Chronic diseases and allergies are risk factors predictive of a history of Medial Tibial Stress Syndrome (MTSS) in distance runners: SAFER study XXIV

ABSTRACT

Background

Medial Tibial Stress Syndrome (MTSS) is one of the most common causes of exercise-associated lower leg pain in distance runners.

Aim

To identify risk factors predictive of a history of MTSS in distance runners entering the Two Oceans Marathon races (21.1 km and 56 km).

Design

Cross-sectional study.

Setting

2012 to 2015 Two Oceans Marathon races (21.1 km and 56 km).

Participants

Consenting race entrants.

Methods

106,743 race entrants completed an online pre-race medical screening questionnaire. 76,654 consenting runners (71.8%) were studied. 558 verified MTSS injuries were reported in the previous 12 months. Risk factors predictive of a history of MTSS were explored using uni – & multivariate analyses: demographics (race distance, sex, and age groups), training/racing history, history of chronic diseases, allergies, and medication use.

Results

Independent risk factors predictive of a history of MTSS (adjusted for sex, age group, and race distance) were a higher chronic disease composite score (PR = 3.1 times increase risk for every two additional chronic diseases; p < 0.0001) and a history of allergies (PR = 1.9; p < 0.0001). Chronic diseases (PR > 2) predictive of a history of MTSS were: symptoms of CVD (PR = 4.2; p < 0.0001); GIT disease (PR = 3.3; p < 0.0001); kidney/bladder disease (PR = 3.3; p < 0.0001); nervous system/psychiatric disease (PR = 3.2; p < 0.0001); respiratory disease (PR = 2.9; p < 0.0001) a history of CVD (PR = 2.9; p < 0.0001); and risk factors of CVD (PR = 2.4; p < 0.0001) (univariate analysis). Average running speed was associated with higher risk of MTSS.

Conclusion

Novel independent risk factors predictive of a history of MTSS in distance runners (56 km, 21.1 km) were multiple chronic diseases and a history of allergies. Identifying athletes at higher risk for MTSS can guide healthcare professionals in their prevention and rehabilitation efforts.

KEYWORDS:

• Running
• Medial Tibial Stress Syndrome (MTSS)
• shin pain
• shin “splints“
• epidemiology
• risk
• ultramarathon

Acknowledgments

The authors would like to thank the medical staff, the Two Oceans Marathon organisers, and all the runners participating in this study.

Disclosure statement

The authors report no conflict of interest pertaining to this manuscript.

Author contributorship

Pieter-Henk Boer (PB): manuscript (first draft), data analysis including statistical analysis, data interpretation, manuscript editing.

Martin Schwellnus (MS): responsible for the overall content as guarantor, study concept, study planning, data collection, data interpretation, manuscript editing, facilitating funding.

Esmè Jordaan (EJ): data cleaning, study planning, data analysis including statistical analysis, data interpretation, manuscript editing.

Author current position titles

Pieter Boer (PB): Senior Lecturer, Department of Human Movement Science, Cape Peninsula University of Technology, Wellington, South Africa.

Martin Schwellnus (MS): Director, SEMLI, University of Pretoria.

Esme Jordaan (EJ): Specialist Scientist, Biostatistics Unit, South African Medical Research Council.

Data sharing statement

No additional data are available.

Ethics (specific details removed to blind manuscript)

Ethics approval was obtained from both the Research Ethics Committees of the University of Cape Town (REC 009/2011) and the University of Pretoria (REC 433/2015 and 700/2019).

Supplementary material

Supplemental data for this article can be accessed here.