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Background: It is essential to find out the presence of shin splint in recreational marathon runners to prevent the injury from causing more damage. This study was conducted to identify shin splint in recreational marathon runners in Krishna Hospital, Karad. This study was designed to provide meaningful insight into the cause of shin splint in recreational marathon runners. Objectives of the study were to find out the impact of shin splint in recreational marathon runners and to assess the severity of shin splint in recreational marathon runners of age group 20-30 years both males and females in Krishna Hospital, Karad. Material and Methods: 190 recreational marathon runners who fit in the criteria were given Runner’s Questionnaire and were asked to fill it. Result: There was marked significance pain was present during(p=0.04) and running throughout(p
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Int J Physiother 2020; 7(1) Page | 37
Background: It is essential to nd out the presence of shin splint in recreational marathon runners to prevent the
injury from causing more damage. is study was conducted to identify shin splint in recreational marathon runners
in Krishna Hospital, Karad. is study was designed to provide meaningful insight into the cause of shin splint in
recreational marathon runners.
Objectives of the study were to nd out the impact of shin splint in recreational marathon runners and to assess the
severity of shin splint in recreational marathon runners of age group 20-30 years both males and females in Krishna
Hospital, Karad.
Material and Methods: 190 recreational marathon runners who t in the criteria were given Runner’s Questionnaire
and were asked to ll it.
Result: ere was marked signicance pain was present during(p=0.04) and running throughout(p<0.0001) in
recreational marathon runners.
Conclusion: It was concluded from the present study that there is a prevalence of shin splint in marathon runners. Shin
splint was found more in females (55.3%)than in males (44.7%). Based on the duration of pain and shoe surface was
found to be more prevalent to cause shin splint in marathon runners.
Keywords: Shin Splint, Recreational marathon runners, Pain, Shoe surface, Medial tibial stress syndrome.
Received 13th December 2019, accepted 05th February 2020, published 09th February 2020
www.ijphy.or g
Int J Physiother. Vol 7(1), 37-41, February (2020) ISSN: 2348 - 8336
¹Prina. Y. Patel
*2Namrata Patil
*2Namrata Patil
Assistant Professor, Department of Paediatrics,
Faculty of Physiotherapy, Krishna Institute of
Medical Sciences Deemed To Be University,
Karad, Maharashtra, India.
¹Final year, Faculty of Physiotherapy,
Krishna Institute of Medical Sciences
Deemed To Be University, Karad,
Maharashtra, India.
is article is licensed under a Creative Commons Attribution-Non Commercial 4.0 International License.
Copyright © 2020 Author(s) retain the copyright of this article.
Int J Physiother 2020; 7(1) Page | 38
Shin splint is most oen used to described as exertional leg
pain. ere are mainly two types of shin splint that occur
which are a) Anterior shin splint refers to as dysfunction
of the anterior leg compartment or surrounding structures
b) Medial tibial stress syndrome refers to as exercise due to
pain associated to distal two-third of the leg [1].
Recreational runners are increasing in number and
are mostly participating in marathon runners. Mostly
recreational runners having training intervention has
important implications for that design of training protocol
[2]. Improper foot biomechanics such as static pronated
foot, lower standing foot angle, varus rearfoot and forefoot,
maximum pronation, and increased navicular drop is
associated with medial tibial stress syndrome among
runners [3]. In most of the studies, recreational runners
have medial tibial stress syndrome, mostly or second
most frequently diagnosed injury. Pain is present during
exercise in mild cases, and in severe cases, pain is present
during rest [4]. e posteromedial muscular weakness is a
consequence of muscular overuse and chronic fatigue [5].
Cause of anterior shin splint is not completely understood;
overuse or chronic injury of the anterior compartment
muscles, fascia, bony, and periosteal attachment. Causes
of medial tibial stress syndrome are traction periostitis
of soleus or exor digitorium longus muscle origin and
increased heel eversion [1]. Some studies suggested that
Medial tibial stress syndrome is a consequence of repetitive
stress imposed by impact force that eccentrically fatigue
the soleus, which creates repetitive bending and bowing of
tibia [2].
Detmer classied medial tibial stress syndrome based on
etiology, i.e., Type 1: included local stress fracture, Type
2: periostitis/periostaligia, and Type 3:was due to deep
posterior compartment syndrome [4]. A study showed no
connection of myofascial attachment of the deep crural
fascia, soleus, exor didgitorum longus and tibialis in the
posterior border of tibialis in which the pain appeared as
Medial tibial stress syndrome [5].
A large study showed no connection of the deep coral to
the coral fascia, long exor digitorium, and tibialis in the
posterior border of the tibia, in which the pain appeared as
a tibial stress syndrome.
Medial tibial stress syndrome should be dierentiated
from chronic exertional compartment syndrome, stress
fracture, popliteal artery entrapment syndrome, and
various neuropathies [4]. A navicular drop with feet
shoulder-width apart was measured, which was found
to be signicantly associated with Medial tibial stress
syndrome [5]. One of the most oen causes of Medial tibial
stress syndrome is increased valgus force on the rear foot
and excessive pronation [4].
People with higher Body mass index and the individuals
who used prior orthotic devices for a prolonged period
were found to be more prone to develop Medial tibial stress
syndrome [5]. Other studies suggested that over two times
more likely to incur Medial tibial stress syndrome injury
in runners who had experienced previous running injury
[3]. Women appear more frequently to have this diused
tenderness over the posteromedial aspect of the distal third
of the tibia, as compared to men[4].
Positive conrmation of Medial tibial stress syndrome
can be done by bone stress marker, advances in computed
tomography, magnetic resonance imaging technique, and
dual-energy absorptiometry [5]. Shock-absorbent insoles,
pronation-control insoles, and graduated running the
program have been proven to be a preventive method of
Medial tibial stress syndrome [2]. Running on an uneven
platform and hill running should be prevented whereas
to minimize rearfoot valgus and to correct the excessive
pronation, pes cavus or pes planus appropriate shoe wear
is an essential tool to use [4]. e lower limb musculature
stretch has been consistently proven not to prevent Medial
tibial stress syndrome [2].
Flexibility and the strengthing regime should be initiated
to correct any muscle imbalances; Non-steroidal anti-
inammatory drugs and Anti-inammatory modalities
can also be used for rehabilitation of Medial tibial stress
syndrome [4]. Person conditioning, which is included as
one of the graduated running programs, is accepted as
one of the preventive measures for many injuries [2]. For
an athlete which severe limitation of physical activities,
frequent recurrence, or no response to available therapy,
an operative method has been suggested [4]. e
runner’s questionnaire is used to evaluate the shin splint
in recreational marathon runners. e purpose of the
present study is to determine the individual having shin
splint in a recreational marathon runner, which is usually
misdiagnosed and can cause more damage to the area.
Overuse injuries result in repetitive microtrauma, which
leads to damage in cellular and intracellular degeneration.
is is most likely to occur due to change in mode, intensity,
or duration of the timing.
Common overuse injuries of the lower leg include
tendinopathy, stress fracture, chronic exertional
compartment syndrome, and shin splint. e incorrect
method of training or lack of proper training is the leading
cause of this injury. An adequate light upon the correct
regime can prevent this injury.
For a recreational marathoner, injury this early and oen
can hamper that individuals performance and daily
activities. If the marathoner is enlightened about the injury
and its cause, prevention can cause betterment in his
performance hereaer.
Considering the above facts, the present study was planned
to determine shin splint in recreational marathon runners
in Krishna Hospital, Karad. e current study objectives
were to nd out the impact of shin splint in recreational
marathon runners and assess the severity of shin splint in
recreational marathon runners.
Int J Physiother 2020; 7(1) Page | 39
e present cross-sectional observational study was
conducted at KIMS for three months. A total of 190
subjects were selected by using simple random method.
e subjects were included in the present study of both
males and females with the age group 20 to 30 years. e
subjects who participated in cross country runners, long-
distance runners, and who are not willing to participate in
the study were excluded from the present study.
Data collection procedure:
Procedure: 190 subjects aged between 20 to 30 years, both
male and female, were selected randomly for the present
study. Individuals who are not willing to participate and
who participated in cross country runners and long-
distance runners were excluded. Written consent was taken
from subjects those willing to participate. Institutional
Ethical Committee approved was obtained (Ref No:
0481/2018-2019) before the beginning of the study. e
assessment was done based on the Runners Questionnaire
lled by the subjects.
Statistical Analysis:
Descriptive statistics such as mean, SD, and the percentage
was used to present the data. Association of shin splint with
various variables was assessed by using the Chi-square test.
A p-value of less than 0.05 was considered signicant. Data
analysis was performed by using Microso Excel and SPSS
Majority of the subjects were belongs to age group 23-25
(46.3%) followed by 26-28 (31.1%), 20-22 (21.1%) and
29-31 (1.6%). In the present, male and female subjects
were almost the same. In the present study, the prevalence
of shin splint in marathon runners was 132 out of 190
i.e.69.5% (Table - 1).
Table 1: Basic characteristics
Characteristics Number Percentage
20-22 40 21.1
23-25 88 46.3
26-28 59 31.1
29-31 3 1.6
Male 95 50.0
Female 95 50.0
Shin splint
Yes 132 69.5
No 58 30.5
Majority of running interest was multisport (32.65%).
82.6% having pain during running and 81.1% having pain
aer running (Table - 2).
Table 2: Distribution of subjects according to sports-
related parameters
Parameters Number Percentage
Duration of running
1-5 46 24.2
6-10 63 33.2
11-15 75 39.5
>15 6 3.2
Running interest
Fitness and fun 58 30.5
Multisport 62 32.6
Racing for Improvement 15 7.9
Recreational and social 55 28.9
Pain during running
Yes 157 82.6
No 33 17.4
Running throughout
No 33 17.4
Same 65 34.2
Better 41 21.6
Wor s t 51 26.8
Pain aer running
Yes 154 81.1
No 36 18.9
Out of 190 recreation marathon runners with shin splint,
a maximum of 88 (48.5%) were in the age group of 23-25
years, and a minimum of 2 (1.5%) were in the age group of
29-30 years. ere was no statistical association between
shin splint and age (p=0.56). Maximum of getting shin
splint in recreational marathon runners were Females
(55.3%), and remaining were males (44.7%). ere was
a statistical association between a shin splint and gender
(p=0.03) (Table - 3).
Table 3: Association of shin splint with socio-
demographic data
Variables Shin splint (%). χ2 value p-value
Yes No
20-22 28 (21.2) 12 (20.7)
1.16 0.56
23-25 64 (48.5) 24 (41.4)
26-28 38 (28.8) 21 (36.2)
29-31 2 (1.5) 1 (1.7)
Male 59 (44.7) 36 (62.1) 4.86 0.03
Female 73 (55.3) 22 (37.9)
Maximum 49 (37.1%) was in duration between 6-10, and
a minimum of 3 (2.3%) was in duration between >15.
ere was no statistical association between shin splint
and duration of running (p=0.16). In turn, it shows that
the occurrence of shin splint was not dependent on the
duration of running.
Int J Physiother 2020; 7(1) Page | 40
Maximum was Multisport 47(35.6%), and minimum were
Racing for improvement 9(6.8%). ere was no statistical
association between shin splint and duration of running
Maximum people have pain during running 114(86.4%),
and the minimum has no pain during running 18(13.6%).
ere was a highly statistical association between shin
splint and pain during running (p=0.04). It shows pain
during running plays a signicant role in shin splint.
Maximum was at worst 50(37.9%), and the minimum was
at not present 18(13.6%). ere was a highly statistical
association between shin splint and pain throughout
running (p<0.0001).
Maximum people have pain aer running 111(84.1%), and
minimum people have present with no pain 21(15.9%).
ere was no statistical association between shin splint and
pain aer running (p=0.11) (Table - 4).
Table 4: Association of shin splint with sports-related
factors of the respondents
Variables Shin splint (%). χ2 value p-value
Yes No
Duration of
1-5 32 (24.2) 14 (24.1)
3.67 0.16
6-10 49 (37.1) 14 (24.1)
11-15 48 (36.4) 27 (46.6)
>15 3 (2.3) 3 (5.2)
Running interest
Fitness and fun 41 (31.1) 17 (29.3)
2.73 0.43
Multisport 47 (35.6) 15 (25.9)
Racing for Im-
provement 9 (6.8) 6 (10.3)
Recreational and
social 35 (26.5) 20 (34.5)
Pain during
Yes 114 (86.4) 43 (74.1) 4.19 0.04
No 18 (13.6) 15 (25.9)
No 18 (13.6) 15 (25.9)
60.31 <0.0001
Same 26 (19.7) 39 (67.2)
Better 38 (28.8) 3 (5.2)
Wor s t 50 (37.9) 1 (1.7)
Pain aer run-
Yes 111 (84.1) 43 (74.1) 2.60 0.11
No 21 (15.9) 15 (25.9)
e present study was found that the current prevalence of
shin splint among recreational marathon was 69.5%. e
previous research has reported the onset of pain during
early sports events, aer the sports events, during the whole
sports events, during the initial steps from the bed always,
etc. [9]. e present study shows the same nature of the
pain and as well as there has been pain aer the running.
e current research says that there is an occurrence of shin
splint in both the gender. Some studies stated that females
are at signicantly higher risk of developing medial tibial
stress syndrome than males, as females have typically later
onset of menarche and suer commonly from menstrual
disturbance. Bennell (1996) et al., in a prospective
study of 53 female athletes, found the age of menarche,
menstrual disorder, lower bone mineral density, leg length
discrepancy, a less lean mass of the shank and a lower-
fat diet were a signicant risk factor for a stress fracture
in females [10]. e present study has stated that the shin
splint is seen in age groups around the adult. ere has
been a close relationship between sports events and sports
injuries, and among them, a shin splint is very common
in sports injury in the lower leg [11]. Regarding the risk
factors of shin splint, this study found no any signicant
association with socio-demographic data characteristic of
this study such as age, gender, and anthropometrical factors
such as height, weight, body mass index, etc. and also with
lifestyle-related factors such as smoking, maintenance of
diet plan, water intake, etc.. In contrast, other study found
association with gender and body mass index [12]. Again
present study suggested that gender was associated with
causing shin splint and not with other factors for causing
shin splint.
Regarding the risk factors of shin splint, the present study
found a signicant association with the pain while running
(p=0.04) and running throughout (p<0.0001), ndings
were comparable with research done by Middelkoop 2008
Musculoskeletal pain is associated with the amount of
weekly training and the number of years of running in
recreational runners [14-16]; this relationship was not
found in the present study, maybe because of the sample
was homogeneous in the amount training and the number
of years running. Other factors, such as the use of dierent
running shoes and preferred running surface, the non-
treadmill, and the stability of the thigh muscles, have been
identied as triggers for injuries and can also be related to
muscle pain[15,17]. However, in the present study, these
factors were not evaluated.
Clinical implementation of present research:
Based on the high prevalence of shin splint, the pain that is
observed in this population, it is important to take action
on the recreational marathon by conducting education
aims to promote more information about the risks and
consequences of renewal. It can help reduce the incidence
of overuse injuries and contribute to the development of
injury prevention strategies. However, this hypothesis
should be conrmed in future studies.
It was concluded from the present study that there is a
prevalence of shin splint in marathon runners. Shin splint
was found more in females than in males. Based on the
duration of pain and shoe surface was found to be more
prevalent to cause shin splint in marathon runners.
Further, it is also essential to give more emphasis on the
Int J Physiother 2020; 7(1) Page | 41
recreational marathon by conducting education aims to
promote more information about the risks.
We acknowledge the guidance and support of the faculty
of physiotherapy.
Prina Y. Patel conducted the study by working on protocol
preparation, collecting samples, literature review for
this manuscript, developed introduction section of the
script, together with the discussion of the study ndings,
collected data and analyzed the data. Namrata Patil guided
in providing a description of the background information
and draing the article.
e authors declare that there are no conicts of interest
concerning the content of the present study.
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... Two types are anterior leg compartment dysfunction and posterior leg compartment dysfunction. It commonly occurs in the distal two-thirds of the leg, preventing exercising [1] . The source of this condition was previously unknown, and numerous possible reasons were proposed, such as increased intracompartmental pressure or traction-induced periostitis [2] . ...
... A recreational marathoner's performance and everyday activities might be hampered by injury. If the marathoner is aware of the damage and its origin, he may enhance his performance in the future by preventing that type of complication [1,14] . ...
... Group A will have instrumentassisted soft tissue mobilization (control group), whereas Group B will receive cupping (experimental group) by a 1:1 ratio. reported to be more common among marathon runners based on the length of discomfort and the shoe surface [1] . showed and significantly affected pain relief. ...
Medial tibial stress syndrome (MTSS) is Exertional leg discomfort. There are two forms of shin splints: anterior leg compartment dysfunction and posterior leg compartment dysfunction. MTSS patients are routinely offered graded jogging, strengthening, and stretching activities for the calf muscles. Instrument-assisted soft tissue mobilization (IASTM) includes stroking the skin with a bar or spurtle to apply repetitive mechanical stimulations to (tendons, muscle, and overlaying deep fascia) soft tissue. Cupping is a therapeutic technique that involves applying negative pressure to the skin over a sore location to relieve muscular spasms and discomfort. The rationale of the study is to find how effective the therapy for shin pain in recreational runners. The effectiveness of cupping therapy in MTSS and compares the efficacy of IASTM and cupping with strengthening and stretching exercises to see which can enhance function and reduce discomfort in a short duration of time in runners. These is randomized control trials. The study’s sample will be 46. The group B experimental group in which cupping therapy will be given, the control group, i.e., group A in which IASTM will be given for four weeks with the following baseline examinations- VAS, Treadmill test, step up and down test with MMT and ROM. The efficacy of the technique for both groups will be examined every week utilizing treadmill testing, VAS, step up and step down as end measures the pain assessment, the improvement in termination time of treadmill test as well as step up and down test.
... People with a higher body mass index (BMI) and those who had previously used orthotic devices for a long time were shown to be more likely to develop diabetes. This condition affects the lower leg [4]. ...
Medial tibial stress syndrome (MTSS), usually referred to as "shin splints," is a common overuse injury of the lower extremities affecting a large percentage of athletes. A variety of factors can lead to shin splints, including overtraining, poor footwear, muscular imbalances at the ankle, overtight or weak triceps surae muscles, imbalances at the thoracolumbar complex, and a body mass index (BMI) above 30. Injuries present with diffuse palpable pain that is often described as a dull ache following exercise. The pain is often alleviated by resting. Often, athletes complain of tenderness along the posteromedial edge of the tibia and pain along the middle to distal third of the posteromedial border of the tibia following an exercise session. The pain caused by a shin splint should be categorized according to its location and cause, such as lower medial tibial pain caused by periostitis or upper lateral tibial pain caused by raised compartment pressure. In order to prevent MTSS or shin splints, it is important to avoid excessive stress. The main objectives of shin splint treatment are to relieve pain and to enable the patient to return to normal activities without pain. To prevent shin splints, repetitive stress should be avoided. In this paper, we review what is known about the pathophysiology of shin splint syndrome, present evidence regarding risk factors associated with shin splints, assess the effectiveness of prevention strategies, and make recommendations for prevention. The purpose of this study is to assess the effectiveness of interventions to prevent shin splints.
... In leg runners, inflammatory traction most commonly occurs in the tibial region. "It is a more elaborated nomenclature which simply explains the medial tibial periostitis or tibial traction of medial periostitis" [5,6]. ...
Full-text available
Leg pain caused by recurrent stressors is known as shin pain, also known as the medial tibial stress syndrome (MTSS). Athletes, particularly runners, are more vulnerable. As a result, runners devote little time to practice and avoid exercises completely. The precise cause is yet to be identified. Microdamage caused by recurrent stressors has been proposed as the fundamental mechanism in other investigations. Gender, navicular bone loss, higher body mass index, activities of high intensity, and increased range in external hip rotation in males are all risk factors. A common complaint is a bilateral pain in the distal leg, primarily on the anterior and medial sides. Pain is exacerbated by activity and eased by relaxation. Particularly, pain and swelling in the posterior and medial aspects of the tibia, as well as other causative symptoms, may be discovered during the examination. To rule out alternate origins of the same symptoms, imaging modalities such as computed tomography, radiography, bone scintigraphy, and magnetic resonance imaging might be used. Preventative measures include shock-absorbing insoles, repetitive stress avoidance, and effective treatment of repetitive stress disorder and anatomical abnormalities. Rest, ice, and pain medications are the most common treatments.
Full-text available
Sports injuries are the very common phenomenon among sports persons during the sports events. Among all kinds of lower leg injuries, shin splints is also occupied a noticeable extent. The aims of the study were to determine the prevalence and the associated risk factors of shin splints among the sports persons especially cricketers, footballers, tennis players and hockey players of [111]
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Successful training must involve overload but also must avoid the combination of excessive overload plus inadequate recovery. Athletes can experience short term performance decrement, without severe psychological, or lasting other negative symptoms. This Functional Overreaching (FOR) will eventually lead to an improvement in performance after recovery. When athletes do not sufficiently respect the balance between training and recovery, Non-Functional Overreaching (NFOR) can occur. The distinction between NFOR and the Overtraining Syndrome (OTS) is very difficult and will depend on the clinical outcome and exclusion diagnosis. The athlete will often show the same clinical, hormonal and other signs and symptoms. A keyword in the recognition of OTS might be ‘prolonged maladaptation' not only of the athlete, but also of several biological, neurochemical, and hormonal regulation mechanisms. It is generally thought that symptoms of OTS, such as fatigue, performance decline, and mood disturbances, are more severe than those of NFOR. However, there is no scientific evidence to either confirm or refute this suggestion. One approach to understanding the aetiology of OTS involves the exclusion of organic diseases or infections and factors such as dietary caloric restriction (negative energy balance) and insufficient carbohydrate and/or protein intake, iron deficiency, magnesium deficiency, allergies, etc. together with identification of initiating events or triggers. In this paper we provide the recent status of possible markers for the detection of OTS. Currently several markers (hormones, performance tests, psychological tests, biochemical and immune markers) are used, but none of them meets all criteria to make its use generally accepted. We propose a “check list” that might help the physicians and sport scientists to decide on the diagnosis of OTS and to exclude other possible causes of underperformance.
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Medial tibial stress syndrome (MTSS) affects 5%-35% of runners. Research over the last 40 years investigating a range of interventions has not established any clearly effective management for MTSS that is better than prolonged rest. At the present time, understanding of the risk factors and potential causative factors for MTSS is inconclusive. The purpose of this review is to evaluate studies that have investigated various risk factors and their association with the development of MTSS in runners. Medical research databases were searched for relevant literature, using the terms "MTSS AND prevention OR risk OR prediction OR incidence". A systematic review of the literature identified ten papers suitable for inclusion in a meta-analysis. Measures with sufficient data for meta-analysis included dichotomous and continuous variables of body mass index (BMI), ankle dorsiflexion range of motion, navicular drop, orthotic use, foot type, previous history of MTSS, female gender, hip range of motion, and years of running experience. The following factors were found to have a statistically significant association with MTSS: increased hip external rotation in males (standard mean difference [SMD] 0.67, 95% confidence interval [CI] 0.29-1.04, P<0.001); prior use of orthotics (risk ratio [RR] 2.31, 95% CI 1.56-3.43, P<0.001); fewer years of running experience (SMD -0.74, 95% CI -1.26 to -0.23, P=0.005); female gender (RR 1.71, 95% CI 1.15-2.54, P=0.008); previous history of MTSS (RR 3.74, 95% CI 1.17-11.91, P=0.03); increased body mass index (SMD 0.24, 95% CI 0.08-0.41, P=0.003); navicular drop (SMD 0.26, 95% CI 0.02-0.50, P=0.03); and navicular drop >10 mm (RR 1.99, 95% CI 1.00-3.96, P=0.05). Female gender, previous history of MTSS, fewer years of running experience, orthotic use, increased body mass index, increased navicular drop, and increased external rotation hip range of motion in males are all significantly associated with an increased risk of developing MTSS. Future studies should analyze males and females separately because risk factors vary by gender. A continuum model of the development of MTSS that links the identified risk factors and known processes is proposed. These data can inform both screening and countermeasures for the prevention of MTSS in runners.
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This study examines the effect of progressive increases in footwear minimalism on injury incidence and pain perception in recreational runners. One hundred and three runners with neutral or mild pronation were randomly assigned a neutral (Nike Pegasus 28), partial minimalist (Nike Free 3.0 V2) or full minimalist shoe (Vibram 5-Finger Bikila). Runners underwent baseline testing to record training and injury history, as well as selected anthropometric measurements, before starting a 12-week training programme in preparation for a 10 km event. Outcome measures included number of injury events, Foot and Ankle Disability (FADI) scores and visual analogue scale pain rating scales for regional and overall pain with running. 99 runners were included in final analysis with 23 injuries reported; the neutral shoe reporting the fewest injuries (4) and the partial minimalist shoe (12) the most. The partial minimalist shoe reported a significantly higher rate of injury incidence throughout the 12-week period. Runners in the full minimalist group reported greater shin and calf pain. Running in minimalist footwear appears to increase the likelihood of experiencing an injury, with full minimalist designs specifically increasing pain at the shin and calf. Clinicians should exercise caution when recommending minimalist footwear to runners otherwise new to this footwear category who are preparing for a 10 km event.
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Question: What is the prevalence and nature of musculoskeletal pain in recreational runners immediately before a race? Cross-sectional survey. Adults intending to compete in a recreational running race between 5000 and 10 000 metres. Demographic data collected about the respondents included: age, gender, height, weight, duration of running experience, distance run per week, number of training sessions per week, training surface, and use of coaching. Respondents were asked if they had any pain. If pain was present, data were collected regarding its location, duration, current intensity, and behaviour. All data were self-reported. Data were collected from 1049 runners at five recreational races in São Paulo, Brazil. Of these respondents, 227 (22%) reported musculoskeletal pain before the race. Male respondents reported a greater running experience, a higher distance run per week, and a greater body mass index. Despite this, the prevalence of pain was 20% among the 796 male respondents and 27% among the 253 female respondents (RR 1.35, 95% CI 1.05 to 1.72). Where pain was present, it was typical of overuse injuries and its duration, intensity, and behaviour were similar between male and female respondents. The prevalence of musculoskeletal pain in recreational runners about to compete is substantial. Physiotherapists might be able to circumvent worsening of existing overuse injuries in this population with advice and preventive interventions.
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REFERENCE: Thacker SB, Gilchrist J, Stroup DF, Kimsey CD. The prevention of shin splints in sports: a systematic review of literature. Med Sci Sports Exerc. 2002;34(1):32-40. Among physically active individuals, which medial tibial stress syndrome (MTSS) prevention methods are most effective to decrease injury rates? Studies were identified by searching MEDLINE (1966-2000), Current Contents (1996-2000), Biomedical Collection (1993-1999), and Dissertation Abstracts. Reference lists of identified studies were searched manually until no further studies were identified. Experts in the field were contacted, including first authors of randomized controlled trials addressing prevention of MTSS. The Cochrane Collaboration (early stage of Cochrane Database of Systematic Reviews) was contacted. Inclusion criteria included randomized controlled trials or clinical trials comparing different MTSS prevention methods with control groups. Excluded were studies that did not provide primary research data or that addressed treatment and rehabilitation rather than prevention of incident MTSS. A total of 199 citations were identified. Of these, 4 studies compared prevention methods for MTSS. Three reviewers independently scored the 4 studies. Reviewers were blinded to the authors' names and affiliations but not the results. Each study was evaluated independently for methodologic quality using a 100-point checklist. Final scores were averages of the 3 reviewers' scores. Prevention methods studied were shock-absorbent insoles, foam heel pads, Achilles tendon stretching, footwear, and graduated running programs. No statistically significant results were noted for any of the prevention methods. Median quality scores ranged from 29 to 47, revealing flaws in design, control for bias, and statistical methods. No current evidence supports any single prevention method for MTSS. The most promising outcomes support the use of shock-absorbing insoles. Well-designed and controlled trials are critically needed to decrease the incidence of this common injury.
Objective There are over 30 million runners worldwide, with high levels of injury reported. However, there is little evidence regarding utilisation levels or perceived benefit of CAM, including chiropractic, among runners. This study investigated utilisation and perceived effectiveness of CAM in non-elite marathon runners in the UK, aiming to enhance understanding of healthcare and treatment preferences in this population. An additional aim was to generate preliminary data on modalities chosen to treat specific running injuries. Method A retrospective, non-experimental survey was distributed to 100 non-elite runners participating in the 2007 Flora London Marathon. Results Ninety-nine completed questionnaires were analysed (response rate = 99%). Forty-three per cent of participants sustained running-related injuries in the past year, predominantly to the knee/lower leg (48%) and back (21%). Thirty-seven per cent used CAM or non-CAM modalities alongside orthodox medical care. A further 37% used these without consulting their GP. CAM utilisation was 21%, with chiropractic (11%), massage (12%) and acupuncture (9%) being most utilised, particularly for back/low back pain, knee/ankle and lower limb soft tissue injuries. Most users recommended treatments received, and 84% would like to see CAM available on the NHS. The majority perceived CAM, including chiropractic, as beneficial and reasonable in cost. Results Runners use CAM for treatment of specific running injuries, as well as injury prevention and enhancement of general well-being. Utilisation appears higher than reported levels for the general population and there is a high level of satisfaction with CAM. Further research is indicated to investigate clinical efficacy of CAM modalities for specific running-related injuries.
The aim of this 12-month prospective study was to investigate risk factors for stress fractures in a cohort of 53 female and 58 male track and field athletes, aged 17 to 26 years. Total bone mineral content, regional bone density, and soft tissue composition were meas ured using dual-energy x-ray absorptiometry and an thropometric techniques. Menstrual characteristics, current dietary intake, and training were assessed us ing questionnaires. A clinical biomechanical assess ment was performed by a physical therapist. The inci dence of stress fractures during the study was 21.1%, with most injuries located in the tibia. Of the risk factors evaluated, none was able to predict the occurrence of stress fractures in men. However, in female athletes, significant risk factors included lower bone density, a history of menstrual disturbance, less lean mass in the lower limb, a discrepancy in leg length, and a lower fat diet. Multiple logistic regression revealed that age of menarche and calf girth were the best independent predictors of stress fractures in women. This bivariate model correctly assigned 80% of the female athletes into their respective stress fracture or nonstress frac ture groups. These results suggest that it may be pos sible to identify female athletes most at risk for this overuse bone injury.
Overuse soft-tissue injuries occur frequently in runners. Stretching exercises, modification of training schedules, and the use of protective devices such as braces and insoles are often advocated for prevention. This is an update of a review first published in 2001. To assess the effects of interventions for preventing lower limb soft-tissue running injuries. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (March 2011); The Cochrane Library 2010, Issue 4; MEDLINE (1966 to January 2011); EMBASE (1980 to January 2011); and international trial registries (17 January 2011). Randomised or quasi-randomised trials evaluating interventions to prevent lower limb soft-tissue running injuries. Two authors independently assessed risk of bias (relating to sequence generation, allocation concealment, blinding, incomplete outcome data) and extracted data. Data were adjusted for clustering if necessary and pooled using the fixed-effect model when appropriate. We included 25 trials (30,252 participants). Participants were military recruits (19 trials), runners from the general population (three trials), soccer referees (one trial), and prisoners (two trials). The interventions tested in the included trials fell into four main preventive strategies: exercises, modification of training schedules, use of orthoses, and footwear and socks. All 25 included trials were judged as 'unclear' or 'high' risk of bias for at least one of the four domains listed above.We found no evidence that stretching reduces lower limb soft-tissue injuries (6 trials; 5130 participants; risk ratio [RR] 0.85, 95% confidence interval [95% CI] 0.65 to 1.12). As with all non-significant results, this is compatible with either a reduction or an increase in soft-tissue injuries. We found no evidence to support a training regimen of conditioning exercises to improve strength, flexibility and coordination (one trial; 1020 participants; RR 1.20, 95% CI 0.77 to 1.87).We found no evidence that a longer, more gradual increase in training reduces injuries in novice runners (one trial; 486 participants; RR 1.02, 95% CI 0.72 to 1.45). There was some evidence from a poor quality trial that additional training resulted in a significant increase in the number of naval recruits with shin splints (one trial; 1670 participants; RR 2.02, 95% CI 1.11 to 3.70). There was limited evidence that injuries were less frequent in prisoners when running duration (one trial; 69 participants; RR 0.41, 95% CI 0.21 to 0.79) or frequency (one trial; 58 participants; RR 0.19, 95% CI 0.06 to 0.66) were reduced.Patellofemoral braces appear to be effective for preventing anterior knee pain (two trials; 227 participants; RR 0.41, 95% CI 0.24 to 0.67).Custom-made biomechanical insoles may be more effective than no insoles for reducing shin splints (medial tibial stress syndrome) in military recruits (one trial; 146 participants; RR 0.24, 95% CI 0.08 to 0.69).We found no evidence in military recruits that wearing running shoes based on foot shape, rather than standard running shoes, significantly reduced rate of running injuries (2 trials; 5795 participants; Rate Ratio 1.03, 95% CI 0.93 to 1.14). Overall, the evidence base for the effectiveness of interventions to reduce soft-tissue injury after intensive running is very weak, with few trials at low risk of bias. More well-designed and reported RCTs are needed that test interventions in recreational and competitive runners.
This prospective study of 583 habitual runners used baseline information to examine the relationship of several suspected risk factors to the occurrence of running-related injuries of the lower extremities that were severe enough to affect running habits, cause a visit to a health professional, or require use of medication. During the 12-month follow-up period, 252 men (52%) and 48 women (49%) reported at least one such injury. The multiple logistic regression results identified that running 64.0 km (40 miles) or more per week was the most important predictor of injury for men during the follow-up period (odds ratio = 2.9). Risk also was associated with having had a previous injury in the past year (odds ratio = 2.7) and with having been a runner for less than 3 years (odds ratio = 2.2). These results suggest that the incidence of lower-extremity injuries is high for habitual runners, and that for those new to running or those who have been previously injured, reducing weekly distance is a reasonable preventive behavior.