Medial Tibial Stress Syndrome in Active Individuals: A Systematic Review and Meta-analysis of Risk Factors

Abstract

Context:

Medial tibial stress syndrome (MTSS) is a common condition in active individuals and presents as diffuse pain along the posteromedial border of the tibia.

Objective:

To use cross-sectional, case-control, and cohort studies to identify significant MTSS risk factors.

Data Sources:

Bibliographic databases (PubMed, Scopus, CINAHL, SPORTDiscus, EMBASE, EBM Reviews, PEDRo), grey literature, electronic search of full text of journals, manual review of reference lists, and automatically executed PubMed MTSS searches were utilized. All searches were conducted between 2011 and 2015.

Study Selection:

Inclusion criteria were determined a priori and included original research with participants’ pain diffuse, located in the posterior medial tibial region, and activity related.

Study Design:

Systematic review with meta-analysis.

Level of evidence:

Level 4.

Data Extraction:

Titles and abstracts were reviewed to eliminate citations that did not meet the criteria for inclusion. Study characteristics identified a priori were extracted for data analysis. Statistical heterogeneity was examined using the I² index and Cochran Q test, and a random-effects model was used to calculate the meta-analysis when 2 or more studies examined a risk factor. Two authors independently assessed study quality.

Results:

Eighty-three articles met the inclusion criteria, and 22 articles included risk factor data. Of the 27 risk factors that were in 2 or more studies, 5 risk factors showed a significant pooled effect and low statistical heterogeneity, including female sex (odds ratio [OR], 2.35; CI, 1.58-3.50), increased weight (standardized mean difference [SMD], 0.24; CI, 0.03-0.45), higher navicular drop (SMD, 0.44; CI, 0.21-0.67), previous running injury (OR, 2.18; CI, 1.00-4.72), and greater hip external rotation with the hip in flexion (SMD, 0.44; CI, 0.23-0.65). The remaining risk factors had a nonsignificant pooled effect or significant pooled effect with high statistical heterogeneity.

Conclusion:

Female sex, increased weight, higher navicular drop, previous running injury, and greater hip external rotation with the hip in flexion are risk factors for the development of MTSS.

Keywords

medial tibial stress syndrome risk factors meta-analysis

Get full access to this article

View all access options for this article.

References

Bandholm

Boysen

Haugaard

Zebis

Bencke

. Foot medial longitudinal-arch deformation during quiet standing and gait in subjects with medial tibial stress syndrome. J Foot Ankle Surg. 2008;47:89-95.

Bartosik

Sitler

Hillstrom

Palamarchuk

Huxel

Kim

. Anatomical and biomechanical assessments of medial tibial stress syndrome. J Am Podiatr Med Assoc. 2010;100:121-132.

Bennett

Reinking

Pluemer

Pentel

Seaton

Killian

. Factors contributing to the development of medial tibial stress syndrome in high school runners. J Orthop Sports Phys Ther. 2001;31:504-510.

Borenstein

Hedges

Higgins

JPT

Rothstein

. Introduction to Meta-Analysis. Chichester, UK: Wiley; 2009.

Burne

Khan

Boudville

. Risk factors associated with exertional medial tibial pain: a 12 month prospective clinical study. Br J Sports Med. 2004;38:441-445.

Chowdhury

Mawokomatanda

. Surveillance for certain health behaviors, chronic diseases, and conditions, access to health care, and use of preventive health services among states and selected local areas—Behavioral Risk Factor Surveillance System, United States, 2012. MMWR Surveill Summ. 2016;65:1-142.

Clement

. Tibial stress syndrome in athletes. J Sports Med. 1974;2:81-85.

Degen

Hoppe

Petrisor

Bhandari

. Making decisions about prognosis in evidence-based practice. Hand Clin. 2009;25:59-66.

Eickhoff

Hossain

Slawski

. Effects of prescribed foot orthoses on medial tibial stress syndrome in collegiate cross-country runners. Clin Kines. 2000;54(4):76-80.

10.

Franklyn

Oakes

Field

Wells

Morgan

. Section modulus is the optimum geometric predictor for stress fractures and medial tibial stress syndrome in both male and female athletes. Am J Sports Med. 2008;36:1179-1189.

11.

Gaeta

Minutoli

Vinci

. High-resolution CT grading of tibial stress reactions in distance runners. AJR Am J Roentgenol. 2006;187:789-793.

12.

Guyatt

Rennie

Meade

Cook

. Users’ Guides to the Medical Literature: Essentials of Evidence-Based Clinical Practice. 2nd ed. New York, NY: McGraw-Hill Medical; 2008.

13.

Hamstra-Wright

Bliven

Bay

. Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis. Br J Sports Med. 2015;49:362-369.

14.

Hayden

Cote

Bombardier

. Evaluation of the quality of prognosis studies in systematic reviews. Ann Intern Med. 2006;144:427-437.

15.

Higgins

Thompson

Deeks

Altman

. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557-560.

16.

Hubbard

Carpenter

Cordova

. Contributing factors to medial tibial stress syndrome: a prospective investigation. Med Sci Sports Exerc. 2009;41:490-496.

17.

Johnson

Hayes

Brown

Hoo

Ethier

; Centers for Disease Control and Prevention (CDC). CDC National Health Report: leading causes of morbidity and mortality and associated behavioral risk and protective factors—United States, 2005-2013. MMWR Suppl. 2014;63(4):3-27.

18.

Lee

. Direct and Indirect Effects of Alignment, Range of Motion, and Gait Measures on Medial Tibial Stress Syndrome Status of Runners [dissertation]. Charlottesville: University of Virginia; 2009.

19.

Madeley

Munteanu

Bonanno

. Endurance of the ankle joint plantar flexor muscles in athletes with medial tibial stress syndrome: a case-control study. J Sci Med Sport. 2007;10:356-362.

20.

Magnusson

Ahlborg

Karlsson

Nyquist

Karlsson

. Low regional tibial bone density in athletes with medial tibial stress syndrome normalizes after recovery from symptoms. Am J Sports Med. 2003;31:596-600.

21.

Magnusson

Westlin

Nyqvist

Gardsell

Seeman

Karlsson

. Abnormally decreased regional bone density in athletes with medial tibial stress syndrome. Am J Sports Med. 2001;29:712-715.

22.

Mak

Kum

. How to appraise a prognostic study. World J Surg. 2005;29:567-569.

23.

McPoil

Cornwall

. The relationship between static lower extremity measurements and rearfoot motion during walking. J Orthop Sports Phys Ther. 1996;24:309-314.

24.

Messier

Pittala

. Etiologic factors associated with selected running injuries. Med Sci Sports Exerc. 1988;20:501-505.

25.

Michael

Holder

. The soleus syndrome: a cause of medial tibial stress (shin splints). Am J Sports Med. 1985;13:87-94.

26.

Moen

Bongers

Bakker

. Risk factors and prognostic indicators for medial tibial stress syndrome. Scand J Med Sci Sports. 2012;22:34-39.

27.

Moen

Tol

Weir

Steunebrink

De Winter

. Medial tibial stress syndrome: a critical review. Sports Med. 2009;39:523-546.

28.

Moons

Royston

Vergouwe

Grobbee

Altman

. Prognosis and prognostic research: what, why, and how? BMJ. 2009;338:b375.

29.

Mueller

Host

Norton

. Navicular drop as a composite measure of excessive pronation. J Am Podiatr Med Assoc. 1993;83:198-202.

30.

National Institutes of Health, National Heart, Lung, and Blood Institute. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report. Bethesda, MD: National Institutes of Health; 1998.

31.

Newman

Witchalls

Waddington

Adams

. Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis. Open Access J Sports Med. 2013;4:229-241.

32.

Plisky

Rauh

Heiderscheit

Underwood

Tank

. Medial tibial stress syndrome in high school cross-country runners: incidence and risk factors. J Orthop Sports Phys Ther. 2007;37:40-47.

33.

Puranen

. The medial tibial syndrome: exercise ischaemia in the medial fascial compartment of the leg. J Bone Joint Surg Br. 1974;56-B:712-715.

34.

Raissi

Cherati

Mansoori

Razi

. The relationship between lower extremity alignment and medial tibial stress syndrome among non-professional athletes. Sports Med Arthrosc Rehabil Ther Technol. 2009;1:11.

35.

Rathleff

Kelly

Christensen

Simonsen

Kaalund

Laessoe

. Dynamic midfoot kinematics in subjects with medial tibial stress syndrome. J Am Podiatr Med Assoc. 2012;102:205-212.

36.

Rathleff

Samani

Olesen

Kersting

Madeleine

. Inverse relationship between the complexity of midfoot kinematics and muscle activation in patients with medial tibial stress syndrome. J Electromyogr Kinesiol. 2011;21:638-644.

37.

Sharma

Golby

Greeves

Spears

. Biomechanical and lifestyle risk factors for medial tibia stress syndrome in army recruits: a prospective study. Gait Posture. 2011;33:361-365.

38.

Slocum

. The shin splint syndrome: medical aspects and differential diagnosis. Am J Surg. 1967;114:875-881.

39.

Sommer

Vallentyne

. Effect of foot posture on the incidence of medial tibial stress syndrome. Med Sci Sports Exerc. 1995;27:800-804.

40.

Straus

McAlister

. A clinician’s guide to journal articles about prognosis. ACP J Club. 1999;130(3):A13-A15.

41.

Tweed

Campbell

Avil

. Biomechanical risk factors in the development of medial tibial stress syndrome in distance runners. J Am Podiatr Med Assoc. 2008;98:436-444.

42.

Viitasalo

Kvist

. Some biomechanical aspects of the foot and ankle in athletes with and without shin splints. Am J Sports Med. 1983;11:125-130.

43.

Yagi

Muneta

Sekiya

. Incidence and risk factors for medial tibial stress syndrome and tibial stress fracture in high school runners. Knee Surg Sports Traumatol Arthrosc. 2013;21:556-563.

44.

Yates

White

. The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. Am J Sports Med. 2004;32:772-780.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.02 MB

0.01 MB

0.04 MB

0.70 MB

0.00 MB