Prevalence of Medial Tibial Stress Syndrome in Grade 9–12 Students Participating in Sports Activities in Punjab, Pakistan

Background: Medial tibial stress syndrome (MTSS) is one of the most common overuse injuries affecting athletes and physically active individuals, particularly those engaged in repetitive lower-limb loading activities such as running and jumping. Despite its recognized clinical importance, epidemiological evidence in adolescent sports populations from Pakistan remains limited. Objective: To determine the prevalence of medial tibial stress syndrome among grade 9–12 students participating in sports activities in Punjab, Pakistan, and to examine its distribution in relation to selected demographic, anthropometric, and sports-related factors. Methods: A cross-sectional observational study was conducted among 800 sports-active students from high schools and colleges in Punjab. Participants completed a structured questionnaire and underwent standardized physical examination including navicular drop test. MTSS diagnosis was based on compatible history and clinical findings. Descriptive statistics were calculated, and associations between MTSS and selected variables were assessed using contingency analyses and trend evaluation. Results: Among 800 participants (68.1% male; mean age 16.46 ± 1.77 years), MTSS was identified in 345 students, yielding a prevalence of 43.1% (95% CI 39.7–46.6). Navicular drop test positivity was observed in 34.4% of participants. Increasing duration of daily sports participation demonstrated a significant trend association with MTSS occurrence (OR 1.15 per exposure category increase, p = 0.002). No statistically significant associations were observed between MTSS and body mass index (p = 0.992) or warm-up practice (p = 0.134). Prevalence varied descriptively across sport categories but did not reach statistical significance. Conclusion: MTSS was highly prevalent among adolescent sports participants in Punjab, with greater sports participation duration associated with increased occurrence. Monitoring training exposure and promoting structured sports conditioning may help reduce the burden of MTSS in school athletes.