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Published in: Knee Surgery, Sports Traumatology, Arthroscopy 3/2013

01-03-2013 | Sports Medicine

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

Authors: Shigenori Yagi, Takeshi Muneta, Ichiro Sekiya

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 3/2013

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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.
Literature
1.
go back to reference Anderson MW (1997) Shin splints. MR appearance in a preliminary study. Radiology 204:177–180PubMed Anderson MW (1997) Shin splints. MR appearance in a preliminary study. Radiology 204:177–180PubMed
2.
go back to reference Andrish JT, Bergfeld JA, Walheim J (1974) A prospective study on the management of shin splints. J Bone Joint Surg Am 56:1697–1700PubMed Andrish JT, Bergfeld JA, Walheim J (1974) A prospective study on the management of shin splints. J Bone Joint Surg Am 56:1697–1700PubMed
3.
go back to reference Batt ME, Ugalde V, Anderson MW, Shelton DK (1998) A prospective controlled study of diagnostic imaging for acute shin splints. Med Sci Sports Exerc 30:1564–1571PubMedCrossRef Batt ME, Ugalde V, Anderson MW, Shelton DK (1998) A prospective controlled study of diagnostic imaging for acute shin splints. Med Sci Sports Exerc 30:1564–1571PubMedCrossRef
4.
go back to reference 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 24:810–818PubMedCrossRef 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 24:810–818PubMedCrossRef
5.
go back to reference 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 31:504–510PubMed 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 31:504–510PubMed
6.
go back to reference Bouche RT, Johnson CH (2007) Medial tibial stress syndrome (tibial fasciitis): a proposed pathomechanical model involving fascial traction. J Am Podiatr Med Assoc 97:31–36PubMed Bouche RT, Johnson CH (2007) Medial tibial stress syndrome (tibial fasciitis): a proposed pathomechanical model involving fascial traction. J Am Podiatr Med Assoc 97:31–36PubMed
7.
go back to reference Bohannon RW, Andrews AW (1989) Accuracy of spring and strain gauge hand-held dynamometers. J Orthop Sports Phys Ther 10:323–325PubMed Bohannon RW, Andrews AW (1989) Accuracy of spring and strain gauge hand-held dynamometers. J Orthop Sports Phys Ther 10:323–325PubMed
8.
go back to reference Brody DM (1982) Techniques in the evaluation and treatment of the injured runner. Orthop Clin N Am 13:541–558 Brody DM (1982) Techniques in the evaluation and treatment of the injured runner. Orthop Clin N Am 13:541–558
9.
go back to reference 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 38:44–445CrossRef 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 38:44–445CrossRef
10.
go back to reference Diamond JE, Mueller MJ, Delitto A, Sinacore DR (1989) Reliability of a diabetic foot evaluation. Phys Ther 69:797–802PubMed Diamond JE, Mueller MJ, Delitto A, Sinacore DR (1989) Reliability of a diabetic foot evaluation. Phys Ther 69:797–802PubMed
11.
go back to reference Gehlsen GM, Seger A (1980) Selected measures of angular displacement, strength and flexibility in subjects with and without shin splints. Res Q Excec Sport 51:478–485 Gehlsen GM, Seger A (1980) Selected measures of angular displacement, strength and flexibility in subjects with and without shin splints. Res Q Excec Sport 51:478–485
12.
go back to reference Giladi M, Milgrom C, Simkin A, Danon Y (1991) Stress fractures. Identifiable risk factors. Am J Sports Med 19:647–652PubMedCrossRef Giladi M, Milgrom C, Simkin A, Danon Y (1991) Stress fractures. Identifiable risk factors. Am J Sports Med 19:647–652PubMedCrossRef
13.
go back to reference Holder LE, Michael RH (1984) The specific scintigraphic pattern of “shin splints in the lower leg”: concise communication. J Nucl Med 25:865–869PubMed Holder LE, Michael RH (1984) The specific scintigraphic pattern of “shin splints in the lower leg”: concise communication. J Nucl Med 25:865–869PubMed
14.
go back to reference Hubbard TJ, Carpenter EM, Cordova ML (2009) Contributing factors to medial tibial stress syndrome; a prospective investigation. Med Sci Sports Exerc 41:490–496PubMed Hubbard TJ, Carpenter EM, Cordova ML (2009) Contributing factors to medial tibial stress syndrome; a prospective investigation. Med Sci Sports Exerc 41:490–496PubMed
15.
go back to reference Johnell O, Rausing A, Wendeberg B, Westlin N (1982) Morphological bone changes in shin splints. Clin Orthop Relat Res 187:180–184 Johnell O, Rausing A, Wendeberg B, Westlin N (1982) Morphological bone changes in shin splints. Clin Orthop Relat Res 187:180–184
16.
go back to reference 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 171:40–44PubMed 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 171:40–44PubMed
17.
go back to reference Kaufman KR, Bordine SK (1999) The effect of foot structure and range of motion on musculoskeletal overuse injuries. Am J Sports Med 27:585–593PubMed Kaufman KR, Bordine SK (1999) The effect of foot structure and range of motion on musculoskeletal overuse injuries. Am J Sports Med 27:585–593PubMed
18.
go back to reference Kortebein PM, Kaufman KR, Basford JR, Stuart MJ (2000) Medial tibial stress syndrome. Med Sci Sports Exerc 32(3 Suppl):S27–S33PubMed Kortebein PM, Kaufman KR, Basford JR, Stuart MJ (2000) Medial tibial stress syndrome. Med Sci Sports Exerc 32(3 Suppl):S27–S33PubMed
19.
go back to reference 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 318:29PubMedCrossRef 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 318:29PubMedCrossRef
20.
go back to reference 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 15:46–58PubMedCrossRef 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 15:46–58PubMedCrossRef
21.
go back to reference Messier SP, Pittala KA (1988) Etiologic factors associated with selected running injuries. Med Sci Sports Exerc 20:501–505PubMed Messier SP, Pittala KA (1988) Etiologic factors associated with selected running injuries. Med Sci Sports Exerc 20:501–505PubMed
22.
go back to reference Norkin CC, White DJ (1995) Measurement of joint motion: a guide to goniometry. F.A. Davis Company, Philadelphia, pp 119–146 Norkin CC, White DJ (1995) Measurement of joint motion: a guide to goniometry. F.A. Davis Company, Philadelphia, pp 119–146
24.
go back to reference 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 37:40–47PubMedCrossRef 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 37:40–47PubMedCrossRef
25.
go back to reference 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 1:11PubMedCrossRef 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 1:11PubMedCrossRef
26.
go back to reference 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 38:1571–1577PubMedCrossRef 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 38:1571–1577PubMedCrossRef
27.
go back to reference Reinking MF (2006) Exercise-related leg pain in female collegiate athletes: the influence of intrinsic and extrinsic factors. Am J Sports Med 34:1500–1507PubMedCrossRef Reinking MF (2006) Exercise-related leg pain in female collegiate athletes: the influence of intrinsic and extrinsic factors. Am J Sports Med 34:1500–1507PubMedCrossRef
28.
go back to reference Reinking MF, Hayes AM (2006) Intrinsic factors associated with exercise related leg pain in collegiate cross-country runners. Clin J Sport Med 16:10–14PubMedCrossRef Reinking MF, Hayes AM (2006) Intrinsic factors associated with exercise related leg pain in collegiate cross-country runners. Clin J Sport Med 16:10–14PubMedCrossRef
29.
go back to reference 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 18:636–641PubMedCrossRef 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 18:636–641PubMedCrossRef
30.
go back to reference Shaffer RA, Rauh MJ, Brodine SK, Trone DW, Macera CA (2006) Predictors of stress fracture susceptibility in young female recruits. Am J Sport Med 34:108–115CrossRef Shaffer RA, Rauh MJ, Brodine SK, Trone DW, Macera CA (2006) Predictors of stress fracture susceptibility in young female recruits. Am J Sport Med 34:108–115CrossRef
31.
go back to reference Sullivan D, Warren RF, Pavlov H, Kelman G (1984) Stress fractures in 51 runners. Clin Orthop Relat Res 187:188–192PubMed Sullivan D, Warren RF, Pavlov H, Kelman G (1984) Stress fractures in 51 runners. Clin Orthop Relat Res 187:188–192PubMed
32.
go back to reference Tiberio D (1988) Pathomechanics of structural foot deformities. Phys Ther 68:1840–1849PubMed Tiberio D (1988) Pathomechanics of structural foot deformities. Phys Ther 68:1840–1849PubMed
33.
go back to reference Viitasalo JK, Kvist M (1983) Some biomechanical aspects of the foot and ankle in athletes with and without shin splints. Am J Sports Med 11:125–130PubMedCrossRef Viitasalo JK, Kvist M (1983) Some biomechanical aspects of the foot and ankle in athletes with and without shin splints. Am J Sports Med 11:125–130PubMedCrossRef
34.
go back to reference 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 32:772–780PubMedCrossRef 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 32:772–780PubMedCrossRef
Metadata
Title
Incidence and risk factors for medial tibial stress syndrome and tibial stress fracture in high school runners
Authors
Shigenori Yagi
Takeshi Muneta
Ichiro Sekiya
Publication date
01-03-2013
Publisher
Springer-Verlag
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 3/2013
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-012-2160-x

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