Abstract
Purpose: The aim of this study was to investigate potential risk factors associated with a history of medial tibial stress syndrome (MTSS) in football referees.
Methods: A total of 39 referees participated in this cross-sectional study. Based on the definition criteria for MTSS reported in the literature, participants were divided into two groups: those with a history of MTSS (n=14) and those without (n=25). All assessments were conducted in a blinded manner, with examiners unaware of group allocation. The navicular drop test, Craig's test, and heel elevation endurance test were administered to evaluate lower extremity function. Hip internal and external rotation, knee flexion, and ankle dorsiflexion and plantarflexion ROM were measured using a standard goniometer. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Additionally, participants were asked about their athletic history and the comfort of the footwear they used during training and competition. Perceived running condition was evaluated using the Visual Analog Scale (VAS).
Results: MTSS history was determined in 14 of the referees participating in the study. Statistically significant differences were found between groups regarding height length (p = 0.006), condition (p = 0.045), left knee flexion angle (p = 0.007) and right knee flexion angle (p = 0.046). According to the regression analysis result, MTSS history (right) and left knee flexion angle were found to be significantly related (p = 0.015). There was no significant difference or relationship between other variables (p> 0.05).
Conclusion: According to our results, individuals with a history of MTSS had significantly greater height, while their running condition and knee flexion angle were significantly lower compared to those without a history of MTSS. These variables showed statistically significant differences between the two groups.
References
- 1. Ohya S, Nakamura M, Aoki T, Suzuki D, Kikumoto T, Nakamura E, et al. The effect of a running task on muscle shear elastic modulus of posterior lower leg. J Foot Ankle Res. 2017; 10: 56.
- 2. Yates B, White S. The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. Am J Sports Med. 2004; 32(3): 772-780.
- 3. Newman P, Adams R, Waddington G. Two simple clinical tests for predicting onset of medial tibial stress syndrome: shin palpation test and shin oedema test. Br J Sports Med. 2012; 46(12): 861-864.
- 4. Hubbard TJ, Carpenter EM, Cordova ML. Contributing factors to medial tibial stress syndrome: a prospective investigation. Med Sci Sports Exerc. 2009; 41(3): 490-496.
- 5. Menéndez C, Batalla L, Prieto A, Rodríguez MÁ, Crespo I, Olmedillas H. Medial Tibial Stress Syndrome in Novice and Recreational Runners: A Systematic Review. Int J Environ Res Public Health. 2020; 17(20): 7457.
- 6. Reinking MF, Austin TM, Richter RR, Krieger MM. Medial Tibial Stress Syndrome in Active Individuals: A Systematic Review and Meta-analysis of Risk Factors. Sports Health. 2017; 9(3): 252-261.
- 7. Fernández-Ruiz V, López-Samanes Á, Del Coso J, Pino-Ortega J, Sánchez-Sánchez J, Terrón-Manrique P, et al. Influence of Football Match-Play on Isometric Knee Flexion Strength and Passive Hip Flexion ROM in Football Referees and Assistant Referees. Int J Environ Res Public Health. 2021; 18(22): 11941.
- 8. Weston M. Match performances of soccer referees: the role of sports science. Movement Sport SciencesScience and Motricite. 2015; 87: 113-117.
- 9. Ardigo PL. Low-Cost match analysis of Italian sixth and seventh division soccer refereeing. Journal of Strength and Conditioning Research. 2010; 24(9): 2532-2538.
- 10. Schenk K, Bizzini M, Gatterer H. Exercise physiology and nutritional perspectives of elite soccer refereeing. Scandinavian Journal of Medicine & Science in Sports. 2018; 28(3): 782-793.
- 11. Catterall C, Reilly T, Atkinson G, Coldwells A. Analysis of the work rates and heart rates of association football referees. Journal of Science and Medicine in Sport. 1993; 27(3): 193-196.
- 12. D’Ottavio S, Castagna C. Analysis of match activities in elite soccer referees during actual match play. Journal of Strength and Conditioning Research. 2001; 15(2): 167-171.
- 13. Garcia SM, Sanchez SJ, Fernandez RA, Solano D, Castillo D. Relationships between Sprint Ability and Endurance Capacity in Soccer Referees. Sports. 2018; 6(28): 1-5.
- 14. Yagi S, Muneta T, Sekiya I. Incidence and risk factors for medial tibial stress syndrome and tibial stress fracture in high school runners. Knee Surgery, Sports Traumatology, Arthroscopy, 2013; 21(3), 556–563.
- 15. Lee SY. Direct and indirect effects of alignment, ROM, and gait measures on medial tibial stress syndrome status of runners [dissertation]. Charlottesville: University of Virginia; 2009.
- 16. 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. BMJ Open Sport Exerc Med. 2018; 4(1): e000421.
- 17. Franklyn M, Oakes B. Aetiology and mechanisms of injury in medial tibial stress syndrome: Current and future developments. World J Orthop. 2015; 6(8): 577-589.
- 18. Young, CC, Niedfeldt MW. Clinical Examination of the Foot and Ankle. Primary Care: Clinics in Office Practice, 2005; 32: 105-132.
- 19. Woodford-Rogers B, Cyphert L. Risk Factors for Anterior Cruciate Ligament Injury in High School and College Athletes. Journal of Athletic Training, 1994; 29(4): 343-346.
- 20. Tiftik T, Ünsal Ds, Özel S, Tunç H, Gülçek S, Hatipoğlu C. Serebral Palside Femoral Anteversiyonun Değerlendirilmesi. Türkiye Fiziksel Tıp ve Rehabilitasyon Dergisi, 2013; 59: 26-31.
- 21. Mattock J, Steele JR, Mickle KJ. A protocol to prospectively assess risk factors for medial tibial stress syndrome in distance runners. BMC Sports Sci Med Rehabil. 2018; 10: 20.
- 22. Norkin C, White DJ, Davis FA. Measurement of Joint Motion: A guide to goniometry; 2003.
- 23. Crichton N. "Visual analogue scale (VAS)." J Clin Nurs 10.5, 2001; 706.
- 24. Ağargün MY, Kara H, Anlar O.Pittsburgh Uyku Kalitesi İndeksi’nin Geçerliği ve Güvenirliği. Türk Psikiyatri Dergisi, 1996; 7: 107-111.
- 25. Moen MH, Tol JL, Weir A, Steunebrink M, De Winter TC. Medial tibial stress syndrome; a critical review. Sports Medicine, 2009; 39(7): 523–546.
- 26. Milner CE, Ferber R, Pollard CD, Hamill J, Davis IS. Biomechanical factors associated with tibial stress fracture in female runners. Medicine and science in sports and exercise, 2006; 38(2), 323–328.
- 27. Milner CE, Hamill J, Davis IS. Distinct hip and rearfoot kinematics in female runners with a history of tibial stress fracture. The Journal of orthopaedic and sports physical therapy, 2010; 40(2), 59–66.
- 28. Winkelmann ZK, Anderson D, Games KE, Eberman LE. Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review. J Athl Train. 2016; 51(12): 1049-1052.
- 29. Naderi A, Degens H, Sakinepoor A. Arch-support foot-orthoses normalize dynamic in-shoe foot pressure distribution in medial tibial stress syndrome. Eur J Sport Sci. 2019; 19(2): 247-257.
- 30. Madeley LT, Munteanu SE, Bonanno DR. Endurance of the ankle joint plantar flexor muscles in athletes with medial tibial stress syndrome: a case-control study. Journal of Science Medicine in Sport. 2007; 10(6): 356–362.
- 31. Mousavi SH, Hijmans JM, Minoonejad H, Rajabi R, Zwerver J. Factors Associated With Lower Limb Injuries in Recreational Runners: A Cross-Sectional Survey Including Mental Aspects and Sleep Quality. Journal of sports science & medicine, 2021; 20(2): 204–215.
- 32. Yu P, Liang M, Fekete G, Baker JS, Gu, Y. Effect of running-induced fatigue on lower limb mechanics in novice runners. Technology and health care : official journal of the European Society for Engineering and Medicine, 2021; 29(2), 231–242.
- 33. Becker J, Nakajima M, Wu WFW. Factors Contributing to Medial Tibial Stress Syndrome in Runners: A Prospective Study. Med Sci Sports Exerc. 2018; 50(10): 2092-2100.
Details
| Primary Language | English |
|---|---|
| Subjects | Physiotherapy |
| Journal Section | Research Article |
| Authors | |
| Publication Date | June 30, 2025 |
| Submission Date | March 20, 2025 |
| Acceptance Date | June 2, 2025 |
| Published in Issue | Year 2025 Volume: 1 Issue: 1 |
