Transcript 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
1. 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 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
Role of pronation
 Increased pronation signifigant
 Maximum velosity of pronation showed greater
correlation that pronation alone.
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
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.
Navicular Drop
 Correlates with increase incidence of MTSS
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.
Imageing: X-ray
Imaging: X-ray
Imaging X-ray
Bone Scan
Treatment