Medial Tibial Stress Syndrome: A Case Study

Medial Tibial Stress Syndrome: A Case Study Mark Lewis Clinic II

What is MTSS? • Overuse injury • Usually due to… • Exercising on hard surfaces, uneven ground, or worn out/ill fitting shoes • Beginning an exercise program after a long period of time off • Increasing intensity or duration too quickly • Excessive uphill or downhill running • Poor running mechanics • Biomechanical inefficiencies… • Pes planus (flat feet) / Over-pronation • Pes cavus (high arch)

Anatomy

Anatomy • Origin • Insertion • Nerve • Function

Background / History • Rowan women’s lacrosse athlete • Gradual onset • Posteromedial pain (bilateral) • History of medial tibial stress syndrome • ‘Shin splints’

Assessment Results • Mild to moderate sharp pain during practice that goes away with rest • Located along the medial boarder of the tibia (bilateral) • Point tenderness along medial tibial boarders decreases with rest • No swelling or obvious deformities • Pes planus (functional) • Poor running mechanics • Faulty equipment • Improper training shoes

Assessment Results • Range of motion (ROM) • WNL • Strength (MMT) • WNL • Mild pain with tibialis posterior • Neurological • WNL

Differential Diagnosis • Stress fracture • Chronic compartment syndrome • Periostitis

Treatment • Stretching (pre and post) • Gastrocnemius and soleus • Quadriceps and hamstrings • Thera-band strengthening exercises • Plantarflexion, dorsiflexion, inversion, and eversion • Single-leg toe raises • Wall lean toe pumps

Treatment cont. • Ice-massage • Ice bag + compression • Whirlpool • Friction massage • Ibuprofen • Tape techniques • Shin splint taping • X-arch and low-dye • Arch foam inserts

Uniqueness • Medial tibial stress syndrome is one of the most common lower leg injuries in sports. Studies have shown medial tibial stress syndrome to be responsible for as much as 50% of all lower leg injuries reported in select populations. Overuse of the muscle causes an irritation to the tendons and the attachment of these tendons to the bone. • This case was unique due to the numerous intrinsic and extrinsic factors leading to this pathology.

Prevention • Earlier training and conditioning • Improved mechanics • Proper equipment • Abnormalities • Strength and flexibility • Training surface consistency

Conclusion • Condition has improved • Treatment • Turf practice rather than indoor court/track • Complains of mild to sometimes moderate pain during practice • Has not missed any play time • Goal is to… • Manage pain • Consistent treatment and awareness

Relating to Article • Most promising outcomes support the use of shock-absorbing insoles • Foam heel pads • Achilles tendon stretching • Footwear • Gradual running programs • Soleus strength and endurance training • Complete rest is key

Reference • Craig, Debbie, PhD. Medial Tibial Stress Syndrome: Evidence Based Prevention. Journal of Athletic Training. 2008; 43(3):316-318.

Medial Tibial Stress Syndrome: A Case Study