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Singh A, Wadhwani N, Sharma M. Short-term effectiveness of dry needling on pain and ankle range of motion in athletes with medial tibial stress syndrome- a randomized control trial. J Man Manip Ther 2024:1-7. [PMID: 39097941 DOI: 10.1080/10669817.2024.2384611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 07/20/2024] [Indexed: 08/06/2024] Open
Abstract
INTRODUCTION Medial tibial stress syndrome (MTSS) is also called soleus syndrome because the resultant periostitis is localized to the medial insertion of the soleus muscle. This study explores the effectiveness of dry needling (DN) targeting soleus myofascial trigger points (MTrPs) in managing MTSS. AIM To assess the impact of DN on pain reduction and ankle range of motion (ROM) improvement in athletes with MTSS. STUDY DESIGN This randomized controlled trial (RCT) included 50 university-level athletes. (DN group = 25; control group = 25). METHOD Outcome variables, pain, and ankle dorsiflexion ROM were measured using the Numeric Pain Rating Scale (NPRS) and universal goniometer, respectively. The trial used statistical analyses like Wilcoxon rank test for within-group comparisons and Mann-Whitney U test for between-group comparisons. The trial was registered with the Clinical Trials Registry of India; CTRI/2023/10/058837. RESULT There were 24 Females (Age = 21.4 ± 2.06) & 26 Males (Age = 20.5 ± 2.35). DN significantly reduced pain in the intervention group from NPRS 7 ± 1.30 to 2 ± 0.87 (p < 0.001), but in the control group, the pain increased from NPRS 7 ± 0.99 to 7 ± 1.05 (p = 0.009). There was no improvement in ankle ROM. CONCLUSION DN effectively alleviated MTSS-associated pain in the short-term but was not effective in improving ankle ROM.
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Affiliation(s)
- Amrinder Singh
- MYAS -GNDU Department of Sports Sciences & Medicine, Guru Nanak Dev University, Amritsar, India
| | - Nikita Wadhwani
- MYAS -GNDU Department of Sports Sciences & Medicine, Guru Nanak Dev University, Amritsar, India
| | - Monika Sharma
- MYAS -GNDU Department of Sports Sciences & Medicine, Guru Nanak Dev University, Amritsar, India
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Wilson K, Oca M, Meller LLT, Allen MR, Strauss MB. Exertional Compartment Syndrome in a Volleyball Player with Structural Abnormalities: A Case Report. Curr Sports Med Rep 2024; 23:280-283. [PMID: 39102582 DOI: 10.1249/jsr.0000000000001186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Affiliation(s)
- Katherine Wilson
- San Diego School of Medicine, University of California, La Jolla, CA
| | - Michael Oca
- San Diego School of Medicine, University of California, La Jolla, CA
| | - Leo L T Meller
- San Diego School of Medicine, University of California, La Jolla, CA
| | - Matthew R Allen
- San Diego School of Medicine, University of California, La Jolla, CA
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Hashim M, Alhazani FA, AlQarni AS, Albogami MA, Alomar AO, Alsultan AS. Medial Tibial Stress Syndrome (Shin Splint): Prevalence, Causes, Prevention, and Management in Saudi Arabia. Cureus 2024; 16:e59441. [PMID: 38826935 PMCID: PMC11140428 DOI: 10.7759/cureus.59441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
Background/aims Medial tibial stress syndrome (MTSS), also known as "shin splint", is most often described as exertional leg pain along the shinbone (tibia), which occurs due to the inflammation of the muscles, tendons, and bone tissue in this area. This study aims to assess the prevalence, risk factors, and their association with the development of MTSS, as well as the effective treatments that reduce pain and improve functions among the Saudi general population. Materials and method The present cross-sectional study was conducted on the general population of Saudi Arabia through an electronic survey over a period of three months. The study sample of 443 patients was deemed and considered. The study included participants from the general population in Saudi Arabia above the age of 18. A structured self-response questionnaire was given to the participants after institutional research ethical approval was obtained for the study. Results Among the 443 participants, the majority were male (n = 228, 51.5%), aged 18-29 (n = 227, 51.2%), and residing in the central region of Saudi Arabia (n = 398, 89.8%). Most participants reported engaging in sporting activities (n = 211, 47.6%), with high-intensity training being the most common (n = 93, 44.1%). Only a small proportion (n = 8, 1.8%) reported a previous diagnosis of MTSS. Analysis revealed associations between MTSS prevalence and certain demographic factors, including walking surface preferences and engagement in specific sports. Treatment strategies for MTSS included rest, ice application, physiotherapy, and pain-relieving medication, with varying degrees of satisfaction and recurrence rates among participants. Conclusion The study provides valuable insights into the prevalence, risk factors, management, and preventive measures related to MTSS among the Saudi general population. While certain demographic factors and exercise practices were associated with MTSS prevalence, effective treatment options such as rest, physiotherapy, and appropriate footwear were reported. Moreover, adherence to preventive measures such as stretching, proper footwear selection, and gradual training progression may help mitigate the risk of MTSS development.
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Affiliation(s)
- Majdi Hashim
- Department of Orthopedics, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, SAU
| | - Faisal A Alhazani
- College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, SAU
| | - Ayedh S AlQarni
- College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, SAU
| | - Mazen A Albogami
- College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, SAU
| | - Abdulrahman O Alomar
- College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, SAU
| | - Abdullah S Alsultan
- College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, SAU
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Bosnina F, Padhiar N, Miller S, Girotra K, Massoura C, Morrissey D. Developing a diagnostic framework for patients presenting with Exercise Induced Leg Pain (EILP): a scoping review. J Foot Ankle Res 2023; 16:82. [PMID: 37990284 PMCID: PMC10662794 DOI: 10.1186/s13047-023-00680-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/31/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Numerous conditions are grouped under the generic term exercise-induced leg pain (EILP), yet clear diagnostic guidelines are lacking. This scoping review was conducted to clarify the definition and diagnostic criteria of nine commonly occurring EILP conditions. METHODS Three online databases were searched from inception to April 2022 for any English language original manuscripts identifying, describing, or assessing the clinical presentation and diagnostic criteria of the nine most common conditions that cause EILP. We included manuscripts considering all adults with any reported diagnostic criteria for EILP in any setting. Methodological quality was assessed using the Mixed Method Appraisal tool. Condition definitions were identified and categorised during data charting. Twenty-five potential elements of the history, 24 symptoms, 41 physical signs, 21 investigative tools, and 26 overarching diagnostic criteria, were identified and coded as counts of recommendation per condition, alongside qualitative analysis of the clinical reasoning. Condition definitions were constructed with 11 standardised elements based on recent consensus exercises for other conditions. RESULTS One hundred nineteen retained manuscripts, of which 18 studied multiple conditions, had a median quality of 2/5. A combination of the history, pain location, symptoms, physical findings, and investigative modalities were fundamental to identify each sub-diagnosis alongside excluding differentials. The details differed markedly for each sub-diagnosis. Fifty-nine manuscripts included data on chronic exertional compartment syndrome (CECS) revealing exertional pain (83% history), dull aching pain (76% symptoms), absence of physical signs (78% physical findings) and elevated intercompartment pressure (93% investigative modality). Twenty-one manuscripts included data on medial tibial stress syndrome (MTSS), revealing persistent pain upon discontinuation of activity (81% history), diffuse medial tibial pain (100% pain location), dull ache (86% symptoms), diffuse tenderness (95% physical findings) and MRI for exclusion of differentials (62% investigative modality). Similar analyses were performed for stress fractures (SF, n = 31), popliteal artery entrapment syndrome (PAES, n = 22), superficial peroneal nerve entrapment syndrome (SPNES, n = 15), lumbar radiculopathy (n = 7), accessory/low-lying soleus muscle syndrome (ALLSMS, n = 5), myofascial tears (n = 3), and McArdle's syndrome (n = 2). CONCLUSION Initial diagnostic frameworks and definitions have been developed for each condition of the nine most common conditions that cause EILP, suitable for clinical consideration and consensus confirmation.
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Affiliation(s)
- Fatma Bosnina
- Sports & Exercise Medicine, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Nat Padhiar
- Sports & Exercise Medicine, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK.
- London Sportswise, London, UK.
| | - Stuart Miller
- Sports & Exercise Medicine, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Krishna Girotra
- Sports & Exercise Medicine, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Chrysovalanto Massoura
- Sports & Exercise Medicine, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Dylan Morrissey
- Sports & Exercise Medicine, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
- Barts Health NHS Trust Physiotherapy Department, London, UK
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DeJong Lempke AF, Stracciolini A, Willwerth SB, Ackerman KE, d'Hemecourt PA, Meehan WP, Whitney KE. Clinical assessment, treatment, and referral trends for adolescent runners seeking care at an injured runners' clinic. J Pediatr Rehabil Med 2023:PRM220082. [PMID: 38007679 DOI: 10.3233/prm-220082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2023] Open
Abstract
PURPOSE Over a 10-year time frame, this study aimed to evaluate diagnosis, treatment, and referral trends for adolescent runners seeking care for running-related injuries (RRIs) at a clinic that specializes in running medicine. METHODS This study was a retrospective chart review of 392 adolescent runners (2,326 encounters) who sought care for RRIs between the years 2011 and 2021. Descriptive statistics were used to summarize clinical assessments, referrals, assistive devices, and medications prescribed or administered overall and by injury type. Chi-square analyses were used to compare proportions of services rendered across the 10-year time frame. RESULTS Patients most frequently received manual evaluations or special tests during clinic visits. Most visits resulted in at least one referral (91%), primarily for physical therapy or gait-training. Assistive devices and medications/supplements were offered at only 18% of patient visits. The majority of assessments (X2 = 69.7, p = 0.002), treatments (X2: 23.6-43.8, p: < 0.001-0.003), and referrals (X2 = 132, p < 0.001) were for shin injuries. Larger proportions of nutrition assessments (X2 = 40.7, p < 0.001), interventions (X2 = 26.8, p = 0.003), and referrals (X2 = 27.5, p = 0.002) were performed in or after the year 2015. CONCLUSION Clinic visits for shin injuries required the most clinical resources per episode of care. There were observed shifts in clinical assessment and treatment approaches to include more expanded nutritional and physiologic considerations.
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Affiliation(s)
- Alexandra F DeJong Lempke
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
- Micheli Center for Sports Injury Prevention, Waltham, MA, USA
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA
| | - Andrea Stracciolini
- Micheli Center for Sports Injury Prevention, Waltham, MA, USA
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sarah B Willwerth
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Kathryn E Ackerman
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Wu Tsai Female Athlete Program, Boston Children's Hospital, Boston, MA, USA
| | - Pierre A d'Hemecourt
- Micheli Center for Sports Injury Prevention, Waltham, MA, USA
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - William P Meehan
- Micheli Center for Sports Injury Prevention, Waltham, MA, USA
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kristin E Whitney
- Micheli Center for Sports Injury Prevention, Waltham, MA, USA
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Ohmi T, Aizawa J, Hirohata K, Ohji S, Mitomo S, Ohara T, Yagishita K. Biomechanical characteristics of the lower extremities during running in male long-distance runners with a history of medial tibial stress syndrome: a case control study. BMC Musculoskelet Disord 2023; 24:103. [PMID: 36750819 PMCID: PMC9903575 DOI: 10.1186/s12891-023-06216-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Medial tibial stress syndrome (MTSS) is a running-related injury of the lower extremities. After returning to competition, there are often recurring episodes of MTSS. Therefore, it is important to prevent the onset and recurrence of MTSS among long-distance runners. This case-control study aimed to compare the kinematics and kinetics of runners with and without previous MTSS during running to clarify the biomechanical characteristics of the lower extremity of runners with previous MTSS. METHODS Thirteen male long-distance runners aged over 18 years and asymptomatic at the time of measurement were divided into an MTSS group and a non-MTSS group based on their history of MTSS as reported in a questionnaire. The kinetics and kinematics of running were analyzed when participants ran at a speed of 2.0 ± 0.2 m/s by a three-dimensional motion analysis system and two force plates. Data regarding the joint angles, moments, and powers of the ankle, knee, and hip during the stance phase while running were extracted and compared between the two groups using the Mann-Whitney U test. RESULTS Of the 13 participants, 5 and 8 were included in the MTSS (10 legs) and non-MTSS (16 legs) groups, respectively. The ankle maximum eversion moment was significantly larger in the MTSS group than in the non-MTSS group (p = 0.04). There were no significant differences in other parameters. CONCLUSIONS This study found that the ankle maximum eversion moment during the stance phase of running was larger in the MTSS group than in the non-MTSS group. Even after the disappearance of the symptoms of MTSS, the running biomechanics of participants with previous MTSS differed from those of participants without previous MTSS.
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Affiliation(s)
- Takehiro Ohmi
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Tokyo, Bunkyo-Ku, 113-8519, Japan.
| | - Junya Aizawa
- grid.258269.20000 0004 1762 2738Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Kenji Hirohata
- grid.265073.50000 0001 1014 9130Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Tokyo, Bunkyo-Ku 113-8519 Japan
| | - Shunsuke Ohji
- grid.265073.50000 0001 1014 9130Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Tokyo, Bunkyo-Ku 113-8519 Japan
| | - Sho Mitomo
- grid.265073.50000 0001 1014 9130Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Tokyo, Bunkyo-Ku 113-8519 Japan
| | - Toshiyuki Ohara
- grid.265073.50000 0001 1014 9130Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Tokyo, Bunkyo-Ku 113-8519 Japan
| | - Kazuyoshi Yagishita
- grid.265073.50000 0001 1014 9130Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Tokyo, Bunkyo-Ku 113-8519 Japan
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Muacevic A, Adler JR. Shin Splint: A Review. Cureus 2023; 15:e33905. [PMID: 36819450 PMCID: PMC9937638 DOI: 10.7759/cureus.33905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Medial tibial stress syndrome (MTSS), usually referred to as "shin splints," is a common overuse injury of the lower extremities affecting a large percentage of athletes. A variety of factors can lead to shin splints, including overtraining, poor footwear, muscular imbalances at the ankle, overtight or weak triceps surae muscles, imbalances at the thoracolumbar complex, and a body mass index (BMI) above 30. Injuries present with diffuse palpable pain that is often described as a dull ache following exercise. The pain is often alleviated by resting. Often, athletes complain of tenderness along the posteromedial edge of the tibia and pain along the middle to distal third of the posteromedial border of the tibia following an exercise session. The pain caused by a shin splint should be categorized according to its location and cause, such as lower medial tibial pain caused by periostitis or upper lateral tibial pain caused by raised compartment pressure. In order to prevent MTSS or shin splints, it is important to avoid excessive stress. The main objectives of shin splint treatment are to relieve pain and to enable the patient to return to normal activities without pain. To prevent shin splints, repetitive stress should be avoided. In this paper, we review what is known about the pathophysiology of shin splint syndrome, present evidence regarding risk factors associated with shin splints, assess the effectiveness of prevention strategies, and make recommendations for prevention. The purpose of this study is to assess the effectiveness of interventions to prevent shin splints.
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Wong AKO, Fung HJW, Chan ACH, Szabo E, Mathur S, Giangregorio L, Cheung AM. Ankle flexor torque, size and density are differential determinants of distal tibia trabecular plate-rod morphometry and bone strength: The Ankle Quality Study. Bone 2023; 166:116582. [PMID: 36243400 DOI: 10.1016/j.bone.2022.116582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/23/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
HYPOTHESIS Greater peak torque and higher myotendinous density at the ankle are associated with a more plate-like architecture at the distal tibia. METHODS In this cross-sectional study, women and men ≥ 50 years old with no metal implants, reconstructive surgery, muscular dystrophies, or tendinopathies in any leg were recruited by convenience. Isometric ankle dorsi-plantar flexion and inversion-eversion peak torques were measured using dynamometry. HR-pQCT distal tibia scans were completed. Both assessments were completed on the same day on the non-dominant leg. Integral and trabecular vBMD were derived from standard analyses, failure load (FL) was obtained from finite element analysis, plate-specific parameters were computed from individual trabecula segmentation (ITS) analysis, myotendinous density (MyD) and volume fraction (MyV/TV) were computed from soft tissue analysis. pQCT scans of the 66 % mid-leg were performed (500 μm at 15 mm/s) to obtain muscle density (MD) and muscle cross-sectional area (MCSA). STATISTICAL ANALYSIS General linear models estimated how ankle muscle group torque and muscle size and density differentially related, both separately and together, to whole-bone properties (integral vBMD, FL) and trabecular morphometry (ITS plate parameters). Models were adjusted for age, sex, BMI, use of glucocorticoids, current osteoarthritis, and participation in moderate to vigorous recreational or sport activities. RESULTS Among 105 participants (77 % female, mean age: 63 (10) years, BMI: 25.8 (5.4) kg/m2, 25 % with OA, 17 % fracture history, 42 % falls history), all torque measures, particularly ankle dorsiflexion and eversion, were correlates of plate-plate/rod junction density and failure load. However, muscle size and density measures were further associated with vBMD. The effect of greater ankle flexor-extensor torque on more connected bone was stronger when MyD was higher (interaction p < 0.001). CONCLUSION Strength of muscles around the ankle are correlates of plate-like trabeculae at the distal tibia, while leaner muscle and myotendinous tissues facilitates better quality bone for stronger ankle muscle torque.
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Affiliation(s)
- Andy K O Wong
- Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Hugo J W Fung
- Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada; Department of Exercise Sciences, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Adrian C H Chan
- Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Eva Szabo
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Osteoporosis Program, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
| | - Sunita Mathur
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Lora Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Angela M Cheung
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Osteoporosis Program, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Guo S, Liu P, Feng B, Xu Y, Wang Y. Efficacy of kinesiology taping on the management of shin splints: a systematic review. PHYSICIAN SPORTSMED 2022; 50:369-377. [PMID: 34176444 DOI: 10.1080/00913847.2021.1949253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Shin splint is one of the most common sports injuries after strenuous exercise. Kinesiology taping (KT) is a popular noninvasive remedy used in sports-related disorders, with the potential effects of relieving pain, facilitating proprioception, modulating muscle activation and correcting abnormal movement patterns. However, the exact efficacy of KT on shin splints is still unknown, and previous findings are inconsistent. Hence, this study aimed to conduct a systematic review to evaluate the current status of relevant evidence on its efficacy. METHODS The review was performed according to the PRISMA guidelines, and a systematic search of the literature was conducted in December 2020. Electronic databases, Embase, Scopus, Medline, Web of Science, PubMed and Biomed Central were searched for the identification of pertinent studies with pre-defined key terms on shin splints and KT. RESULTS Four studies with a total sample size of 141 participants were included and analyzed. Two studies had within-subject designs, whereas the other two were randomized clinical trials. Although the positive results of KT were reported by the studies, methodological quality varied from poor to moderate according to the Physiotherapy Evidence Database Scale or Non-Randomized Studies-of Interventions. CONCLUSION In conclusion, this review revealed that the efficacy of KT on shin splints remains not clear. Evidence that supports its effectiveness in individuals with shin splints is currently limited. Further studies with good methodological quality and study design are warranted.
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Affiliation(s)
- Suimin Guo
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, CHINA.,Department of Children's Healthcare and Mental Health Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, CHINA
| | - Peizhen Liu
- Operating Theatre, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong Province, CHINA
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Effect of extracorporeal shockwave therapy on medial tibial stress syndrome: a systematic review. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Naderi A, Bagheri S, Ramazanian Ahoor F, Moen MH, Degens H. Foot Orthoses Enhance the Effectiveness of Exercise, Shockwave, and Ice Therapy in the Management of Medial Tibial Stress Syndrome. Clin J Sport Med 2022; 32:e251-e260. [PMID: 33797477 DOI: 10.1097/jsm.0000000000000926] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 02/08/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Our aim was to assess the effects of adding arch-support foot-orthoses (ASFO) to a multimodal therapeutic intervention on the perception of pain and improvement of recovery from medial tibial stress syndrome (MTSS) in recreational runners. DESIGN A prospective randomized controlled trial. SETTING Sport training and medical centers. PARTICIPANTS Fifty female recreational runners with MTSS were randomized into 2 groups. INTERVENTIONS Runners either received ASFO or sham flat noncontoured orthoses. Both groups received a multimodal therapeutic intervention, including ice massage, ankle muscle exercises, and extracorporeal shockwave therapy. MAIN OUTCOME MEASURES Pain during bone pressure using a numerical Likert scale (0-10), MTSS severity using an MTSS scale, perceived treatment effect using the global rating of change scale, and quality of life using the short Form-36 questionnaire were determined at week 6, 12, and 18. RESULTS Pain intensity and MTSS severity were lower, and the perceived treatment effect and physical function were better in the ASFO than in the sham flat noncontoured orthoses group at week 6 and week 12. Cohen's dz effect size for between-group differences showed a medium difference. However, arch-support foot-orthoses did not add to the benefits of multimodal therapeutic intervention on pain, MTSS severity and perceived treatment effect at week 18. CONCLUSIONS Adding ASFO to a therapeutic intervention leads to an earlier diminishment of pain and MTSS severity, and improved PF and perceived therapeutic effects.
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Affiliation(s)
- Aynollah Naderi
- School of Sport Science, Shahrood University of Technology, Shahrood, Semnan, Iran
| | | | - Fatemeh Ramazanian Ahoor
- Department of Sport Science, School of Humanities, University College of Omran and Tosseeh, Hamadan, Iran
| | - Maarten H Moen
- Bergman Clinics, Naarden, the Netherlands
- The Sport Physician Group, OLVG West, Amsterdam, the Netherlands
- Department of Elite Sports, National Olympic Committee and National Sports Federation, Arnhem, the Netherlands
| | - Hans Degens
- Department of Life Sciences, Research Centre for Musculoskeletal Science and Sports Medicine, Manchester Metropolitan University, United Kingdom ; and
- Institute of Sport Science and Innovations, Lithuanian Sports University, Lithuanian, Lithuania
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Effect of Compression Therapy in the Treatment of Tibial Stress Syndrome in Military Service Members. J Sport Rehabil 2022; 31:771-777. [PMID: 35453124 DOI: 10.1123/jsr.2021-0327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 11/18/2022]
Abstract
CONTEXT Tibial stress syndrome (TSS) is an overuse injury of the lower extremities. There is a high incidence rate of TSS among military recruits. Compression therapy is used to treat a wide array of musculoskeletal injuries. The purpose of this study was to investigate the use of compression therapy as a treatment for TSS in military service members. DESIGN A parallel randomized study design was utilized. METHODS Military members diagnosed with TSS were assigned to either a relative rest group or compression garment group. Both groups started the study with 2 weeks of lower extremity rest followed by a graduated running program during the next 6 weeks. The compression garment group additionally wore a shin splints compression wrap during the waking hours of the first 2 weeks and during activity only for the next 6 weeks. Feelings of pain, TSS symptoms, and the ability to run 2 miles pain free were assessed at baseline, 4 weeks, and 8 weeks into the study. RESULTS Feelings of pain and TSS symptoms decreased during the 8-week study in both groups (P < .05), but these changes were not significantly different between groups (P > .05). The proportion of participants who were able to run 2 miles pain free was significantly different (P < .05) between the 2 groups at the 8-week time point with the compression garment group having a significantly increased ability to complete the run without pain. CONCLUSIONS Although perceptions of pain at rest were not different between groups, the functional ability of running 2 miles pain free was significantly improved in the compression garment group. These findings suggest that there is a moderate benefit to using compression therapy as an adjunct treatment for TSS, promoting a return to training for military service members.
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Hasegawa M, Singh D, Yim N, Parsa FD. Recurrent Tibial Periostitis Due to Blunt Trauma. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2022; 81:38-41. [PMID: 35156055 PMCID: PMC8815004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Periostitis is characterized by periosteal inflammation surrounding tubular bones. The pathophysiology is now considered to be multifactorial and a spectrum of disorders, recently being redefined as medial tibial stress syndrome (MTSS). Current treatment modalities include preventative and conservative measures, such as activity modification and footwear alterations. There is a paucity of literature for more invasive treatments, such as steroid injections. In conflict with the currently available limited literature, this study reports a case of recurrent tibial periostitis due to blunt trauma treated with steroid injections resulting in symptom resolution and no adverse events. While this case may suggest a therapeutic role for steroids in the treatment of MTSS from blunt trauma, it also highlights the need for additional studies to elucidate the safety profile and therapeutic efficacy of steroid injections.
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Affiliation(s)
- Morgan Hasegawa
- Hawai‘i Residency Program, Department of Surgery, Division of Orthopedics, John A. Burns School of Medicine, University of Hawai‘i (MH)
| | - Dylan Singh
- John A. Burns School of Medicine, University of Hawai‘i (NY, DS)
| | - Nicholas Yim
- John A. Burns School of Medicine, University of Hawai‘i (NY, DS)
| | - F. Don Parsa
- Hawai‘i Residency Program, Department of Surgery, John A. Burns School of Medicine, University of Hawai‘i (FDP)
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Kuwabara A, Dyrek P, Olson EM, Kraus E. Evidence-Based Management of Medial Tibial Stress Syndrome in Runners. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00326-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Nozawa T, Bell-Peter A, Doria AS, Marcuz JA, Stimec J, Whitney K, Feldman BM. Tibia stress injury and the imaging appearance of stress fracture in juvenile dermatomyositis: six patients' experiences. Pediatr Rheumatol Online J 2021; 19:17. [PMID: 33596941 PMCID: PMC7890837 DOI: 10.1186/s12969-021-00501-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 02/04/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Tibial stress injuries are frequent injuries of the lower extremity and the most common causes of exercise-induced leg pain among athletes and military recruits. They sometimes occur in patients with pathological conditions of bone metabolism such as osteoporosis or rheumatoid arthritis, but there are previously no cases reported in juvenile dermatomyositis (JDM). Here we report 6 JDM patients who presented with shin pain, and the imaging appearance of tibial stress fractures or stress reactions. CASE PRESENTATION All 6 patients with JDM presented with shin pain or tenderness in the anterior tibia without any evidence of excessive exercise or traumatic episode. They were diagnosed with tibial stress injuries based on a combination of radiographs, three-phase bone scans, and magnetic resonance imaging (MRI), and 5 out of 6 patients had been treated with prednisone and/or methotrexate at onset of tibial stress injuries. In one patient, we could not find any abnormalities in his radiograph, but the subsequent MRI showed tibial stress reaction. In all 6 patients, the tibial stress injuries improved with only rest and/or analgesics. CONCLUSION We experienced 6 children with JDM who presented with shin pain, and who were diagnosed with tibial stress fractures or stress reactions. Their underlying disease and weakness, treatment with glucocorticoid and methotrexate, or inactivity may have resulted in these tibial injuries, and made these patients more predisposed than other children. In addition to preventing JDM patients from getting osteoporosis, we need to consider stress reactions when children with JDM complain of sudden shin pain.
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Affiliation(s)
- Tomo Nozawa
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada. .,Department of Pediatrics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan.
| | - Audrey Bell-Peter
- grid.42327.300000 0004 0473 9646Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, 555 University Ave, M5G 1X8 Toronto, ON Canada
| | - Andrea S. Doria
- grid.17063.330000 0001 2157 2938Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave, M5G 1X8 Toronto, ON Canada
| | - Jo-Anne Marcuz
- grid.42327.300000 0004 0473 9646Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, 555 University Ave, M5G 1X8 Toronto, ON Canada
| | - Jennifer Stimec
- grid.17063.330000 0001 2157 2938Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave, M5G 1X8 Toronto, ON Canada
| | - Kristi Whitney
- grid.42327.300000 0004 0473 9646Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, 555 University Ave, M5G 1X8 Toronto, ON Canada
| | - Brian M. Feldman
- grid.42327.300000 0004 0473 9646Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, 555 University Ave, M5G 1X8 Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M6 Toronto, Toronto, ON Canada
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Martinez RE, Lopez EB, Cox RW, Stankevitz D, Larkins L, Baker RT, May J. Exploring treatment of medial tibial stress syndrome via posture and the MyoKinesthetic system. J Bodyw Mov Ther 2020; 24:82-87. [PMID: 31987568 DOI: 10.1016/j.jbmt.2019.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 06/02/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION A standard treatment protocol for medial tibial stress syndrome (MTSS) has not been identified. Clinical practice focuses on local evaluation and treatment neglecting a global approach. The MyoKinesthetic™ (MYK) System includes a full-body postural assessment to identify compensatory patterns that may lead to MTSS. The purpose of this study was to assess the effects of the MYK System in treating patients diagnosed with MTSS. METHOD A multi-site exploratory study was used to assess the effects of the MYK System on perceived pain and disability in patients diagnosed with MTSS. Eighteen physically active patients (6 female, 12 male), ages 18-25 years (19.89 ± 1.32) were treated with the MYK System. RESULTS Paired T-tests were utilized to assess change. The change in patient reported pain was statistically significant (t(17) = 10.48, p < .001, Cohen's d = 2.48) and represented an average decrease of 96% in patient reported pain. The change in disablement was statistically significant (t(17) = 7.39, p < .001, Cohen's d = 1.74) and represented an average decrease of 88.2% in patient reported disablement. DISCUSSION Participants treated with the MYK System experienced significant improvements and appear to surpass traditional interventions without the need of rest. CONCLUSION Implementation of the MYK System to treat MTSS led to significant decreases in patient reported pain and dysfunction. A full-scale clinical investigation of the MYK System is warranted to determine its effects compared to traditional treatment options.
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Efficacy of Extracorporeal Shock Wave Therapy for Lower-Limb Tendinopathy: A Meta-analysis of Randomized Controlled Trials. Am J Phys Med Rehabil 2019; 97:605-619. [PMID: 29557811 DOI: 10.1097/phm.0000000000000925] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Extracorporeal shock wave therapy, including radial shock wave and focused shock wave types, is widely used for managing tendinopathies. The difference in efficacy between the 2 shock wave characteristics with different dosage levels remains controversial, and the purpose of this meta-analysis was to examine it for patients with lower-limb tendinopathy. DESIGN A comprehensive search of online databases and search engines was performed. This study included randomized controlled trials reporting the efficacy of extracorporeal shock wave therapy in treating lower-limb tendinopathy. The included randomized controlled trials were subjected to a meta-analysis and risk of bias assessment. RESULTS In total, 29 randomized controlled trials were included, all of which had a good methodological quality, with a PEDro score of ≥6/10. General extracorporeal shock wave therapy showed significant effects at the immediate follow-up [pain score: standardized mean difference = -1.41, 95% confidence interval = -2.01 to -0.82, P < 0.00001; function: standardized mean difference = 2.59, 95% confidence interval = 1.54 to 3.64, P < 0.00001] as well as at 3, 6, and ≥12 months. In sequence, high-dosage focused shock wave, high-dosage radial shock wave, and low-dosage radial shock wave had superior pooled effects on overall clinical outcomes. CONCLUSIONS Extracorporeal shock wave therapy exerted a positive overall effect on pain and function for lower-limb tendinopathy. Shock wave types and dosage levels may have different contributions to treatment efficacy. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Describe benefits of extracorporeal shock wave therapy for individuals with lower-limb tendinopathy; (2) Understand the impact of dosing and type of extracorporeal shock wave therapy has on treatment efficacy; and (3) Identify appropriate indications for incorporating extracorporeal shock wave therapy into the treatment plan for patients with lower-limb tendinopathy. LEVEL Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Kinoshita K, Okada K, Saito I, Saito A, Takahashi Y, Kimoto M, Wakasa M. Alignment of the rearfoot and foot pressure patterns of individuals with medial tibial stress syndrome: A cross-sectional study. Phys Ther Sport 2019; 38:132-138. [DOI: 10.1016/j.ptsp.2019.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 03/17/2019] [Accepted: 03/22/2019] [Indexed: 11/24/2022]
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Krabak BJ, Tenforde AS, Davis IS, Fredericson M, Harrast MA, d'Hemecourt P, Luke AC, Roberts WO. Youth Distance Running: Strategies for Training and Injury Reduction. Curr Sports Med Rep 2019; 18:53-59. [PMID: 30730342 DOI: 10.1249/jsr.0000000000000564] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Running is a popular sport for children in the United States. However, review of available literature on health effects and safety recommendations for youth running has not been previously conducted. Unique factors for injury include periods of growth during puberty and potential for growth plate injury. Youth runners may benefit from activities that incorporate high-impact loading and multidirectional movement for optimal bone maturation, exercises to strengthen tendons and muscles, and strategies aimed at improving running biomechanics to reduce risk of injury. In addition, addressing lifestyle factors, including nutrition and sleep is essential for a runner's general health. Similar to other sports, sports specialization should not be encouraged in youth runners. Reducing running-related injury in growing children and assessing readiness for running should be based on a combination of physical, emotional, psychological, social, and cognitive factors. Youth runners require individualized training and competition to safely participate in the sport.
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Affiliation(s)
- Brian J Krabak
- Rehabilitation, Orthopedics, and Sports Medicine, University of Washington and Seattle Children's Sports Medicine, Seattle, WA
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, MA
| | - Irene S Davis
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA.,Spaulding National Running Center, Cambridge, MA
| | - Michael Fredericson
- Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Mark A Harrast
- Rehabilitation, Orthopedics, and Sports Medicine, University of Washington, Seattle, WA
| | | | - Anthony C Luke
- UCSF Primary Care Sports Medicine, UCSF Department of Orthopaedics, UCSF Department of Family and Community Medicine, San Francisco, CA
| | - William O Roberts
- Department of Family Medicine, University of Minnesota Medical School, Minneapolis, MN
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Ghasemi SH, Kalantari H, Abdollahikho SS, Nowak AS. Fatigue reliability analysis for medial tibial stress syndrome. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 99:387-393. [PMID: 30889713 DOI: 10.1016/j.msec.2019.01.076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 01/03/2019] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
Abstract
Medial Tibial Stress Syndrome MTSS is frequently diagnosed as a severe clinical issue which occurs due to the cycle loadings (fatigue failure). Since the mechanical properties of the bones are random variables, therefore, there is a need for a probabilistic approach to rationally assess the reliability level of the fatigue failure of the tibia. The main contribution of this paper is to introduce a novel limit state function to determine the fatigue damage state and the reliability index of MTSS based on the different loading and aging conditions. In this study, the tibias of the several people at the different ages are subjected to the fatigue loadings. The load carrying capacities of the considered specimen are determined based on the reliability analysis. Indeed, several 3D finite element analyses are performed to find out the damage states of the tibias. Accordingly, the reliability-based stress analysis is accomplished to localize the most vulnerable zone of the bone. As it was expected, the higher loading cycles associated with the elder bones is related to the lowest fatigue reliability level. Finally, the target reliability level of MTSS is proposed to deliberate the safe level of the loading condition on the tibia in terms of the walking distance.
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Affiliation(s)
- Seyed Hooman Ghasemi
- Department of Civil Engineering, Qazvin Branch, Islamic Azad University, Qazvin 14778-93855, Iran; Department of Civil Engineering, Auburn University, USA.
| | - Hamidreza Kalantari
- Department of Civil Engineering, Qazvin Branch, Islamic Azad University, Qazvin 14778-93855, Iran
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Naderi A, Degens H, Sakinepoor A. Arch-support foot-orthoses normalize dynamic in-shoe foot pressure distribution in medial tibial stress syndrome. Eur J Sport Sci 2018; 19:247-257. [DOI: 10.1080/17461391.2018.1503337] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Aynollah Naderi
- Department of Health and Corrective Exercise, School of Physical Education and Sport Sciences, Shahrood University of Technology, Shahrood, Iran
| | - Hans Degens
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
- Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
| | - Ainollah Sakinepoor
- Department of Physical Education and Sport Science, Faculty of Human Science Borujerd Branch, Islamic Azad University Borujerd, Borujerd, Iran
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Hammad YN, Johnson A, Norrish A. Chronic osteomyelitis of the tibia in a runner: catastrophic consequences of shin splints. BMJ Case Rep 2018; 2018:bcr-2017-223186. [PMID: 29496686 DOI: 10.1136/bcr-2017-223186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Medial tibial stress syndrome and chronic osteomyelitis are conditions that are traditionally thought to affect very different patient groups. We present a case of shin splints in a recreational long-distance runner, complicated by chronic osteomyelitis of the tibia. This is a unique case in which the microtrauma resulting from shin splints was implicated as an entry point for bacterial infection into the bone. Clinical evaluation and bone biopsy culture results indicated haematogenous spread of bacteria originating from the oral cavity. The patient required surgical resection of the affected bone and a prolonged course of intravenous antibiotic treatment. We illustrate that when shin splints show signs of acute inflammation with delayed recovery, the possibility of osteomyelitis should be kept in mind.
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Affiliation(s)
| | - Abigail Johnson
- Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge, UK
| | - Alan Norrish
- Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge, UK
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Gomez Garcia S, Ramon Rona S, Gomez Tinoco MC, Benet Rodriguez M, Chaustre Ruiz DM, Cardenas Letrado FP, Lopez-Illescas Ruiz Á, Alarcon Garcia JM. Shockwave treatment for medial tibial stress syndrome in military cadets: A single-blind randomized controlled trial. Int J Surg 2017; 46:102-109. [PMID: 28882773 DOI: 10.1016/j.ijsu.2017.08.584] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/26/2017] [Accepted: 08/17/2017] [Indexed: 02/09/2023]
Abstract
Medial tibial stress syndrome (MTSS) is a common injury in athletes and soldiers. Several studies have demonstrated the effectiveness of extracorporeal shockwave treatment (ESWT) in athletes with MTSS. OBJECTIVE To assess whether one session of focused ESWT is effective in the treatment of military cadets with MTSS. DESIGN A randomized, prospective, controlled, single-blind, parallel-group clinical study. LEVEL OF EVIDENCE Ib. SETTING Military School of Cadets of the Colombian Army. METHODS Forty-two military cadets with unilateral chronic MTSS were randomly assigned to either one session of focused electromagnetic ESWT (1500 pulses at 0.20 mJ/mm2) plus a specific exercise programme (muscle stretching and strengthening exercises) or the exercise programme alone. The primary endpoint was change in asymptomatic running test (RT) duration at four weeks from baseline. Secondary endpoints were changes in the visual analogue scale (VAS) after running and modified Roles and Maudsley (RM) score also at four weeks from baseline. RESULTS ESWT patients were able to run longer. Mean RT after four weeks was 17 min 33 s (SE: 2.36) compared to 4 min 48 s (SE: 1.03) in the exercise-only group (p = 0.000). Mean VAS after running was 2.17 (SE: 0.44) in the ESWT group versus 4.26 (SE: 0.36) in the exercise-only group (p = 0.001). The ESWT group had a significantly higher RM score, with excellent or good results for 82.6% of patients vs. 36.8% in the exercise-only group (p = 0.002). No significant adverse effects of ESWT were observed. CONCLUSION A single application of focused shockwave treatment in combination with a specific exercise programme accelerates clinical and functional recovery in military cadets with MTSS.
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Affiliation(s)
- Santiago Gomez Garcia
- Orthopaedic Surgeon and Sports Medicine Physician, Military School of Cadets of the Colombian Army, Calle 80 No. 38-00, Bogotá, Colombia.
| | - Silvia Ramon Rona
- Director of Physical Medicine and Rehabilitation Department, Hospital Quirón, Garcia Cugat Foundation CEU-UCH Chair of Medicine and Regenerative, International University of Catalonia, Plaça d'Alfonso Comín, 5-7, 08023, Barcelona, Spain.
| | - Martha Claudia Gomez Tinoco
- Psychology Unit of the Academic Vice-Rectory, Military School of Cadets of the Colombian Army, Calle 80 No. 38-00, Bogotá, Colombia.
| | | | - Diego Mauricio Chaustre Ruiz
- Department of Physical Medicine and Rehabilitation, Central Military Hospital, Transversal 3 No.49-00, Bogotá, Colombia.
| | | | - África Lopez-Illescas Ruiz
- Director of Physical Rehabilitation Unit, National Sports Medicine Center, Higher Sports Council, C/ Pintor El Greco S/N, 28040, Madrid, Spain.
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Newman P, Waddington G, Adams R. Shockwave treatment for medial tibial stress syndrome: A randomized double blind sham-controlled pilot trial. J Sci Med Sport 2017; 20:220-224. [DOI: 10.1016/j.jsams.2016.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 06/19/2016] [Accepted: 07/13/2016] [Indexed: 02/02/2023]
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Abstract
Exertional leg pain is a common condition seen in runners and the general population. Given the broad differential diagnosis of this complaint, this article focuses on the incidence, anatomy, pathophysiology, clinical presentation, diagnostic evaluation, and management of common causes that include medial tibial stress syndrome, tibial bone stress injury, chronic exertional compartment syndrome, arterial endofibrosis, popliteal artery entrapment syndrome, and entrapment of the common peroneal, superficial peroneal, and saphenous nerves. Successful diagnosis of these conditions hinges on performing a thorough history and physical examination followed by proper diagnostic testing and appropriate management.
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Affiliation(s)
- Sathish Rajasekaran
- Department of Orthopaedics and Rehabilitation, University of Iowa Sports Medicine, 2701 Prairie Meadow Drive, Iowa City, IA 52242, USA; Division of Physical Medicine and Rehabilitation, University of Alberta, 10230 111 Avenue Northwest, Edmonton, AB T5G 0B7, Canada.
| | - Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, Mayo Clinic School of Medicine, 200 1st St SW, Rochester, MN 55905, USA; Department of Physical Medicine and Rehabilitation, University of California Davis School of Medicine, 4860 Y Street, Sacramento, CA 95817, USA; Mayo Clinic Sports Medicine Center, Mayo Clinic Square, 600 Hennepin Avenue, Suite 310, Minneapolis, MN 55403, USA
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Abstract
We present a case of a bilateral synchronous stress fracture of the tibia in a young female basketball player. The patient was initially referred for ultrasound and radiographs of the knees to exclude Osgood-Schlatter disease. Radiographs and subsequent MRI revealed bilateral stress fractures of the proximal tibia. A synchronous and symmetrical occurrence of stress fractures in the lower limbs is unusual. As clinical presentation is often nonspecific, appropriate imaging (plain films and MRI) plays a pivotal role in the correct diagnosis of this uncommon entity.
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Kudo S, Hisada T, Sato T. Determination of the fascicle length of the gastrocnemius muscle during calf raise exercise using ultrasonography. J Phys Ther Sci 2016; 27:3763-6. [PMID: 26834347 PMCID: PMC4713786 DOI: 10.1589/jpts.27.3763] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/17/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to find a strength training protocol which maintains isometric contraction of the triceps surae during dorsal flexion of the ankle. [Subjects] The left feet of 22 young normal volunteers who did not have orthopedic injuries or lower limb pain participated in this study. [Methods] All subjects performed four sets of five repetitions of four sets calf-raise (CR) exercise at were (1) 60 bpm without a pedestal, (2) 60 bpm with a pedestal, (3) 90 bpm without a pedestal, and (4) 90 bpm with a pedestal. The fascicle length of the lateral head of the gastrocnemius and ankle angle were measured using ultrasonography and a video camera. The CR exercise was divided into two or three phases using the kinematics of the ankle. The average change in fascicle length over the five repetitions of each phase were compared. [Results] The change of the fascicle length during the hyper-dorsiflexion phase was significantly smaller than during the other two phases. [Conclusion] It is possible that eccentric CR exercises have progressed to motor learning of the isometric contraction during counter movement, and improved the release of elastic energy of the Achilles tendon during running, jumping, and other athletic activities.
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Affiliation(s)
- Shintarou Kudo
- Department of Physical Therapy, Morinomiya University of Medical Sciences, Japan; Gradutate School of Health Science, Suzuka University of Medical Science, Japan
| | - Tomoyuki Hisada
- Gradutate School of Health Science, Suzuka University of Medical Science, Japan
| | - Takanori Sato
- Department of Physical Therapy, International Institute of Medical Therapy, Japan
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Abstract
Currently, the exact role of telocytes within fascial structures is unknown. The morphology, distribution and behaviour of fascial telocytes as well as the mutual relationship between telocytes and other cellular fascia constituents should be definitely a subject of further studies. It will contribute to better understanding of the role of the fascial system in health and diseases, may shed light on the regeneration potential of these tissues and may help to find targets for future treatments for locomotor disorders, including fascial diseases. Last but not least, confirmation of the presence of telocytes within fascia may contribute to optimise the use of fascia as a graft material.
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Abstract
PURPOSE To investigate the association between medial tibial stress syndrome (MTSS) and morphology and flexibility of the foot arches. METHODS 131 feet from 74 healthy subjects and 31 feet from 27 patients with MTSS were classified as normal feet (n=78 in 40 subjects), flat feet (n=53 in 34 subjects), or MTSS feet (n=31 in 27 patients). The medial longitudinal arch (MLA) ratio and the transverse arch length (TAL) were measured in both rearfoot and forefoot loading positions. The difference between the 2 positions indicated the flexibility of the MLA (diff-MLA ratio) and the transverse arch (diff- TAL). RESULTS The MLA ratio was higher in normal feet than MTSS feet or flat feet (15.1% vs. 12.8% vs. 12.3%, p<0.001). The diff-TAL was lower in MTSS feet than normal feet or flat feet (0.4% vs. 0.8% vs. 0.9%, p<0.001]). The 3 groups were comparable in terms of the diff-MLA ratio and the TAL. Respectively for the MLA ratio and the diff-TAL, the cut-off value was 11.9% and 0.61% based on the Youden index. The sensitivity, specificity, and odds ratio of the cut-off value were 0.4, 0.9, and 4.8 for the MLA ratio, and 0.6, 0.7, and 9.8 for the diff-TAL, respectively. CONCLUSION Decreased flexibility of the transverse arch and decreased MLA ratio are risk factors for MTSS. In contrast, the flexibility of the MLA and the height of the transverse arch were not risk factors for MTSS.
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Affiliation(s)
- Shintarou Kudo
- Graduate School of Health Science, Suzuka University of Medical Science, Japan & Department of Physical Therapy, Morinomiya University of Medical Sciences, Japan
| | - Yasuhiko Hatanaka
- Department of Physiotherapy, Suzuka University of Medical Science, Japan
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Luedke LE, Heiderscheit BC, Williams DB, Rauh MJ. ASSOCIATION OF ISOMETRIC STRENGTH OF HIP AND KNEE MUSCLES WITH INJURY RISK IN HIGH SCHOOL CROSS COUNTRY RUNNERS. Int J Sports Phys Ther 2015; 10:868-876. [PMID: 26618066 PMCID: PMC4637921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND High school cross country runners have a high incidence of overuse injuries, particularly to the knee and shin. As lower extremity strength is modifiable, identification of strength attributes that contribute to anterior knee pain (AKP) and shin injuries may influence prevention and management of these injuries. PURPOSE To determine if a relationship existed between isometric hip abductor, knee extensor and flexor strength and the incidence of AKP and shin injury in high school cross country runners. MATERIALS/METHODS Sixty-eight high school cross country runners (47 girls, 21 boys) participated in the study. Isometric strength tests of hip abductors, knee extensors and flexors were performed with a handheld dynamometer. Runners were prospectively followed during the 2014 interscholastic cross country season for occurrences of AKP and shin injury. Bivariate logistic regression was used to examine risk relationships between strength values and occurrence of AKP and shin injury. RESULTS During the season, three (4.4%) runners experienced AKP and 13 (19.1%) runners incurred a shin injury. Runners in the tertiles indicating weakest hip abductor (chi-square = 6.140; p=0.046), knee extensor (chi-square = 6.562; p=0.038), and knee flexor (chi-square = 6.140; p=0.046) muscle strength had a significantly higher incidence of AKP. Hip and knee muscle strength was not significantly associated with shin injury. CONCLUSIONS High school cross country runners with weaker hip abductor, knee extensor and flexor muscle strength had a higher incidence of AKP. Increasing hip and knee muscle strength may reduce the likelihood of AKP in high school cross country runners. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Lace E. Luedke
- Department of Kinesiology, University of Wisconsin –Oshkosh, Oshkosh, WI, USA
| | - Bryan C. Heiderscheit
- Department of Orthopedics and Rehabilitation, Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA
| | | | - Mitchell J. Rauh
- Doctor of Physical Therapy Program, San Diego State University, San Diego, CA
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Franklyn M, Oakes B. Aetiology and mechanisms of injury in medial tibial stress syndrome: Current and future developments. World J Orthop 2015; 6:577-589. [PMID: 26396934 PMCID: PMC4573502 DOI: 10.5312/wjo.v6.i8.577] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 05/31/2015] [Accepted: 07/27/2015] [Indexed: 02/06/2023] Open
Abstract
Medial tibial stress syndrome (MTSS) is a debilitating overuse injury of the tibia sustained by individuals who perform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, in most cases it is also an injury involving underlying cortical bone microtrauma, although it is not clear if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and magnetic resonance imaging (MRI) can both be used for the diagnosis of MTSS, but the patient’s history and clinical symptoms need to be considered in conjunction with the imaging findings for a correct interpretation of the results, as both imaging modalities have demonstrated positive findings in the absence of injury. However, MRI is rapidly becoming the preferred imaging modality for the diagnosis of bone stress injuries. It can also be used for the early diagnosis of MTSS, as the developing periosteal oedema can be identified. Retrospective studies have demonstrated that MTSS patients have lower bone mineral density (BMD) at the injury site than exercising controls, and preliminary data indicates the BMD is lower in MTSS subjects than tibial stress fracture (TSF) subjects. The values of a number of tibial geometric parameters such as cross-sectional area and section modulus are also lower in MTSS subjects than exercising controls, but not as low as the values in TSF subjects. Thus, the balance between BMD and cortical bone geometry may predict an individual's likelihood of developing MTSS. However, prospective longitudinal studies are needed to determine how these factors alter during the development of the injury and to find the detailed structural cause, which is still unknown. Finite element analysis has recently been used to examine the mechanisms involved in tibial stress injuries and offer a promising future tool to understand the mechanisms involved in MTSS. Contemporary accurate diagnosis of either MTSS or a TSF includes a thorough clinical examination to identify signs of bone stress injury and to exclude other pathologies. This should be followed by an MRI study of the whole tibia. The cause of the injury should be established and addressed in order to facilitate healing and prevent future re-occurrence.
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Toepfer A, Harrasser N, Lenze U, Liska F, Mühlhofer H, von Eisenhart-Rothe R, Banke IJ. Bilateral diaphyseal bone cysts of the tibia mimicking shin splints in a young professional athlete--a case report and depiction of a less-invasive surgical technique. BMC Musculoskelet Disord 2015; 16:220. [PMID: 26296652 PMCID: PMC4546294 DOI: 10.1186/s12891-015-0668-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 08/10/2015] [Indexed: 11/22/2022] Open
Abstract
Background Medial tibial stress syndrome is one of the most common causes of exertional leg pain in runners whereas musculoskeletal tumors and tumor-like lesions are rare encounters in orthopedic sports medicine practice. Unicameral (simple) bone cyst is a well-known tumor-like lesions of the bone typically affecting children and adolescents. Bilateral occurrence is very rare though and has never been reported before in both tibiae. Failing to accurately diagnose a tumorous lesion can entail far-reaching consequences for both patients and physicians. Case presentation We report the case of large bilateral unicameral bone cysts of the diaphyseal tibiae mimicking medial tibial stress syndrome in a 17-year old professional athlete. This is the first report of symmetric tibial unicameral bone cysts in the literature. The patient complained about persisting shin splint-like symptoms over 5 months despite comprehensive conservative treatment before MRI revealed extensive osteolytic bone lesions in both diaphyseal tibiae. The patient-tailored, less-invasive surgical procedure, allowing the patient to return to his competitive sports level symptom-free 3 months after surgery and to eventually qualify for this years Biathlon Junior World Championships, is outlined briefly. Pathogenesis and various treatment options for this entity will be discussed. Conclusion This report will help to raise awareness for musculoskeletal tumors as differential diagnosis for therapy-refractory symptoms in young athletes and encourage medical staff involved in sports medicine and athlete support to perform early high quality imaging and initiate sufficient surgical treatment in similar cases. Moreover, our less-invasive surgical procedure aiming for a fast return to sports might be an optimal compromise between traditional open curettage with low risk of recurrence and a soft tissue-saving and bone-sparing minimal-invasive technique.
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Affiliation(s)
- Andreas Toepfer
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Norbert Harrasser
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Ulrich Lenze
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Franz Liska
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Heinrich Mühlhofer
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Rüdiger von Eisenhart-Rothe
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Ingo J Banke
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstr. 22, 81675, Munich, Germany.
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Massage treatment and medial tibial stress syndrome; A commentary to provoke thought about the way massage therapy is used in the treatment of MTSS. J Bodyw Mov Ther 2015; 19:447-52. [DOI: 10.1016/j.jbmt.2014.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/17/2014] [Accepted: 11/02/2014] [Indexed: 11/13/2022]
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Burrus MT, Werner BC, Starman JS, Gwathmey FW, Carson EW, Wilder RP, Diduch DR. Chronic leg pain in athletes. Am J Sports Med 2015; 43:1538-47. [PMID: 25157051 DOI: 10.1177/0363546514545859] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Chronic leg pain is commonly treated by orthopaedic surgeons who take care of athletes. The sources are varied and include the more commonly encountered medial tibial stress syndrome, chronic exertional compartment syndrome, stress fracture, popliteal artery entrapment syndrome, nerve entrapment, Achilles tightness, deep vein thrombosis, and complex regional pain syndrome. Owing to overlapping physical examination findings, an assortment of imaging and other diagnostic modalities are employed to distinguish among the diagnoses to guide the appropriate management. Although most of these chronic problems are treated nonsurgically, some patients require operative intervention. For each condition listed above, the pathophysiology, diagnosis, management option, and outcomes are discussed in turn.
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Affiliation(s)
- M Tyrrell Burrus
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jim S Starman
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - F Winston Gwathmey
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Eric W Carson
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Robert P Wilder
- Physical Medicine and Rehabilitation Department, University of Virginia Health System, Charlottesville, Virginia, USA
| | - David R Diduch
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
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Sharma J, Greeves JP, Byers M, Bennett AN, Spears IR. Musculoskeletal injuries in British Army recruits: a prospective study of diagnosis-specific incidence and rehabilitation times. BMC Musculoskelet Disord 2015; 16:106. [PMID: 25935751 PMCID: PMC4443544 DOI: 10.1186/s12891-015-0558-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 04/17/2015] [Indexed: 11/10/2022] Open
Abstract
Background Musculoskeletal injuries during initial military training are a significant medical problem facing military organisations globally. In order to develop an injury management programme, this study aims to quantify the incidence and rehabilitation times for injury specific diagnoses. Methods This was a prospective follow-up study of musculoskeletal injuries in 6608 British Army recruits during a 26-week initial military training programme over a 2-year period. Incidence and rehabilitation times for injury specific diagnoses were recorded and analysed. Results During the study period the overall incidence of musculoskeletal injuries was 48.6%, and the most common diagnosis was iliotibial band syndrome (6.2%). A significant proportion of the injuries occurred during the first 11 weeks of the programme. The longest rehabilitation times were for stress fractures of the femur, calcaneus and tibia (116 ± 17 days, 92 ± 12 days, and 85 ± 11 days, respectively). The combination of high incidence and lengthy rehabilitation indicates that medial tibial stress syndrome had the greatest impact on training, accounting for almost 20% of all days spent in rehabilitation. Conclusion When setting prevention priorities consideration should be given to both the incidence of specific injury diagnoses and their associated time to recovery.
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Affiliation(s)
- Jagannath Sharma
- Medical Centre Defence Primary Healthcare, Infantry Training Centre Catterick Garrison, DL9 3PS, North Yorkshire, UK. .,School of Social Sciences and Law, Teesside University, TS1 3BA, Middlesbrough, UK.
| | - Julie P Greeves
- Department of Occupational Medicine, HQ Army Recruiting and Training Division, Trenchard Lines, SN9 6BE, Upavon, Wilts, UK.
| | - Mark Byers
- Medical Centre Defence Primary Healthcare, Infantry Training Centre Catterick Garrison, DL9 3PS, North Yorkshire, UK.
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation DMRC Headley Court, KT18 6JW, Surrey, UK.
| | - Iain R Spears
- School of Social Sciences and Law, Teesside University, TS1 3BA, Middlesbrough, UK.
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36
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Bonasia DE, Rosso F, Cottino U, Rossi R. Exercise-induced leg pain. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2015; 2:73-84. [PMID: 29264244 PMCID: PMC5730650 DOI: 10.1016/j.asmart.2015.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/11/2015] [Accepted: 03/27/2015] [Indexed: 12/03/2022]
Abstract
Exercise-induced leg pain is a common condition in athletes and in people involved in recreational sports. The diagnosis is not always straightforward: many conditions may cause exercise-induced leg pain. The aim of the present review is to provide a complete discussion of the most common pathologies related to this condition. Particular attention is dedicated to the history and the physical examination, which are fundamental for requesting the correct diagnostic tests or imaging techniques necessary for a precise diagnosis.
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Affiliation(s)
- Davide Edoardo Bonasia
- Department of Orthopaedics and Traumatology, AO Città della Salute e della Scienza, Torino, Italy
| | - Federica Rosso
- Department of Orthopaedics and Traumatology, AO Mauriziano Umberto I, Torino, Italy
| | - Umberto Cottino
- Department of Orthopaedics and Traumatology, University of Torino, Torino, Italy
| | - Roberto Rossi
- Department of Orthopaedics and Traumatology, AO Mauriziano Umberto I, Torino, Italy
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Treatment of medial tibial stress syndrome according to the fascial distortion model: a prospective case control study. ScientificWorldJournal 2014; 2014:790626. [PMID: 25379543 PMCID: PMC4212583 DOI: 10.1155/2014/790626] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 09/08/2014] [Accepted: 09/09/2014] [Indexed: 12/21/2022] Open
Abstract
Medial tibial stress syndrome (MTSS) is a common problem among athletes and soldiers. There is no proven theory that could explain the pathophysiology of shin splints. The therapies described so far are time-consuming and involve a high risk of relapse. The method according to the fascial distortion model (FDM) addresses local changes in the area of the lower leg fascia. It is suited to reduce pain and functional impairments associated with this symptom complex by applying targeted manual techniques. 32 patients (male: 30; female: 2) participated in this study. Visual analogue scale (VAS) was used for the quantification of pain. Scores were also given to rate the maximum painless exercise tolerance of the patients. Subsequently treatment of the crural fascia was performed. Patients retested ability of running and jumping. Therapy was continued until full exercise tolerance or painlessness was reached. A significant reduction of the VAS pain score from 5.2 to 1.1 could be achieved (P < 0.001). The impairment of exercise tolerance could be reduced from 7 to 2 points (P < 0.001). The duration of treatment was 6.3 (SD: 4.3) days on average. The FDM therapy is a potential effective method for acute treatment of MTSS.
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Franettovich Smith MM, Coates SS, Creaby MW. A comparison of rigid tape and exercise, elastic tape and exercise and exercise alone on pain and lower limb function in individuals with exercise related leg pain: a randomised controlled trial. BMC Musculoskelet Disord 2014; 15:328. [PMID: 25274252 PMCID: PMC4201713 DOI: 10.1186/1471-2474-15-328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 09/19/2014] [Indexed: 11/20/2022] Open
Abstract
Background Exercise related leg pain (ERLP) is a common lower limb overuse injury characterised by pain located between the knee and ankle that occurs during activity. The high incidence of the condition, subsequent interference with participation in physical activity and substantial recovery time, highlights a need for effective interventions. Whilst many interventions have been described for the management of ERLP, currently there is a lack of high quality evidence for an effective intervention for the condition. Methods/Design A single-blinded randomised controlled clinical trial will be conducted in a community setting. Forty-five female volunteers aged between 18 and 40 years with a history of insidious onset of pain located between the knee and ankle of at least one month duration that is aggravated by weight bearing activities will be recruited for the study. Suitable participants will be randomly allocated to one of three treatment groups for the 6 week intervention period: (i) exercise only, (ii) rigid anti-pronation tape and exercise, (iii) elastic anti-pronation tape and exercise. Outcomes will be measured at baseline, 1, 2 and 6 weeks using primary outcome measures of usual and worst pain visual analogue scale and global perceived improvement. Secondary outcome measures will include Foot and Ankle Ability Measure, Patient Specific Functional Scale and amount of activity in the previous week. In addition, participants will be contacted by phone to obtain primary and secondary outcome measures at 12, 18, 24 and 30 weeks. Discussion This article describes a single-blinded randomised controlled clinical trial that will utilise high quality methodologies in accordance with CONSORT guidelines. The results of this study will contribute to the limited knowledge regarding effective interventions for the management of ERLP. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN12613000914763) Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-328) contains supplementary material, which is available to authorized users.
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Brewer RB, Gregory AJM. Chronic lower leg pain in athletes: a guide for the differential diagnosis, evaluation, and treatment. Sports Health 2012; 4:121-7. [PMID: 23016078 PMCID: PMC3435913 DOI: 10.1177/1941738111426115] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Context: Chronic lower leg pain in athletes can be a frustrating problem for patients and a difficult diagnosis for clinicians. Myriad approaches have been suggested to evaluate these conditions. With the continued evolution of diagnostic studies, evidence-based guidance for a standard approach is unfortunately sparse. Evidence Acquisition: PubMed was searched from January 1980 to May 2011 to identify publications regarding chronic lower leg pain in athletes (excluding conditions related to the foot), including differential diagnosis, clinical presentation, physical examination, history, diagnostic workup, and treatment. Results: Leg pain in athletes can be caused by many conditions, with the most frequent being medial tibial stress syndrome; chronic exertional compartment syndrome, stress fracture, nerve entrapment, and popliteal artery entrapment syndrome are also considerations. Conservative management is the mainstay of care for the majority of causes of chronic lower leg pain; however, surgical intervention may be necessary. Conclusion: Chronic lower extremity pain in athletes includes a wide differential and can pose diagnostic dilemmas for clinicians.
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Tenforde AS, Sayres LC, McCurdy ML, Collado H, Sainani KL, Fredericson M. Overuse injuries in high school runners: lifetime prevalence and prevention strategies. PM R 2011; 3:125-31; quiz 131. [PMID: 21333951 DOI: 10.1016/j.pmrj.2010.09.009] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 09/13/2010] [Accepted: 09/17/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate lifetime prevalence and risk factors for overuse injuries in high school athletes currently participating in long-distance running and provide recommendations for injury prevention strategies. DESIGN Retrospective study design. SETTING Twenty-eight high schools in the San Francisco Bay Area. PARTICIPANTS A total of 442 female and 306 male athletes, ages 13-18 years, who are on cross-country and track and field teams. METHODS Online survey with questions that detailed previous injuries sustained and risk factors for injury. MAIN OUTCOME MEASUREMENTS Previous overuse injuries and association of risk factors to injury (including training variables, dietary patterns, and, in girls, menstrual irregularities). RESULTS Previous injuries were reported by 68% of female subjects and 59% of male subjects. More injury types were seen in girls (1.2 ± 1.1 versus 1.0 ± 1.0, P < .01). Both genders had similar participation in running (2.5 ± 2.2 versus 2.3 ± 2.1 years), and previous injury prevalence followed a similar pattern: tibial stress injury (girls, 41%; boys, 34%), ankle sprain (girls, 32%; boys, 28%), patellofemoral pain (girls, 21%; boys, 16%), Achilles tendonitis (girls, 9%; boys, 6%), iliotibial band syndrome (girls, 7%; boys, 5%), and plantar fasciitis (girls, 5%; boys, 3%). Higher weekly mileage was associated with previous injuries in boys, (17.1 ± 11.9 versus 14.1 ± 11.5, P < .05) but not in girls (14.4 ± 10.2 versus 12.6 ± 11.8, not significant). A strong association between higher mileage and faster performances was seen in both groups. No association between previous injury and current dietary patterns (including disordered eating and calcium intake) or menstrual irregularities was seen. CONCLUSIONS The majority of athletes currently participating in high school cross-country and track and field have a history of sustaining an overuse injury, with girls having a higher prevalence of injury. A modest mileage reduction may represent a modifiable risk factor for injury reduction. Future research is needed to evaluate the effects of incorporating a comprehensive strength training program on the prospective development of overuse injury and performance in this population.
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Affiliation(s)
- Adam S Tenforde
- Division of Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, Stanford University, Stanford, CA 94063, USA
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