Medial tibial stress syndrome
A common overuse lower extremity injury among sportsmen is medial tibial stress syndrome (MTSS). An early stress injury in the spectrum of tibial stress fractures, MTSS is discomfort over the anterior tibia brought on by activity. Physicians frequently see patients with medial tibial stress syndrome, an overuse disorder that manifests as a tibial bone overload injury with accompanying periostitis, in athletes who engage in repetitive impact exercises like running and jumping. In runners, the prevalence of medial tibial stress syndrome varies from 13.6% to 20%, whereas in military recruits, it can reach up to 35%. Exercises with high impact, volume, and significantly rising loads might increase the risk of MTSS and other bone stress injuries. The unrepaired microdamage buildup in the distal tibia’s cortical bone is the basic pathophysiologic mechanism that leads to MTSS. The location of bone damage usually has an overlaying periostitis, which is correlated with the tendinous attachments of the posterior tibialis, flexor digitorum longus, and soleus1.
If you are suffering from medial tibial stress syndrome than you may experience
- growing discomfort in the middle and lower third of the medial tibial border during activity.
- Pain lasts for several hours or days following an activity stop.
- Extreme tenderness in the medial tibial border.
- In early stages pain reduces during running.
- Sometimes pain becomes much worse which disturbs the sleep.
- Generally pain terminates after activity2.
An extensive evaluation of the patient’s symptoms and medical background is the first step in a physical therapist’s diagnosis of medial tibial stress syndrome (MTSS). They will inquire about the beginning, length, and nature of the pain, particularly in connection with strenuous activity like running or jumping. Subsequently, the therapist will do a physical assessment, palpating the inner edge of the tibia to detect any soreness, as this is a crucial sign of MTSS. In order to detect any biomechanical problems like overpronation or poor running mechanics, they may also evaluate the patient’s gait and the strength, flexibility, and range of motion of their lower leg muscles. They will also conduct function test like single leg hop test3 and may perform resisted isometrics for plantar flexion. The physical therapist will confirm the diagnosis of MTSS and provide a customized treatment plan by using this all-inclusive approach. A physical therapist’s approach to treating medial tibial stress syndrome (MTSS) centers on pain management, healing enhancement, and recurrence prevention. Initially, treatment begins with rest from aggravating activities and ice application to allow the inflammation in the shin to subside and will promote reduction in swelling. As per Galabraith et al; ice application in acute phase is an important part of this condition. Following the management of the acute pain, the therapist will implement a rehabilitation program for subacute phase that comprises low impact exercises initially, than strengthening exercises for the lower limbs and core to improve stability and lessen strain on the tibia, as well as stretching activities to increase flexibility in the hamstrings and calves. A daily routine of eccentric and calf-stretching exercises has received widespread approval in the literature4. Strong hip and core muscles can help patients since they will provide stable base and less likely to get overuse problems4. Proprioceptive training will also be introduced by the therapist during the procedure. Wobble boards, single-leg workouts, and many more activities can be used for this. According to Galabraith et al; Enhancing proprioception can assist the body respond to incongruent surfaces by boosting the effectiveness of the muscles that stabilize joints and posture4. To stop this condition from becoming worse, early intervention is essential. This involves putting an emphasis on rest, appropriate pain treatment, and rehabilitation activities. Physical therapy will help you to prevent recurrence by addressing biomechanical causes and enhancing strength and flexibility in addition to relieving symptoms. You can safely resume your activities and preserve long-term shin health by following physical therapy strategies.
References:
1. McClure CJ, Oh R. Medial Tibial Stress Syndrome. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538479/
2. Lohrer, H., Malliaropoulos, N., Korakakis, V., & Padhiar, N. (2019). Exercise-induced leg pain in athletes: diagnostic, assessment, and management strategies. The Physician and sportsmedicine, 47(1), 47-59.
3. Bradley, Leah & Blakey, Shelley. (2014). Single-Leg Hop Test in the Evaluation of Stress Injuries. Athletic Training & Sports Health Care. 6. 201-202. 10.3928/19425864-20140916-11.
4. Galbraith, R. M., & Lavallee, M. E. (2009). Medial tibial stress syndrome: conservative treatment options. Current reviews in musculoskeletal medicine, 2, 127-133.
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