• EPIDEMIOLOGY
• Musculoskeletal disorders
• REHABILITATION MEDICINE

• exercise-related lower leg pain
• overuse injury
• risk factor
• running injury
• shin splint

• Humans
• Range of Motion, Articular/physiology
• Biomechanical Phenomena
• Muscle Strength/physiology
• Gait/physiology
• Medial Tibial Stress Syndrome/physiopathology
• Medial Tibial Stress Syndrome/etiology
• Risk Factors
• Lower Extremity/physiopathology

• RunScribe
• kinematics
• runners
• stride
• wearable technology

• Humans
• Biomechanical Phenomena
• Running/physiology
• Wearable Electronic Devices
• Reproducibility of Results
• Male
• Adult
• Female
• Young Adult

• Female sports injuries
• Foot and ankle injuries
• Football
• Gender differences
• Risk factors

• Humans
• Ankle Injuries
• Female
• Athletic Injuries/epidemiology
• Foot Injuries
• Male
• Sex Factors
• Risk Factors

• athletic leg pain
• distal tibia
• exertional leg pain
• medial tibial stress syndrome
• shin splints

• adolescent
• injury history
• relative energy deficiency in sport
• step rate

• Female
• Humans
• Knee Joint/physiology
• Risk Factors
• Running/injuries
• Schools

• Humans
• Adolescent
• Child
• Outpatients
• Retrospective Studies
• Athletic Injuries/therapy
• Athletic Injuries/prevention & control
• Ambulatory Care
• Running/injuries

• Humans
• Prospective Studies
• Foot
• Knee Joint
• Logistic Models
• Running

• Science Foundation Ireland (SFI), co-funded by the European Regional Development Fund

• Medial Tibial Stress Syndrome (MTSS)
• Running
• epidemiology
• risk
• shin pain
• shin “splints“
• ultramarathon

• Biomechanical phenomena
• Kinetics
• Medial tibial stress syndrome
• Running

• Cadaver
• S-like curve
• Sex differences
• Tibia
• Tibialis anterior muscle

• biomechanical
• footstrike pattern
• kinematics
• kinetics
• running-related injuries
• youth

• Bicycling
• Biomechanical Phenomena
• Female
• Humans
• Knee
• Knee Joint
• Lower Extremity
• Male

• Athletes
• Female
• Humans
• Male
• Prospective Studies
• Risk Factors
• Running

• Deutsche Forschungsgemeinschaft
• Projekt DEAL

• Achilles Tendon/injuries
• Achilles Tendon/physiopathology
• Adult
• Age Factors
• Biomechanical Phenomena
• Body Mass Index
• Case-Control Studies
• Female
• Foot/physiology
• Foot Injuries/etiology
• Foot Injuries/physiopathology
• Gait
• Groin/injuries
• Groin/physiopathology
• Hip Injuries/etiology
• Hip Injuries/physiopathology
• Humans
• Knee Injuries/etiology
• Knee Injuries/physiopathology
• Logistic Models
• Lower Extremity/injuries
• Lower Extremity/physiopathology
• Male
• Middle Aged
• Retrospective Studies
• Risk Factors
• Running/injuries
• Sex Factors
• Young Adult

• Athlete
• Looser zone
• Medial tibial stress syndrome (MTSS)
• Pseudofracture
• Vitamin D

• consensus statement
• injury
• prevention
• running
• young

• athlete
• chronic pain
• compartment syndrome
• entrapment
• lower leg
• stress fracture
• tendinopathy

• extra-osseous talotarsal stabilization
• flat feet
• hyperpronation
• pediatric flatfeet
• pes planus
• subtalar joint instability

• forefoot kinematics
• hindfoot kinematics
• kinematics
• medial tibial stress syndrome
• running
• walking

Injury is common in running and seen to impact up to 94% of recreational runners. Clinicians often use alterations from normal musculoskeletal clinical assessments to assess for risk of injury, but it is unclear if these assessments are associated with future injury.

To identify alterations in muscle strength, flexibility, range of motion, and alignment that may predict lower extremity injury in runners.

Articles were selected following a comprehensive search of PubMed, Embase, CINAHL, and SPORTDiscus from database inception to May 2018. Included articles were prospective cohort studies, which specifically analyzed musculoskeletal impairments associated with future running-related injury. Two authors extracted study data, assessed the methodological quality of each study using the Critical Appraisal Tool and assessed the overall quality using the GRADE approach.

Seven articles met the inclusion criteria. There was very low quality of evidence for the 7 identified clinical assessment alteration categories. Strong hip abductors were significantly associated with running-related injury in one study. Increased hip external-to-internal rotation strength and decreased hip internal range of motion were protective for running injury, each in one study. Decreased navicular drop in females had a protective effect for running-related injury in one study.

Due to very low quality of evidence for each assessment, confounders present within the studies, a limited number of studies, different measurement methods among studies, measurement variability within clinical assessments, inconsistent definitions of injury and runner, different statistical modeling, and study bias, caution is suggested in interpreting these results.

• Examination
• Injury
• Running

Medial tibial stress syndrome (MTSS) is a lower leg injury with a reported incidence rate of up to 35% in active individuals. Although numerous prospective studies have tried to identify risk factors for developing MTSS, managing the syndrome remains difficult. One risk factor yet to be extensively explored in MTSS development is reduced lower leg girth. Further investigation of reduced lower leg girth is required due to the important role lower leg musculature plays in attenuating ground reaction forces during the gait cycle. Therefore, the primary aim of this study is to ascertain whether lower leg muscle morphology and function contribute to the development of MTSS. Our ultimate aim is to identify potential risk factors for MTSS that can be targeted in future studies to better manage the injury or, preferably, prevent individuals developing MTSS.

This study will be prospective in design and will recruit asymptomatic distance runners. All participants will be tested at base line and participants will have their training data longitudinally tracked over the following 12 months to assess any individuals who develop MTSS symptoms. At base line, outcome measures will include bilateral measures of lower limb anthropometry; cross sectional area (CSA) and thickness of the tibialis anterior, peroneals, flexor digitorum longus, flexor hallucis longus and thickness of soleus, medial and lateral head of gastrocnemius. Tibial bone speed of sound, ankle dorsiflexion range of motion, strength of the six previously described muscles, foot alignment and ankle plantar flexor endurance will also be assessed. Participants will also complete a treadmill running protocol where three-dimensional kinematics, plantar pressure distribution and electromyography data will be collected.

This study will aim to identify characteristics of individuals who develop MTSS and, in turn, identify modifiable risk factors that can be targeted to prevent individuals developing this injury.

• Injury prevention
• Medial tibial stress syndrome
• Protocols
• Running injuries

• Medial tibial stress syndrome
• Military injuries
• Regenerative therapy
• Shin splints
• Shockwave
• Shockwave treatment

• Achilles tendinopathy
• medial tibial stress syndrome
• period of pronation
• running injuries

A high proportion of flexor digitorum longus attachment is found at the posteromedial border of the tibia, which is the most common location of medial tibial stress syndrome (MTSS). Therefore, plantar flexion strength of the lesser toes could be related to MTSS; however, the relationship between MTSS and muscle strength of the hallux and lesser toes is not yet evaluated due to the lack of quantitative methods. This study investigated the muscle strength characteristics in runners with a history of MTSS by using a newly developed device to measure the muscle strength of the hallux, lesser toes, and ankle.

This study comprised 27 collegiate male runner participants (20.0 ± 1.6 years, 172.1 ± 5.1 cm, 57.5 ± 4.0 kg). Maximal voluntary isometric contraction (MVIC) torque of the plantar flexion, dorsiflexion, inversion, and eversion of the ankle were measured by using an electric dynamometer. MVIC torque of the 1st metatarsophalangeal joint (MTPJ) and 2nd–5th MTPJ were measured by using a custom-made torque-measuring device. MVIC torques were compared between runners with and without a history of MTSS.

MVIC torque of the 1st MTPJ plantar flexion was significantly higher in runners with a history of MTSS than in those without it. In contrast, there were no significant differences in the MVIC torque values of the 2nd–5th MTPJ plantar flexion and each MVIC torque of the ankle between runners with and without a history of MTSS.

A history of MTSS increased the isometric FHL strength.

• Flexor digitorum longus
• Flexor hallucis longus
• Hallux
• Lesser toes
• Medial tibial stress syndrome
• Metatarsophalangeal joint
• Shin splints
• Toe flexor muscle strength

• medial tibial stress syndrome
• meta-analysis
• risk factors

• Body Mass Index
• Female
• Gait/physiology
• Hip/physiology
• Humans
• Male
• Medial Tibial Stress Syndrome/etiology
• Medial Tibial Stress Syndrome/physiopathology
• Muscle Strength/physiology
• Physical Conditioning, Human
• Range of Motion, Articular
• Risk Factors
• Rotation
• Running/injuries
• Sex Factors

• Injury
• Pediatric
• Running
• Youth

• MTSS
• chiasms
• etiology
• female
• traction theory

• Injury
• Lower extremity
• Risk Factors

Medial tibial stress syndrome (MTSS) is a debilitating overuse injury of the tibia sustained by individuals who perform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, in most cases it is also an injury involving underlying cortical bone microtrauma, although it is not clear if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and magnetic resonance imaging (MRI) can both be used for the diagnosis of MTSS, but the patient’s history and clinical symptoms need to be considered in conjunction with the imaging findings for a correct interpretation of the results, as both imaging modalities have demonstrated positive findings in the absence of injury. However, MRI is rapidly becoming the preferred imaging modality for the diagnosis of bone stress injuries. It can also be used for the early diagnosis of MTSS, as the developing periosteal oedema can be identified. Retrospective studies have demonstrated that MTSS patients have lower bone mineral density (BMD) at the injury site than exercising controls, and preliminary data indicates the BMD is lower in MTSS subjects than tibial stress fracture (TSF) subjects. The values of a number of tibial geometric parameters such as cross-sectional area and section modulus are also lower in MTSS subjects than exercising controls, but not as low as the values in TSF subjects. Thus, the balance between BMD and cortical bone geometry may predict an individual's likelihood of developing MTSS. However, prospective longitudinal studies are needed to determine how these factors alter during the development of the injury and to find the detailed structural cause, which is still unknown. Finite element analysis has recently been used to examine the mechanisms involved in tibial stress injuries and offer a promising future tool to understand the mechanisms involved in MTSS. Contemporary accurate diagnosis of either MTSS or a TSF includes a thorough clinical examination to identify signs of bone stress injury and to exclude other pathologies. This should be followed by an MRI study of the whole tibia. The cause of the injury should be established and addressed in order to facilitate healing and prevent future re-occurrence.

• Medial tibial stress syndrome
• Tibia
• Injury
• Shin splints
• Fatigue injury
• Strain gauge
• Cortical bone geometry
• Bone mineral density
• Finite element model

• Bias
• Humans
• Incidence
• Lower Extremity/injuries
• Pain/etiology
• Physical Endurance/physiology
• Risk Factors
• Running/injuries
• Time Factors

• adolescents
• athletes
• epidemiology
• sports

• barefoot
• low-dye taping
• navicular-sling taping
• running

Dynamic foot function is considered a risk factor for lower limb overuse injuries including Achilles tendinopathy, shin pain, patellofemoral pain and stress fractures. However, no single source has systematically appraised and summarised the literature to evaluate this proposed relationship. The aim of this systematic review was to investigate dynamic foot function as a risk factor for lower limb overuse injury.

A systematic search was performed using Medline, CINAHL, Embase and SportDiscus in April 2014 to identify prospective cohort studies that utilised dynamic methods of foot assessment. Included studies underwent methodological quality appraisal by two independent reviewers using an adapted version of the Epidemiological Appraisal Instrument (EAI). Effects were expressed as standardised mean differences (SMD) for continuous scaled data, and risk ratios (RR) for nominal scaled data.

Twelve studies were included (total n = 3,773; EAI 0.44 to 1.20 out of 2.00, representing low to moderate quality). There was limited to very limited evidence for forefoot, midfoot and rearfoot plantar loading variables (SMD 0.47 to 0.85) and rearfoot kinematic variables (RR 2.67 to 3.43) as risk factors for patellofemoral pain; and plantar loading variables (forefoot, midfoot, rearfoot) as risk factors for Achilles tendinopathy (SMD 0.81 to 1.08). While there were significant findings from individual studies for plantar loading variables (SMD 0.3 to 0.84) and rearfoot kinematic variables (SMD 0.29 to 0.62) as risk factors for ‘non-specific lower limb overuse injuries’, these were often conflicting regarding different anatomical regions of the foot. Findings from three studies indicated no evidence that dynamic foot function is a risk factor for iliotibial band syndrome or lower limb stress fractures.

This systematic review identified very limited evidence that dynamic foot function during walking and running is a risk factor for patellofemoral pain, Achilles tendinopathy, and non-specific lower limb overuse injuries. It is unclear whether these risk factors can be identified clinically (without sophisticated equipment), or modified to prevent or manage these injuries. Future prospective cohort studies should address methodological limitations, avoid grouping different lower limb overuse injuries, and explore clinically meaningful representations of dynamic foot function.

The online version of this article (doi:10.1186/s13047-014-0053-6) contains supplementary material, which is available to authorized users.

• Biomechanics
• Kinematics
• Musculoskeletal diseases
• Plantar pressures
• Prospective studies
• Review

Static measures of foot posture are regularly used as part of a clinical examination to determine the need for foot level interventions. This is based on the premise that pronated and supinated foot postures may be risk factors for or associated with lower limb injury. This systematic review and meta-analysis investigates foot posture (measured statically) as a potential risk factor for lower limb overuse injuries.

A systematic search was performed using Medline, CINAHL, Embase, SportDiscus in April 2014, to identify prospective cohort studies that investigated foot posture and function as a risk factor for lower limb overuse injury. Eligible studies were classified based on the method of foot assessment: (i) static foot posture assessment; and/or (ii) dynamic foot function assessment. This review presents studies evaluating static foot posture. The methodological quality of included studies was evaluated by two independent reviewers, using an adapted version of the Epidemiological Appraisal Instrument (EAI). Where possible, effects were expressed as standardised mean differences (SMD) for continuous scaled data, and risk ratios (RR) for nominal scaled data. Meta-analysis was performed where injuries and outcomes were considered homogenous.

Twenty-one studies were included (total n = 6,228; EAI 0.8 to 1.7 out of 2.0). There was strong evidence that a pronated foot posture was a risk factor for medial tibial stress syndrome (MTSS) development and very limited evidence that a pronated foot posture was a risk factor for patellofemoral pain development, although associated effect sizes were small (0.28 to 0.33). No relationship was identified between a pronated foot posture and any other evaluated pathology (i.e. foot/ankle injury, bone stress reactions and non-specific lower limb overuse injury).

This systematic review identified strong and very limited evidence of small effect that a pronated foot posture is a risk factor for MTSS and patellofemoral pain respectively. Evaluation of static foot posture should be included in a multifactorial assessment for both MTSS and patellofemoral pain, although only as a part of the potential injury risk profile. Whilst the included measures are clinically applicable, further studies are required to determine their relationship with dynamic foot function.

The online version of this article (doi:10.1186/s13047-014-0055-4) contains supplementary material, which is available to authorized users.

• Foot
• Lower extremity
• Musculoskeletal diseases
• Pronation
• Prospective studies
• Review
• Risk factors
• Supination

Medial tibial stress syndrome (MTSS) is a common problem among athletes and soldiers. There is no proven theory that could explain the pathophysiology of shin splints. The therapies described so far are time-consuming and involve a high risk of relapse. The method according to the fascial distortion model (FDM) addresses local changes in the area of the lower leg fascia. It is suited to reduce pain and functional impairments associated with this symptom complex by applying targeted manual techniques. 32 patients (male: 30; female: 2) participated in this study. Visual analogue scale (VAS) was used for the quantification of pain. Scores were also given to rate the maximum painless exercise tolerance of the patients. Subsequently treatment of the crural fascia was performed. Patients retested ability of running and jumping. Therapy was continued until full exercise tolerance or painlessness was reached. A significant reduction of the VAS pain score from 5.2 to 1.1 could be achieved (P < 0.001). The impairment of exercise tolerance could be reduced from 7 to 2 points (P < 0.001). The duration of treatment was 6.3 (SD: 4.3) days on average. The FDM therapy is a potential effective method for acute treatment of MTSS.

• females
• high school
• offseason
• risk factors
• running injuries

• Medial tibial stress syndrome
• fluoroscopy
• foot biomechanics
• longitudinal arch