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Table 3 Summary of the study design, inclusion criteria, measured variables and main outcomes of the 17 articles included in the systematic review

From: Are Leg Muscle, Tendon and Functional Characteristics Associated with Medial Tibial Stress Syndrome? A Systematic Review

Article Study design Injury criteria Variables of interest Main outcomes
Akiyama et al. [13] Case–control Yates et al. [6] Lower leg muscle shear modulus Shear Moduli of MG, LG, SOL, PL and TA was significantly greater (p = 0.01) in participants with MTSS compared to control group
Burne et al. [10] Prospective cohort Atraumatic, 7-day history of at least 10 cm of diffuse medial tibial pain Lean lower leg girth Men with EMTP had a significantly reduced right lean calf girth of 4.2% (p = 0.044) compared to control group
Clement et al. [14] Case series Early stage bone stress continuum with end stage being TSF Maximal lower leg girth Atrophy of 1.46 cm at level of maximal muscle mass of the anterior tibial group and gastrocnemius on the affected side compared to unaffected side
Ercan et al. [23] Case–control Atraumatic activity related diffuse (> 5 cm) pain at the distal 2/3rd of the tibia Lower leg peak isokinetic force MTSS and control participants displayed no significant difference in isokinetic ankle plantar flexion and dorsiflexion strength
Franettovich et al. [15] Case–control History of ERLP within previous 12 months. Excluded if diagnosis of CECS or TSF Lower leg muscle recruitment parameters Individuals with a history of ERLP demonstrated a significant lower peak LG activity during stance 20.5% (p = 0.04) and swing 1.7% (p = 0.03) of MVC respectively compared to control participants
Garth et al. [16] Case–control Diffuse incapacitating pain at the posteromedial middle one-third of the tibia aggravated by repetitive weight bearing MTPJ ROM Injured participants displayed a significant increase (p ≤ 0.01) in sagittal plane ROM of the MTPJ, pain on flexion of FDL and mild claw toe deformity of digits 2–5
Hubbard et al. [17] Prospective cohort Yates et al. [6] Lower leg muscle MVIC MTSS and control participants demonstrated no significant difference in lower leg muscle strength measures compared to control participants
Madeley et al. [12] Case–control Yates et al. [6] Standing heel raise endurance Injured participants completed significantly less heel raise repetitions (p < 0.001) compared to non-injured group
Moen et al. [18] Case–control Yates et al. [6] Maximal and lean lower leg girth No significant difference in maximal or lean lower girth between injured and control participants
Naderi et al. [37] Prospective cohort Yates et al. [6] Lower leg muscle recruitment parameters Injured group displayed significantly larger peak SOL EMG amplitude during propulsion (p = 0.01) compared to control group
Rathleff et al. [19] Case–control Pain in the distal 2/3rd of the posterior-medial tibia, exacerbated with repetitive weight-bearing activity Lower leg muscle recruitment parameters Injured group displayed significantly increased complexity of EMG signal of the TA (p = 0.02) and SOL (p = 0.01) compared to control group
Sabeti et al. [24] Case–control Yates et al. [6] Maximal lower leg girth No statistically significant difference between injured and control group
Saeki et al. [22] Case–control Yates et al. [6] Lower leg muscle shear modulus Individuals with a history of MTSS have a statistically significant higher shear modulus of FDL (p < 0.01) and TP (p < 0.05) compared to the control group
Saeki et al. [21] Case–control Yates et al. [6] Lower leg muscle MVIC Runners with a history of MTSS displayed a statistically significant higher plantarflexion MVIC torque of the 1st MTPJ (p = 0.04) compared to control participants
Sobhani et al. [20] Case–control Yates et al. [6] Maximal lower leg girth No statistically significant difference in maximal lower leg girth between injured and control group
Winters et al. [38] Case–control Yates et al. [6] Musculoskeletal ultrasound Tendinous abnormalities were commonly found in MTSS and asymptomatic individuals
Yüksel et al. [11] Case–control Yates et al. [6] Lower leg muscle peak isokinetic force Average eversion concentric strength was significantly higher (p < 0.05) in the injured group with those individuals displaying a strength imbalance whereby the evertor muscles were stronger than the invertor muscles
  1. CECS, Chronic exertional compartment syndrome; EMG, Electromyography; EMTP, Exertional medial tibial pain; ERLP, Exercise-related leg pain; FDL, Flexor digitorum longus; LG, Lateral Gastrocnemius; MG, Medial gastrocnemius; MTPJ, Metatarsophalangeal joint; MVC, Maximal voluntary contraction; MVIC, Maximal voluntary isometric contraction; PL, Peroneus longus; ROM, Range of Motion; SOL, Soleus; TA, Tibialis anterior; TP, Tibialis posterior; TSF, Tibial stress fracture; TSS, Tibial stress syndrome