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Contributing Factors to Medial Tibial Stress Syndrome: A Prospective Investigation


Medicine & Science in Sports & Exercise: March 2009 - Volume 41 - Issue 3 - p 490-496
doi: 10.1249/MSS.0b013e31818b98e6
Clinical Sciences

Purpose: To conduct a prospective, multisite, cohort study investigating the possible risk factors for medial tibial stress syndrome (MTSS) in college athletes.

Methods: One hundred and forty-six healthy, collegiate athletes from NCAA Division I and Division II institutions participated in the study. Subjects first completed a health history questionnaire to establish previous history of injury and underwent a physical examination to assess their ankle/foot strength, ankle/foot range of motion, tibial varum, and navicular drop before the start of their respective athletic season. Athletes were instructed to report to a certified athletic trainer if they developed pain on their tibia. If MTSS was present, subjects were then placed into the symptomatic group. Independent t-tests and chi-square analyses were used to determine whether differences existed between MTSS and healthy athletes for the continuous and the discrete dependent variables, respectively. The significant dependent variables were then used in the discriminant function analysis.

Results: Twenty-nine subjects developed MTSS during this study. Athletes that had been participating in athletic activity for fewer than 5 yr were significantly more likely to develop MTSS (P = 0.002). Additionally, athletes with a previous history of MTSS (P = 0.0001), a previous history of stress fracture (P = 0.039), and the use of orthotics (P = 0.031) were more likely to develop MTSS compared with those who did not develop MTSS.

Conclusion: This study established that the factors most influencing MTSS development were previous history of MTSS and stress fracture, years of running experience, and orthotic use. These data demonstrate the importance of establishing a thorough history before the start of the season so that athletes who might be at risk for MTSS development can be identified.

1Biodynamics Research Laboratory, Department of Kinesiology, The University of North Carolina at Charlotte, Charlotte, NC; and 2Center for Biomedical Engineering Systems, The University of North Carolina at Charlotte, Charlotte, NC

Address for correspondence: Tricia J. Hubbard, Ph.D., ATC, 240-A Belk Gymnasium, Department of Kinesiology, The University of North Carolina at Charlotte, Charlotte, NC 28223; E-mail:

Submitted for publication June 2008.

Accepted for publication August 2008.

©2009The American College of Sports Medicine