Risk Factors Associated With Medial Tibial Stress Syndrome In Military Cadets During Basic Training

Abstract

Medial Tibial Stress Syndrome (MTSS) is one of the most frequent pathologies in military personnel. As the muscles of the lower extremity contribute to the attenuation of impact forces in activities such as running and jumping, neuromuscular performance deficiencies and asymmetries may be associated with an increased risk for musculoskeletal injuries. PURPOSE: To determine the kinetic risk factors associated with MTSS through the bilateral countermovement jump (CMJ) in army cadets. METHODS: Ethical approval was granted by the General José María Córdova Military School of Cadets where the study was conducted. This observational study was executed in a cohort of 123 cadets (followed for 24 weeks) who entered to the military school in 2017. Anthropometric, demographic data and MTSS history were recorded. Jump height (cm), peak landing force (N*kg), peak landing force asymmetry (%), concentric mean force (N*kg), concentric mean force asymmetry (%), eccentric deceleration rate of force development (EDRFD [N/s*Kg]) and EDRFD asymmetry (%) were evaluated through the bilateral CMJ on a pair of uniaxial force platforms. After the follow-up, the cadets with MTSS were determined through the clinical history. RESULTS: The incidence of MTSS was 13% (n= 16). In the bivariate analysis, height, EDRFD asymmetry, sex (female; RR= 2.84; 95% CI = 1.16-6.94), provenance (rural; RR= 2.65; 95% CI= 1.04-6.72), and MTSS history (yes; RR= 5.71; 95% CI= 2.23-14.62), were significantly associated with MTSS (p≤0.05). In the logistic regression, EDRFD asymmetry (OR= 1.03; 95% CI= 1.00-1.07), sex (OR= 4.91; 95% CI = 1.38-13.37), and provenance (OR= 4.82; 95% CI = 1.04-6.72), were significantly associated with MTSS (p≤0.05). MTSS history was significant for p≤0.1 (OR= 8.95; 95% CI= 0.68-118.73). The predictive model was significantly associated with MTSS (p≤0.01), had a sensitivity of 31.3% and a specificity of 99.1% (overall prognosis of 90.2%). CONCLUSIONS: While we identified important non-modifiable risk factors for MTSS in cadets during basic training, we also found that higher CMJ EDRFD asymmetry was a significant risk factor. This suggests that the bilateral CMJ may be a useful tool for pre-entry screening in and that high EDRFD asymmetry could be a potential target of pre-basic training risk reduction conditioning.