Medial Tibial Stress Syndrome: Evidence-Based Prevention

Abstract

Reference: Thacker SB, Gilchrist J, Stroup DF, Kimsey CD. The prevention of shin splints in sports: a systematic review of literature. Med Sci Sports Exerc. 2002;34(1):32-40.Clinical Question: Among physically active individuals, which medial tibial stress syndrome (MTSS) prevention methods are most effective to decrease injury rates?Data Sources: Studies were identified by searching MED-LINE (1966-2000, Current Contents (1996Contents ( -2000, Biomedical Collection (1993Collection ( -1999, and Dissertation Abstracts. Reference lists of identified studies were searched manually until no further studies were identified. Experts in the field were contacted, including first authors of randomized controlled trials addressing prevention of MTSS. The Cochrane Collaboration (early stage of Cochrane Database of Systematic Reviews) was contacted.Study Selection: Inclusion criteria included randomized controlled trials or clinical trials comparing different MTSS prevention methods with control groups. Excluded were studies that did not provide primary research data or that addressed treatment and rehabilitation rather than prevention of incident MTSS.Data Extraction: A total of 199 citations were identified. Of these, 4 studies compared prevention methods for MTSS. Three reviewers independently scored the 4 studies. Reviewers were blinded to the authors' names and affiliations but not the results. Each study was evaluated independently for methodologic quality using a 100-point checklist. Final scores were averages of the 3 reviewers' scores.Main Results: Prevention methods studied were shockabsorbent insoles, foam heel pads, Achilles tendon stretching, footwear, and graduated running programs. No statistically significant results were noted for any of the prevention methods. Median quality scores ranged from 29 to 47, revealing flaws in design, control for bias, and statistical methods.Conclusions: No current evidence supports any single prevention method for MTSS. The most promising outcomes support the use of shock-absorbing insoles. Well-designed and controlled trials are critically needed to decrease the incidence of this common injury.

Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review

“…When designing preventive programs for individuals with increased plantar flexion, practitioners should include eccentric exercises for the tibialis anterior, 5 orthotics and insoles for increased navicular drop, 17,18 and progressive activity programs for increased BMI. 5 Even though researchers do not fully understand the role of greater hip external-rotation ROM, we suggest manual therapy and a balance between flexibility and strength of the hip and pelvis musculature to minimize the risk of developing MTSS.…”

“…5 Even though researchers do not fully understand the role of greater hip external-rotation ROM, we suggest manual therapy and a balance between flexibility and strength of the hip and pelvis musculature to minimize the risk of developing MTSS. Several commonly used injury-prevention methods have been studied, 17,18 and the 4 risk factors of increased BMI, navicular drop, ankle plantar flexion, and hip external-rotation ROM should be investigated.…”

Musculoskeletal Injury Rates in Multiday Marathon Runners Performing Ten Consecutive Marathons on a Repeat Course

“…MTSS refers to exercise-related pain at the posteromedial border of the mid-distal tibia [22]. The high frequency rate of MTSS has been suggested to be related to insufficient capacity of bone remodelling constituted by repetitive and persistent stress on the tibia by muscular contraction and high ground reaction forces during running [23]. This may be exacerbated for the runners during the study due to inadequate healing time when running over 10 consecutive days.…”

Tibial Stress Injuries: Aetiology, Classification, Biomechanics and the Failure of Bone

“…In-shoe orthotics can be beneficial for MTSS patients as they attempt to statically raise the medial arch of the foot, thereby preventing excess medial tibial torque or rotation by attempting to minimise forefoot pronation. However, orthotics have not consistently shown to be effective (Craig, 2008), which is not surprising, as not all MTSS patients show excessive pronation. This highlights the importance for the treating physician to identify the type of MTSS and therefore ensure correct management.…”