Medial Tibial Stress Syndrome: A Case Study

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Medial Tibial Stress Syndrome A Case Study

• Mark Lewis
• Clinic II

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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)

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Anatomy
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Anatomy

• Origin
• Insertion
• Nerve
• Function

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Background / History

• Rowan womens lacrosse athlete
• Gradual onset
• Posteromedial pain (bilateral)
• History of medial tibial stress syndrome
• Shin splints

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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

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Assessment Results

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

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Differential Diagnosis

• Stress fracture
• Chronic compartment syndrome
• Periostitis

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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

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Treatment cont.

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

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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.

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Prevention

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

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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

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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

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Reference

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