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Risk factors associated with exertional medial tibial pain: a 12 month prospective clinical study
  1. S G Burne1,
  2. K M Khan2,
  3. P B Boudville3,
  4. R J Mallet3,
  5. P M Newman3,
  6. L J Steinman3,
  7. E Thornton3
  1. 1University of NSW, Birchgrove, New South Wales, Australia
  2. 2UBC, Vancouver, Canada
  3. 3Duntroon Medical Centre, Duntroon, New South Wales, Australia
  1. Correspondence to:
 Dr Scott G Burne
 PO Box 3, Balmain, NSW 2041, Australia;


Objective: To investigate in a military setting the potential role of intrinsic biomechanical and anthropometric risk factors for, and the incidence of, exertional medial tibial pain (EMTP).

Methods: A prospective clinical outcome study in a cohort of 122 men and 36 women at the Australian Defence Force Academy. Each cadet underwent measurements of seven intrinsic variables: hip range of motion, leg length discrepancy, lean calf girth, maximum ankle dorsiflexion range, foot type, rear foot alignment, and tibial alignment. Test–retest reliability was undertaken on each variable. A physician recorded any cadet presenting with diagnostic criteria of EMTP. Records were analysed at 12 months for EMTP presentation and for military fitness test results.

Results: 23 cadets (12 men, 11 women) met the criteria for EMTP after 12 months, with a cross gender (F/M) odds ratio of 3.1. In men, both internal and external range of hip motion was greater in those with EMTP: left internal (12°, p = 0.000), right internal (8°, p = 0.014), left external (8°, p = 0.042), right external (9°, p = 0.026). Lean calf girth was lower by 4.2% for the right leg (p = 0.040) but by only 2.9% for the left leg (p = 0.141). No intrinsic risk factor was associated with EMTP in women. EMTP was the major cause for non-completion of the run component of the ADFA fitness test in both men and women.

Conclusions: Greater internal and external hip range of motion and lower lean calf girth were associated with EMTP in male military cadets. Women had high rates of injury, although no intrinsic factor was identified. Reasons for this sex difference need to be identified.

  • ADFA, Australian Defence Force Academy
  • EMTP, exertional medial tibial pain
  • MTSS, medial tibial stress syndrome
  • medial tibial stress syndrome
  • military medicine
  • risk factors
  • shin pain
  • shin splints

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