#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Conservative treatment of medial tibial stress syndrome


Authors: Klimešová K.;  Smékal D.;  Hanzlíková I.
Authors‘ workplace: Katedra fyzioterapie, Fakulta tělesné kultury, Univerzita Palackého v Olomouci
Published in: Rehabil. fyz. Lék., 30, 2023, No. 2, pp. 98-104.
Category: Review Article
doi: https://doi.org/10.48095/ccrhfl202398

Overview

The medial tibial stress syndrome (MTSS) is an overuse injury caused by repetitive stress applied to the tibia. The MTSS presents as exercise-induced pain over the distal two-thirds of lower leg, more specifically, over the posteromedial aspect of the tibia. The MTSS is one of the most common injuries among runners, however, it occurs also in other running and jumping sports. The high prevalence of the MTSS is also in soldiers. If not treated properly, the MTSS may limit individuals not only in sport but also in everyday life activities. Moreover, in the case of soldiers and professional athletes, the MTSS may limit their capability to work. For that reason, knowledge of the MTSS and its treatment is required especially in healthcare and sport environment. However, the scientific literature written in the Czech language is lacking on this topic. Therefore, the aim of this article is to summarize the current scientific literature concerning the MTSS. This article focuses on the MTSS pathophysiology, which is still not fully understood, the MTSS diagnosis and differentiation from other pathologies in this area such as tibial stress fractures, and the MTSS injury risk factors. Knowledge of the risk factors is necessary not just for a proper therapy but also for a prevention of this overuse injury. The main focus of the article is on the therapy of MTSS, which is often conservative with physiotherapy playing a crucial role. Usually, it includes a specific individual rehabilitation plan which consists of lifestyle and activity modification, gradual loading of tibia and change of movement biomechanics.

Keywords:

diagnosis – therapy – pathophysiology – risk factors – MTSS – overload injury


Sources

1. Menéndez C, Batalla L, Prieto A et al. Medial tibial stress syndrome in novice and recreational runners: a systematic review. Int J Environ Res Public Health 2020; 17(20): 7457. doi: 10.3390/IJERPH17207457.

2. Kakouris N, Yener N, Fong DTP. A systematic review of running-related musculoskeletal injuries in runners. J Sport Heal Sci 2021; 10(5): 513–522. doi: 10.1016/J.JSHS.2021.04.001.

3. Arnold MJ, Moody AL. Common running injuries: evaluation and management. Am Fam Physician 2018; 97(8): 510–516.

4. Winters M, Eskes M, Weir A et al. Treatment of medial tibial stress syndrome: a systematic review. Sport Med 2013; 43(12): 1315–1333. doi: 10.1007/S40279-013-0087-0.

5. Molloy JM. Factors influencing running-related musculoskeletal injury risk among U.S. military recruits. Mil Med 2016; 181(6): 512–523. doi: 10.7205/MILMED-D-15-00143.

6. Winters M, Bakker EWP, Moen MH et al. Medial tibial stress syndrome can be diagnosed reliably using history and physical examination. Br J Sports Med 2018; 52(19): 1267–1272. doi: 10.1136/BJSPORTS-2016-097037.

7. Galbraith RM, Lavallee ME. Medial tibial stress syndrome: conservative treatment options. Curr Rev Musculoskelet Med 2009; 2(3): 127–133. doi: 10.1007/S12178-009-9055-6.

8. Nielsen RO, Rønnow L, Rasmussen S et al. A prospective study on time to recovery in 254 injured novice runners. PLoS One 2014; 9(6): e99877. doi: 10.1371/JOURNAL.PONE.0099877.

9. Mulvad B, Nielsen RO, Lind M et al. Diagnoses and time to recovery among injured recreational runners in the RUN CLEVER trial. PLoS One 2018; 13(10): e0204742. doi: 10.1371/JOURNAL.PONE.0204742.

10. Scheer V, Krabak BJ. Musculoskeletal injuries in ultra-endurance running: a scoping review. Front Physiol 2021; 12: 664071. doi: 10.3389/FPHYS.2021.664071.

11. Hamstra-Wright KL, Bliven KCH, Bay C. Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis. Br J Sports Med 2015; 49(6): 362–369. doi: 10.1136/BJSPORTS-2014-093462.

12. Sobhani V, Shakibaee A, Aghda AK et al. Studying the relation between medial tibial stress syndrome and anatomic and anthropometric characteristics of military male personnel. Asian J Sports Med 2015; 6(2): e23811. doi: 10.5812/ASJSM.23811.

13. Sharma J, Greeves JP, Byers M et al. Musculoskeletal injuries in British Army recruits: a prospective study of diagnosis-specific incidence and rehabilitation times. BMC Musculoskelet Disord 2015; 16(1): e106. doi: 10.1186/S12891-015-0558-6.

14. Yates B, White S. The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. Am J Sports Med 2004; 32(3): 772–780. doi: 10.1177/0095399703258776.

15. Garnock C, Witchalls J, Newman P. Predicting individual risk for medial tibial stress syndrome in navy recruits. J Sci Med Sport 2018; 21(6): 586–590. doi: 10.1016/J.JSAMS.2017.10.020.

16. Milgrom C, Zloczower E, Fleischmann C et al. Medial tibial stress fracture diagnosis and treatment guidelines. J Sci Med Sport 2021; 24(6): 526–530. doi: 10.1016/J.JSAMS.2020.11.015.

17. Winters M, Bon P, Bijvoet S et al. Are ultrasonographic findings like periosteal and tendinous edema associated with medial tibial stress syndrome? A case-control study. J Sci Med Sport 2017; 20(2): 128–133. doi: 10.1016/J.JSAMS.2016.07.001.

18. Zwas ST, Elkanovitch R, Frank G. Interpretation and classification of bone scintigraphic findings in stress fractures. J Nucl Med 1987; 28(4): 452–457.

19. Fogarty S. Massage treatment and medial tibial stress syndrome; a commentary to provoke thought about the way massage therapy is used in the treatment of MTSS. J Bodyw Mov Ther 2015; 19(3): 447–452. doi: 10.1016/j.jbmt.2014.11.003.

20. Reshef N, Guelich DR. Medial tibial stress syndrome. Clin Sports Med 2012; 31(2): 273–290. doi: 10.1016/J.CSM.2011.09.008.

21. Winters M, Burr DB, van der Hoeven H et al. Microcrack-associated bone remodeling is rarely observed in biopsies from athletes with medial tibial stress syndrome. J Bone Miner Metab 2019; 37(3): 496–502. doi: 10.1007/S00774-018-0945-9.

22. Milgrom C, Burr DB, Finestone AS et al. Understanding the etiology of the posteromedial tibial stress fracture. Bone 2015; 78: 11–14. doi: 10.1016/J.BONE.2015.04.033.

23. Winters M. The diagnosis and management of medial tibial stress syndrome: an evidence update. Unfallchirurg 2020; 123 (Suppl 1): 15–19.doi: 10.1007/S00113-019-0667-Z.

24. Newman P, Witchalls J, Waddington G et al. Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis. Open Access J Sports Med 2013; 4: 229–241. doi: 10.2147/OAJSM.S39331.

25. Reinking MF, Austin TM, Richter RR et al. Medial tibial stress syndrome in active individuals: a systematic review and meta-analysis of risk factors. Sports Health 2017; 9(3): 252–261. doi: 10.1177/1941738116673299.

26. Nakhaee Z, Rahimi A, Abaee M et al. The relationship between the height of the medial longitudinal arch (MLA) and the ankle and knee injuries in professional runners. Foot (Edinb) 2008; 18(2): 84–90. doi: 10.1016/J.FOOT.2008.01.004.

27. Čihák R. Anatomie 1, 3. upr. a dopl. vyd. Praha: Grada Publishing 2011.

28. Magnusson HI, Ahlborg HG, Karlsson C et al. Low regional tibial bone density in athletes with medial tibial stress syndrome normalizes after recovery from symptoms. Am J Sports Med 2003; 31(4): 596–600. doi: 10.1177/03635465030310042001.

29. Richter RR, Austin TM, Reinking MF. Foot orthoses in lower limb overuse conditions: a systematic review and meta-analysis – critical appraisal and commentary. J Athl Train 2011; 46(1): 103–106. doi: 10.4085/1062-6050-46.1.103.

30. Loudon JK, Reiman MP. Lower extremity kinematics in running athletes with and without a history of medial shin pain. Int J Sports Phys Ther 2012; 7(4): 356–364.

31. Chumanov ES, Wall-Scheffler C, Heiderscheit BC. Gender differences in walking and running on level and inclined surfaces. Clin Biomech 2008; 23(10): 1260–1268. doi: 10.1016/J.CLINBIOMECH.2008.07.011.

32. Luedke LE, Heiderscheit BC, Williams DSB et al. Influence of step rate on shin injury and anterior knee pain in high school runners. Med Sci Sports Exerc 2016; 48(7): 1244–1250. doi: 10.1249/MSS.0000000000000890.

33. Luedke LE, Rauh MJ. Factors associated with self-selected step rates between collegiate and high school cross country runners. Front Sport Act Living 2021; 2: 628348. doi: 10.3389/fspor.2020.628348.

34. Meardon SA, Derrick TR. Effect of step width manipulation on tibial stress during running. J Biomech 2014; 47(11): 2738–2744. doi: 10.1016/J.JBIOMECH.2014.04.047.

35. Mohile N, Perez J, Rizzo M et al. Chronic lower leg pain in athletes: overview of presentation and management. HSS J 2020; 16(1): 86–100. doi: 10.1007/S11420-019-09669-Z.

36. Saunier J, Chapurlat R. Stress fracture in athletes. J Bone Spine 2018; 85(3): 307–310. doi: 10.1016/J.JBSPIN.2017.04.013.

37. Velasco TO, Leggit JC. Chronic exertional compartment syndrome: a clinical update. Curr Sports Med Rep 2020; 19(9): 347–352. doi: 10.1249/JSR.0000000000000747.

38. Winkes M, van Eerten P, Scheltinga M. Deep posterior chronic exertional compartment syndrome as a cause of leg pain. Unfallchirurg 2020; 123 (Suppl 1): 3–7. doi: 10.1007/S00113-019-0665-1.

39. Winters M, Moen MH, Zimmermann WO et al. The medial tibial stress syndrome score: a new patient-reported outcome measure. Br J Sports Med 2016; 50(19): 1192–1199. doi: 10.1136/BJSPORTS-2015-095060.

40. Winters M, Moen MH, Zimmermann WO et al. Correction: the medial tibial stress syndrome score: a new patient-reported outcome measure. Br J Sports Med 2020; 54(4): e2. doi: 10.1136/BJSPORTS-2015-095060CORR1.

41. Kuwabara A, Dyrek P, Olson EM et al. Evidence-based management of medial tibial stress syndrome in runners. Curr Phys Med Rehabil Reports 2021; 9(4): 177–185. doi: 10.1007/S40141-021-00326-3/FIGURES/2.

42. Swanson CM, Kohrt WM, Buxton OM et al. The importance of the circadian system & sleep for bone health. Metabolism 2018; 84: 28–42. doi: 10.1016/J.METABOL.2017.12.002.

43. Franklyn M, Oakes B. Aetiology and mechanisms of injury in medial tibial stress syndrome: current and future developments. World J Orthop 2015; 6(8): 577–589. doi: 10.5312/WJO.V6.I8.577.

44. Gabbett TJ. The training – injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med 2016; 50(5): 273–280. doi: 10.1136/BJSPORTS-2015-095788.

45. Vlachopoulos D, Barker AR, Ubago-Guisado E et al. The effect of 12-month participation in osteogenic and non-osteogenic sports on bone development in adolescent male athletes. The PRO-BONE study. J Sci Med Sport 2018; 21(4): 404–409. doi: 10.1016/j.jsams.2017.08.018.

46. Winters M. Critically appraising the evidence to help our patients with overload syndromes: should we prioritise knowledge from observational studies and focus on ‚the essentials‘? Br J Sports Med 2018; 52(22): 1414–1415. doi: 10.1136/BJSPORTS-2018-099181.

47. Moen MH, Holtslag L, Bakker E et al. The treatment of medial tibial stress syndrome in athletes; a randomized clinical trial. Sport Med Arthrosc Rehabil Ther Technol 2012; 4(1): 12. doi: 10.1186/1758-2555-4-12.

48. Warden SJ, Davis IS, Fredericson M. Management and prevention of bone stress injuries in long-distance runners. J Orthop Sports Phys Ther 2014; 44(10): 749–765. doi: 10.2519/JOSPT.2014.5334.

49. Miller EM, Crowell MS, Morris JB et al. Gait retraining improves running impact loading and function in previously injured U.S. military cadets: a pilot study. Mil Med 2021; 186(11–12): e1077–e1087. doi: 10.1093/milmed/usaa383.

50. Zimmermann WO, Helmhout PH, Beutler A. Prevention and treatment of exercise related leg pain in young soldiers; a review of the literature and current practice in the Dutch armed forces. J R Army Med Corps 2017; 163(2): 94–103. doi: 10.1136/JRAMC-2016-000635.

Labels
Physiotherapist, university degree Rehabilitation Sports medicine
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#