Risk Factors of Medial Tibial Stress Syndrome in Active Adolescents: A Validation Case Series

Abstract

Current literature reports that an increase in body mass index (BMI), navicular drop, ankle plantarflexion range of motion (ROM), and hip external rotation ROM are key modifiable risk factors in the development of medial tibial stress syndrome (MTSS) in physically active adults. The purpose of this validation case series was to investigate these four measures as risk factors of MTSS in adolescent athletes. In total, 100 cross country, volleyball, and/or basketball athletes (age = 15.89±1.31 years, 54 assigned female at birth) were included. The competitive sports season was the intervention in this case series and all athletes experienced 6 athlete-exposures per week. Of the 100 athletes, 21% (n = 21/100) of participants developed MTSS during their respective sports season. Demographic data were analyzed using measures of central tendency. Mean differences (MD) between the MTSS and non-MTSS groups were calculated for the main outcome variables. A Kruskal-Wallis one-way analysis of variance was used to determine differences in main outcome variables between groups. There were no significant differences in BMI (p ≥ 0.42), navicular drop (p ≥ 0.27), active ankle plantarflexion ROM (p ≥ 0.65), or active hip external rotation ROM (p ≥ 0.77) between MTSS and non-MTSS groups. The MD between groups were BMI = 0.22, navicular drop = 0.95mm, active ankle plantarflexion ROM = -1.36°, and active hip external rotation ROM = -0.40°. These results do not prospectively confirm adolescents who develop MTSS have a significant increase in the risk factors described in the literature. Therefore, more research should be performed to determine if the risk factors for MTSS between adults and adolescents differ.