The Role of Leg Stiffness in Prediction of Medial Tibial Stress Syndrome in Active People: A Prospective Cohort Study

Document Type : Original Articles

Authors

1 PhD Student, Department of Sports Biomechanics, School of Physical Education and Sport Sciences, University of Mazandaran, Babolsar, Iran

2 Associate Professor, Department of Sports Biomechanics, School of Physical Education and Sport Sciences, University of Mazandaran, Babolsar, Iran

3 Associate Professor, Department of Physical Therapy, School of Rehabilitation Sciences, University of Babol, Babol, Iran

4 Associate Professor, Department of Statistics, School of Mathematical Sciences, University of Mazandaran, Babolsar, Iran

10.22122/jrrs.v13i5.3045

Abstract

Introduction: Medial tibial stress syndrome or shin splints is one of the most common overuse injuries in active people, that its risk factors are unknown. On the other hand, leg stiffness is a modifiable mechanical property that may be related to overuse injury. So, the aim of this study was to investigate the role of the leg stiffness in the prediction of medial tibial stress syndrome in active people.Materials and Methods: 80 students in physical education (50 girls and 30 boys) were selected in  a convenience manner. Before the start of training sessions, the stiffness of both legs was measured. During the sessions, injured‏ people were examined, and the type of injury registered by the orthopedic physician. At the end of the training sessions, the subjects were divided into two groups of injured and non-injured. The independent t-test was used to compare the leg stiffness between the two groups. Binary logistic regression was used to investigate the role of leg stiffness in the prediction of the occurrence of this syndrome.Results: There was a significant difference in leg stiffness between the two groups (P = 0.001). Logistic regression analysis revealed that injured subjects had a significantly more leg stiffness‏ before the injury compared to‏ non-injured group. So, leg stiffness was a risk factor this syndrome.Conclusion: This study showed that leg stiffness could predict medial tibial stress syndrome or shin splint. So, high leg stiffness may increase the risk of overuse injuries. This research provides important information to the coaches and team doctors about the management of injury and its treatment.

Keywords

  1. Hamstra-Wright KL, Huxel Bliven KC, Bay C. 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 2014; 49(6): 362-9.
  2. Hubbard TJ, Carpenter EM, Cordova ML. Contributing factors to medial tibial stress syndrome: a prospective investigation. Med Sci Sports Exerc 2009; 41(3): 490-6.
  3. Griebert MC, Needle AR, McConnell J, Kaminski TW. Lower-leg Kinesio tape reduces rate of loading in participants with medial tibial stress syndrome. Phys Ther Sport 2016; 18: 62-7.
  4. Yagi S, Muneta T, Sekiya I. Incidence and risk factors for medial tibial stress syndrome and tibial stress fracture in high school runners. Knee Surg Sports Traumatol Arthrosc 2013; 21(3): 556-63.
  5. Newman P, Witchalls J, Waddington G, Adams R. Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis. Open Access J Sports Med 2013; 4: 229-41.
  6. Butler RJ, Crowell HP 3rd, Davis IM. Lower extremity stiffness: implications for performance and injury. Clin Biomech (Bristol, Avon) 2003; 18(6): 511-7.
  7. McMahon JJ, Comfort P, Pearson S. Lower limb stiffness: Effect on performance and training considerations. Strength Cond J 2012; 34(6): 94-101.
  8. Milner CE, Hamill J, Davis I. Are knee mechanics during early stance related to tibial stress fracture in runners? Clin Biomech (Bristol, Avon) 2007; 22(6): 697-703.
  9. Zeni JA, Jr., Higginson JS. Dynamic knee joint stiffness in subjects with a progressive increase in severity of knee osteoarthritis. Clin Biomech (Bristol, Avon) 2009; 24(4): 366-71.
  10. Williams DS 3rd, Davis IM, Scholz JP, Hamill J, Buchanan TS. High-arched runners exhibit increased leg stiffness compared to low-arched runners. Gait Posture 2004; 19(3): 263-9.
  11. Thomson A. The relationship between musculoskeletal stiffness and lower limb injury in athletes: A systematic review. Br J Sports Med 2014; 48(7): 665.
  12. Lorimer AV. Evaluating stiffness of the lower limb 'springs' as a multifactorial measure of achilles tendon injury risk in triathletes [PhD Thesis]. Auckland, New Zealand: Auckland University of Technology; 2014.
  13. Watsford ML, Murphy AJ, McLachlan KA, Bryant AL, Cameron ML, Crossley KM, et al. A prospective study of the relationship between lower body stiffness and hamstring injury in professional Australian rules footballers. Am J Sports Med 2010; 38(10): 2058-64.
  14. Pruyn EC, Watsford ML, Murphy AJ, Pine MJ, Spurrs RW, Cameron ML, et al. Relationship between leg stiffness and lower body injuries in professional Australian football. J Sports Sci 2012; 30(1): 71-8.
  15. Serpell BG, Scarvell JM, Ball NB, Smith PN. Vertical stiffness and muscle strain in professional Australian football. J Sports Sci 2014; 32(20): 1924-30.
  16. Lin CF, Chen CY, Lin CW. Dynamic ankle control in athletes with ankle instability during sports maneuvers. Am J Sports Med 2011; 39(9): 2007-15.
  17. Habibi Tirtashi F, Eslami M. The immediate effect of shoe insoles on the frequency components of ground reaction force during running. J Res Rehabil Sci 2014; 10(3): 359-71. [In Persian].
  18. Hobara H, Inoue K, Omuro K, Muraoka T, Kanosue K. Determinant of leg stiffness during hopping is frequency-dependent. Eur J Appl Physiol 2011; 111(9): 2195-201.
  19. Willems TM, De Clercq D, Delbaere K, Vanderstraeten G, De Cock A, Witvrouw E. A prospective study of gait related risk factors for exercise-related lower leg pain. Gait Posture 2006; 23(1): 91-8.
  20. Coleman DR, Cannavan D, Horne S, Blazevich AJ. Leg stiffness in human running: Comparison of estimates derived from previously published models to direct kinematic-kinetic measures. J Biomech 2012; 45(11): 1987-91.
  21. Tazike-Lemeski Z, Eslami M, Habibi-Tirtashi F. The effect of shoe insole stiffness on leg stiffness during stance phase of running in two different speeds among active Men. J Res Rehabil Sci 2016; 12(1): 34-41. [In Persian].
  22. Morin JB, Samozino P, Zameziati K, Belli A. Effects of altered stride frequency and contact time on leg-spring behavior in human running. J Biomech 2007; 40(15): 3341-8.
  23. Thomas JM. Factors affecting lower extremity loading during running. Ames, IA: Iowa State University; 2008.
  24. Beerse M, Wu J. Comparison of whole-body vertical stiffness and leg stiffness during single-leg hopping in place in children and adults. J Biomech 2017; 56: 71-5.
  25. Waxman JP, Ford KR, Nguyen AD, Taylor JB. Female athletes with varying levels of vertical stiffness display kinematic and kinetic differences during single-leg hopping. J Appl Biomech 2018; 34(1): 65-75.
  26. Newman P. Medial tibial stress syndrome [PhD Thesis]. Canberra, Australia: University of Canberra; 1996.
  27. Serpell BG, Ball NB, Scarvell JM, Smith PN. A review of models of vertical, leg, and knee stiffness in adults for running, jumping or hopping tasks. J Sports Sci 2012; 30(13): 1347-63.
Volume 13, Issue 5 - Serial Number 5
January 2018
Pages 287-295
  • Receive Date: 03 May 2018
  • Revise Date: 19 April 2024
  • Accept Date: 22 May 2022