Medial Tibial Stress Syndrome

1. Medial Tibial Stress Syndrome MEDIAL TIBIAL STRESS SYNDROME Most common lower leg injury in sports Accounts for 6-16% of all running injuries and 50% of all lower leg injuries

2. Cause CAUSE: Related to training volume, training surface, physical conditi0n of the athlete,

3. 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

4. Involvement of the soleus muscle • Disruption of the fibers of sharpey • Repeditive stress eccentrically that fatigue the soleus which creates tibial bending or bowing over loading the bone-remodeling capabilities of the tibia

5. Role of pronation • Increased pronation signifigant • Maximum velosity of pronation showed greater correlation that pronation alone.

6. Prevention • Insoles most promising in controlled trials, shock absorbing-pronation controlled • Weak or fatigues muscles cannot absorb the shock it is transferred to the bone. Increase muscular strength. • Shoes should be replaced every 600 miles • Graduated running programs • Decrease volume, increase intensity • Stretching

7. Treatment • Reduce inflammation • Promote healing with HF24 and laser • Kinesiontaping • Orthotics • Navicular, cuboid, talar and adjustments to the kinetic chain. Adjust head of fibula • Check the SI joint • Look for imbalance in the external rotators, iliopsoas, and adductors.

8. Navicular Drop • Correlates with increase incidence of MTSS

9. Differential Diagnosis • Shin 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.

10. Imageing: X-ray

11. Imaging: X-ray

12. Imaging X-ray

15. Bone Scan

16. Treatment