Medial Tibial Stress Syndrome

MEDIAL TIBIAL STRESS SYNDROME

Most common lower leg injury in sportsAccounts for 6-16% of all running injuries and 50%

of all lower leg injuries

Cause1. CAUSE: Related to training

volume, training surface, physical conditi0n of the athlete,

Risk factors Increased pronation• Increased muscular strength of the foot

planter flexors• Increased varus of the forefoot or hindfoot• Abrupt increase in training intensity• Inadequate calcium intake• Hard or inclined surfaces• Shoes• Previous injuries

Involvement of the soleus muscleDisruption of the fibers of sharpeyRepeditive stress eccentrically that fatigue

the soleus which creates tibial bending or bowing over loading the bone-remodeling capabilities of the tibia

Role of pronationIncreased pronation signifigantMaximum velosity of pronation showed

greater correlation that pronation alone.

PreventionInsoles most promising in controlled trials,

shock absorbing-pronation controlledWeak or fatigues muscles cannot absorb the

shock it is transferred to the bone. Increase muscular strength.

Shoes should be replaced every 600 milesGraduated running programsDecrease volume, increase intensityStretching

TreatmentReduce inflammationPromote healing with HF24 and laserKinesiontapingOrthoticsNavicular, cuboid, talar and adjustments to

the kinetic chain. Adjust head of fibulaCheck the SI joint Look for imbalance in the external rotators,

iliopsoas, and adductors.

Navicular DropCorrelates with increase incidence of MTSS

Differential DiagnosisShin Splints: tenoperiostial tearing with

inflammation and pain. Usually along a diffuse area of the tibia and involving the posterior tibial muscle origin

Stress Fractures: Usually point tenderness. Very localized.

Imageing: X-ray

Imaging: X-ray

Imaging X-ray

Bone Scan

Treatment