Limited Hip Rotational Range of Motion Is Associated with Kinesiophobia in Patients with Femoroacetabular Impingement

Limited Hip Rotational Range of Motion Is Associated with Kinesiophobia in Patients with Femoroacetabular Impingement | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Limited Hip Rotational Range of Motion Is Associated with Kinesiophobia in Patients with Femoroacetabular Impingement Yağmur İldeniz, Gülay Aras Bayram, Safa Gürsoy This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8976253/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background The severity of acetabular cartilage or labral injuries does not always correspond with clinical symptoms. This observational, cross-sectional study aimed to investigate the association between kinesiophobia levels and clinical findings in patients with femoroacetabular impingement syndrome. Methods Twenty-two individuals with symptomatic femoroacetabular impingement syndrome (12 females, 10 males; aged 18–65 years) were included in the study. Radiographic assessments comprised the alpha and the lateral center-edge angle. Kinesiophobia was assessed using the Tampa Scale for Kinesiophobia (TSK), pain intensity with the Visual Analog Scale, and pressure pain threshold using an algometer. Hip range of motion was measured using the Clinometer mobile application, hip function with the Harris Hip Score, and lower-extremity strength with the 30-Second Sit to Stand Test. Results A statistically significant inverse relationship was observed between kinesiophobia levels and hip external rotation (p = 0.006) and internal rotation range of motion (p = 0.027). Kinesiophobia levels were also significantly associated with the Harris Hip Score (p = 0.012). However, no relationship was found between kinesiophobia levels and the lateral center-edge angle (p = 0.824) or the alpha angle (p = 0.150). Additionally, no association was identified between the 30-Second Sit to Stand Test and either the lateral center-edge angle (p = 0.967) or the alpha angle (p = 0.943). Conclusions Kinesiophobia was significantly associated with hip rotation range of motion and functional status, whereas radiographic measures showed no meaningful clinical relevance. Trial registration: ClinicalTrials.gov ID: NCT06198829 Femoracetabular Impingement Kinesiophobia Hip Joint Pain Radiology 1. BACKGROUND Femoroacetabular impingement syndrome (FAIS) is one of the most common causes of hip pain. This condition may present as a cam deformity, characterized by excessive osseous formation at the femoral head–neck junction; a pincer deformity, resulting from excessive acetabular coverage of the femoral head; or a mixed type in which both deformities coexist. 1 Abnormal contact between the acetabulum and the femoral head–neck junction can lead to significant pain and discomfort, potentially resulting in acetabular labral or chondral injuries. 2 Radiographic imaging plays a fundamental role in the definitive diagnosis of FAIS. 3 The Dunn view provides optimal visualization of the anterolateral aspect of the femoral head–neck complex, where cam deformities are typically observed, while the anteroposterior (AP) pelvic radiograph effectively depicts femoral and acetabular morphology. 4 The lateral center-edge angle (LCEA or Wiberg angle), measured on the AP pelvic radiograph, reflects acetabular coverage, whereas the alpha angle is commonly used to evaluate cam morphology. 4,5 However, it is important to recognize that abnormal morphology does not necessarily indicate pathological tissue damage; therefore, clinical symptoms and physical examination findings should be integrated into a comprehensive diagnostic approach. 6 Individuals with femoroacetabular impingement syndrome (FAIS) often exhibit altered hip biomechanics, particularly during functional activities such as walking, squatting, and stair climbing. Pain may lead these individuals to adopt compensatory movement patterns—including maintaining the hip in a flexed position or reducing load on the affected limb—which can present as a Trendelenburg gait. 7 These compensations may, over time, contribute to the development of kinesiophobia, defined as an excessive and irrational fear of movement driven by the belief that physical activity will exacerbate pain or cause reinjury. 8 A study published in 2022 reported that higher levels of kinesiophobia in individuals with FAIS were associated with poorer physical performance and more unfavorable patient-reported outcomes. The same study also demonstrated that elevated kinesiophobia levels correlated with reduced hip-related quality of life as well as lower overall quality of life. 8 Grace et al. demonstrated that the severity of acetabular cartilage or labral injuries is not always associated with more pronounced clinical symptoms. 9 However, biochemical changes detected in the femoral cartilage by MRI may provide insight into symptom progression. 9 In the study conducted by Ratcliff et al., no association was found between radiographic findings and symptoms in individuals with FAIS, and it was emphasized that the sources of hip pain should be further investigated. 10 In this context, the present study aimed to evaluate the relationship between kinesiophobia and radiological and clinical parameters in individuals with FAIS. It was hypothesized that kinesiophobia would be significantly associated with hip joint range of motion and functional status in patients with femoroacetabular impingement syndrome. 2. METHODS 2.1.Trial design This study was designed as an observational, cross-sectional study. The study was ethically reviewed and approved by the Istanbul Medipol University Non-Interventional Ethics Committee on the date of 25.12.2023 with the file number E-10840098-772.02-7986. The study was registered in the ClinicalTrials database (ID: NCT06198829Reporting of the present cross-sectional study was guided by the STROBE statement. 11 2.2.Participants Individuals aged 18–65 years who were diagnosed with femoroacetabular impingement syndrome, were symptomatic, had not undergone surgical intervention in the hip region within the past year, and had not previously participated in a physical therapy program, and who presented to the Orthopedics and Traumatology Department of Acibadem Atasehir Hospital between February and June 2024 were included in the study. Individuals with a history of psychiatric or mental illness, as well as those with other hip disorders that may present with symptoms similar to femoroacetabular impingement syndrome—such as osteoarthritis, trochanteric bursitis, or hip dysplasia—were excluded from the study. Verbal and written informed consent was obtained from all patients who agreed to participate in the study. Demographic information of the participants was recorded. The study size was determined by the number of patients who met the inclusion criteria during the data collection period. To reduce potential sources of bias, participants were consecutively enrolled based on predefined inclusion and exclusion criteria. Radiographic assessments were conducted using standardized protocols, and validated instruments were employed to evaluate kinesiophobia and clinical outcomes. All measurements were performed by a single trained assessor, and data analyses were carried out using predefined statistical procedures. 2.3.Outcome Measures 2.3.1.The Tampa Scale of Kinesiophobia The Tampa Scale of Kinesiophobia (TSK) is a questionnaire developed by Miller et al. 12 and validated in Turkish by Yılmaz et al. 13 , assessing fear of movement/(re)injury and fear-avoidance parameters associated with work-related activities. The scale consists of 17 items rated on a 4-point Likert scale. The total score ranges from 17 to 68, with higher scores indicating a higher level of kinesiophobia. 2.3.2.The Harris Hip Score The Harris Hip Score (HHS) was developed by Harris to evaluate hip disability 14 and was validated in Turkish by Çelik et al. 15 The scale assesses parameters such as pain, function, absence of deformity, and range of motion. The questionnaire contains 10 main items and is scored out of a maximum of 100 points. Scores of 90–100 are considered excellent, 80–89 good, 70–79 fair, and below 70 poor. 16 2.3.3.The 30-Second Sit to Stand Test The 30-Second Sit to Stand Test (30STS) was used to measure the functional lower-limb strength of the participants. With arms crossed over the chest, participants stood up fully from a 44 cm-high chair and sat back down repeatedly for 30 seconds. After ensuring that the test was clearly understood, the score was recorded as the total number of full stands completed at a self-selected pace within 30 seconds. 17 2.3.4.Range of Motion Range of Motion (ROM) was measured using a mobile application called Clinometer (Plaincode app development and tech blog, Stephanskirchen, Germany), which has been shown by Wheyte et al. 18 to have excellent reliability for assessing hip extension and rotation. For hip flexion, the participant was in the supine position, with the pivot point placed on the greater trochanter, aligning the bottom corner of the phone, and the moving arm of the device following the lateral midline of the femur. Hip extension was measured while the participant transitioned from a seated position into the Modified Thomas Test position, with the lateral edge of the phone placed on the anterosuperior region of the femur. For internal and external rotation, the participant was seated with the hip and knee at 90° flexion, the leg hanging freely, and the thigh stabilized. Measurements were taken from the neutral position into rotation. 18 For internal and external rotation, the pivot point was aligned with the tibial tuberosity, placing the upper edge of the phone at this point, while the moving arm followed the tibial crest. 19 2.3.5.Pain Pain was assessed using both subjective and objective methods. Subjective pain was evaluated using the Visual Analog Scale (VAS). 20 The scale consisted of a 10 cm line with the endpoints labelled “No Pain” and “Unbearable Pain.” Participants were asked to mark their pain intensity at rest and during activities (e.g., squatting, stair climbing, walking) on separate lines. The distance in centimeters from the 0 point to the participant’s mark was measured and recorded. 21 Objective pain was assessed using a pressure algometer (JTECH Commander, JTECH Medical, USA). After providing instructions and performing a demonstration on another body area, pressure was applied in kg/cm² using a device with a 1 cm round plastic tip to the groin and greater trochanter regions. When pressure was applied, the kg value indicated at the participant’s maximum tolerance point was recorded. Each measurement was repeated three times, and the average value was taken as the final score. 22 2.3.6.Radiography Radiographic assessment was performed using Dunn view and Pelvis AP radiographs. Cam-type deformities were evaluated through the alpha angle measured on the Dunn view. 23 Pincer deformity was assessed on the Pelvis AP using the lateral center-edge angle. 24 Alpha angles ≥ 58° and lateral center-edge angles > 39° were considered abnormal. 2.4.Statistical analysis Statistical analysis was conducted using SPSS software version 23.0 (IBM, SPSS Inc., Chicago, IL). Normality was assessed using the Shapiro–Wilk test. Continuous variables obtained from the participants were presented as mean (X) and standard deviation (SD), while categorical variables were presented as frequency (N) and percentage (%). Pearson correlation analysis was performed. Correlation coefficients were interpreted as follows: 0.00–0.29 very weak; 0.30–0.49 weak; 0.50–0.69 moderate; 0.70–0.89 strong; 0.90–1.00 very strong. No missing data were observed for any of the analyzed variables. A p-value < 0.05 was considered statistically significant. 3. RESULTS The demographic characteristics of the participants are presented in Table 1 . A total of 22 symptomatic FAIS patients (12 females, 10 males; 18–65 years) were included in the study. Nineteen participants were university graduates. FAIS symptoms were present in the left hip in 54.5% of individuals, while 45.5% had right-sided involvement. The mean age of the participants was 39.77 ± 11.36 years, mean height was 173.36 ± 11.42 cm, mean body weight was 75.12 ± 17.17 kg, and mean BMI was 24.68 ± 3.79 kg/m² (Table 2 ). Table 1 Participant Characteristics: Gender, Education Level, and Symptomatic Side Variables n % Gender Female 12 54.5 Male 10 45,5 Education Level High School 3 %13.6 University 19 %86.3 Symptomatic Side Right 10 %45.5 Left 12 %54.5 Table 2 Descriptive Statistics of Participants Variables Mean ± SD Min. Max. Age (years) 39.77 ± 11.36 22 63 Height (cm) 173.36 ± 11.42 150 192 Body Weight (kg) 75.12 ± 17.17 44.6 107.2 BMI (kg/m 2) 24.68 ± 3.79 19 31.6 VAS-Rest 3.35 ± 2.93 0 9.1 VAS-Actv 6.82 ± 2.08 2 10 PPT-TM (kg) 9.94 ± 3.67 5 19 PPT-GR (kg) 7.43 ± 3.41 3 15.5 Alpha angle (°) 68.47 ± 6.87 57 82 LCEA (°) 35.13 ± 7.03 24 50 ROM-FLX (°) 104 ± 15.45 75 125 ROM-EXT (°) 12.6 ± 5.55 10 30 ROM-EXTR (°) 21.93 ± 6.69 9 35 ROM-INTR (°) 22.33 ± 5.62 13 33 TSK 40.47 ± 6.27 30 48 30STS 13.07 ± 2.46 9 17 HHS 71.14 ± 15.68 43.8 95 SD: Standard deviation, BMI: Body mass index, LCEA: Lateral center-edge angle, Min.: Minimum, Max.: Maximum, kg: kilogram, cm: centimeter, m²: square meter, °: degree, %: percent, VAS: Visual Analog Scale, VAS-Rest: VAS at rest, VAS-Actv: VAS during activity, PPT-TM: Pressure pain threshold at trochanter major, PPT-GR: Pressure pain threshold at groin, ROM-FLX: Range of motion – flexion, ROM-EXT: Range of motion – extension, ROM-EXTR: Range of motion – external rotation, ROM-INTR: Range of motion – internal rotation, TSK: Tampa Scale of Kinesiophobia, 30STS: 30-Second Sit to Stand Test, HHS: Harris Hip Score No significant relationship was found between the alpha angle and TSK scores (p = 0.150) (Table 3 ). Similarly, no significant relationship was observed between the LCEA and TSK scores (p = 0.824) (Table 3 ). A moderate positive correlation was found between VAS scores at rest and during activity (r = 0.562, p = 0.007). A moderate negative correlation was observed between external rotation and VAS scores at rest (r = − 0.536, p = 0.010). A low negative correlation was found between flexion and VAS scores during activity (r = − 0.426, p = 0.048). A strong positive correlation was observed between pressure pain thresholds in the groin and greater trochanter regions (r = 0.810, p < 0.001). A moderate negative correlation was found between TSK and external rotation (r = − 0.567, p = 0.006), and a low negative correlation was found between TSK and internal rotation (r = − 0.470, p = 0.027) (Table 4 ). A moderate negative correlation was found between HHS and TSK (r = − 0.527, p = 0.012). A low positive correlation was observed between the 30-second sit to stand test and HHS (r = 0.465, p = 0.029). VAS scores at rest showed a moderate negative correlation with LCEA (r = − 0.584, p = 0.022) and a low positive correlation with the alpha angle (r = 0.494, p = 0.019) (Table 5 ). Table 3 Correlation analysis between kinesiophobia (TSK) and radiographic parameters (LCEA and alpha angle) TSK LCEA ALFA TSK r 1 − .063 .317 p - .824 .150 LCEA r − .063 1 .132 p .824 - .638 ALFA r .317 .132 1 p .150 .638 - TSK: Tampa Scale of Kinesiophobia, LCEA: Lateral Center-Edge Angle, Alpha: Alpha Angle, r: Correlation coefficient, p: Significance level. Pearson correlation analysis was used; p < 0.05 was considered statistically significant Table 4 Correlation matrix of pain, pressure pain threshold, range of motion, and kinesiophobia VAS-Rest VAS-Acvt PPT-TM PPT-GR ROM-FLX ROM-EXT ROM-EXTR ROM-INTR TKS VAS-Rest r 1 0,562 ,143 -,030 -,401 -,242 -0,536 -,158 ,276 p , 007** ,524 ,895 ,065 ,278 , 010* ,483 ,214 VAS-Actv r 0,562 1 -,121 -,337 -0,426 -,095 -,289 ,004 ,138 p , 007** ,593 ,125 , 048* ,675 ,193 ,985 ,540 PPT-TM r ,143 -,121 1 0,810 ,232 0,488 ,196 ,223 -,300 p ,524 ,593 0,00** ,299 , 021* ,381 ,319 ,175 PPT-GR r -,030 -,337 0,810 1 ,259 ,409 ,372 ,300 -,172 p ,895 ,125 0,00** ,244 ,059 ,088 ,175 ,443 ROM-FLX r -,401 -0,426 ,232 ,259 1 ,092 ,354 ,096 -,383 p ,065 , 048* ,299 ,244 ,685 ,106 ,671 ,078 ROM-EXT r -,242 -,095 0,488 ,409 ,092 1 ,138 ,101 -,177 p ,278 ,675 , 021* ,059 ,685 ,540 ,655 ,432 ROM-EXTR r -0,536 -,289 ,196 ,372 ,354 ,138 1 0,498 -0,567 p , 010* ,193 ,381 ,088 ,106 ,540 , 018* , 006** ROM-INTR r -,158 ,004 ,223 ,300 ,096 ,101 0,498 1 -0,47 p ,483 ,985 ,319 ,175 ,671 ,655 , 018* , 027* TKS r ,276 ,138 -,300 -,172 -,383 -,177 -0,567 -0,47 1 p ,214 ,540 ,175 ,443 ,078 ,432 , 006** , 027* VAS: Visual Analog Scale, VAS-Rest: VAS at rest, VAS-Actv: VAS during activity, PPT-TM: Pressure pain threshold at trochanter major, PPT-GR: Pressure pain threshold at groin, ROM-FLX: Range of motion – flexion, ROM-EXT: Range of motion – extension, ROM-EXTR: Range of motion – external rotation, ROM-INTR: Range of motion – internal rotation, TSK: Tampa Scale of Kinesiophobia, r: Correlation coefficient, p: Significance level, Pearson correlation analysis was used. *: p < 0.05, **: p < 0.01 Table 5 Relationships between functional capacity, kinesiophobia, and hip function outcomes 30STS TSK HHS 30STS r 1 − .245 0.465 p .271 .029* TSK r − .245 1 -0.527 p .271 .012* HHS r 0.465 -0.527 1 p .029* .012* 30STS: 30-Second Sit to Stand Test, TSK: Tampa Scale of Kinesiophobia, HHS: Harris Hip Score 4. DISCUSSION In our study aiming to examine the relationship between kinesiophobia and clinical and radiographic parameters in individuals with FAIS, significant associations were found between kinesiophobia levels and clinical parameters, whereas no significant relationships were observed with radiographic parameters. The TSK scores of the individuals in our study were found to be higher compared to previous studies involving patients with FAIS. 8 , 25 , 26 Sharma et al. 27 reported in their systematic review that pain beliefs (particularly fear-avoidance beliefs) and pain coping strategies vary across countries. In a study conducted among Turkish and Swedish patients with musculoskeletal pain, Turkish patients were found to report higher levels of pain intensity, duration, and frequency. 28 Consequently, in some populations, limiting movement in response to pain may be a more common coping strategy, which may lead to higher levels of kinesiophobia. Factors such as education, age, and gender may also contribute to these differences. Luque-Suarez et al. 29 reported that high kinesiophobia in chronic musculoskeletal pain is associated with greater pain, increased disability, and lower quality of life. The inverse relationship found in our study between kinesiophobia and external and internal rotation range of motion indicates that as kinesiophobia levels increase, hip rotation range of motion decreases. It is known that individuals with FAIS exhibit reduced internal rotation, external rotation, and flexion range of motion. 30 The literature has also shown that patients with FAIS generate less external and internal rotation torque during walking compared to healthy individuals. 31 Similar to other pathologies that lead to chronic pain, kinesiophobia in FAIS may originate from avoidance behavior toward movements that provoke pain. Avoidance leads to activity limitation as a result of persistent fear related to pain and the negative thoughts and emotions associated with activity. 32 The inverse relationship observed between TSK scores and the Harris Hip Score (HHS) indicates that higher levels of kinesiophobia are associated with greater disability in individuals. Jochimsen et al. 33 reported in their 2021 study that higher levels of kinesiophobia in individuals with FAIS are associated with poorer functional outcomes. Additionally, it is known that both hip-related and general health-related quality of life are negatively affected by kinesiophobia in this population. 8 The findings of our study also suggest that kinesiophobia in individuals with FAIS reduces participation in daily life activities and negatively impacts functional status. Samaan et al. 34 stated that the 30-second Sit-to-Stand Test (30STS) is a valid measure for assessing lower extremity joint mechanics and functional performance in individuals with FAIS. The positive correlation found in our study between the 30STS test and the Harris Hip Score (HHS) indicates that improved hip joint function is associated with higher lower extremity performance in individuals with FAIS. It has been reported that during the sit-to-stand activity, individuals with FAIS exhibit compensatory concentric activation of the hip internal rotators and reduced activation of the gluteus medius muscle. 35 This suggests that muscle imbalances around the hip may reduce movement efficiency during functional tasks. The literature also indicates that symptomatic individuals with FAIS experience movement impairments during functional tasks such as sit-to-stand. 36 Therefore, the positive relationship identified in our study suggests that increased functional capacity in these individuals may contribute to performing daily activities more efficiently and with better balance. Previous literature has demonstrated that the relationship between hip pain and pathological changes in joint morphology is weak. 37 There is consensus that FAIS should not be diagnosed solely on the basis of radiological findings in the absence of appropriate symptoms and clinical signs, as a substantial proportion of the general population presents with cam and/or pincer morphology. 38 The presence of cam deformity on radiographic assessment does not always lead to impingement, and these morphologies are frequently observed in healthy young adults as well. 39 , 40 Therefore, the terms “radiological FAIS” or “asymptomatic FAIS” are used in the literature to describe structural hip morphology rather than a clinical disorder. This highlights the need to investigate the relationship between pain and hip morphology using more comprehensive biomechanical and clinical parameters. In our study, the relationship between Visual Analog Scale (VAS) scores and joint range of motion was evaluated, and a moderate inverse relationship was observed between pain at rest and external rotation range of motion. This finding indicates that as the level of pain at rest increases, external rotation range of motion decreases. Literature examining range of motion in individuals with FAIS using three-dimensional motion analysis has reported that individuals with FAIS exhibit significantly less external rotation at 90° flexion compared to healthy controls. 41 , 42 Furthermore, symptomatic individuals with FAIS have been shown to demonstrate significantly reduced external rotation compared to both healthy controls and asymptomatic individuals. 43 These findings suggest that pain-related movement limitations in symptomatic individuals are particularly pronounced in external rotation, and that increasing this movement may provoke pain symptoms. Jochimsen et al. 33 did not find a significant relationship between pain levels measured by the Visual Analog Scale (VAS) and kinesiophobia in individuals with FAIS. Similar findings were observed in our study. A possible explanation for this result is that some individuals with FAIS may be less inclined to avoid movement despite pain, due to factors such as education level or prior physical activity habits. Additionally, the VAS measures only the intensity of pain and may not fully capture its psychosocial dimensions, which could also explain the lack of association. This suggests that kinesiophobia in individuals with FAIS should be considered not only in relation to pain intensity but also in the context of pain perception, coping strategies, and psychosocial factors. In our study, significant relationships were observed between VAS scores at rest and radiographic parameters. A low positive correlation was found between pain at rest and the alpha angle, whereas a moderate inverse correlation was observed with the lateral center-edge angle (LCEA). It is known that increases in the alpha angle are associated with labral degeneration and cam deformity 44 – 46 ; therefore, higher alpha angles are expected to correspond with increased pain levels. In adults, an alpha angle above 55° has been reported to be associated with hip pain. 45 Allen et al. 46 noted that alpha angles of 60° and above are more commonly associated with hip pain. The mean alpha angle of our participants being above the threshold values associated with pain in the literature supports this finding. Our results differ from those reported by Yamauchi et al. 47 , which may be attributed to differences in participant characteristics and measurement methods. The lateral center-edge angle (LCEA) is a parameter indicating the degree of acetabular coverage, and deviations above or below normal values may lead to different clinical outcomes. 5 In our study, a moderate inverse relationship was observed between LCEA and pain at rest. This finding is consistent with literature reporting that coxa profunda (high LCEA) is associated with lower pain levels. 48 Therefore, an increase in LCEA may correspond to reduced pain during rest. However, since LCEA values in our sample were generally within normal limits, the generalizability of this relationship is limited. No significant relationships were found between LCEA and alpha angle with range of motion (ROM) measurements in our study. Similarly, the literature indicates that symptomatic FAIS is not associated with reduced ROM, and surgical interventions do not lead to significant changes in ROM. 47 , 49 Furthermore, asymptomatic individuals with FAIS morphology have been shown to have ROM values similar to healthy controls. 50 Naili et al. 51 also noted that ROM limitations cannot be explained solely by morphological factors. Meta-analytic findings support the notion that individuals with FAIS reduce their movement depth due to pain or fear of movement. 31 These findings are in agreement with our study. It can be suggested that ROM limitations in individuals with FAIS are influenced not only by bony morphology but also by pain, capsuloligamentous changes, and kinesiophobia. In our study, no significant relationships were found between radiographic parameters (alpha angle, LCEA) and the Harris Hip Score or 30-second Sit-to-Stand (30STS) test. Similarly, Zhang et al. 52 reported that hip scores and muscle strength in asymptomatic individuals with FAIS did not differ from those of healthy controls. These findings suggest that radiographic parameters do not directly influence hip function, and that the functional status of individuals with FAIS is more affected by factors such as limitations in range of motion, pain, and kinesiophobia. The literature indicates that maladaptive pain-related thoughts and emotions in individuals with chronic hip pain may lead to kinesiophobia, which in turn can result in increased pain and functional limitations. 53 These results suggest that fear of movement is more strongly influenced by pain perception and maladaptive beliefs rather than structural deformities. These findings also highlight the importance of addressing kinesiophobia and functional limitations in the management of FAIS, rather than relying solely on radiographic morphology for treatment decisions. Rehabilitation programs that include targeted strategies to reduce fear-avoidance behaviors, improve joint mobility, and enhance functional capacity may be beneficial. In addition, assessing psychosocial factors and patients’ pain beliefs could help tailor individualized interventions, potentially improving adherence, reducing disability, and optimizing post-surgical or conservative outcomes. 4.1.Study limitations Our study has several limitations. First, the small sample size may limit the generalizability of our findings. Another limitation is the variability in participants’ physical activity levels, which could have influenced both functional performance and kinesiophobia levels. In addition, our cross-sectional design prevents establishing causal relationships between kinesiophobia, pain, functional status, and radiographic parameters. Additionally, radiographic measurements may not fully capture dynamic joint mechanics; more advanced imaging techniques, such as magnetic resonance imaging (MRI) or three-dimensional motion analysis, could provide further insights. Future studies with larger, more homogeneous cohorts, longitudinal designs, and comprehensive psychosocial and biomechanical assessments are warranted to better elucidate the role of kinesiophobia in individuals with FAIS. 5. CONCLUSION Kinesiophobia was significantly associated with hip rotation range of motion and functional status, whereas radiographic measures showed no meaningful clinical relevance. These findings emphasize the need to include psychosocial factors—particularly fear of movement—in the clinical evaluation and rehabilitation of individuals with FAIS, as addressing kinesiophobia may contribute to improved mobility and functional outcomes. Declarations Ethics approval The study was ethically reviewed and approved by the “Istanbul Medipol University Institution Non-Interventional Ethics Committee” on the date of 25.12.2023 with the file number E-10840098-772.02-7986. Ethical approval was obtained from the Istanbul Medipol University Non-Interventional Ethics Committee on 25 December 2023 (Approval No: E-10840098-772.02-7986). Written informed consent was obtained from all participants. Author Contributions: G.A.B. and Y.I. contributed to conceptualization of the study. Y.I. collected the data and wrote the original draft of the manuscript. G.A.B. contributed to writing – review & editing. S.G. contributed to conceptualization and provided supervision. All authors read and approved the final version of the manuscript. Conflıcts of ınterest None to declare. Funding No financial support was received for this study. Acknowledgments The authors declare that there are no acknowledgements to declare. Declaration of conflicting interest The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article Funding statement The authors did not receive support from any organization for the submitted work. The authors have no relevant financial or non-financial interests to disclose. Data availability The datasets generated during the current study are not publicly available because of ethical approval limitations, but may be obtained from the corresponding author on reasonable request. References Chamberlain R. Hip pain in adults: evaluation and differential diagnosis. Am Fam Physician. 2021;103(2):81–9. Dooley PJ. Femoroacetabular impingement syndrome: nonarthritic hip pain in young adults. Can Fam Physician. 2008;54(1):42–7. Zhang C, Li L, Forster BB, et al. Femoroacetabular impingement and osteoarthritis of the hip. Can Fam Physician. 2015;61(12):1055–60. Aşık M, Polat G. Femoroasetabular sıkışmada direkt radyoloji. 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Orthop J Sports Med. 2018;6(6):2325967118778783. Ratcliff TL, Chhabra A, Okpara SO, et al. Correlation of the imaging features of femoroacetabular impingement syndrome with clinical findings and patient functional scores. Orthopedics. 2021;44(4):e577–82. von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453–7. Miller RP, Kori SH, Todd DD. The Tampa Scale: a measure of kinesiophobia. Clin J Pain. 1991;7(1):51–2. Yılmaz ÖT, Yakut Y, Uygur F. Tampa Kinezyofobi Ölçeği’nin Türkçe versiyonu ve test–tekrar test güvenilirliği. Fizyoter Rehabil. 2011;22(1):44–9. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures. J Bone Joint Surg Am. 1969;51(4):737–55. Çelik D, Can C, Aslan Y, et al. Translation, cross-cultural adaptation, and validation of the Turkish version of the Harris Hip Score. Hip Int. 2014;24(5):473–9. Nilsdotter A, Bremander A. Measures of hip function and symptoms. Arthritis Care Res (Hoboken). 2011;63(Suppl 11):S200–7. Bennell K, Dobson F, Hinman R. Measures of physical performance assessments. Arthritis Care Res (Hoboken). 2011;63(Suppl 11):S350–70. Whyte E, Doinn Ó, Downey T. Reliability of a smartphone goniometric application in the measurement of hip range of motion. J Sport Rehabil. 2021;30(6):969–72. Ganokroj P, Sompornpanich N, Kerdsomnuek P, et al. Validity and reliability of smartphone applications for measurement of hip rotation. BMC Musculoskelet Disord. 2021;22(1):166. Gift AG. Visual analogue scales: measurement of subjective phenomena. Nurs Res. 1989;38(5):286–7. Heller GZ, Manuguerra M, Chow R. How to analyze the visual analogue scale. Scand J Pain. 2016;13:67–75. Vanderweeën L, Oostendorp RA, Vaes P, et al. Pressure algometry in manual therapy. Man Ther. 1996;1(5):258–65. Barton C, Salineros MJ, Rakhra KS, et al. Validity of the alpha angle measurement on plain radiographs. Clin Orthop Relat Res. 2011;469(2):464–9. Monazzam S, Bomar JD, Cidambi K, et al. Lateral center-edge angle on conventional radiography and CT. Clin Orthop Relat Res. 2013;471(7):2233–7. Clapp IM, Nwachukwu BU, Beck EC, et al. Role of kinesiophobia and pain catastrophizing after hip arthroscopy. Arthrosc Sports Med Rehabil. 2020;2(2):e97–104. Murphy MC, Rio EK, Scholes MJ, et al. A 7-item Tampa Scale for Kinesiophobia in FAI syndrome. Musculoskelet Sci Pract. 2024;74:103200. Sharma S, Ferreira-Valente A, de Williams AC, et al. Group differences in pain-related beliefs and coping. Pain Med. 2020;21(9):1847–62. Joaquim JFS, Giorgio G. Psychosocial factors among Turkish and Swedish patients. Scand J Occup Ther. 1999;6(4):174–83. Luque-Suarez A, Martinez-Calderon J, Falla D. Role of kinesiophobia in chronic musculoskeletal pain. Br J Sports Med. 2019;53(9):554–9. Menge TJ, Truex NW. Femoroacetabular impingement: a common cause of hip pain. Phys Sportsmed. 2018;46(2):139–44. King MG, Lawrenson PR, Semciw AI, et al. Lower limb biomechanics in FAI syndrome. Br J Sports Med. 2018;52(9):566–80. Vlaeyen JW, Crombez G, Linton SJ. The fear-avoidance model of pain. Pain. 2016;157(8):1588–9. Jochimsen KN, Mattacola CG, Noehren B, et al. Low self-efficacy and high kinesiophobia in FAI syndrome. J Sport Rehabil. 2020;30(3):445–51. Samaan MA, Schwaiger BJ, Gallo MC, et al. Abnormal joint moment distributions in FAI. PM R. 2017;9(6):563–70. Spiker AM, Kraszewski AP, Maak TG, et al. Dynamic assessment of FAI syndrome hips. Arthroscopy. 2022;38(2):404–e4163. Brown-Taylor L, Pendley C, Glaws K, et al. Movement impairments and function in FAI syndrome. Phys Ther. 2021;101(9):pzab157. Bell E, Mosler A, Barton C, et al. Participant beliefs regarding physical therapy-led treatment. Braz J Phys Ther. 2024;28(3):101077. Griffin DR, Dickenson EJ, O’Donnell J, et al. The Warwick Agreement on FAI syndrome. Br J Sports Med. 2016;50(19):1169–76. Agricola R, Heijboer MP, Bierma-Zeinstra SM, et al. Cam impingement causes osteoarthritis. Ann Rheum Dis. 2013;72(6):918–23. Morales-Avalos R, Tapia-Náñez A, Simental-Mendía M, et al. Prevalence of FAI-related morphology. Orthop J Sports Med. 2021;9(2):2325967120977892. Diamond LE, Dobson FL, Bennell KL, et al. Physical impairments in FAI. Br J Sports Med. 2015;49(4):230–42. Kennedy M, Lamontagne M, Beaulé PE. Effect of cam FAI on hip dynamic ROM. J Orthop. 2009;6(1):41–50. Audenaert E, Van Houcke J, Maes B, et al. Range of motion in FAI. Acta Orthop Belg. 2012;78(3):327–32. Youngman TR, Wagner KJ, Montanez B, et al. Association of alpha angle with disease severity. J Pediatr Orthop. 2021;41(2):88–92. Lansdown DA, Kunze K, Ukwuani G, et al. Importance of comprehensive cam correction. Am J Sports Med. 2018;46(9):2072–8. Allen D, Beaulé PE, Ramadan O, et al. Prevalence of deformities in cam-type FAI. J Bone Joint Surg Br. 2009;91(5):589–94. Yamauchi R, Inoue R, Chiba D, et al. Association of clinical and radiographic signs of FAI. J Orthop Sci. 2017;22(1):94–8. Ranawat AS, Schulz B, Baumbach SF, et al. Radiographic predictors of hip pain in FAI. HSS J. 2011;7(2):115–9. Freke MD, Kemp J, Svege I, et al. Physical impairments in symptomatic FAI. Br J Sports Med. 2016;50(19):1180. Albertoni DB, Gianola S, Bargeri S, et al. Does FAI syndrome affect range of motion? Br Med Bull. 2023;145(1):45–59. Naili JE, Stålman A, Valentin A, et al. Hip joint ROM restricted by pain rather than impingement. Arch Orthop Trauma Surg. 2022;142(8):1985–94. Zhang J, Kim Y, Choi M. Biomechanical characteristics in acetabular impingement. Healthc (Basel). 2022;10(8):1484. Coyne NC, Baez S, Murro M, et al. Pain self-efficacy and function in chronic hip pain. JOSPT Open. 2024;2:264–71. Additional Declarations No competing interests reported. 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BACKGROUND","content":"\u003cp\u003eFemoroacetabular impingement syndrome (FAIS) is one of the most common causes of hip pain. This condition may present as a cam deformity, characterized by excessive osseous formation at the femoral head\u0026ndash;neck junction; a pincer deformity, resulting from excessive acetabular coverage of the femoral head; or a mixed type in which both deformities coexist.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Abnormal contact between the acetabulum and the femoral head\u0026ndash;neck junction can lead to significant pain and discomfort, potentially resulting in acetabular labral or chondral injuries.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Radiographic imaging plays a fundamental role in the definitive diagnosis of FAIS.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e The Dunn view provides optimal visualization of the anterolateral aspect of the femoral head\u0026ndash;neck complex, where cam deformities are typically observed, while the anteroposterior (AP) pelvic radiograph effectively depicts femoral and acetabular morphology.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e The lateral center-edge angle (LCEA or Wiberg angle), measured on the AP pelvic radiograph, reflects acetabular coverage, whereas the alpha angle is commonly used to evaluate cam morphology. \u003csup\u003e4,5\u003c/sup\u003e However, it is important to recognize that abnormal morphology does not necessarily indicate pathological tissue damage; therefore, clinical symptoms and physical examination findings should be integrated into a comprehensive diagnostic approach. \u003csup\u003e6\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIndividuals with femoroacetabular impingement syndrome (FAIS) often exhibit altered hip biomechanics, particularly during functional activities such as walking, squatting, and stair climbing. Pain may lead these individuals to adopt compensatory movement patterns\u0026mdash;including maintaining the hip in a flexed position or reducing load on the affected limb\u0026mdash;which can present as a Trendelenburg gait.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e These compensations may, over time, contribute to the development of kinesiophobia, defined as an excessive and irrational fear of movement driven by the belief that physical activity will exacerbate pain or cause reinjury.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e A study published in 2022 reported that higher levels of kinesiophobia in individuals with FAIS were associated with poorer physical performance and more unfavorable patient-reported outcomes. The same study also demonstrated that elevated kinesiophobia levels correlated with reduced hip-related quality of life as well as lower overall quality of life. \u003csup\u003e8\u003c/sup\u003e Grace et al. demonstrated that the severity of acetabular cartilage or labral injuries is not always associated with more pronounced clinical symptoms. \u003csup\u003e9\u003c/sup\u003e However, biochemical changes detected in the femoral cartilage by MRI may provide insight into symptom progression.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e In the study conducted by Ratcliff et al., no association was found between radiographic findings and symptoms in individuals with FAIS, and it was emphasized that the sources of hip pain should be further investigated.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn this context, the present study aimed to evaluate the relationship between kinesiophobia and radiological and clinical parameters in individuals with FAIS. It was hypothesized that kinesiophobia would be significantly associated with hip joint range of motion and functional status in patients with femoroacetabular impingement syndrome.\u003c/p\u003e"},{"header":"2. METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1.Trial design\u003c/h2\u003e \u003cp\u003eThis study was designed as an observational, cross-sectional study. The study was ethically reviewed and approved by the Istanbul Medipol University Non-Interventional Ethics Committee on the date of 25.12.2023 with the file number E-10840098-772.02-7986. The study was registered in the ClinicalTrials database (ID: NCT06198829Reporting of the present cross-sectional study was guided by the STROBE statement.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2.Participants\u003c/h2\u003e \u003cp\u003eIndividuals aged 18\u0026ndash;65 years who were diagnosed with femoroacetabular impingement syndrome, were symptomatic, had not undergone surgical intervention in the hip region within the past year, and had not previously participated in a physical therapy program, and who presented to the Orthopedics and Traumatology Department of Acibadem Atasehir Hospital between February and June 2024 were included in the study. Individuals with a history of psychiatric or mental illness, as well as those with other hip disorders that may present with symptoms similar to femoroacetabular impingement syndrome\u0026mdash;such as osteoarthritis, trochanteric bursitis, or hip dysplasia\u0026mdash;were excluded from the study. Verbal and written informed consent was obtained from all patients who agreed to participate in the study. Demographic information of the participants was recorded. The study size was determined by the number of patients who met the inclusion criteria during the data collection period.\u003c/p\u003e \u003cp\u003eTo reduce potential sources of bias, participants were consecutively enrolled based on predefined inclusion and exclusion criteria. Radiographic assessments were conducted using standardized protocols, and validated instruments were employed to evaluate kinesiophobia and clinical outcomes. All measurements were performed by a single trained assessor, and data analyses were carried out using predefined statistical procedures.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3.Outcome Measures\u003c/h2\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.3.1.The Tampa Scale of Kinesiophobia\u003c/h2\u003e \u003cp\u003eThe Tampa Scale of Kinesiophobia (TSK) is a questionnaire developed by Miller et al. \u003csup\u003e12\u003c/sup\u003e and validated in Turkish by Yılmaz et al.\u003csup\u003e13\u003c/sup\u003e, assessing fear of movement/(re)injury and fear-avoidance parameters associated with work-related activities. The scale consists of 17 items rated on a 4-point Likert scale. The total score ranges from 17 to 68, with higher scores indicating a higher level of kinesiophobia.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.3.2.The Harris Hip Score\u003c/h2\u003e \u003cp\u003eThe Harris Hip Score (HHS) was developed by Harris to evaluate hip disability\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e and was validated in Turkish by \u0026Ccedil;elik et al.\u003csup\u003e15\u003c/sup\u003e The scale assesses parameters such as pain, function, absence of deformity, and range of motion. The questionnaire contains 10 main items and is scored out of a maximum of 100 points. Scores of 90\u0026ndash;100 are considered excellent, 80\u0026ndash;89 good, 70\u0026ndash;79 fair, and below 70 poor.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.3.3.The 30-Second Sit to Stand Test\u003c/h2\u003e \u003cp\u003eThe 30-Second Sit to Stand Test (30STS) was used to measure the functional lower-limb strength of the participants. With arms crossed over the chest, participants stood up fully from a 44 cm-high chair and sat back down repeatedly for 30 seconds. After ensuring that the test was clearly understood, the score was recorded as the total number of full stands completed at a self-selected pace within 30 seconds.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.3.4.Range of Motion\u003c/h2\u003e \u003cp\u003eRange of Motion (ROM) was measured using a mobile application called Clinometer (Plaincode app development and tech blog, Stephanskirchen, Germany), which has been shown by Wheyte et al.\u003csup\u003e18\u003c/sup\u003e to have excellent reliability for assessing hip extension and rotation. For hip flexion, the participant was in the supine position, with the pivot point placed on the greater trochanter, aligning the bottom corner of the phone, and the moving arm of the device following the lateral midline of the femur. Hip extension was measured while the participant transitioned from a seated position into the Modified Thomas Test position, with the lateral edge of the phone placed on the anterosuperior region of the femur. For internal and external rotation, the participant was seated with the hip and knee at 90\u0026deg; flexion, the leg hanging freely, and the thigh stabilized. Measurements were taken from the neutral position into rotation.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e For internal and external rotation, the pivot point was aligned with the tibial tuberosity, placing the upper edge of the phone at this point, while the moving arm followed the tibial crest.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e2.3.5.Pain\u003c/h2\u003e \u003cp\u003ePain was assessed using both subjective and objective methods. Subjective pain was evaluated using the Visual Analog Scale (VAS).\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e The scale consisted of a 10 cm line with the endpoints labelled \u0026ldquo;No Pain\u0026rdquo; and \u0026ldquo;Unbearable Pain.\u0026rdquo; Participants were asked to mark their pain intensity at rest and during activities (e.g., squatting, stair climbing, walking) on separate lines. The distance in centimeters from the 0 point to the participant\u0026rsquo;s mark was measured and recorded.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e Objective pain was assessed using a pressure algometer (JTECH Commander, JTECH Medical, USA). After providing instructions and performing a demonstration on another body area, pressure was applied in kg/cm\u0026sup2; using a device with a 1 cm round plastic tip to the groin and greater trochanter regions. When pressure was applied, the kg value indicated at the participant\u0026rsquo;s maximum tolerance point was recorded. Each measurement was repeated three times, and the average value was taken as the final score.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003e2.3.6.Radiography\u003c/h2\u003e \u003cp\u003eRadiographic assessment was performed using Dunn view and Pelvis AP radiographs. Cam-type deformities were evaluated through the alpha angle measured on the Dunn view.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e Pincer deformity was assessed on the Pelvis AP using the lateral center-edge angle.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e Alpha angles\u0026thinsp;\u0026ge;\u0026thinsp;58\u0026deg; and lateral center-edge angles\u0026thinsp;\u0026gt;\u0026thinsp;39\u0026deg; were considered abnormal.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e2.4.Statistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was conducted using SPSS software version 23.0 (IBM, SPSS Inc., Chicago, IL). Normality was assessed using the Shapiro\u0026ndash;Wilk test. Continuous variables obtained from the participants were presented as mean (X) and standard deviation (SD), while categorical variables were presented as frequency (N) and percentage (%). Pearson correlation analysis was performed. Correlation coefficients were interpreted as follows: 0.00\u0026ndash;0.29 very weak; 0.30\u0026ndash;0.49 weak; 0.50\u0026ndash;0.69 moderate; 0.70\u0026ndash;0.89 strong; 0.90\u0026ndash;1.00 very strong. No missing data were observed for any of the analyzed variables. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. RESULTS","content":"\u003cp\u003eThe demographic characteristics of the participants are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. A total of 22 symptomatic FAIS patients (12 females, 10 males; 18\u0026ndash;65 years) were included in the study. Nineteen participants were university graduates. FAIS symptoms were present in the left hip in 54.5% of individuals, while 45.5% had right-sided involvement. The mean age of the participants was 39.77\u0026thinsp;\u0026plusmn;\u0026thinsp;11.36 years, mean height was 173.36\u0026thinsp;\u0026plusmn;\u0026thinsp;11.42 cm, mean body weight was 75.12\u0026thinsp;\u0026plusmn;\u0026thinsp;17.17 kg, and mean BMI was 24.68\u0026thinsp;\u0026plusmn;\u0026thinsp;3.79 kg/m\u0026sup2; (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipant Characteristics: Gender, Education Level, and Symptomatic Side\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45,5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%13.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%86.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSymptomatic Side\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%45.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%54.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive Statistics of Participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMin.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMax.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e39.77\u0026thinsp;\u0026plusmn;\u0026thinsp;11.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e173.36\u0026thinsp;\u0026plusmn;\u0026thinsp;11.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e192\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody Weight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e75.12\u0026thinsp;\u0026plusmn;\u0026thinsp;17.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e107.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e24.68\u0026thinsp;\u0026plusmn;\u0026thinsp;3.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS-Rest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.35\u0026thinsp;\u0026plusmn;\u0026thinsp;2.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS-Actv\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.82\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePPT-TM (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e9.94\u0026thinsp;\u0026plusmn;\u0026thinsp;3.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePPT-GR (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e7.43\u0026thinsp;\u0026plusmn;\u0026thinsp;3.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlpha angle (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e68.47\u0026thinsp;\u0026plusmn;\u0026thinsp;6.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLCEA (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e35.13\u0026thinsp;\u0026plusmn;\u0026thinsp;7.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eROM-FLX (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e104\u0026thinsp;\u0026plusmn;\u0026thinsp;15.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eROM-EXT (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e12.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eROM-EXTR (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e21.93\u0026thinsp;\u0026plusmn;\u0026thinsp;6.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eROM-INTR (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e22.33\u0026thinsp;\u0026plusmn;\u0026thinsp;5.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTSK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e40.47\u0026thinsp;\u0026plusmn;\u0026thinsp;6.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30STS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e13.07\u0026thinsp;\u0026plusmn;\u0026thinsp;2.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHHS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e71.14\u0026thinsp;\u0026plusmn;\u0026thinsp;15.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eSD: Standard deviation, BMI: Body mass index, LCEA: Lateral center-edge angle, Min.: Minimum, Max.: Maximum, kg: kilogram, cm: centimeter, m\u0026sup2;: square meter, \u0026deg;: degree, %: percent, VAS: Visual Analog Scale, VAS-Rest: VAS at rest, VAS-Actv: VAS during activity, PPT-TM: Pressure pain threshold at trochanter major, PPT-GR: Pressure pain threshold at groin, ROM-FLX: Range of motion \u0026ndash; flexion, ROM-EXT: Range of motion \u0026ndash; extension, ROM-EXTR: Range of motion \u0026ndash; external rotation, ROM-INTR: Range of motion \u0026ndash; internal rotation, TSK: Tampa Scale of Kinesiophobia, 30STS: 30-Second Sit to Stand Test, HHS: Harris Hip Score\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNo significant relationship was found between the alpha angle and TSK scores (p\u0026thinsp;=\u0026thinsp;0.150) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Similarly, no significant relationship was observed between the LCEA and TSK scores (p\u0026thinsp;=\u0026thinsp;0.824) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). A moderate positive correlation was found between VAS scores at rest and during activity (r\u0026thinsp;=\u0026thinsp;0.562, p\u0026thinsp;=\u0026thinsp;0.007). A moderate negative correlation was observed between external rotation and VAS scores at rest (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.536, p\u0026thinsp;=\u0026thinsp;0.010). A low negative correlation was found between flexion and VAS scores during activity (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.426, p\u0026thinsp;=\u0026thinsp;0.048). A strong positive correlation was observed between pressure pain thresholds in the groin and greater trochanter regions (r\u0026thinsp;=\u0026thinsp;0.810, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). A moderate negative correlation was found between TSK and external rotation (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.567, p\u0026thinsp;=\u0026thinsp;0.006), and a low negative correlation was found between TSK and internal rotation (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.470, p\u0026thinsp;=\u0026thinsp;0.027) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). A moderate negative correlation was found between HHS and TSK (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.527, p\u0026thinsp;=\u0026thinsp;0.012). A low positive correlation was observed between the 30-second sit to stand test and HHS (r\u0026thinsp;=\u0026thinsp;0.465, p\u0026thinsp;=\u0026thinsp;0.029). VAS scores at rest showed a moderate negative correlation with LCEA (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.584, p\u0026thinsp;=\u0026thinsp;0.022) and a low positive correlation with the alpha angle (r\u0026thinsp;=\u0026thinsp;0.494, p\u0026thinsp;=\u0026thinsp;0.019) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation analysis between kinesiophobia (TSK) and radiographic parameters (LCEA and alpha angle)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTSK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLCEA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eALFA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTSK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.317\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.824\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.150\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLCEA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.132\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.824\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.638\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eALFA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.317\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.638\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eTSK: Tampa Scale of Kinesiophobia, LCEA: Lateral Center-Edge Angle, Alpha: Alpha Angle, r: Correlation coefficient, p: Significance level. Pearson correlation analysis was used; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation matrix of pain, pressure pain threshold, range of motion, and kinesiophobia\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVAS-Rest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVAS-Acvt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePPT-TM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePPT-GR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eROM-FLX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eROM-EXT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eROM-EXTR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eROM-INTR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eTKS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVAS-Rest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,562\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e,143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-,030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-,401\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-,242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0,536\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-,158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e,276\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e,\u003cb\u003e007**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e,524\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e,895\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e,065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e,278\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e,\u003cb\u003e010*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e,483\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e,214\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVAS-Actv\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,562\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-,121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-,337\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0,426\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-,095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-,289\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e,004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e,138\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e,\u003cb\u003e007**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e,593\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e,125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e,\u003cb\u003e048*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e,675\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e,193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e,985\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e,540\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePPT-TM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e,143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-,121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0,810\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e,232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0,488\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e,196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e,223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-,300\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e,524\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e,593\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0,00**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e,299\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e,\u003cb\u003e021*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e,381\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e,319\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e,175\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePPT-GR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-,030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-,337\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,810\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e,259\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e,409\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e,372\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e,300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-,172\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e,895\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e,125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,00**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e,244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e,059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e,088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e,175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e,443\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eROM-FLX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-,401\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0,426\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e,232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e,259\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e,092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e,354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e,096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-,383\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e,065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e,\u003cb\u003e048*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e,299\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e,244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e,685\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e,106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e,671\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e,078\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eROM-EXT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-,242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-,095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,488\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e,409\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e,092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e,138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e,101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-,177\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e,278\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e,675\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e,\u003cb\u003e021*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e,059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e,685\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e,540\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e,655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e,432\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eROM-EXTR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0,536\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-,289\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e,196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e,372\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e,354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e,138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0,498\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-0,567\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e,\u003cb\u003e010*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e,193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e,381\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e,088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e,106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e,540\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e,\u003cb\u003e018*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e,\u003cb\u003e006**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eROM-INTR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-,158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e,004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e,223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e,300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e,096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e,101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0,498\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-0,47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e,483\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e,985\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e,319\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e,175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e,671\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e,655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e,\u003cb\u003e018*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e,\u003cb\u003e027*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTKS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e,276\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e,138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-,300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-,172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-,383\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-,177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0,567\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-0,47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e,214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e,540\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e,175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e,443\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e,078\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e,432\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e,\u003cb\u003e006**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e,\u003cb\u003e027*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003eVAS: Visual Analog Scale, VAS-Rest: VAS at rest, VAS-Actv: VAS during activity, PPT-TM: Pressure pain threshold at trochanter major, PPT-GR: Pressure pain threshold at groin, ROM-FLX: Range of motion \u0026ndash; flexion, ROM-EXT: Range of motion \u0026ndash; extension, ROM-EXTR: Range of motion \u0026ndash; external rotation, ROM-INTR: Range of motion \u0026ndash; internal rotation, TSK: Tampa Scale of Kinesiophobia, r: Correlation coefficient, p: Significance level, Pearson correlation analysis was used. *: p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **: p\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRelationships between functional capacity, kinesiophobia, and hip function outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30STS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTSK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHHS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e30STS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.465\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.271\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.029*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTSK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.527\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.271\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.012*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHHS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.465\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.527\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.029*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.012*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003e30STS: 30-Second Sit to Stand Test, TSK: Tampa Scale of Kinesiophobia, HHS: Harris Hip Score\u003c/h3\u003e\n"},{"header":"4. DISCUSSION","content":"\u003cp\u003eIn our study aiming to examine the relationship between kinesiophobia and clinical and radiographic parameters in individuals with FAIS, significant associations were found between kinesiophobia levels and clinical parameters, whereas no significant relationships were observed with radiographic parameters.\u003c/p\u003e \u003cp\u003eThe TSK scores of the individuals in our study were found to be higher compared to previous studies involving patients with FAIS.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e Sharma et al. \u003csup\u003e27\u003c/sup\u003e reported in their systematic review that pain beliefs (particularly fear-avoidance beliefs) and pain coping strategies vary across countries. In a study conducted among Turkish and Swedish patients with musculoskeletal pain, Turkish patients were found to report higher levels of pain intensity, duration, and frequency.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e Consequently, in some populations, limiting movement in response to pain may be a more common coping strategy, which may lead to higher levels of kinesiophobia. Factors such as education, age, and gender may also contribute to these differences. Luque-Suarez et al.\u003csup\u003e29\u003c/sup\u003e reported that high kinesiophobia in chronic musculoskeletal pain is associated with greater pain, increased disability, and lower quality of life.\u003c/p\u003e \u003cp\u003eThe inverse relationship found in our study between kinesiophobia and external and internal rotation range of motion indicates that as kinesiophobia levels increase, hip rotation range of motion decreases. It is known that individuals with FAIS exhibit reduced internal rotation, external rotation, and flexion range of motion.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e The literature has also shown that patients with FAIS generate less external and internal rotation torque during walking compared to healthy individuals.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e Similar to other pathologies that lead to chronic pain, kinesiophobia in FAIS may originate from avoidance behavior toward movements that provoke pain. Avoidance leads to activity limitation as a result of persistent fear related to pain and the negative thoughts and emotions associated with activity.\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe inverse relationship observed between TSK scores and the Harris Hip Score (HHS) indicates that higher levels of kinesiophobia are associated with greater disability in individuals. Jochimsen et al.\u003csup\u003e33\u003c/sup\u003e reported in their 2021 study that higher levels of kinesiophobia in individuals with FAIS are associated with poorer functional outcomes. Additionally, it is known that both hip-related and general health-related quality of life are negatively affected by kinesiophobia in this population.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e The findings of our study also suggest that kinesiophobia in individuals with FAIS reduces participation in daily life activities and negatively impacts functional status.\u003c/p\u003e \u003cp\u003eSamaan et al.\u003csup\u003e34\u003c/sup\u003e stated that the 30-second Sit-to-Stand Test (30STS) is a valid measure for assessing lower extremity joint mechanics and functional performance in individuals with FAIS. The positive correlation found in our study between the 30STS test and the Harris Hip Score (HHS) indicates that improved hip joint function is associated with higher lower extremity performance in individuals with FAIS. It has been reported that during the sit-to-stand activity, individuals with FAIS exhibit compensatory concentric activation of the hip internal rotators and reduced activation of the gluteus medius muscle.\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e This suggests that muscle imbalances around the hip may reduce movement efficiency during functional tasks. The literature also indicates that symptomatic individuals with FAIS experience movement impairments during functional tasks such as sit-to-stand.\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e Therefore, the positive relationship identified in our study suggests that increased functional capacity in these individuals may contribute to performing daily activities more efficiently and with better balance.\u003c/p\u003e \u003cp\u003ePrevious literature has demonstrated that the relationship between hip pain and pathological changes in joint morphology is weak.\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e There is consensus that FAIS should not be diagnosed solely on the basis of radiological findings in the absence of appropriate symptoms and clinical signs, as a substantial proportion of the general population presents with cam and/or pincer morphology.\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e The presence of cam deformity on radiographic assessment does not always lead to impingement, and these morphologies are frequently observed in healthy young adults as well.\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e,\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e Therefore, the terms \u0026ldquo;radiological FAIS\u0026rdquo; or \u0026ldquo;asymptomatic FAIS\u0026rdquo; are used in the literature to describe structural hip morphology rather than a clinical disorder. This highlights the need to investigate the relationship between pain and hip morphology using more comprehensive biomechanical and clinical parameters.\u003c/p\u003e \u003cp\u003eIn our study, the relationship between Visual Analog Scale (VAS) scores and joint range of motion was evaluated, and a moderate inverse relationship was observed between pain at rest and external rotation range of motion. This finding indicates that as the level of pain at rest increases, external rotation range of motion decreases. Literature examining range of motion in individuals with FAIS using three-dimensional motion analysis has reported that individuals with FAIS exhibit significantly less external rotation at 90\u0026deg; flexion compared to healthy controls.\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e,\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e Furthermore, symptomatic individuals with FAIS have been shown to demonstrate significantly reduced external rotation compared to both healthy controls and asymptomatic individuals.\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e These findings suggest that pain-related movement limitations in symptomatic individuals are particularly pronounced in external rotation, and that increasing this movement may provoke pain symptoms.\u003c/p\u003e \u003cp\u003eJochimsen et al.\u003csup\u003e33\u003c/sup\u003e did not find a significant relationship between pain levels measured by the Visual Analog Scale (VAS) and kinesiophobia in individuals with FAIS. Similar findings were observed in our study. A possible explanation for this result is that some individuals with FAIS may be less inclined to avoid movement despite pain, due to factors such as education level or prior physical activity habits. Additionally, the VAS measures only the intensity of pain and may not fully capture its psychosocial dimensions, which could also explain the lack of association. This suggests that kinesiophobia in individuals with FAIS should be considered not only in relation to pain intensity but also in the context of pain perception, coping strategies, and psychosocial factors.\u003c/p\u003e \u003cp\u003eIn our study, significant relationships were observed between VAS scores at rest and radiographic parameters. A low positive correlation was found between pain at rest and the alpha angle, whereas a moderate inverse correlation was observed with the lateral center-edge angle (LCEA). It is known that increases in the alpha angle are associated with labral degeneration and cam deformity \u003csup\u003e\u003cspan additionalcitationids=\"CR45\" citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e; therefore, higher alpha angles are expected to correspond with increased pain levels. In adults, an alpha angle above 55\u0026deg; has been reported to be associated with hip pain.\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e Allen et al.\u003csup\u003e46\u003c/sup\u003e noted that alpha angles of 60\u0026deg; and above are more commonly associated with hip pain. The mean alpha angle of our participants being above the threshold values associated with pain in the literature supports this finding. Our results differ from those reported by Yamauchi et al.\u003csup\u003e47\u003c/sup\u003e, which may be attributed to differences in participant characteristics and measurement methods.\u003c/p\u003e \u003cp\u003eThe lateral center-edge angle (LCEA) is a parameter indicating the degree of acetabular coverage, and deviations above or below normal values may lead to different clinical outcomes.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e In our study, a moderate inverse relationship was observed between LCEA and pain at rest. This finding is consistent with literature reporting that coxa profunda (high LCEA) is associated with lower pain levels.\u003csup\u003e\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e Therefore, an increase in LCEA may correspond to reduced pain during rest. However, since LCEA values in our sample were generally within normal limits, the generalizability of this relationship is limited.\u003c/p\u003e \u003cp\u003eNo significant relationships were found between LCEA and alpha angle with range of motion (ROM) measurements in our study. Similarly, the literature indicates that symptomatic FAIS is not associated with reduced ROM, and surgical interventions do not lead to significant changes in ROM.\u003csup\u003e\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e,\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u003c/sup\u003e Furthermore, asymptomatic individuals with FAIS morphology have been shown to have ROM values similar to healthy controls.\u003csup\u003e\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u003c/sup\u003e Naili et al. \u003csup\u003e51\u003c/sup\u003e also noted that ROM limitations cannot be explained solely by morphological factors. Meta-analytic findings support the notion that individuals with FAIS reduce their movement depth due to pain or fear of movement.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e These findings are in agreement with our study. It can be suggested that ROM limitations in individuals with FAIS are influenced not only by bony morphology but also by pain, capsuloligamentous changes, and kinesiophobia.\u003c/p\u003e \u003cp\u003eIn our study, no significant relationships were found between radiographic parameters (alpha angle, LCEA) and the Harris Hip Score or 30-second Sit-to-Stand (30STS) test. Similarly, Zhang et al.\u003csup\u003e52\u003c/sup\u003e reported that hip scores and muscle strength in asymptomatic individuals with FAIS did not differ from those of healthy controls. These findings suggest that radiographic parameters do not directly influence hip function, and that the functional status of individuals with FAIS is more affected by factors such as limitations in range of motion, pain, and kinesiophobia. The literature indicates that maladaptive pain-related thoughts and emotions in individuals with chronic hip pain may lead to kinesiophobia, which in turn can result in increased pain and functional limitations.\u003csup\u003e\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThese results suggest that fear of movement is more strongly influenced by pain perception and maladaptive beliefs rather than structural deformities. These findings also highlight the importance of addressing kinesiophobia and functional limitations in the management of FAIS, rather than relying solely on radiographic morphology for treatment decisions. Rehabilitation programs that include targeted strategies to reduce fear-avoidance behaviors, improve joint mobility, and enhance functional capacity may be beneficial. In addition, assessing psychosocial factors and patients\u0026rsquo; pain beliefs could help tailor individualized interventions, potentially improving adherence, reducing disability, and optimizing post-surgical or conservative outcomes.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e4.1.Study limitations\u003c/h2\u003e \u003cp\u003eOur study has several limitations. First, the small sample size may limit the generalizability of our findings. Another limitation is the variability in participants\u0026rsquo; physical activity levels, which could have influenced both functional performance and kinesiophobia levels. In addition, our cross-sectional design prevents establishing causal relationships between kinesiophobia, pain, functional status, and radiographic parameters. Additionally, radiographic measurements may not fully capture dynamic joint mechanics; more advanced imaging techniques, such as magnetic resonance imaging (MRI) or three-dimensional motion analysis, could provide further insights. Future studies with larger, more homogeneous cohorts, longitudinal designs, and comprehensive psychosocial and biomechanical assessments are warranted to better elucidate the role of kinesiophobia in individuals with FAIS.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. CONCLUSION","content":"\u003cp\u003eKinesiophobia was significantly associated with hip rotation range of motion and functional status, whereas radiographic measures showed no meaningful clinical relevance. These findings emphasize the need to include psychosocial factors—particularly fear of movement—in the clinical evaluation and rehabilitation of individuals with FAIS, as addressing kinesiophobia may contribute to improved mobility and functional outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was ethically reviewed and approved by the \u0026ldquo;Istanbul Medipol University Institution Non-Interventional Ethics Committee\u0026rdquo; on the date of 25.12.2023 with the file number E-10840098-772.02-7986.\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Istanbul Medipol University Non-Interventional Ethics Committee on 25 December 2023 (Approval No: E-10840098-772.02-7986). Written informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eG.A.B. and Y.I. contributed to conceptualization of the study. Y.I. collected the data and wrote the original draft of the manuscript. G.A.B. contributed to writing \u0026ndash; review \u0026amp; editing. S.G. contributed to conceptualization and provided supervision. All authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflıcts of ınterest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo financial support was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no acknowledgements to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of conflicting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors did not receive support from any organization for the submitted work.\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during the current study are not publicly available because of ethical approval limitations, but may be obtained from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChamberlain R. Hip pain in adults: evaluation and differential diagnosis. Am Fam Physician. 2021;103(2):81\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDooley PJ. Femoroacetabular impingement syndrome: nonarthritic hip pain in young adults. Can Fam Physician. 2008;54(1):42\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang C, Li L, Forster BB, et al. Femoroacetabular impingement and osteoarthritis of the hip. Can Fam Physician. 2015;61(12):1055\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAşık M, Polat G. Femoroasetabular sıkışmada direkt radyoloji. TOTBİD Derg. 2016;23:23\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClohisy JC, Carlisle JC, Beaul\u0026eacute; PE, et al. A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am. 2008;90(Suppl 4):47\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTerrell SL, Olson GE, Lynch J. Therapeutic exercise approaches to nonoperative and postoperative management of femoroacetabular impingement syndrome. J Athl Train. 2021;56(1):31\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrowning RB, Clapp IM, Alter TD, et al. Pain catastrophizing and kinesiophobia affect return to sport in patients undergoing hip arthroscopy for femoroacetabular impingement. Arthrosc Sports Med Rehabil. 2021;3(4):e1087\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePazzinatto MF, Rio EK, Crossley KM, et al. The relationship between kinesiophobia and self-reported outcomes and physical function differs between women and men with femoroacetabular impingement syndrome. 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Br J Sports Med. 2016;50(19):1180.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlbertoni DB, Gianola S, Bargeri S, et al. Does FAI syndrome affect range of motion? Br Med Bull. 2023;145(1):45\u0026ndash;59.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNaili JE, St\u0026aring;lman A, Valentin A, et al. Hip joint ROM restricted by pain rather than impingement. Arch Orthop Trauma Surg. 2022;142(8):1985\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang J, Kim Y, Choi M. Biomechanical characteristics in acetabular impingement. Healthc (Basel). 2022;10(8):1484.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoyne NC, Baez S, Murro M, et al. Pain self-efficacy and function in chronic hip pain. JOSPT Open. 2024;2:264\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Femoracetabular Impingement, Kinesiophobia, Hip Joint, Pain, Radiology","lastPublishedDoi":"10.21203/rs.3.rs-8976253/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8976253/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe severity of acetabular cartilage or labral injuries does not always correspond with clinical symptoms. This observational, cross-sectional study aimed to investigate the association between kinesiophobia levels and clinical findings in patients with femoroacetabular impingement syndrome.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTwenty-two individuals with symptomatic femoroacetabular impingement syndrome (12 females, 10 males; aged 18\u0026ndash;65 years) were included in the study. Radiographic assessments comprised the alpha and the lateral center-edge angle. Kinesiophobia was assessed using the Tampa Scale for Kinesiophobia (TSK), pain intensity with the Visual Analog Scale, and pressure pain threshold using an algometer. Hip range of motion was measured using the Clinometer mobile application, hip function with the Harris Hip Score, and lower-extremity strength with the 30-Second Sit to Stand Test.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA statistically significant inverse relationship was observed between kinesiophobia levels and hip external rotation (p\u0026thinsp;=\u0026thinsp;0.006) and internal rotation range of motion (p\u0026thinsp;=\u0026thinsp;0.027). Kinesiophobia levels were also significantly associated with the Harris Hip Score (p\u0026thinsp;=\u0026thinsp;0.012). However, no relationship was found between kinesiophobia levels and the lateral center-edge angle (p\u0026thinsp;=\u0026thinsp;0.824) or the alpha angle (p\u0026thinsp;=\u0026thinsp;0.150). Additionally, no association was identified between the 30-Second Sit to Stand Test and either the lateral center-edge angle (p\u0026thinsp;=\u0026thinsp;0.967) or the alpha angle (p\u0026thinsp;=\u0026thinsp;0.943).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eKinesiophobia was significantly associated with hip rotation range of motion and functional status, whereas radiographic measures showed no meaningful clinical relevance.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTrial registration:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eClinicalTrials.gov ID: NCT06198829\u003c/p\u003e","manuscriptTitle":"Limited Hip Rotational Range of Motion Is Associated with Kinesiophobia in Patients with Femoroacetabular Impingement","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-09 15:34:13","doi":"10.21203/rs.3.rs-8976253/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-29T10:42:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"98606012648762659773556927159064474376","date":"2026-04-14T04:06:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"181183029841506758960480945143259085060","date":"2026-04-09T18:40:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"262532623024182406893230253751225878758","date":"2026-04-09T00:02:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-16T00:36:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"124044176245339065167230819262825251247","date":"2026-03-09T07:08:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"56273851919060450508510802142205208763","date":"2026-03-04T21:21:44+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-04T06:25:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-03T14:17:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-02T11:47:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-02T11:44:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2026-02-26T09:35:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a45a4ed4-0694-44b0-a5fa-1edf27575934","owner":[],"postedDate":"March 9th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-04-29T10:42:25+00:00","index":111,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-09T15:34:13+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-09 15:34:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8976253","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8976253","identity":"rs-8976253","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}