get my head around something. You mention a loss of internal tibial rotation quite frequently and I also see this a lot in patients especially with lower quarter dysfunctions.

I'm just trying to understand why this loss of internal rotation occurs??

Do you think this is from lateral hip instability, this can lead to excessive adduction and internal rotation of the femur, leading to external rotation of the tibia??

What I don't understand however is in those that show excessive pronation (which would also cause increased tibial rotation) you would expect then with these patients they display a EXCESS in passive internal rotation of the tibia?? But I have however often found the opposite and just got me thinking why this may happen??

Appreciate your opinion, keep up the awesome work!!

Cheers

Dr Luke Nelson
Sports Chiropractor"

Doc, this is my best guess, you already answered along with a decent amount of literature showing instability of the hip during single limb stance activities leading to pain and or injury. Whether this is due to "glut weakness" or ankle instability or dysfunction, that is beside the point of this Q&A. (I actually think it's a bit of all of the above in many cases btw).

So yes the "loss" of tibial IR comes from:

First answer, you answered yourself - The IR and adduction moment of the femur during SLS or DL closed chain activities on the involved side

Second answer - In the case of "excessive" pronation, you would think the tibia is rotating excessively and passively internally, but it's more of an osteokinematic movement of adduction.

  • osteokinematic being the movement of the bone (flexion, extension) as in gross movement in a plane
  • arthrokinematically, what is happening to the articulation surfaces due to osteokinematic movements (roll, slide, etc)
    • because it's a closed chain movement, and the forefoot is pronating, but also often everting, the adduction and IR of the femur is causing relative tibial ER
    • femur IR - tibia ER, despite femur as a whole moving medially
weird perspective, kinda looks like she's floating, doesn't it?
yes, she has chronic left knee pain while running, a DPT student nonetheless!
That is my best guess as to why when performing the SFMA breakout of seated tibia IR/ER you often see the loss of tibia IR with concomitant ankle df loss on the half kneel ankle df test. It's also why the functional mobilization tibial IR works so well, especially when enhanced with an EDGE Mobility Band!

Keeping it Eclectic...

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