Tibial torsion has been implicated by Gigante and colleagues, who found that those with the greatest angles of external tibial rotation
the greater shear forces were placed across the tibial tuberosity
during knee extension (screw home mechanism), and found that those
symptomatic had significantly greater angles to tibial external
rotation compared to those who did not have pain.
The significance of tibial torsion is great in considering high quality movement and determining the appropriate selection of
exercises. When the tibia is locked in such positions, shifting into
the ipsilateral hip becomes significantly more difficult, which
ultimately will lead to inefficient gait and places the knee at greater
risk of degenerative complications. While not all cases are easily
managed, you’ll often find runners with short and stiff TFL and ITB to
exhibit greater external tibial torsion.
Naturally, from a movement perspective, we should be sure to address the issue from the hip with by improving hip flexion ability, reduce
the tone of the TFL, improving mobility of the ITB over VL, and then we
can look to improve from the ground up. There are a number of good MET
techniques that can be used to help eliminate exogenous tension at the
hip and help restore better interaction of the tibiofemoral joint.
Sarcevic observed in those with OS that the majority of the subjects displayed highly limited dorsiflexion range of motion (most <10
degrees). This lack of dorsiflexion mobility forces greater demand for
tibial IR motion, pronation, hip, and knee flexion. As the quadriceps
contract eccentrically during the stance phase, requiring more knee
flexion is not a recipe for unloading the tibial tuberosity.
Commonly, however, you’ll notice that athletes display both poor talocrural mobility AND the restrictions at TFL and ITB. In this case,
it is often that the subtalar joint needs to be addressed as the ankle
is locked into inversion.
Should this be the case, a complementary grouping of sound mobility work from the hallux (are they externally rotating the limb to get
around a big to restriction?) to the hip seems like it may be a smart
As you can tell, everything affects everything, so we should keep that in mind. Simply because a knee is hurting, there are a number of
joints (and structures that influence those joints) that may be to