Tibial Stress Injuries

An Aetiological Review for the Purposes of Guiding Management

Beck 1998



Review the evidence and theory behind “chronic tibial bending” (almost 200 papers)

  • some bending papers: citations 11 12 14 18 19

Bone Geometry

As bones are curved, compressive loads applied at the joint surfaces rarely act through the centre of the bone and, thus, bending occurs.[25] Long bones with narrow diaphyseal widths will bend to a greater extent when loaded than those with wider diaphyses.[26,27]

Muscle Loads

Bowerman (not Bill :sad:) quote: “… stress fractures can occur as a result of… repeated contractions of the muscles of the lower leg” (pg 131) [107]

  • Lanyon et al [97] thought tibial deformations were a combination of muscle tension and bodyweight.
  • Muscle contracting in opposition to tensile loads (or bending moment) in bone:
    • citations # 8, 112-118


In the broadest sense, hyperpronation has been associated with an increased incidence of ‘shin splints’ in general,[131] and tibial stress injuries more specifically. [22,24,83,127,132-135] Indeed, in runners who hyperpronate, the transmission of force up the leg has been found to be exaggerated.[127] The velocity of pronation may also be a risk factor for tibial injury.[131]

Notable References


  1. Burrows HJ. Fatigue infraction of the middle of the tibia in ballet dancers. J Bone Joint Surg 1956
  2. Daffner RH. Anterior tibial striations. Am J Roengenol 1984;
  3. Beck TJ, Ruff CB, Mourtada FA, et al. Dual-energy x-ray absorptiometry derived structural geometry for stress fracture prediction in male U.S. Marine Corps recruits


  1. Hayes WC. Biomechanics of cortical and trabecular bone: implications for assessment of fracture risk. In: Mow VC, Hayes WC, editors. Basic orthopaedic biomechanics
  2. Martin & Burr: structure, function, and adaptation of compact bone
  3. Myburgh, Charette, Zhou, et al : influences of recreational activity and muscle strength on ulnar bending stiffness in men 1993

mucle loads

  1. Bowerman RF 1977 the control of arthropod walking not sure if I should bring in invertebrates…
  2. Lanyon, Hampson, Goodship et al 1975 Bone deformation recorded in vivo from strain gauges attached to the human tibial shaft


  1. Sullivan1984Stress
  2. Clement1974Tibial
  3. McKeag & Dolan: overuse syndromes of the lower extremity
  4. Mubarak, Gould, Lee, et al 1982 The medial tibial stress syndrome: a cause of shin splints
  5. sommer, vallentyne 1995: effect of foot posture on the incidence of medial tibial stress syndrome