{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T23:13:32Z","timestamp":1793661212100,"version":"4.5.1"},"reference-count":42,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[1995,7,1]],"date-time":"1995-07-01T00:00:00Z","timestamp":804556800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[1995,7]]},"abstract":"<jats:p>Medial tibial pain in runners has traditionally been di agnosed as either a shin splint syndrome or as a stress fracture. Our work using magnetic resonance imaging suggests that a progression of injury can be identified, starting with periosteal edema, then progressive mar row involvement, and ultimately frank cortical stress fracture. Fourteen runners, with a total of 18 sympto matic legs, were evaluated and, within 10 days, referred for radiographs, a technetium bone scan, and a mag netic resonance imaging scan. In 14 of the 18 symp tomatic legs, magnetic resonance imaging findings cor related with an established technetium bone scan grading system and more precisely defined the ana tomic location and extent of injury. We identified clinical symptoms, such as pain with daily ambulation and physical examination findings, including localized tibial tenderness and pain with direct or indirect percussion, that correlated with more severe tibial stress injuries. When clinically warranted, we recommend magnetic resonance imaging over bone scan for grading of tibial stress lesions in runners. Magnetic resonance imaging is more accurate in correlating the degree of bone in volvement with clinical symptoms, allowing for more ac curate recommendations for rehabilitation and return to impact activity. Additional advantages of magnetic reso nance imaging include lack of exposure to ionizing ra diation and significantly less imaging time than three- phase bone scintigraphy.<\/jats:p>","DOI":"10.1177\/036354659502300418","type":"journal-article","created":{"date-parts":[[2007,6,21]],"date-time":"2007-06-21T20:46:52Z","timestamp":1182458812000},"page":"472-481","source":"Crossref","is-referenced-by-count":575,"title":["Tibial Stress Reaction in Runners"],"prefix":"10.1177","volume":"23","author":[{"given":"Michael","family":"Fredericson","sequence":"first","affiliation":[{"name":"Department of Functional Restoration, Division of Physical Medicine, Stanford University Medical Center, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Gabrielle","family":"Bergman","sequence":"additional","affiliation":[{"name":"Department of Radiology, Stanford University Medical Center, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth L.","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Department of Radiology, Stanford University Medical Center, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Dillingham","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Stanford University Medical Center, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[1995,7,1]]},"reference":[{"key":"atypb1","unstructured":"Andrish JT The leg, in DeLee JC, Drez D Jr (eds) Orthopedic Sports Medicine Principles and Practice Philadelphia, WB Saunders Co, 1994, pp 1603-1631"},{"key":"atypb2","doi-asserted-by":"publisher","DOI":"10.1177\/036354658801600302"},{"key":"atypb3","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.1990.tb125491.x"},{"key":"atypb4","unstructured":"Chu DA: Jumping Into Plyometrics Champagne, IL, Leisure Press, 1992"},{"key":"atypb5","doi-asserted-by":"publisher","DOI":"10.1016\/S0278-5919(20)31181-9"},{"key":"atypb6","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.159.2.1632335"},{"key":"atypb7","doi-asserted-by":"publisher","DOI":"10.1097\/00007611-198704000-00007"},{"key":"atypb8","doi-asserted-by":"publisher","DOI":"10.1080\/00913847.1994.11710482"},{"key":"atypb9","unstructured":"Griffiths HJ , Galloway HR, Arendt L., et al The MR spectrum of stress injury to bone and its clmical relevance Am J Sports Med, in press, 1995"},{"key":"atypb10","doi-asserted-by":"crossref","unstructured":"Ha KI, Hahn SH, Chung MY, et al A clinical study of stress fractures in sports activities Orthopedics 14. 1089-1095, 1991","DOI":"10.3928\/0147-7447-19911001-07"},{"key":"atypb11","unstructured":"Holder LE, Michael RH The specific scintigraphic pattern of shin splints in the lower leg Concise communication J Nucl Med 25(8) 865-869, 1984"},{"key":"atypb12","doi-asserted-by":"publisher","DOI":"10.1055\/s-2008-1025659"},{"key":"atypb13","doi-asserted-by":"publisher","DOI":"10.1080\/00913847.1978.11710776"},{"key":"atypb14","doi-asserted-by":"publisher","DOI":"10.1177\/036354657800600202"},{"key":"atypb15","unstructured":"Johnson LC, Stradford HT, Geits RW, et al: Histogenesis of stress fractures (abstract) J Bone Joint Surg 45A: 1542, 1963"},{"key":"atypb16","doi-asserted-by":"crossref","unstructured":"Jones BH, Harris JM, Vinh TN, et al Exercise-induced stress fractures and stress reactions of bone Epidemiology, etiology, and classification Exerc Sports Sci Rev 17. 379-422, 1989","DOI":"10.1249\/00003677-198900170-00014"},{"key":"atypb17","doi-asserted-by":"publisher","DOI":"10.1177\/036354659202000414"},{"key":"atypb18","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.169.1.3420261"},{"key":"atypb19","doi-asserted-by":"publisher","DOI":"10.1177\/036354658501300501"},{"key":"atypb20","doi-asserted-by":"publisher","DOI":"10.1016\/S0278-5919(20)31038-3"},{"key":"atypb21","doi-asserted-by":"crossref","unstructured":"Martin SD, Healey JH, Horowitz S. 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