Bolthouse E, Hunt A, Mandrachia K, Monarski L, Lee K. Return to running after a tibial stress fracture: a suggested protocol. government site. Scand J . Moen MH, Tol JL, Weir A, Steunebrink M, De Winter TC. Prevention and treat-ment of exercise related leg pain in young soldiers; a review of the literature and current practice in the Dutch Armed Forces. Massage treatment and medial tibial stress syndrome; A commentary to provoke thought about the way massage therapy is used in the treatment of MTSS. 2009;41(11):19916. Over time, the condition can worsen and pain may be felt throughout any exercise regimen and continue after exercise. [The diagnosis and management of medial tibial stress syndrome : An evidence update-German version]. 2016;51(12):104952. Bliekendaal S, Moen M, Fokker Y, Stubbe JH, Twisk J, Verhagen E. Incidence and risk factors of medial tibial stress syndrome: a prospective study in Physical Education Teacher Education students. Jeffcoach DR, Sams VG, Lawson CM, et al. Elsevier; 2020 [cited 2021 Aug 3]. 2002;21(5):2358. Tamma R, dellEndice S, Notarnicola A, et al. Common names for this problem include shin splints, soleus syndrome, tibial stress syndrome, and periostitis. Medial tibial stress syndrome: a critical review. Am J Sports Med. 2014;46(9):168492. The exact cause of this condition is unknown. 2015;49(6):3629. For instance, comparing a pronation-control orthotic group, a shock-absorption insole group, a soleus strength and endurance training group, and a control group would be a valuable addition to the MTSS prevention literature. PMC Inclusion criteria included randomized controlled trials or clinical trials comparing different MTSS prevention methods with control groups. Most commonly reported by runners and military personnel. Your physical therapist will further perform a series of tests and measures of your musculoskeletal system that assess your strength, mobility, flexibility, and pain response. https://doi.org/10.2106/00004623-200310000-00017. Medial Tibial Stress Syndrome (Shin Splints) - Treatment Medial tibial stress syndrome (MTSS) is a local overuse injury on the medial side (inside) of the distal two-thirds of the tibia. If you experience pain in your shin, thoroughly stretch before exercising, reduce your activity level, and check your footwear. The authors noted no association between MTSS and navicular drop. 8600 Rockville Pike All exercise programs should begin gently and progress slowly. Biomechanical and lifestyle risk factors for medial tibia stress syndrome in army recruits: a prospective study. Medial tibial stress syndrome (MTSS) is a condition that causes pain and tenderness along the inside of the shinbone (tibia), specifically where the bone meets the muscle. Bone takes time to adapt to new stress levels. J Athl Train. Medial tibial stress syndrome in high school cross-country runners: incidence and risk factors. 2016 Dec;51(12):1049-1052. doi: 10.4085/1062-6050-51.12.13. 2002;109(11):140515. Indomethacin modulation of load-related stimulation of new bone formation in vivo. Recipient(s) will receive an email with a link to 'Medial Tibial Stress Syndrome: Evidence-Based Prevention' and will not need an account to access the content. Medial tibial stress syndrome: evidence-based prevention. Two weeks after surgery, he developed pain proximal and lateral to the knee. HHS Vulnerability Disclosure, Help Your physical therapist will determine what risk factors have caused your MTSS and will teach you how to address those causes. Pain can be felt on the inside or the front of the shin bone. IJERPH. Methods: In 8 cadaveric knees, the distance between the medial tibial and femoral condyles was measured using ultrasonography. Pain can be felt on the inside or the front of the shin bone. Reference lists of identified studies were searched manually until no further studies were identified. Others4,8 suggested that MTSS is a consequence of repetitive stress imposed by impact forces that eccentrically fatigue the soleus, which creates repeated tibial bending or bowing, in turn overloading the bone-remodeling capabilities of the tibia. Excluded were studies that did not provide primary research data or that addressed treatment and rehabilitation rather than prevention of incident MTSS. Many of the investigations with large numbers of participants focused on military recruits, as did all 4 studies cited in the reference article. In conclusion, Thacker et al3 provided an excellent and critical systematic review, illustrating that the evidence available concerning prevention of MTSS is limited and inconclusive. Accuracy of unloading with the anti-gravity treadmill. Google Scholar. MTSS is one of the most common athletic injuries. Surgical division of the insertion of the soleus on the periosteum can relieve associated periostitis. Can This Injury or Condition Be Prevented? These measurements were obtained in the intact state . Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips, Not logged in J Ultrasound Med. Bethesda, MD 20894, Web Policies Available from: https://linkinghub.elsevier.com/retrieve/pii/B97803236794970001241. Lastly, statistical analysis was inadequately reported in all 4 studies, ranging from a lack of description of the statistical testing methods to no report of power scores to a lack of multivariate analysis use when appropriate. Kohrt WM, Bloomfield SA, Little KD, et al. Extracorporeal Shockwave Therapy in the Management of Sports Medicine Injuries. Journal of Science and Medicine in Sport. The clinical relevance of these components directs clinicians to (1) increase the strength and endurance of the soleus muscle in their athletes, (2) control overpronation, which may alleviate some stress on the medial fascial attachment of the soleus, (3) promote adequate shock absorption via insoles, new shoes, and maintenance of proper foot biomechanics, and (4) work with coaches to commit at least 1 day per week to a pool workout or some other form of cross-training that unloads the tibia and allows the bone remodeling response to catch up. El sindrome de estres tibial medial, SETM, una de las causas mas comunes de dolor inducido por el ejercicio en las extremidades inferiores entre los practicantes de actividad fisica y deporte, como corredores y militares en formacion, es un evento semiologico producido por lesiones repetitivas de estres mecanico en la region medial de la tibia. J Athl Train. Shin splints, or 'medial tibial stress syndrome' (MTSS) is a painful condition affecting the shin bone and surrounding tissues. https://doi.org/10.2519/jospt.2014.5334. Physical activity and bone health. 2010;2(8):74050. Am J Orthop (Belle Mead NJ). 2016;50(8):47680. Authors R Michael Galbraith 1 , Mark E Lavallee Affiliation 1 South Bend Primary Care Sports Medicine Fellowship, 111 W. Jefferson, Suite # 100, South Bend, IN 46601 USA. Clinical presentation Medial tibial stress syndrome is characterized by localized pain that occurs during exercise at the medial surface of the distal two-thirds of the tibial shaft. volume9,pages 177185 (2021)Cite this article. Physical therapists help people who develop MTSS recover pain-free movement and learn exercises and tactics to prevent reinjury. Am J Sports Med. Research Support, American Recovery and Reinvestment Act. a pneumatic leg brace in the treatment of recruits with medial tibial stress syndrome; a randomized study. https://doi.org/10.1016/j.ptsp.2014.01.001. Identifying risk factors is important for prevention and individualized management. Thacker et al3 provided a high-quality review of the literature on prevention of MTSS. Journal of Athletic Training. Address correspondence to Debbie I. Craig, PhD, LAT, ATC, Department of Physical Therapy and Athletic Training, Northern Arizona University, PO Box 15094, Flagstaff, AZ 86011-5094, e-mail: Search for other works by this author on: The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. . government site. Curr Phys Med Rehabil Rep 9, 177185 (2021). The years of publication of the 4 studies were 1974, 1983, 1986, and 1990. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider. The protective effect of neuromuscular training on the medial tibial stress syndrome in youth female track-and-field athletes: a clinical trial and cohort study. Curr Sports Med Rep. 2021;20(6):298305. 2020;17(20):7457. 2012;15. Unfallchirurg. A case-control study. BMC Sports Sci Med Rehabil. What Kind of Physical Therapist Do I Need? The pain may be sharp when you touch the tender area, or occur as an ache during or after exercise. Prospective comparison of running injuries between shod and barefoot runners. Pronation control to prevent MTSS has been studied extensively, although with various results.14,7,9,10,20 In a study involving 63 cross-country athletes, 52% of whom reported a history of exercise-related lower leg pain, the investigators measured navicular drop. MTSS is commonly referred to as "shin splints" due to the location of pain over the shin bone. Medial tibial stress syndrome (MTSS) is one of the most common lower leg injuries in sports. Lower extremity biomechanical examination of athletes. Unfallchirurg. Originally coined by Drez and reported by Mubarak et al. Low ratings were due to design, bias, and statistical-method flaws. An official website of the United States government. 2000;32(3 Suppl):S27eS33. Osteoporos Int. Medial tibial stress syndrome (MTSS), aka Medial Tibial Traction Periostitis, is a common result of this increased load. Naderi A, Degens H, Sakinepoor A. Arch-support foot-orthoses normalize dynamic in-shoe foot pressure distribution in medial tibial stress syndrome. Unfallchirurg. Identifying risk factors is important for prevention and individualized management. A plyometric training model used to augment rehabilitation from tibial fasciitis. It typically occurs in runners and other athletes that are exposed to intensive weight-bearing activities such as jumpers [1]. 2008;43(3):316 . Medial tibial stress syndrome: conservative treatment options. Winters M, Eskes M, Weir A, Moen MH, Backx FJ, Bakker EW. Can we prevent MTSS? Effect of foot posture on the incidence of medial tibial stress syndrome. 11. The Cochrane Collaboration (early stage of Cochrane Database of Systematic Reviews) was contacted. Winkelmann ZK, Anderson D, Games KE, Eberman LE. 2015;50(6):60311. 2016;18:627. The prevention of shin splints in sports: a systematic review of literature. Treatment often includes cessation of high-impact activity, gait retraining, neuromuscular training, and orthotics. Reshef N, Guelich DR. Medial tibial stress syndrome. J Athl Train. PT, DPT, board-certified clinical specialist in orthopaedic physical therapy, There are numerous benefits to running, including improved cardiovascular, mental, and physical health, to name a few. Intrinsic factors associated with exercise-related leg pain in collegiate cross-country runners. MTSS is one of the most common athletic injuries. Epub 2016 Nov 11. Most heal well with conservative treatment, but some are associated with . Interventions for preventing and treating stress fractures and stress reactions of bone of the lower limbs in young adults. Reilly JM, Bluman E, Tenforde AS. 2009;39(7):523-46. doi: 10.2165/00007256-200939070-00002. Experts in the field were contacted, including first authors of randomized controlled trials addressing prevention of MTSS. The .gov means its official. If you run on a hard surface, find some softer ground to train on. Tenforde AS, Sayres LC, Sainani KL, Fredericson M. Evaluating the relationship of calcium and vitamin D in the prevention of stress fracture injuries in the young athlete: a review of the literature. Perform strength and endurance exercises for the foot, hip, and pelvic muscles. J Trauma Acute Care Surg. PMC Rajasekaran S, Finnoff JT. J Biol Chem. Menndez C, Batalla L, Prieto A, Rodrguez M, Crespo I, Olmedillas H. Int J Environ Res Public Health. PubMed J Athl Train. Cryotherapy Mountjoy M, Sundgot-Borgen J, Burke L, Carter S, Constantini N, Lebrun C, et al. Chow JW, Chambers TJ. Prolonged pronation, indirectly measured via static observation, an excessive . Moraux A, Gitto S, Bianchi S. Ultrasound features of the normal and pathologic periosteum: ultrasound features of the normal and pathologic periosteum. Herring KM. Risk factors for medial tibial stress syndrome in active individuals: an evidence-based review. MTSS is commonly referred to as "shin splints" due to the location of pain over the shin bone. Medial tibial stress syndrome, or shin splints, manifests with pain along the medial tibia and is the most common overuse injury of the lower leg. Tibial stress reaction in runners: correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging system. Disclaimer, National Library of Medicine Rompe JD, Cacchio A, Furia JP, et al. 8600 Rockville Pike Available from: https://linkinghub.elsevier.com/retrieve/pii/B9780323679497000197. Medial tibial stress syndrome develops when too much stress is placed on the tibia (main shin bone). 1994;267(2 Pt 1):E28792. As clinicians working with running athletes or patients, we must thoroughly understand MTSS in order to develop effective prevention methods. doi: https://doi.org/10.4085/1062-6050-43.3.316. Nieves JW, Melsop K, Curtis M, Kelsey JL, Bachrach LK, Greendale G, et al. ), Northern Arizona University, Flagstaff, AZ. Mattock J, Steele JR, Mickle KJ. 2020 Oct 13;17(20):7457. doi: 10.3390/ijerph17207457. PubMedGoogle Scholar. Well-controlled trials involving multiple sites and multiple-year comparison studies of various isolated prevention techniques on injury rate outcomes are critically needed. the National Athletic Trainers' Association, Inc, Briana Lawry-Popelka, MSAT, ATC, Sunghoon Chung, MS, ATC, Ryan S. McCann, PhD, ATC, CSCS, Kenneth C. Lam, ScD, ATC, Ashley N. Marshall, PhD, ATC, R. Curtis Bay, PhD, Erik A. Wikstrom, PhD, ATC, Greg Hock, PT, DPT, OCS, Andrew Johnson, PT, DPT, Patrick Barber, PT, DPT, SCS, Cassidy Papa, PT, DPT, CSCS, Cailee E. Welch Bacon, PhD, ATC, Barton E. Anderson, DHSc, ATC, Julie M. Cavallario, PhD, ATC, Bonnie L. Van Lunen, PhD, ATC, FNATA, Lindsey E. Eberman, PhD, ATC, Kristen G Quigley, Madison R Taylor, Dustin Hopfe, LAT, ATC, Phil Pavilionis, MS, ATC, Nicholas G Murray, PhD, Sungwan Kim, MS, ATC, Yuyeon Roh, MS, Neal R. Glaviano, PhD, ATC, Jihong Park, PhD, ATC, CSCS, Victoria Lambert, MS, RDN, LD, Aaron Carbuhn, PhD, RDN, CSSD, Amy Culp, RDN, CSSD, LD, CEDRD, Jennifer Ketterly, MS, RDN, CSSD, LD, Becci Twombley, RDN, Dana White, MS, RDN, ATC, This site uses cookies. PubMed Central 2010;156(4):236-40. Medial tibial stress syndrome (MTSS) is a lower leg injury with a reported incidence rate of up to 35% in active individuals. . (This is the only randomized controlled trial in recent literature that evaluates the role of neuromuscular training in prevention of MTSS in female athletes. Treatment strategies will vary from person to person, but below is a general outline for treating MTSS and CECS: . None of the 4 groups reported appropriate randomization procedures or whether participant assignment to groups was blinded. Medial tibial stress syndrome (MTSS), commonly known as "shin splints," is a frequent injury of the lower extremity and one of the most common causes of exertional leg pain in athletes (Willems T, Med Sci Sports Exerc 39(2):330-339, 2007; Korkola M, Amendola A, Phys Sportsmed 29(6):35-50, 2001; Hreljac A, Med Sci Sports Exerc 36(5):845-849, 2004). Bookshelf Choose appropriate cross-training activities to condition the core and leg muscles. Nutritional factors that influence change in bone density and stress fracture risk among young female cross-country runners. However, until we better understand the true causes of MTSS, attempting to control all of these risk factors for all of our athletes is nearly impossible. Disclaimer, National Library of Medicine Mendez-Rebolledo G, Figueroa-Ureta R, Moya-Mura F, Guzmn-Muoz E, Ramirez-Campillo R, Lloyd RS. Treatments include cryotherapy, stretching and strengthening exercises, nonsteroidal anti-inflammatory drugs, and adjustments in training programs, which vary according to an individual. The only method that had some evidence (although it was not statistically significant) for preventing MTSS was training program alterationsreduction in the distance, frequency, and duration of running bouts. 2015 Jul;19(3):447-52. doi: 10.1016/j.jbmt.2014.11.003. Epub 2020 Aug 6. Pain typically occurs along the inner border of the tibia, where muscles attach to the bone. Strengthen the calf muscle. MeSH Curr Sports Med Rep. 2019;18(2):539. Efforts have been made to determine the efficacy of certain prevention methods, but most of these studies have had serious design or control flaws, as noted in the reference article.3 The mean quality scores in the 4 studies included in the reference article ranged from 29 to 47 on a 100-point scale. J Physiol Anthropol Appl Human Sci. All physical therapists are prepared through education and experience to treat MTSS. sharing sensitive information, make sure youre on a federal The effect of muscle fatigue on in vivo tibial strains. J Bone Miner Metab. J Athl Train. Scand J Med Sci Sports. Definition of medial tibial stress syndrome: Medial tibial stress syndrome (MTSS), also known as shin splints, is a condition that results from repeatedly stressing the shin bone. Keywords: Clin Podiatr Med Surg. The medial tibial stress syndrome is a symptom com plex seen in athletes who complain of exercise-in duced pain along the distal posterior-medial aspect of the tibia. Elsevier; 2020 [cited 2021 Apr 14]. and transmitted securely. Shin splint pain most often occurs on the inside edge of your tibia (shinbone). Median quality scores ranged from 29 to 47, revealing flaws in design, control for bias, and statistical methods. Differential inhibition of fracture healing by non-selective and cyclooxygenase-2 selective non-steroidal anti-inflammatory drugs. Management includes activity modification, gait retraining, orthotics, medications, and, very rarely, surgery. Curr Sports Med Rep. 2006;5(3):14754. Randomized controlled trials comparing prevention methods with control groups would be ideal. So far, the characteristic signs and symptoms of MTSS are fully defined, but the pathophysiology of this disorder is not exactly known. 2014;48(7):4917. Federal government websites often end in .gov or .mil. Am Fam Physician. 2020 Jan;123(Suppl 1):15-19. doi: 10.1007/s00113-019-0667-z. Johnson SC. The prevention of shin splints in sports: a systematic, Reference/Citation: Hamstra-Wright KL, Bliven KC, Bay C. Risk factors for, The differential diagnosis varies based on location, but commonly includes tendinopathy, compartment, medial tibial stress syndrome treatment review - PubMed. 9. Table representation of search results timeline featuring number of search results per year. Intramuscular pressures within the posterior compartments of the leg were measured in 12 patients with this disorder. CAS Goss DL, Lewek M, Yu B, Ware WB, Teyhen DS, Gross MT. 1996;11(11):168893. Newman P, Witchalls J, Waddington G, Adams R. Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis. Kelly JL, Valier AR. Studies were identified by searching MEDLINE (19662000), Current Contents (19962000), Biomedical Collection (19931999), and Dissertation Abstracts. https://doi.org/10.1249/MSS.0000000000000290. Ras induction of superoxide activates ERK-dependent angiogenic transcription factor HIF-1alpha and VEGF-A expression in shock wave-stimulated osteoblasts. Despite popular belief, it is not an inflammatory condition of the periosteum (1), and anti-inflammatory drugs are not helpful in treating MTSS. Since the Thacker et al3 review was published, a significant amount of literature has been added on this topic. McNeill D, De Heert H, Bounds R, et al. Diagnosis is made clinically with tenderness along the posteromedial distal tibia made worse with plantarflexion. J Strength Cond Res. Radiographs or bone scans may be obtained to rule out stress fractures. Sep 12, 2018 Well-designed and controlled trials are critically needed to decrease the incidence of this common injury. 2018;27(6):5915. A recent study found that medial tibial stress syndrome can sideline a new runner. 10. 2009;35:2093100. Hamstra-Wright KL, Bliven KCH, 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. J Bone Miner Res. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. 2009;2(3):127e133. What Is Medial Tibial Stress Syndrome? The .gov means its official. Get an annual functional fitness examination, including strength, flexibility, mobility, and sport-specific analyses. . Symptoms. The https:// ensures that you are connecting to the Tibial stress injuries: decisive diagnosis and treatment of shin splints.. Experts do not agree upon the cause of MTSS.410 With the cause unknown, prevention is very difficult. The https:// ensures that you are connecting to the There is a not a general consensus on the etiologic factors contributing to MTSS making treatment challenging and thus stressing the importance of preventative measures, and who is at risk, symptoms, conservative treatment and surgical options to combat this common overuse injury are discussed. The . PubMed Evidence-Based Management of Medial Tibial Stress Syndrome in Runners. Of these, level I evidence exists only for a shock absorbing insole1. Moen MH, Rayer S, Schipper M, et al. Thacker SB, Gilchrist J, Stroup DF, Kimsey CD. diagnosis; measurement; meta-analysis; shin splints; validation. Treatment of medial tibial stress syndrome: a . J Am Podiatr Med Assoc. Exercise on a softer, more pliable surface whenever possible. J Bone Miner Res. 2020, pp. Some studies show it accounting for 6% to 16% of all running injuries and also being responsible for as much as 50% of all lower leg injuries reported in select populations.1,2 Athletic trainers have been attempting to prevent MTSS through various methods for years. In: Clinical care of the runner [Internet]. MTSS exists on a spectrum of tibial bone stress injuries (BSIs) and is synonymous with a Fredericson grade I BSI. Prevention methods studied were shock-absorbent insoles, foam heel pads, Achilles tendon stretching, footwear, and graduated running programs. To relieve pain, your physical therapist may prescribe: To help strengthen weak muscles, your physical therapist may teach you: Your physical therapist also may prescribe orthotics or shoe inserts that support the arch of the foot if your feet flatten out too much, or if your foot muscles are weak. Clin Sports Med. Methods The study design was randomized and multi-centered. Fredericson M, Bergman AG, Hoffman KL, Dillingham MS. Tibial stress reaction in runners: correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Conversely, when athletes who developed MTSS during a cross-country season (n = 15) were compared with an uninjured group (n = 21), a difference in navicular drop was noted.10 Yet another group7 found that a standing foot angle of less than 140 predicted a previous history of MTSS. Medial tibial stress syndrome: evidence-based prevention. When pressing in over the area your leg will feel tender and sore. Google Scholar. Agresta C, Brown A. Gait retraining for injured and healthy runners using augmented feedback: a systematic literature review. Medial tibial stress syndrome: diagnosis, treatment and outcome assessment (PhD Academy Award) Medial tibial stress syndrome: diagnosis, treatment and outcome assessment (PhD Academy Award) Medial tibial stress syndrome: diagnosis, treatment and outcome assessment (PhD Academy Award) Br J Sports Med. Google Scholar, Winters M, Burr DB, van der Hoeven H, Condon KW, Bellemans J, Moen MH. Experts appear to agree on 2 etiologic components: the soleus muscle is involved in MTSS somehow, and bone-remodeling capabilities are insufficient to compensate for persistent insults to the tibia. Revised: PubMed Central Learn more about Institutional subscriptions. Leg pain caused by recurrent stressors is known as shin pain, also known as the medial tibial stress syndrome (MTSS). Scand J Med Sci Sports. Perform dynamic stretches before exercising and static stretches after exercising. Orthotic devices are used to correct biomechanical anomalies, and the rest are all traditional treatments [11]. To date, no evidence suggests that a specific prevention program will be effective. Graduated running programs, including preseason conditioning, are accepted methods of prevention for many injuries.1,4,13,15 In one study,15 training errors were the cause of MTSS in nearly 60% of participants.15 Training errors include an abrupt increase in intensity, duration or frequency of training (measured as an increase of more than 30% of initial training mileage within 1 year); hill training; and a change in running surface to a harder or tilted type.1 In 12 trials involving 8806 participants,14 the prevention methods of stretching, use of insoles, footwear modifications, and training program alterations were studied. Okunuki T, Koshino Y, Yamanaka M, Tsutsumi K, Igarashi M, Samukawa M, et al. Medial tibial stress syndrome. 2003;21(4):6705. Gender differences of muscle and crural fascia origins in relation to the occurrence of medial tibial stress syndrome. The increased activity overworks the muscles, tendons and bone tissue. Curr Sports Med Rep. 2021 Jun 1;20(6):298-305. doi: 10.1249/JSR.0000000000000851. It affects both the muscle on the inside of the shin and the bone to which it attaches, causing the connection between them to become irritated or even develop minor tears due to overwork. 2013 Dec;43(12):1315-33. doi: 10.1007/s40279-013-0087-0. Treatment/prevention. Athletic trainers are in an optimal position to perform this research and contribute to this body of knowledge. J Orthop Sports Phys Ther. Medial Tibial Stress Syndrome (MTSS) is a common manifestation of leg pain, accounting for 5% of all injuries in the physically active, (Brewer and Gregory, 2012;Burrus et al., 2015) and between . Altman AR, Davis IS. Medial tibial stress syndrome a critical review. Medial tibial stress syndrome (MTSS) is one of the most common lower leg injuries in sports. The prevention of shin splints in sports: a systematic review of literature. The pathophysiology remains disputed, and diagnosis is often determined from clinical presentation alone. Sports Med. Med Sci Sports Exerc. Final scores were averages of the 3 reviewers' scores. Prevention methods showing promise through limited research are shock-absorbent insoles, pronation-control insoles, and graduated running programs.

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