medial tibial stress syndrome most common lower leg injury in sports accounts for 6-16% of all...
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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