Incidence and risk factors for medial tibial stress syndrome and tibial stress fracture in high school runners

Sports Medicine

Abstract

Purpose

Medial tibial stress syndrome (MTSS) and tibial stress fracture (SF) are common lower leg disorders in runners. A prospective study was done to identify the incidence of MTSS and SF in high school runners and to determine risk factors.

Methods

A total of 230 runners participating in high school running teams were evaluated. All runners aged 15 years as first grade of high school were involved in the study. They were followed up for 3 years. The measured items included height, weight, body mass index (BMI), range of hip and ankle motion, straight leg raising (SLR), intercondylar and intermalleolar interval, Q-angle, navicular drop test, hip abductor strength and physical conditioning. Each runner was followed for 3 years to report occurrence of MTSS and SF.

Results

A total number of 102 MTSS (0.29 athlete exposures) and 21 SF (0.06 athlete exposures) were identified. In females, BMI significantly increased the risk of MTSS after adjustment for the other variables in this study (adjusted odds ratio, 0.51; 95 % confidence interval, 0.31–0.86). Increased internal rotation of the hip significantly increased the risk of MTSS (adjusted odds ratio, 0.91; 95 % confidence interval, 0.85–0.99). In males, limited SLR also significantly increased the risk of SF with adjustment for the other variables in this study (adjusted odds ratio, 1.38; 95 % confidence interval, 1.04–1.83).

Conclusion

A significant relationship was found between BMI, internal hip rotation angle and MTSS in females, and between limited SLR and SF in males.

Level of evidence

Prospective cohort study, Level II.

Keywords

Medial tibial stress syndrome Shin splints Tibial stress fracture Incidence Risk factor 

References

  1. 1.
    Anderson MW (1997) Shin splints. MR appearance in a preliminary study. Radiology 204:177–180PubMedGoogle Scholar
  2. 2.
    Andrish JT, Bergfeld JA, Walheim J (1974) A prospective study on the management of shin splints. J Bone Joint Surg Am 56:1697–1700PubMedGoogle Scholar
  3. 3.
    Batt ME, Ugalde V, Anderson MW, Shelton DK (1998) A prospective controlled study of diagnostic imaging for acute shin splints. Med Sci Sports Exerc 30:1564–1571PubMedCrossRefGoogle Scholar
  4. 4.
    Bennell KL, Malcolm SA, Thomas SA, Reid SJ, Brukner PD, Ebeling PR, Wark JD (1996) Risk factors for stress fractures in track and field athletes. A twelve-month prospective study. Am J Sports Med 24:810–818PubMedCrossRefGoogle Scholar
  5. 5.
    Bennett JE, Reinking MF, Pluemer B, Pentel A, Seaton M, Killian C (2001) Factors contributing to the development of medial tibial stress syndrome in high school runners. J Orthop Sports Phys Ther 31:504–510PubMedGoogle Scholar
  6. 6.
    Bouche RT, Johnson CH (2007) Medial tibial stress syndrome (tibial fasciitis): a proposed pathomechanical model involving fascial traction. J Am Podiatr Med Assoc 97:31–36PubMedGoogle Scholar
  7. 7.
    Bohannon RW, Andrews AW (1989) Accuracy of spring and strain gauge hand-held dynamometers. J Orthop Sports Phys Ther 10:323–325PubMedGoogle Scholar
  8. 8.
    Brody DM (1982) Techniques in the evaluation and treatment of the injured runner. Orthop Clin N Am 13:541–558Google Scholar
  9. 9.
    Burne SG, Khan KM, Boudville PB, Mallet RJ, Newman PM, Steinman LJ, Thornton E (2004) Risk factors associates with external tibial pain: a twelve months prospective clinical study. Br J Sports Med 38:44–445CrossRefGoogle Scholar
  10. 10.
    Diamond JE, Mueller MJ, Delitto A, Sinacore DR (1989) Reliability of a diabetic foot evaluation. Phys Ther 69:797–802PubMedGoogle Scholar
  11. 11.
    Gehlsen GM, Seger A (1980) Selected measures of angular displacement, strength and flexibility in subjects with and without shin splints. Res Q Excec Sport 51:478–485Google Scholar
  12. 12.
    Giladi M, Milgrom C, Simkin A, Danon Y (1991) Stress fractures. Identifiable risk factors. Am J Sports Med 19:647–652PubMedCrossRefGoogle Scholar
  13. 13.
    Holder LE, Michael RH (1984) The specific scintigraphic pattern of “shin splints in the lower leg”: concise communication. J Nucl Med 25:865–869PubMedGoogle Scholar
  14. 14.
    Hubbard TJ, Carpenter EM, Cordova ML (2009) Contributing factors to medial tibial stress syndrome; a prospective investigation. Med Sci Sports Exerc 41:490–496PubMedGoogle Scholar
  15. 15.
    Johnell O, Rausing A, Wendeberg B, Westlin N (1982) Morphological bone changes in shin splints. Clin Orthop Relat Res 187:180–184Google Scholar
  16. 16.
    Johnston E, Flynn T, Bean M (2006) A randomized controlled trial of a leg orthosis versus traditional treatment for soldiers with shin splints: a pilot study. Mil Med 171:40–44PubMedGoogle Scholar
  17. 17.
    Kaufman KR, Bordine SK (1999) The effect of foot structure and range of motion on musculoskeletal overuse injuries. Am J Sports Med 27:585–593PubMedGoogle Scholar
  18. 18.
    Kortebein PM, Kaufman KR, Basford JR, Stuart MJ (2000) Medial tibial stress syndrome. Med Sci Sports Exerc 32(3 Suppl):S27–S33PubMedGoogle Scholar
  19. 19.
    Macleod MA, Houston AS, Sanders L, Anagnostopoulos C (1999) Incidence of trauma related stress fractures and shin splints in male and female army recruits: retrospective case study. BMJ 318:29PubMedCrossRefGoogle Scholar
  20. 20.
    Matheson GO, Clement DB, McKenzie DC, Taunton JE, Lloyd-Smith DR, MacIntyre JG (1987) Stress fractures in athletes: a study of 320 cases. Am J Sports Med 15:46–58PubMedCrossRefGoogle Scholar
  21. 21.
    Messier SP, Pittala KA (1988) Etiologic factors associated with selected running injuries. Med Sci Sports Exerc 20:501–505PubMedGoogle Scholar
  22. 22.
    Norkin CC, White DJ (1995) Measurement of joint motion: a guide to goniometry. F.A. Davis Company, Philadelphia, pp 119–146Google Scholar
  23. 23.
    Orava S, Puranen J (1979) Athletes’ leg pains. Br J Sports Med 13:92–97PubMedCrossRefGoogle Scholar
  24. 24.
    Plisky MS, Rauh MJ, Heiderscheit B, Underwood FB, Tank RT (2007) Medial tibial stress syndrome in high school cross-country runners: incidence and risk factors. J Orthop Sports Phys Ther 37:40–47PubMedCrossRefGoogle Scholar
  25. 25.
    Raissi GR, Cherati AD, Mansoori KD, Razi MD (2009) The relationship between lower extremity alignment and Medial Tibial Stress Syndrome among non-professional athletes. Sports Med Arthrosc Rehabil Ther Technol 1:11PubMedCrossRefGoogle Scholar
  26. 26.
    Rauh MJ, Macera CA, Trone DW, Shaffer RA, Brodine SK (2006) Epidemiology of stress fracture and lower—extremity overuse injury in female recruits. Med Sci Sports Exerc 38:1571–1577PubMedCrossRefGoogle Scholar
  27. 27.
    Reinking MF (2006) Exercise-related leg pain in female collegiate athletes: the influence of intrinsic and extrinsic factors. Am J Sports Med 34:1500–1507PubMedCrossRefGoogle Scholar
  28. 28.
    Reinking MF, Hayes AM (2006) Intrinsic factors associated with exercise related leg pain in collegiate cross-country runners. Clin J Sport Med 16:10–14PubMedCrossRefGoogle Scholar
  29. 29.
    Schwellnus MP, Jordaan G, Noakes TD (1990) Prevention of common overuse injuries by the use of shock absorbing insoles: a prospective study. Am J Sports Med 18:636–641PubMedCrossRefGoogle Scholar
  30. 30.
    Shaffer RA, Rauh MJ, Brodine SK, Trone DW, Macera CA (2006) Predictors of stress fracture susceptibility in young female recruits. Am J Sport Med 34:108–115CrossRefGoogle Scholar
  31. 31.
    Sullivan D, Warren RF, Pavlov H, Kelman G (1984) Stress fractures in 51 runners. Clin Orthop Relat Res 187:188–192PubMedGoogle Scholar
  32. 32.
    Tiberio D (1988) Pathomechanics of structural foot deformities. Phys Ther 68:1840–1849PubMedGoogle Scholar
  33. 33.
    Viitasalo JK, Kvist M (1983) Some biomechanical aspects of the foot and ankle in athletes with and without shin splints. Am J Sports Med 11:125–130PubMedCrossRefGoogle Scholar
  34. 34.
    Yates B, White S (2004) The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. Am J Sports Med 32:772–780PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Department of Joint Surgery and Sports Medicine, Graduate School of MedicineTokyo Medical and Dental UniversityBunkyo-ku, TokyoJapan
  2. 2.Section of Cartilage Regeneration, Graduate School of MedicineTokyo Medical and Dental UniversityTokyoJapan

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