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Boer PH, Schwellnus MP, Jordaan E. Chronic diseases and allergies are risk factors predictive of a history of Medial Tibial Stress Syndrome (MTSS) in distance runners: SAFER study XXIV. PHYSICIAN SPORTSMED 2023; 51:166-174. [PMID: 35073241 DOI: 10.1080/00913847.2021.2021597] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Medial Tibial Stress Syndrome (MTSS) is one of the most common causes of exercise-associated lower leg pain in distance runners. AIM To identify risk factors predictive of a history of MTSS in distance runners entering the Two Oceans Marathon races (21.1 km and 56 km). DESIGN Cross-sectional study. SETTING 2012 to 2015 Two Oceans Marathon races (21.1 km and 56 km). PARTICIPANTS Consenting race entrants. METHODS 106,743 race entrants completed an online pre-race medical screening questionnaire. 76,654 consenting runners (71.8%) were studied. 558 verified MTSS injuries were reported in the previous 12 months. Risk factors predictive of a history of MTSS were explored using uni - & multivariate analyses: demographics (race distance, sex, and age groups), training/racing history, history of chronic diseases, allergies, and medication use. RESULTS Independent risk factors predictive of a history of MTSS (adjusted for sex, age group, and race distance) were a higher chronic disease composite score (PR = 3.1 times increase risk for every two additional chronic diseases; p < 0.0001) and a history of allergies (PR = 1.9; p < 0.0001). Chronic diseases (PR > 2) predictive of a history of MTSS were: symptoms of CVD (PR = 4.2; p < 0.0001); GIT disease (PR = 3.3; p < 0.0001); kidney/bladder disease (PR = 3.3; p < 0.0001); nervous system/psychiatric disease (PR = 3.2; p < 0.0001); respiratory disease (PR = 2.9; p < 0.0001) a history of CVD (PR = 2.9; p < 0.0001); and risk factors of CVD (PR = 2.4; p < 0.0001) (univariate analysis). Average running speed was associated with higher risk of MTSS. CONCLUSION Novel independent risk factors predictive of a history of MTSS in distance runners (56 km, 21.1 km) were multiple chronic diseases and a history of allergies. Identifying athletes at higher risk for MTSS can guide healthcare professionals in their prevention and rehabilitation efforts.
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Affiliation(s)
- Pieter-Henk Boer
- Department of Human Movement Science, Cape Peninsula University of Technology, Wellington, South Africa
| | - Martin P Schwellnus
- Sport Exercise Medicine and Lifestyle Institute (Semli), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- International Olympic Committee (IOC) Research Centre, South Africa
- Emeritus Professor, Faculty of Health Sciences, University of Cape Town Rondebosch South Africa
| | - Esmè Jordaan
- Biostatistics Unit, South African Medical Research Council, South Africa
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2
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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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Okunuki T, Magoshi H, Maemichi T, Liu Z, Tanaka H, Matsumoto M, Hoshiba T, Kumai T. The prevalence and effect of the sites of pain in female soccer players with medial shin pain. J Sports Med Phys Fitness 2023; 63:111-120. [PMID: 35333031 DOI: 10.23736/s0022-4707.22.13655-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Female soccer players are often diagnosed with medial shin pain, which includes tibial stress fracture, medial tibial stress syndrome, and chronic exertional compartment syndrome. As the possibility of varied sites of pain affecting sports activities has not been fully researched, an urgent discussion and evidence is required. This study investigates the prevalence and effect of sites of pain on the sports activities of female soccer players with medial shin pain. METHODS A questionnaire survey was conducted for 196 female soccer players with medial shin pain to assess symptom duration, the effect of practice and performance, and sites of pain. The players were classified into three conditions (tibial stress fracture, medial tibial stress syndrome, or medial shin pain with neurological symptoms) and compared based on sites of pain. RESULTS We observed that medial tibial stress syndrome had a lower impact on performance compared to that of tibial stress fracture and medial shin pain with neurological symptoms. While participants with tibial stress fracture had to suspend practice sessions more frequently, the difference in symptom duration between the classified groups was not statistically significant. The effect of sites of pain on sports activities was not significantly different in participants with medial tibial stress syndrome. CONCLUSIONS Medial shin pain should be evaluated carefully to differentiate between medial tibial stress syndrome and medial shin pain with neurological symptoms. Restriction of sports activities may help improve the patient's condition early, regardless of the presentation.
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Affiliation(s)
- Takumi Okunuki
- Graduate School of Sport Sciences, Waseda University, Saitama, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Hirohisa Magoshi
- Department of Rehabilitation, Hachioji Sports Orthopedic Clinic, Tokyo, Japan
| | | | - Zijian Liu
- Graduate School of Sport Sciences, Waseda University, Saitama, Japan
| | - Hirofumi Tanaka
- Graduate School of Sport Sciences, Waseda University, Saitama, Japan.,Hyakutake Orthopedic and Sports Clinic, Saga, Japan
| | - Masatomo Matsumoto
- Graduate School of Sport Sciences, Waseda University, Saitama, Japan.,Kuwana City Medical Center, Mie, Japan
| | - Takuma Hoshiba
- Waseda Institute for Sport Sciences, Waseda University, Saitama, Japan
| | - Tsukasa Kumai
- Faculty of Sport Sciences, Waseda University, Saitama, Japan -
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Zarei M, Soltanirad S, Kazemi A, Hoogenboom BJ, Hosseinzadeh M. Composite functional movement screen score predicts injuries in youth volleyball players: a prospective cohort study. Sci Rep 2022; 12:20207. [PMID: 36418436 PMCID: PMC9684421 DOI: 10.1038/s41598-022-24508-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022] Open
Abstract
We aimed to investigate whether composite Functional Movement Screen (FMS) test scores can predict musculoskeletal injuries (MSI) in youth volleyball players. 131 national young volleyball players (Males: n = 100, age = 16.5 years, height = 1.787 m, mass = 68.32 kg; Females: n = 31, age = 13.83 years, height = 1.684 m, mass = 65.12 kg) participated in this prospective cohort study. The FMS screen was performed before starting the season. MSI and exposure data were collected during the season via each team's certified athletic trainer. The mean FMS score and standard deviation for all volleyball players was 15.85 ± 3.31. A score of ≤ 14 was positive to predict MSI with specificity of 0.60 and sensitivity of 0.93. The odds ratio for (≤ 14/˃14) was 0.048. The relative risk for being injured was 3.46. Positive likelihood ratio was 2.34, and negative likelihood ratio was 0.11. The findings of this study demonstrated that an FMS score of ≤ 14 is an identifiable risk factor for injury in young volleyball players. The FMS can be used as a pre-season screening test to identify volleyball players who may be predisposed to sustaining MSI during the season ahead.
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Affiliation(s)
- Mostafa Zarei
- grid.412502.00000 0001 0686 4748Sport Rehabilitation and Health Department, Faculty of Sports Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Shabnam Soltanirad
- grid.472472.00000 0004 1756 1816Department of Sport Injuries and Corrective Exercise, Islamic Azad University Tehran Science and Research Branch (Oloom Tahghighat), Tehran, Iran
| | - Abdolreza Kazemi
- grid.444845.dDepartment of Physical Education, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | | | - Mahdi Hosseinzadeh
- Department of Sport Injuries and Corrective Exercises, Sport Sciences Research Institute, No. 3, 5th Alley, Miremad Street, Motahhari Street, PO Box 1587958711, Tehran, Iran
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5
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Development of a trail running injury screening instrument: A multiple methods approach. Phys Ther Sport 2022; 56:60-75. [DOI: 10.1016/j.ptsp.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022]
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6
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Jardim RAC, Monteiro RL, Landre CB, Pegorari MS, Iosimuta NCR, Matos AP. Isokinetic ankle muscle strength is reduced in recreational runners with medial tibial stress syndrome and is not associated with pain. MOTRIZ: REVISTA DE EDUCACAO FISICA 2022. [DOI: 10.1590/s1980-657420220003122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Mattock JPM, Steele JR, Mickle KJ. Are Leg Muscle, Tendon and Functional Characteristics Associated with Medial Tibial Stress Syndrome? A Systematic Review. SPORTS MEDICINE-OPEN 2021; 7:71. [PMID: 34626247 PMCID: PMC8502183 DOI: 10.1186/s40798-021-00362-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 09/19/2021] [Indexed: 11/30/2022]
Abstract
Background Medial tibial stress syndrome (MTSS) is a common overuse injury that lacks effective evidence-based treatment options. Reduced leg girth has been associated with MTSS development because it is hypothesised to impair the ability of the leg to modulate tibial loading generated during foot–ground contact. Measuring total leg girth, however, does not provide specific information about the structural composition or functional capacity of individual leg muscles. Consequently, uncertainty remains as to which specific muscles are compromised and contribute to MTSS development. Therefore, this paper aimed to systematically review the body of literature pertaining to how the structure and function of the leg muscles are thought to be associated with MTSS injury. Methods The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P). Medline, PubMed, SCOPUS, SPORTDiscus with Full-texts and Web of Science were searched until March 2021 to identify articles in which lower limb muscle structural or functional variables associated with MTSS injury were investigated. Results Seventeen studies, which were predominately case–control in design and captured data from 332 individuals with MTSS symptoms and 694 control participants, were deemed appropriate for review. The average Downs and Black Quality Assessment score was 71.7 ± 16.4%, with these articles focussing on leg girth, tendon abnormalities, muscle strength and endurance, shear modulus and neuromuscular control. Of the risk factors assessed in the 17 studies, decreased lean leg girth and higher peak soleus muscle activity during propulsion were most strongly correlated with MTSS development. Individuals with MTSS also displayed deficits in ankle plantar flexor endurance, greater isokinetic concentric eversion strength, increased muscle shear modulus and altered neuromuscular recruitment strategies compared to asymptomatic controls. Conclusions Future prospective studies are required to confirm whether decreased lean leg girth and higher peak soleus muscle activity during propulsion are associated with MTSS development and to elucidate whether these structural and functional differences in the leg muscles between MTSS symptomatic and asymptomatic controls are a cause or effect of MTSS. Supplementary Information The online version contains supplementary material available at 10.1186/s40798-021-00362-2.
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Affiliation(s)
- Joshua P M Mattock
- Biomechanics Research Laboratory, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia.
| | - Julie R Steele
- Biomechanics Research Laboratory, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Karen J Mickle
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
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8
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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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9
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Mattock J, Steele JR, Mickle KJ. Lower leg muscle structure and function are altered in long-distance runners with medial tibial stress syndrome: a case control study. J Foot Ankle Res 2021; 14:47. [PMID: 34233725 PMCID: PMC8262020 DOI: 10.1186/s13047-021-00485-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Medial tibial stress syndrome (MTSS) is a common lower leg injury experienced by runners. Although numerous risk factors are reported in the literature, many are non-modifiable and management of the injury remains difficult. Lower leg muscle structure and function are modifiable characteristics that influence tibial loading during foot-ground contact. Therefore, this study aimed to determine whether long-distance runners with MTSS displayed differences in in vivo lower leg muscle structure and function than matched asymptomatic runners. Methods Lower leg structure was assessed using ultrasound and a measure of lower leg circumference to quantify muscle cross-sectional area, thickness and lean lower leg girth. Lower leg function was assessed using a hand-held dynamometer to quantify maximal voluntary isometric contraction strength and a single leg heel raise protocol was used to measure ankle plantar flexor endurance. Outcome variables were compared between the limbs of long-distance runners suffering MTSS (n = 20) and matched asymptomatic controls (n = 20). Means, standard deviations, 95 % confidence intervals, mean differences and Cohen’s d values were calculated for each variable for the MTSS symptomatic and control limbs. Results MTSS symptomatic limbs displayed a significantly smaller flexor hallucis longus cross-sectional area, a smaller soleus thickness but a larger lateral gastrocnemius thickness than the control limbs. However, there was no statistical difference in lean lower leg girth. Compared to the matched control limbs, MTSS symptomatic limbs displayed deficits in maximal voluntary isometric contraction strength of the flexor hallucis longus, soleus, tibialis anterior and peroneal muscles, and reduced ankle plantar flexor endurance capacity. Conclusions Differences in lower leg muscle structure and function likely render MTSS symptomatic individuals less able to withstand the negative tibial bending moment generated during midstance, potentially contributing to the development of MTSS. The clinical implications of these findings suggest that rehabilitation protocols for MTSS symptomatic individuals should aim to improve strength of the flexor hallucis longus, soleus, tibialis anterior and peroneal muscles along with ankle plantar flexor endurance. However, the cross-sectional study design prevents us determining whether between group differences were a cause or effect of MTSS. Therefore, future prospective studies are required to substantiate the study findings.
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Affiliation(s)
- Joshua Mattock
- Biomechanics Research Laboratory, University of Wollongong, NSW, Wollongong, Australia.
| | - Julie R Steele
- Biomechanics Research Laboratory, University of Wollongong, NSW, Wollongong, Australia
| | - Karen J Mickle
- School of Allied Health, Human Services and Sport, La Trobe University, VIC, Melbourne, Australia
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Chronic Lower Leg Pain in Athletes: Overview of Presentation and Management. HSS J 2020; 16:86-100. [PMID: 32015745 PMCID: PMC6973789 DOI: 10.1007/s11420-019-09669-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Athletes with chronic lower leg pain present a diagnostic challenge for clinicians due to the differential diagnoses that must be considered. PURPOSE/QUESTIONS We aimed to review the literature for studies on the diagnosis and management of chronic lower leg pain in athletes. METHODS A literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The PubMed, Scopus, and Cochrane library databases were searched, and articles that examined chronic lower leg pain in athletes were considered for review. Two independent reviewers conducted the search utilizing pertinent Boolean operations. RESULTS Following two independent database searches, 275 articles were considered for initial review. After the inclusion and exclusion criteria were applied, 88 were included in the final review. These studies show that the most common causes of lower leg pain in athletes include medial tibial stress syndrome, chronic exertional compartment syndrome, tibial stress fractures, nerve entrapments, lower leg tendinopathies, and popliteal artery entrapment syndrome. Less frequently encountered causes include saphenous nerve entrapment and tendinopathy of the popliteus. Conservative management is the mainstay of care for the majority of cases of chronic lower leg pain; however, surgical intervention may be necessary. CONCLUSIONS Multiple conditions may result in lower leg pain in athletes. A focused clinical history and physical examination supplemented with appropriate imaging studies can guide clinicians in diagnosis and management. We provide a table to aid in the differential diagnosis of chronic leg pain in the athlete.
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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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Takeuchi K, Tsukuda F. Comparison of the effects of static stretching on range of motion and jump height between quadriceps, hamstrings and triceps surae in collegiate basketball players. BMJ Open Sport Exerc Med 2019; 5:e000631. [PMID: 31908836 PMCID: PMC6936985 DOI: 10.1136/bmjsem-2019-000631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2019] [Indexed: 11/04/2022] Open
Abstract
Objectives The purpose of the present study was to compare the effects of static stretching (SS) on the range of motion and vertical jump height between the quadriceps, hamstrings and triceps surae in collegiate basketball players. Methods Fourteen male collegiate basketball players (20.2±0.7 years, 179.0±5.0 cm, 71.9±8.3 kg) underwent 5 min of SS for the quadriceps, hamstrings and triceps surae, in random order. Before and after each stretch, the range of motion (ROM) and vertical jump height were measured. Results ROM of the quadriceps, hamstrings and triceps surae were increased without any difference of relative change in the range. The vertical jump height showed no change after SS of the quadriceps and hamstrings, while it decreased after SS of the triceps surae (p<0.05). Conclusion These results suggested that SS for the triceps surae may have a large impact on jump performance.
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Affiliation(s)
- Kosuke Takeuchi
- Kobe International University, Faculty of Rehabilitation, Department of Physical Therapy, Kobe, Hyogo, Japan
| | - Fumiko Tsukuda
- Biwako Seikei Sport College, Faculty of Sport, Department of Sport, Otsu, Shiga, Japan
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Ercan S. Medial tibial stres sendromlu sporcularda ayak bileği izokinetik kas kuvveti ve naviküler çökme miktarı. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.459411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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14
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Okunuki T, Koshino Y, Yamanaka M, Tsutsumi K, Igarashi M, Samukawa M, Saitoh H, Tohyama H. Forefoot and hindfoot kinematics in subjects with medial tibial stress syndrome during walking and running. J Orthop Res 2019; 37:927-932. [PMID: 30648281 DOI: 10.1002/jor.24223] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/08/2019] [Indexed: 02/04/2023]
Abstract
Excessive foot pronation during static standing, walking and running has been reported as a contributing factor for the development of medial tibial stress syndrome (MTSS). The motion of foot pronation consists of hindfoot and forefoot motion. However, no previous studies have investigated forefoot and hindfoot kinematics during walking and running in subjects with MTSS. The current study sought to compare hindfoot and forefoot kinematics between subjects with and without MTSS while walking and running. Eleven subjects with MTSS and 11 healthy controls (each group containing 10 males and one female) participated in the current study. Segment angles of the hindfoot and forefoot during walking and running barefoot on a treadmill were recorded using three-dimensional kinematic analysis. An independent t-test was used to compare kinematic data between groups. Subjects with MTSS exhibited significantly greater hindfoot eversion and abduction (p < 0.05) during walking and running than subjects without MTSS, significantly greater forefoot eversion and abduction (p < 0.05) during walking, and significantly greater forefoot abduction during running (p < 0.05). Hindfoot and forefoot kinematics during walking and running were significantly different between subjects with and without MTSS. For prevention and rehabilitation of MTSS, it may be important to focus on not only hindfoot but also forefoot kinematics during both running and walking. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Takumi Okunuki
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan.,Department of Rehabilitation, Matsuda Orthopedic Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Yuta Koshino
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan.,Rehabilitation Center, NTT East Japan Sapporo Hospital, Sapporo, Hokkaido, Japan
| | - Masanori Yamanaka
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Kaori Tsutsumi
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Masato Igarashi
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Hiroshi Saitoh
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Harukazu Tohyama
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
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Sharma J, Heagerty R, Dalal S, Banerjee B, Booker T. Risk Factors Associated With Musculoskeletal Injury: A Prospective Study of British Infantry Recruits. Curr Rheumatol Rev 2018; 15:50-58. [DOI: 10.2174/1573397114666180430103855] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 09/08/2017] [Accepted: 04/25/2018] [Indexed: 01/02/2023]
Abstract
Background:Musculoskeletal Injury (MSKI), a common problem in both military and physically active civilian populations, has been suggested to result from both extrinsic and intrinsic factors.Objective:To investigate prospectively whether gait biomechanics, aerobic fitness levels and smoking status as well as entry military selection test variables can be used to predict MSKI development during recruit training.Methods:British infantry male recruits (n = 562) were selected for the study. Plantar pressure variables, smoking habit, aerobic fitness as measured by a 1.5 mile run time and initial military selection test (combination of fitness, Trainability score) were collected prior to commencement of infantry recruit training. Injury data were collected during the 26 week training period.Results:Incidence rate of MSKI over a 26 week training period was 41.28% (95 % CI: 37.28 - 45.40%). The injured group had a higher medial plantar pressure (p < 0.03), shorter time to peak heel rotation (p < 0.02), current smoking status (p < 0.001) and a slower 1.5 mile run time (p < 0.03). In contrast, there were no significant differences (p > 0.23) in lateral heel pressure, age, weight, height, BMI and military selection test. A logistic regression model predicted MSKI significantly (p= 0.03) with an accuracy of 34.50% of all MSK injury and 76.70% of the non-injured group with an overall accuracy of 69.50%.Conclusion:The logistic regression model combining the three risk factors was capable of predicting 34.5% of all MSKI. A specific biomechanical profile, slow 1.5 mile run time and current smoking status were identified as predictors of subsequent MSKI development. The proposed model could include evaluation of other potential risk factors and if validated then further enhance the specificity, sensitivity and applicability.
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Affiliation(s)
- Jagannath Sharma
- Medical Centre & Rehabilitation Department, Defence Primary Healthcare, Infantry Training Centre Catterick Garrison, DL9 3PS, United Kingdom
| | - Robert Heagerty
- Medical Centre & Rehabilitation Department, Defence Primary Healthcare, Infantry Training Centre Catterick Garrison, DL9 3PS, United Kingdom
| | - S Dalal
- Defence Primary Healthcare Head Quarter North Region (DPHC) Catterick Garrison, United Kingdom
| | - B Banerjee
- Vascular Surgery Department, NHS Foundation Trust, City Hospitals Sunderland, United Kingdom
| | - T. Booker
- Medical Centre & Rehabilitation Department, Defence Primary Healthcare, Infantry Training Centre Catterick Garrison, DL9 3PS, United Kingdom
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Mattock J, Steele JR, Mickle KJ. A protocol to prospectively assess risk factors for medial tibial stress syndrome in distance runners. BMC Sports Sci Med Rehabil 2018; 10:20. [PMID: 30479774 PMCID: PMC6251115 DOI: 10.1186/s13102-018-0109-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 11/05/2018] [Indexed: 12/25/2022]
Abstract
Background Medial tibial stress syndrome (MTSS) is a lower leg injury with a reported incidence rate of up to 35% in active individuals. Although numerous prospective studies have tried to identify risk factors for developing MTSS, managing the syndrome remains difficult. One risk factor yet to be extensively explored in MTSS development is reduced lower leg girth. Further investigation of reduced lower leg girth is required due to the important role lower leg musculature plays in attenuating ground reaction forces during the gait cycle. Therefore, the primary aim of this study is to ascertain whether lower leg muscle morphology and function contribute to the development of MTSS. Our ultimate aim is to identify potential risk factors for MTSS that can be targeted in future studies to better manage the injury or, preferably, prevent individuals developing MTSS. Methods This study will be prospective in design and will recruit asymptomatic distance runners. All participants will be tested at base line and participants will have their training data longitudinally tracked over the following 12 months to assess any individuals who develop MTSS symptoms. At base line, outcome measures will include bilateral measures of lower limb anthropometry; cross sectional area (CSA) and thickness of the tibialis anterior, peroneals, flexor digitorum longus, flexor hallucis longus and thickness of soleus, medial and lateral head of gastrocnemius. Tibial bone speed of sound, ankle dorsiflexion range of motion, strength of the six previously described muscles, foot alignment and ankle plantar flexor endurance will also be assessed. Participants will also complete a treadmill running protocol where three-dimensional kinematics, plantar pressure distribution and electromyography data will be collected. Discussion This study will aim to identify characteristics of individuals who develop MTSS and, in turn, identify modifiable risk factors that can be targeted to prevent individuals developing this injury.
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Affiliation(s)
- Joshua Mattock
- 1Biomechanics Research Laboratory, University of Wollongong, Wollongong, NSW Australia
| | - Julie R Steele
- 1Biomechanics Research Laboratory, University of Wollongong, Wollongong, NSW Australia
| | - Karen J Mickle
- 2Institute of Health and Sport, Victoria University, Melbourne, VIC Australia
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17
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Bliekendaal S, Moen M, Fokker Y, Stubbe JH, Twisk J, Verhagen E. Incidence and risk factors of medial tibial stress syndrome: a prospective study in Physical Education Teacher Education students. BMJ Open Sport Exerc Med 2018; 4:e000421. [PMID: 30364458 PMCID: PMC6196946 DOI: 10.1136/bmjsem-2018-000421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2018] [Indexed: 11/24/2022] Open
Abstract
Objective Medial tibial stress syndrome (MTSS) is a common lower extremity overuse injury often causing long-term reduction of sports participation. This study aimed to investigate the incidence and risk factors of MTSS in first-year Dutch Physical Education Teacher Education (PETE) students. Methods This prospective study consisted of physical measures at baseline (height, weight, fat percentage, 3000 m run test, navicular drop test, hip internal and external range of motion, hip adduction and adduction strength, single leg squat and shin palpation), an intake questionnaire at baseline (age, sport participation, presence of MTSS, MTSS history, insole use and use of supportive shoes) and an MTSS registration procedure during the academic year of 2016–2017 (10 months) using a validated questionnaire. In total 221 first-year PETE students were included, of whom 170 (77%) were male and 51 (23%) female. The evaluation of risk factors was conducted with univariable and multivariable logistic generalised estimating equation analyses. Results In total 55 (25%) subjects, 35 (21%) men and 20 (39%) women, developed MTSS during the follow-up period. The associated risk factors were female sex (OR=3.14, 95% CI 1.39 to 7.11), above-average age (OR=0.31, 95% CI 0.13 to 0.76), above-average body mass index (OR=2.29, 95% CI 1.02 to 5.16) and history of MTSS (OR=5.03, 95% CI 1.90 to 13.30). Conclusion The incidence of MTSS is high in PETE students. Several risk factors were identified. These results demonstrate the need for prevention and may provide direction to preventive intervention design.
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Affiliation(s)
- Sander Bliekendaal
- Amsterdam University of Applied Sciences, Centre for Applied Research in Sports and Nutrition, Amsterdam, The Netherlands
| | - Maarten Moen
- Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
| | - Young Fokker
- Amsterdam University of Applied Sciences, Centre for Applied Research in Sports and Nutrition, Amsterdam, The Netherlands
| | - Janine H Stubbe
- Codarts University of the Arts, Rotterdam, The Netherlands.,Performing Artist and Athlete Research Lab (PEARL), Rotterdam, The Netherlands.,Rotterdam Arts and Science Lab (RASL), Rotterdam, The Netherlands
| | - Jos Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports & Department of Public and Occupational Health, Amsterdam Movement Science, VU University Medical Center, Amsterdam, The Netherlands.,UCT/MRC Research Unit for Exercise Science and Sports Medicine (ESSM) Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,School of Physical Education, Faculty of Physical Therapy & Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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18
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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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19
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Predicting individual risk for medial tibial stress syndrome in navy recruits. J Sci Med Sport 2018; 21:586-590. [DOI: 10.1016/j.jsams.2017.10.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 10/11/2017] [Accepted: 10/14/2017] [Indexed: 11/20/2022]
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20
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Hjerrild M, Videbaek S, Theisen D, Malisoux L, Oestergaard Nielsen R. How (not) to interpret a non-causal association in sports injury science. Phys Ther Sport 2018; 32:121-125. [PMID: 29787934 DOI: 10.1016/j.ptsp.2018.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 05/04/2018] [Accepted: 05/08/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To discuss the interpretability of non-causal associations to sports injury development exemplified via the relationship between navicular drop (ND) and running-related injury (RRI) in novice runners using neutral shoes. DESIGN 1-year prospective cohort study. SETTING Denmark. PARTICIPANTS 926 novice runners, representing 1852 feet, were included. MAIN OUTCOME MEASURE The outcome was "a musculoskeletal complaint of the lower extremity or back caused by running, which restricted the amount of running for at least a week". RESULTS Fewer feet with small ND than those feet with a reference ND sustained injuries at 50 (risk difference (RD) = -4.1% [95%CI = -7.9%;-0.4%]) and 100 km (RD = -5.3% [95%CI = -9.9%;-0.7%]). Similarly, fewer feet with a large ND sustained injuries than the feet with a reference drop at 250 (RD = -7.6% [95%CI = -14.9%;-0.3%]) and 500 km (RD = -9.8% [95%CI = -19.1%;-0.4%]). CONCLUSION Non-causal associations can help to identify sub-groups of athletes at an increased or decreased risk of sports injury. Based on the current results, those with a small or large navicular drop sustain fewer injuries than those with a reference drop. Importantly, navicular drop does not cause RRIs, but influences the relationship between training load and RRI. This illustrates that non-causal associations are unsuitable to respond to the question: Why do sports injury develop?
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Affiliation(s)
- Mette Hjerrild
- Department of Public Health, Section of Sport Science, Aarhus University, Dalgas Avenue 4, Room 438, 8000 Aarhus C, Denmark.
| | - Solvej Videbaek
- Department of Public Health, Section of Sport Science, Aarhus University, Dalgas Avenue 4, Room 438, 8000 Aarhus C, Denmark.
| | - Daniel Theisen
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, 76 rue d'Eich, L-1460, Luxembourg.
| | - Laurent Malisoux
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, 76 rue d'Eich, L-1460, Luxembourg.
| | - Rasmus Oestergaard Nielsen
- Department of Public Health, Section of Sport Science, Aarhus University, Dalgas Avenue 4, Room 438, 8000 Aarhus C, Denmark.
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Becker J, James S, Wayner R, Osternig L, Chou LS. Biomechanical Factors Associated With Achilles Tendinopathy and Medial Tibial Stress Syndrome in Runners. Am J Sports Med 2017; 45:2614-2621. [PMID: 28581815 DOI: 10.1177/0363546517708193] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is disagreement in the literature regarding whether the excessive excursion or velocity of rearfoot eversion is related to the development of 2 common running injuries: Achilles tendinopathy (AT) and medial tibial stress syndrome (MTSS). An alternative hypothesis suggests that the duration of rearfoot eversion may be an important factor. However, the duration of eversion has received relatively little attention in the biomechanics literature. HYPOTHESIS Runners with AT or MTSS will demonstrate a longer duration of eversion but not greater excursion or velocity of eversion compared with healthy controls. STUDY DESIGN Controlled laboratory study. METHODS Forty-two runners participated in this study (13 with AT, 8 with MTSS, and 21 matched controls). Participants were evaluated for lower extremity alignment and flexibility, after which a 3-dimensional kinematic and kinetic running gait analysis was performed. Differences between the 2 injuries and between injured and control participants were evaluated for flexibility and alignment, rearfoot kinematics, and 3 ground-reaction force metrics. Binary logistic regression was used to evaluate which variables best predicted membership in the injured group. RESULTS Injured participants, compared with controls, demonstrated higher standing tibia varus angles (8.67° ± 1.79° vs 6.76° ± 1.75°, respectively; P = .002), reduced static dorsiflexion range of motion (6.14° ± 5.04° vs 11.19° ± 5.10°, respectively; P = .002), more rearfoot eversion at heel-off (-6.47° ± 5.58° vs 1.07° ± 2.26°, respectively; P < .001), and a longer duration of eversion (86.02% ± 15.65% stance vs 59.12% ± 16.50% stance, respectively; P < .001). There were no differences in the excursion or velocity of eversion. The logistic regression (χ2 = 20.84, P < .001) revealed that every 1% increase in the duration of eversion during the stance phase increased the odds of being in the injured group by 1.08 (95% CI, 1.023-1.141; P = .006). CONCLUSION Compared with healthy controls, runners currently symptomatic with AT or MTSS have a longer duration of eversion but not greater excursion or velocity of eversion. CLINICAL RELEVANCE Static measures of the tibia varus angle and dorsiflexion range of motion, along with dynamic measures of the duration of eversion, may be useful for identifying runners at risk of sustaining AT or MTSS.
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Affiliation(s)
| | - Stanley James
- Slocum Center for Orthopedics & Sports Medicine, Eugene, Oregon, USA
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Saeki J, Nakamura M, Nakao S, Fujita K, Yanase K, Morishita K, Ichihashi N. Ankle and toe muscle strength characteristics in runners with a history of medial tibial stress syndrome. J Foot Ankle Res 2017; 10:16. [PMID: 28413452 PMCID: PMC5387355 DOI: 10.1186/s13047-017-0197-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 03/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background A high proportion of flexor digitorum longus attachment is found at the posteromedial border of the tibia, which is the most common location of medial tibial stress syndrome (MTSS). Therefore, plantar flexion strength of the lesser toes could be related to MTSS; however, the relationship between MTSS and muscle strength of the hallux and lesser toes is not yet evaluated due to the lack of quantitative methods. This study investigated the muscle strength characteristics in runners with a history of MTSS by using a newly developed device to measure the muscle strength of the hallux, lesser toes, and ankle. Methods This study comprised 27 collegiate male runner participants (20.0 ± 1.6 years, 172.1 ± 5.1 cm, 57.5 ± 4.0 kg). Maximal voluntary isometric contraction (MVIC) torque of the plantar flexion, dorsiflexion, inversion, and eversion of the ankle were measured by using an electric dynamometer. MVIC torque of the 1st metatarsophalangeal joint (MTPJ) and 2nd–5th MTPJ were measured by using a custom-made torque-measuring device. MVIC torques were compared between runners with and without a history of MTSS. Results MVIC torque of the 1st MTPJ plantar flexion was significantly higher in runners with a history of MTSS than in those without it. In contrast, there were no significant differences in the MVIC torque values of the 2nd–5th MTPJ plantar flexion and each MVIC torque of the ankle between runners with and without a history of MTSS. Conclusion A history of MTSS increased the isometric FHL strength.
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Affiliation(s)
- Junya Saeki
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan.,Research Fellow of the Japan Society for the Promotion of Science, 5-3-1 Kojimachi, Chiyoda-ku, Tokyo, 102-0083 Japan
| | - Masatoshi Nakamura
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198 Japan
| | - Sayaka Nakao
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Kosuke Fujita
- Rehabilitation Group, Department of Medical Technique, Nagoya University Hospital, Tsurumai-cho 65, Syowa-ku, Nagoya, 466-0065 Japan
| | - Ko Yanase
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Katsuyuki Morishita
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
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Saeki J, Nakamura M, Nakao S, Fujita K, Yanase K, Ichihashi N. Muscle stiffness of posterior lower leg in runners with a history of medial tibial stress syndrome. Scand J Med Sci Sports 2017; 28:246-251. [DOI: 10.1111/sms.12862] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2017] [Indexed: 12/01/2022]
Affiliation(s)
- J. Saeki
- Human Health Sciences; Graduate School of Medicine; Kyoto University; Kyoto Japan
- Research Fellow of the Japan Society for the Promotion of Science; Tokyo Japan
| | - M. Nakamura
- Institute for Human Movement and Medical Sciences; Niigata University of Health and Welfare; Niigata Japan
| | - S. Nakao
- Human Health Sciences; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - K. Fujita
- Rehabilitation Group; Department of Medical Technique; Nagoya University Hospital; Nagoya Japan
| | - K. Yanase
- Human Health Sciences; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - N. Ichihashi
- Human Health Sciences; Graduate School of Medicine; Kyoto University; Kyoto Japan
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24
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Reinking MF, Austin TM, Richter RR, Krieger MM. Medial Tibial Stress Syndrome in Active Individuals: A Systematic Review and Meta-analysis of Risk Factors. Sports Health 2016; 9:252-261. [PMID: 27729482 PMCID: PMC5435145 DOI: 10.1177/1941738116673299] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
CONTEXT Medial tibial stress syndrome (MTSS) is a common condition in active individuals and presents as diffuse pain along the posteromedial border of the tibia. OBJECTIVE To use cross-sectional, case-control, and cohort studies to identify significant MTSS risk factors. DATA SOURCES Bibliographic databases (PubMed, Scopus, CINAHL, SPORTDiscus, EMBASE, EBM Reviews, PEDRo), grey literature, electronic search of full text of journals, manual review of reference lists, and automatically executed PubMed MTSS searches were utilized. All searches were conducted between 2011 and 2015. STUDY SELECTION Inclusion criteria were determined a priori and included original research with participants' pain diffuse, located in the posterior medial tibial region, and activity related. STUDY DESIGN Systematic review with meta-analysis. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION Titles and abstracts were reviewed to eliminate citations that did not meet the criteria for inclusion. Study characteristics identified a priori were extracted for data analysis. Statistical heterogeneity was examined using the I2 index and Cochran Q test, and a random-effects model was used to calculate the meta-analysis when 2 or more studies examined a risk factor. Two authors independently assessed study quality. RESULTS Eighty-three articles met the inclusion criteria, and 22 articles included risk factor data. Of the 27 risk factors that were in 2 or more studies, 5 risk factors showed a significant pooled effect and low statistical heterogeneity, including female sex (odds ratio [OR], 2.35; CI, 1.58-3.50), increased weight (standardized mean difference [SMD], 0.24; CI, 0.03-0.45), higher navicular drop (SMD, 0.44; CI, 0.21-0.67), previous running injury (OR, 2.18; CI, 1.00-4.72), and greater hip external rotation with the hip in flexion (SMD, 0.44; CI, 0.23-0.65). The remaining risk factors had a nonsignificant pooled effect or significant pooled effect with high statistical heterogeneity. CONCLUSION Female sex, increased weight, higher navicular drop, previous running injury, and greater hip external rotation with the hip in flexion are risk factors for the development of MTSS.
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Affiliation(s)
- Mark F. Reinking
- Rueckert-Hartman College for Health Professions, School of Physical Therapy, Regis University, Denver, Colorado
| | - Tricia M. Austin
- Department of Physical Therapy & Athletic Training, Doisy College of Health Sciences, Saint Louis University, Saint Louis, Missouri
| | - Randy R. Richter
- Department of Physical Therapy & Athletic Training, Doisy College of Health Sciences, Saint Louis University, Saint Louis, Missouri
| | - Mary M. Krieger
- Medical Center Library, Saint Louis University, Saint Louis, Missouri
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Griebert MC, Needle AR, McConnell J, Kaminski TW. Lower-leg Kinesio tape reduces rate of loading in participants with medial tibial stress syndrome. Phys Ther Sport 2016; 18:62-67. [DOI: 10.1016/j.ptsp.2014.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 12/12/2013] [Accepted: 01/20/2014] [Indexed: 11/29/2022]
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Mokha M, Sprague PA, Gatens DR. Predicting Musculoskeletal Injury in National Collegiate Athletic Association Division II Athletes From Asymmetries and Individual-Test Versus Composite Functional Movement Screen Scores. J Athl Train 2016; 51:276-82. [PMID: 26794630 DOI: 10.4085/1062-6050-51.2.07] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT Functional Movement Screen (FMS) scores of ≤14 have been used to predict injury in athletic populations. Movement asymmetries and poor-quality movement patterns in other functional tests have been shown to predict musculoskeletal injury (MSI). Therefore, movement asymmetry or poor-quality movement patterns on the FMS may have more utility in predicting MSI than the composite score. OBJECTIVE To determine if an asymmetry or score of 1 on an individual FMS test would predict MSI in collegiate athletes. DESIGN Cohort study. SETTING National Collegiate Athletic Association Division II university athletic program. PATIENTS OR OTHER PARTICIPANTS A total of 84 Division II rowers, volleyball players, and soccer players (men: n = 20, age = 20.4 ± 1.3 years, height = 1.77 ± 0.04 m, mass = 73.5 ± 4.8 kg; women: n = 64, age = 19.1 ± 1.2 years, height = 1.69 ± 0.09 m, mass = 64.8 ± 9.4 kg). MAIN OUTCOME MEASURE(S) The FMS was administered during preseason preparticipation examinations. Injury-incidence data were tracked for an academic year by each team's certified athletic trainer via computer software. An MSI was defined as physical damage to the body secondary to athletic activity or an event for which the athlete sought medical care, and resulted in modified training or required protective splitting or taping. Composite FMS scores were categorized as low (≤14) or high (>14). Pearson χ(2) analyses were used to determine if MSI could be predicted by the composite FMS score or an asymmetry or score of 1 on an individual FMS test (P < .05). RESULTS Athletes with FMS scores of ≤14 were not more likely to sustain an injury than those with higher scores (relative risk = 0.68, 95% confidence interval = 0.39, 1.19; P = .15). However, athletes with an asymmetry or individual score of 1 were 2.73 times more likely to sustain an injury than those without (relative risk = 2.73, 95% confidence interval = 1.36, 5.4; P = .001). CONCLUSIONS Asymmetry or a low FMS individual test score was a better predictor of MSI than the composite FMS score.
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Sobhani V, Shakibaee A, Khatibi Aghda A, Emami Meybodi MK, Delavari A, Jahandideh D. Studying the Relation Between Medial Tibial Stress Syndrome and Anatomic and Anthropometric Characteristics of Military Male Personnel. Asian J Sports Med 2015; 6:e23811. [PMID: 26448835 PMCID: PMC4592759 DOI: 10.5812/asjsm.23811] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 05/20/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Medial Tibial Stress Syndrome (MTSS) is common among military recruits and to our knowledge; the factors that might put the military recruits at higher risk of incidence of MTSS are not well known. OBJECTIVES This study was done to investigate the association between some anthropometric and anatomical factors and the prevalence of MTSS among military recruits. PATIENTS AND METHODS One hundred and eighty one randomly selected military recruits were included in this cross sectional study. Using history taking and physical examinations they were tested for MTSS. Accordingly the subjects were assigned to the case (those with MTSS) and control groups (normal healthy subjects). Using standard guidelines, the anthropometric and anatomical criteria of the subjects were measured. The correlation between the measurements and the prevalence of MTSS was tested using statistical analysis. RESULTS Data of all the 181 subjects with the mean age of 30.7 ± 4.68 years were Included in the final analysis. The prevalence of MTSS was found to be 16.6% (30 people). Internal and external rotation range of motion, iliospinale height, the score of navicular drop test, and the trochanteric tibial lateral length were significantly different between healthy subjects and patients with MTSS (P < 0.05). DISCUSSION The prevalence of MTSS was relatively lower in this study comparing to other studies on military personnel. It was not probably due to type of military shoes or exercise area surface (none of them were standardized); it could be due to low intensity trainings and the long intervals between training sessions.
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Affiliation(s)
- Vahid Sobhani
- Exercise Physiology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Abolfazl Shakibaee
- Exercise Physiology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Abolfazl Shakibaee, Exercise Physiology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tel: + 98-2182482402, Fax: +98-2188600030, E-mail:
| | - Amidoddin Khatibi Aghda
- Physical Medicine and Rehabilitation Department, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | | | - Abbasali Delavari
- Emergency Medicine Department, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Dariush Jahandideh
- Exercise Physiology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
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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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Akiyama K, Noh B, Fukano M, Miyakawa S, Hirose N, Fukubayashi T. Analysis of the talocrural and subtalar joint motions in patients with medial tibial stress syndrome. J Foot Ankle Res 2015; 8:25. [PMID: 26146519 PMCID: PMC4490758 DOI: 10.1186/s13047-015-0084-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/22/2015] [Indexed: 11/11/2022] Open
Abstract
Background The rearfoot motion during sports activities in patients with the medial tibial stress syndrome (MTSS) is unknown. This study aimed to investigate the difference in kinematics of the rearfoot in MTSS patients (eight male soccer players) and control participants (eight male soccer players) during a forward step. Methods Sixteen male soccer players, including eight players with MTSS, participated. Forward step trials were recorded with cineradiographic images obtained at a sampling rate of 60 Hz. Geometric bone models of the tibia and talus/calcaneus were created from computed tomography scans of the distal part of one lower limb. Following a combination of approaches, anatomical coordinate systems were embedded in each bone model. The talocrural joint motion (relative motion of the talus with respect to the tibia) and subtalar joint motion (relative motion of the calcaneus with respect to the talus) were examined. Results A significantly larger range of internal/external rotation and inversion/eversion motion was observed in the subtalar joint of MTSS patients compared to healthy controls (P < 0.05) from heel contact to heel off. There were no significant differences between the MTSS patients and healthy participants in the ranges of all talocrural joint angles during the forward step. Conclusion Our results indicate that the range of subtalar joint motion is greater in patients with MTSS during the stance phase of the forward step. The kinematic results obtained of this study may have important clinical implications and add quantitative data to an in vivo database of MTSS patients.
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Affiliation(s)
- Kei Akiyama
- Graduate School of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama 359-1192 Japan ; Japan Institute of Sports Sciences, Sports Science, 3-15-1, Nishigaoka, Kita-ku 115-0056 Japan
| | - Byungjoo Noh
- Department of Sports Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577 Japan
| | - Mako Fukano
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama 359-1192 Japan
| | - Shumpei Miyakawa
- Department of Sports Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577 Japan
| | - Norikazu Hirose
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama 359-1192 Japan
| | - Toru Fukubayashi
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama 359-1192 Japan
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Noh B, Ishii T, Masunari A, Harada Y, Miyakawa S. Muscle activation of plantar flexors in response to different strike patterns during barefoot and shod running in medial tibial stress syndrome. THE JOURNAL OF PHYSICAL FITNESS AND SPORTS MEDICINE 2015. [DOI: 10.7600/jpfsm.4.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Byungjoo Noh
- Department of Sports Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Takeo Ishii
- Sports Research & Development Core, University of Tsukuba
| | - Akihiko Masunari
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences
- Department of Sports Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Yuhei Harada
- Laboratory for Sport Biomechanics, Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Shumpei Miyakawa
- Department of Sports Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba
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Neal BS, Griffiths IB, Dowling GJ, Murley GS, Munteanu SE, Franettovich Smith MM, Collins NJ, Barton CJ. Foot posture as a risk factor for lower limb overuse injury: a systematic review and meta-analysis. J Foot Ankle Res 2014; 7:55. [PMID: 25558288 PMCID: PMC4282737 DOI: 10.1186/s13047-014-0055-4] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 11/30/2014] [Indexed: 12/26/2022] Open
Abstract
Background Static measures of foot posture are regularly used as part of a clinical examination to determine the need for foot level interventions. This is based on the premise that pronated and supinated foot postures may be risk factors for or associated with lower limb injury. This systematic review and meta-analysis investigates foot posture (measured statically) as a potential risk factor for lower limb overuse injuries. Methods A systematic search was performed using Medline, CINAHL, Embase, SportDiscus in April 2014, to identify prospective cohort studies that investigated foot posture and function as a risk factor for lower limb overuse injury. Eligible studies were classified based on the method of foot assessment: (i) static foot posture assessment; and/or (ii) dynamic foot function assessment. This review presents studies evaluating static foot posture. The methodological quality of included studies was evaluated by two independent reviewers, using an adapted version of the Epidemiological Appraisal Instrument (EAI). Where possible, effects were expressed as standardised mean differences (SMD) for continuous scaled data, and risk ratios (RR) for nominal scaled data. Meta-analysis was performed where injuries and outcomes were considered homogenous. Results Twenty-one studies were included (total n = 6,228; EAI 0.8 to 1.7 out of 2.0). There was strong evidence that a pronated foot posture was a risk factor for medial tibial stress syndrome (MTSS) development and very limited evidence that a pronated foot posture was a risk factor for patellofemoral pain development, although associated effect sizes were small (0.28 to 0.33). No relationship was identified between a pronated foot posture and any other evaluated pathology (i.e. foot/ankle injury, bone stress reactions and non-specific lower limb overuse injury). Conclusion This systematic review identified strong and very limited evidence of small effect that a pronated foot posture is a risk factor for MTSS and patellofemoral pain respectively. Evaluation of static foot posture should be included in a multifactorial assessment for both MTSS and patellofemoral pain, although only as a part of the potential injury risk profile. Whilst the included measures are clinically applicable, further studies are required to determine their relationship with dynamic foot function. Electronic supplementary material The online version of this article (doi:10.1186/s13047-014-0055-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bradley S Neal
- Pure Sports Medicine, London, UK ; Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK
| | | | - Geoffrey J Dowling
- Department of Podiatry, Faculty of Health Sciences, La Trobe University, Melbourne, Australia
| | - George S Murley
- Department of Podiatry, Faculty of Health Sciences, La Trobe University, Melbourne, Australia ; Lower Extremity and Gait studies program, Faculty of Health Sciences, La Trobe University, Melbourne, Australia
| | - Shannon E Munteanu
- Department of Podiatry, Faculty of Health Sciences, La Trobe University, Melbourne, Australia ; Lower Extremity and Gait studies program, Faculty of Health Sciences, La Trobe University, Melbourne, Australia
| | | | - Natalie J Collins
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Melbourne, Australia
| | - Christian J Barton
- Pure Sports Medicine, London, UK ; Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK ; Lower Extremity and Gait studies program, Faculty of Health Sciences, La Trobe University, Melbourne, Australia ; Complete Sports Care, Melbourne, Australia
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Dowling GJ, Murley GS, Munteanu SE, Smith MMF, Neal BS, Griffiths IB, Barton CJ, Collins NJ. Dynamic foot function as a risk factor for lower limb overuse injury: a systematic review. J Foot Ankle Res 2014; 7:53. [PMID: 25598843 PMCID: PMC4296532 DOI: 10.1186/s13047-014-0053-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 11/18/2014] [Indexed: 12/22/2022] Open
Abstract
Background Dynamic foot function is considered a risk factor for lower limb overuse injuries including Achilles tendinopathy, shin pain, patellofemoral pain and stress fractures. However, no single source has systematically appraised and summarised the literature to evaluate this proposed relationship. The aim of this systematic review was to investigate dynamic foot function as a risk factor for lower limb overuse injury. Methods A systematic search was performed using Medline, CINAHL, Embase and SportDiscus in April 2014 to identify prospective cohort studies that utilised dynamic methods of foot assessment. Included studies underwent methodological quality appraisal by two independent reviewers using an adapted version of the Epidemiological Appraisal Instrument (EAI). Effects were expressed as standardised mean differences (SMD) for continuous scaled data, and risk ratios (RR) for nominal scaled data. Results Twelve studies were included (total n = 3,773; EAI 0.44 to 1.20 out of 2.00, representing low to moderate quality). There was limited to very limited evidence for forefoot, midfoot and rearfoot plantar loading variables (SMD 0.47 to 0.85) and rearfoot kinematic variables (RR 2.67 to 3.43) as risk factors for patellofemoral pain; and plantar loading variables (forefoot, midfoot, rearfoot) as risk factors for Achilles tendinopathy (SMD 0.81 to 1.08). While there were significant findings from individual studies for plantar loading variables (SMD 0.3 to 0.84) and rearfoot kinematic variables (SMD 0.29 to 0.62) as risk factors for ‘non-specific lower limb overuse injuries’, these were often conflicting regarding different anatomical regions of the foot. Findings from three studies indicated no evidence that dynamic foot function is a risk factor for iliotibial band syndrome or lower limb stress fractures. Conclusion This systematic review identified very limited evidence that dynamic foot function during walking and running is a risk factor for patellofemoral pain, Achilles tendinopathy, and non-specific lower limb overuse injuries. It is unclear whether these risk factors can be identified clinically (without sophisticated equipment), or modified to prevent or manage these injuries. Future prospective cohort studies should address methodological limitations, avoid grouping different lower limb overuse injuries, and explore clinically meaningful representations of dynamic foot function. Electronic supplementary material The online version of this article (doi:10.1186/s13047-014-0053-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Geoffrey J Dowling
- Department of Podiatry, Faculty of Health Sciences, La Trobe University, Melbourne, Australia
| | - George S Murley
- Department of Podiatry, Faculty of Health Sciences, La Trobe University, Melbourne, Australia ; Lower Extremity and Gait studies program, Faculty of Health Sciences, La Trobe University, Melbourne, Australia
| | - Shannon E Munteanu
- Department of Podiatry, Faculty of Health Sciences, La Trobe University, Melbourne, Australia ; Lower Extremity and Gait studies program, Faculty of Health Sciences, La Trobe University, Melbourne, Australia
| | | | - Bradley S Neal
- Pure Sports Medicine, London, UK ; Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK
| | | | - Christian J Barton
- Lower Extremity and Gait studies program, Faculty of Health Sciences, La Trobe University, Melbourne, Australia ; Pure Sports Medicine, London, UK ; Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK ; Complete Sports Care, Melbourne, Australia
| | - Natalie J Collins
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Melbourne, Australia
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Prusak KM, Prusak KA, Hunter I, Seeley MK, Hopkins JT. Comparison of Two Taping Techniques on Navicular Drop and Center-of-Pressure Measurements During Stance. ACTA ACUST UNITED AC 2014. [DOI: 10.3928/19425864-20141125-13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hamstra-Wright KL, Bliven KCH, Bay C. Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis. Br J Sports Med 2014; 49:362-9. [DOI: 10.1136/bjsports-2014-093462] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Noh B, Masunari A, Akiyama K, Fukano M, Fukubayashi T, Miyakawa S. Structural deformation of longitudinal arches during running in soccer players with medial tibial stress syndrome. Eur J Sport Sci 2014; 15:173-81. [PMID: 25014846 DOI: 10.1080/17461391.2014.932848] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to compare angular change and translational motion from the medial longitudinal arch (MLA) and lateral longitudinal arch (LLA) during running between medial tibial stress syndrome (MTSS) and non-MTSS subjects. A total of 10 subjects volunteered, comprising 5 subjects with MTSS and 5 subjects without injury (non-MTSS) as the control group. All subjects performed the test movement that simulated running. Fluoroscopic imaging was used to investigate bone movement during landing in running. Sagittal motion was defined as the angular change and translational motion of the arch. A Mann-Whitney U-test was performed to determine the differences in the measured values between the MTSS and non-MTSS groups. The magnitude of angular change for the MLA and LLA was significantly greater for subjects with MTSS than for control subjects. Translational motion of the MLA and LLA of the MTSS group was also significantly greater than that of the non-MTSS group (all p < 0.05). Soccer players with MTSS have an abnormal structural deformation of foot during support (or stance) phase of running, with a large decrease in both the MLA and LLA. This abnormal motion could be a risk factor for the development of MTSS in these subjects.
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Affiliation(s)
- Byungjoo Noh
- a Department of Sports Medicine, Graduate School of Comprehensive Human Sciences , University of Tsukuba , Ibaraki , Japan
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Vincent HK, Herman DC, Lear-Barnes L, Barnes R, Chen C, Greenberg S, Vincent KR. Setting standards for medically-based running analysis. Curr Sports Med Rep 2014; 13:275-83. [PMID: 25014394 PMCID: PMC4469466 DOI: 10.1249/jsr.0000000000000071] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Setting standards for medically based running analyses is necessary to ensure that runners receive a high-quality service from practitioners. Medical and training history, physical and functional tests, and motion analysis of running at self-selected and faster speeds are key features of a comprehensive analysis. Self-reported history and movement symmetry are critical factors that require follow-up therapy or long-term management. Pain or injury is typically the result of a functional deficit above or below the site along the kinematic chain.
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Affiliation(s)
- Heather K. Vincent
- Department of Orthopaedics and Rehabilitation, Interdisciplinary Center for Musculoskeletal Training and Research, University of Florida, Gainesville, FL
- Sports Performance Center, University of Florida, Gainesville, FL
| | - Daniel C. Herman
- Department of Orthopaedics and Rehabilitation, Interdisciplinary Center for Musculoskeletal Training and Research, University of Florida, Gainesville, FL
- Sports Performance Center, University of Florida, Gainesville, FL
| | | | - Robert Barnes
- Department of Orthopaedics and Rehabilitation, Interdisciplinary Center for Musculoskeletal Training and Research, University of Florida, Gainesville, FL
| | - Cong Chen
- Department of Orthopaedics and Rehabilitation, Interdisciplinary Center for Musculoskeletal Training and Research, University of Florida, Gainesville, FL
- Sports Performance Center, University of Florida, Gainesville, FL
| | - Scott Greenberg
- Sports Performance Center, University of Florida, Gainesville, FL
- Shands Physical Therapy, University of Florida, Gainesville, FL
| | - Kevin R. Vincent
- Department of Orthopaedics and Rehabilitation, Interdisciplinary Center for Musculoskeletal Training and Research, University of Florida, Gainesville, FL
- Sports Performance Center, University of Florida, Gainesville, FL
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Newman P, Witchalls J, Waddington G, Adams R. Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis. Open Access J Sports Med 2013; 4:229-41. [PMID: 24379729 PMCID: PMC3873798 DOI: 10.2147/oajsm.s39331] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background Medial tibial stress syndrome (MTSS) affects 5%–35% of runners. Research over the last 40 years investigating a range of interventions has not established any clearly effective management for MTSS that is better than prolonged rest. At the present time, understanding of the risk factors and potential causative factors for MTSS is inconclusive. The purpose of this review is to evaluate studies that have investigated various risk factors and their association with the development of MTSS in runners. Methods Medical research databases were searched for relevant literature, using the terms “MTSS AND prevention OR risk OR prediction OR incidence”. Results A systematic review of the literature identified ten papers suitable for inclusion in a meta-analysis. Measures with sufficient data for meta-analysis included dichotomous and continuous variables of body mass index (BMI), ankle dorsiflexion range of motion, navicular drop, orthotic use, foot type, previous history of MTSS, female gender, hip range of motion, and years of running experience. The following factors were found to have a statistically significant association with MTSS: increased hip external rotation in males (standard mean difference [SMD] 0.67, 95% confidence interval [CI] 0.29–1.04, P<0.001); prior use of orthotics (risk ratio [RR] 2.31, 95% CI 1.56–3.43, P<0.001); fewer years of running experience (SMD −0.74, 95% CI −1.26 to −0.23, P=0.005); female gender (RR 1.71, 95% CI 1.15–2.54, P=0.008); previous history of MTSS (RR 3.74, 95% CI 1.17–11.91, P=0.03); increased body mass index (SMD 0.24, 95% CI 0.08–0.41, P=0.003); navicular drop (SMD 0.26, 95% CI 0.02–0.50, P=0.03); and navicular drop >10 mm (RR 1.99, 95% CI 1.00–3.96, P=0.05). Conclusion Female gender, previous history of MTSS, fewer years of running experience, orthotic use, increased body mass index, increased navicular drop, and increased external rotation hip range of motion in males are all significantly associated with an increased risk of developing MTSS. Future studies should analyze males and females separately because risk factors vary by gender. A continuum model of the development of MTSS that links the identified risk factors and known processes is proposed. These data can inform both screening and countermeasures for the prevention of MTSS in runners.
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Affiliation(s)
- Phil Newman
- Faculty of Health, Physiotherapy, University of Canberra, Bruce, ACT, Australia
| | - Jeremy Witchalls
- Faculty of Health, Physiotherapy, University of Canberra, Bruce, ACT, Australia
| | - Gordon Waddington
- Faculty of Health, Physiotherapy, University of Canberra, Bruce, ACT, Australia
| | - Roger Adams
- Faculty of Health, Physiotherapy, University of Canberra, Bruce, ACT, Australia
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Paterno MV, Taylor-Haas JA, Myer GD, Hewett TE. Prevention of overuse sports injuries in the young athlete. Orthop Clin North Am 2013; 44:553-64. [PMID: 24095071 PMCID: PMC3796354 DOI: 10.1016/j.ocl.2013.06.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The purpose of this article is to review the current theories regarding prevalence, mechanism, and prevention strategies for overuse injuries in a young athletic population. This information provides valuable insight into the state of the current evidence regarding overuse injuries in young athletes as well as the potential future directions in the development of overuse injury prevention interventions.
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Affiliation(s)
- Mark V Paterno
- Human Performance Lab, Division of Sports Medicine, Sports Medicine Biodynamics Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 10001, Cincinnati, OH 45229, USA; Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 10001, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Yagi S, Muneta T, Sekiya I. Incidence and risk factors for medial tibial stress syndrome and tibial stress fracture in high school runners. Knee Surg Sports Traumatol Arthrosc 2013; 21:556-63. [PMID: 22875369 DOI: 10.1007/s00167-012-2160-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Accepted: 07/26/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Medial tibial stress syndrome (MTSS) and tibial stress fracture (SF) are common lower leg disorders in runners. A prospective study was done to identify the incidence of MTSS and SF in high school runners and to determine risk factors. METHODS A total of 230 runners participating in high school running teams were evaluated. All runners aged 15 years as first grade of high school were involved in the study. They were followed up for 3 years. The measured items included height, weight, body mass index (BMI), range of hip and ankle motion, straight leg raising (SLR), intercondylar and intermalleolar interval, Q-angle, navicular drop test, hip abductor strength and physical conditioning. Each runner was followed for 3 years to report occurrence of MTSS and SF. RESULTS A total number of 102 MTSS (0.29 athlete exposures) and 21 SF (0.06 athlete exposures) were identified. In females, BMI significantly increased the risk of MTSS after adjustment for the other variables in this study (adjusted odds ratio, 0.51; 95 % confidence interval, 0.31-0.86). Increased internal rotation of the hip significantly increased the risk of MTSS (adjusted odds ratio, 0.91; 95 % confidence interval, 0.85-0.99). In males, limited SLR also significantly increased the risk of SF with adjustment for the other variables in this study (adjusted odds ratio, 1.38; 95 % confidence interval, 1.04-1.83). CONCLUSION A significant relationship was found between BMI, internal hip rotation angle and MTSS in females, and between limited SLR and SF in males. LEVEL OF EVIDENCE Prospective cohort study, Level II.
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Affiliation(s)
- Shigenori Yagi
- Department of Joint Surgery and Sports Medicine, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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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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Bencke J, Christiansen D, Jensen K, Okholm A, Sonne-Holm S, Bandholm T. Measuring medial longitudinal arch deformation during gait. A reliability study. Gait Posture 2012; 35:400-4. [PMID: 22115733 DOI: 10.1016/j.gaitpost.2011.10.360] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 10/26/2011] [Accepted: 10/30/2011] [Indexed: 02/02/2023]
Abstract
Clinical evaluation of medial longitudinal arch deformation (MLAD) during walking gait is often estimated from static measures of e.g. navicular drop (ND) measured during quiet standing. The aim of the present study was to test the reliability of a new three-dimensional method of measuring the MLAD during gait and to compare this method with a static measure and a 2D dynamic method. Fifty-two feet (26 healthy male participants) were tested twice 4-9 days apart in a biomechanical gait analysis laboratory using a 3D three-marker foot model, a 2D video-based model for the measurement of MLAD during gait, and ND for measurements of MLAD during quiet standing. The 3D method showed the highest test-retest reliability among the measurements of MLAD. Furthermore, the ND showed only moderate correlation with both measurements of MLAD during gait. The new 3D method was found to be highly reliable and showed that ND obtained during quiet standing could not predict the MLAD during gait. The 3D method, or alternatively the 2D method, may be used in clinical settings as reliable methods for easy estimation of the foot longitudinal stability.
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Affiliation(s)
- Jesper Bencke
- Gait Analysis Laboratory, Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark.
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Biomechanical and lifestyle risk factors for medial tibia stress syndrome in army recruits: a prospective study. Gait Posture 2011; 33:361-5. [PMID: 21247766 DOI: 10.1016/j.gaitpost.2010.12.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 11/30/2010] [Accepted: 12/07/2010] [Indexed: 02/08/2023]
Abstract
Medial tibial stress syndrome (MTSS) is a common injury in active populations and has been suggested to be a result of both biomechanical and lifestyle factors. The main aim of this study was to determine prospectively whether gait biomechanics and lifestyle factors can be used as a predictor of MTSS development. British infantry male recruits (n=468) were selected for the study. Plantar pressure variables, lifestyle factors comprising smoking habit and aerobic fitness as measured by a 1.5 mile timed-run were collected on the first day of training. Injury data were collected during the 26 week training period and incidence rate was 7.9% (n=37). A logistic regression model for membership of the MTSS and non-MTSS groups was developed. An imbalance in foot pressure with greater pressure on the medial side than on the lateral side was the primary risk factor. Low aerobic fitness, as deduced from a 1.5 mile timed-run and smoking habit were also important, but were additive risk factors for MTSS. In conclusion, "poor" biomechanics were the strongest predictors of MTSS development but lifestyle factors were also important. The logistic regression model combining all three risk factors was capable of predicting 96.9% of the non-injured group and 67.5% of the MTSS group with an overall accuracy of 87.7%. While the model has yet to be validated against an external sample and limitations exist with regards to the quality of the data collected, it is nonetheless suggested that the combined analysis of biomechanical and lifestyle factors has the potential to improve the prediction of MTSS.
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Moen MH, Bongers T, Bakker EW, Zimmermann WO, Weir A, Tol JL, Backx FJG. Risk factors and prognostic indicators for medial tibial stress syndrome. Scand J Med Sci Sports 2010; 22:34-9. [PMID: 20561280 DOI: 10.1111/j.1600-0838.2010.01144.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The objective of the study was to examine the risk factors and prognostic indicators for medial tibial stress syndrome (MTSS). In total, 35 subjects were included in the study. For the risk factor analysis, the following parameters were investigated: hip internal and external ranges of motion, knee flexion and extension, dorsal and plantar ankle flexion, hallux flexion and extension, subtalar eversion and inversion, maximal calf girth, lean calf girth, standing foot angle and navicular drop test. After multivariate regression decreased hip internal range of motion, increased ankle plantar flexion and positive navicular drop were associated with MTSS. A higher body mass index was associated with a longer duration to full recovery. For other prognostic indicators, no relationship was found.
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Affiliation(s)
- M H Moen
- Rehabilitation and Sports Medicine Department, University Medical Center Utrecht, Utrecht, The Netherlands.
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Rompe JD, Cacchio A, Furia JP, Maffulli N. Low-energy extracorporeal shock wave therapy as a treatment for medial tibial stress syndrome. Am J Sports Med 2010; 38:125-32. [PMID: 19776340 DOI: 10.1177/0363546509343804] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Medial tibial stress syndrome (MTSS) is a pain syndrome along the tibial origin of the tibialis posterior or soleus muscle. Extracorporeal shock wave therapy (SWT) is effective in numerous types of insertional pain syndromes. HYPOTHESIS Shock wave therapy is an effective treatment for chronic MTSS. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Forty-seven consecutive subjects with chronic recalcitrant MTSS underwent a standardized home training program, and received repetitive low-energy radial SWT (2000 shocks; 2.5 bars of pressure, which is equal to 0.1 mJ/mm(2); total energy flux density, 200 mJ/mm(2); no local anesthesia) (treatment group). Forty-seven subjects with chronic recalcitrant MTSS were not treated with SWT, but underwent a standardized home training program only (control group). Evaluation was by change in numeric rating scale. Degree of recovery was measured on a 6-point Likert scale (subjects with a rating of completely recovered or much improved were rated as treatment success). RESULTS One month, 4 months, and 15 months from baseline, success rates for the control and treatment groups according to the Likert scale were 13% and 30% (P < .001), 30% and 64% (P < .001), and 37% and 76% (P < .001), respectively. One month, 4 months, and 15 months from baseline, the mean numeric rating scale for the control and treatment groups were 7.3 and 5.8 (P < .001), 6.9 and 3.8 (P < .001), and 5.3 and 2.7 (P < .001), respectively. At 15 months from baseline, 40 of the 47 subjects in the treatment group had been able to return to their preferred sport at their preinjury level, as had 22 of the 47 control subjects. CONCLUSION Radial SWT as applied was an effective treatment for MTSS.
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Affiliation(s)
- Jan D Rompe
- OrthoTrauma Evaluation Center, Oppenheimer Street 70, D-55130 Mainz, Germany.
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Abstract
Medial tibial stress syndrome (MTSS) is one of the most common lower leg injuries in athletes who run. Studies have reported MTSS to occur in 4% to 20% of this population. It can be defined as an overuse injury that creates pain over an area covering the distal to middle third of the posteriomedial tibial border, which occurs during exercise and creates cyclic loading. Differential diagnosis includes ischemic disorders and stress fractures. Although the pathology of this injury is understood, the etiology is less agreed upon. This makes it difficult for clinicians to diagnose and treat this common injury. The purpose of this article is to present health care practitioners with the most current information regarding MTSS so they can better diagnose and treat this common injury. To this end, a literature review was conducted, with the most current results presented. The areas of etiological theories, imaging techniques, and treatment options for MTSS were searched. Five of the most prevalent etiological theories are presented with supporting evidence. Of the imaging tools available to the clinician, magnetic resonance imaging (MRI) and bone scintigraphy have comparable specificity and sensitivity. Clinicians should first make the clinical diagnosis of MTSS, however, because of high percentages of positive MRI scans in asymptomatic patients. There have been few randomized controlled trials investigating treatment options for athletes with MTSS. Those that have been performed rendered no significant findings, leading researchers to conclude that rest is equal to or better than other treatment options. Given the evidence, treatment suggestions for practitioners caring for athletes with MTSS are provided.
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Affiliation(s)
- Debbie I Craig
- Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff, AZ 86011-5094, USA.
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Moen MH, Tol JL, Weir A, Steunebrink M, De Winter TC. Medial tibial stress syndrome: a critical review. Sports Med 2009; 39:523-46. [PMID: 19530750 DOI: 10.2165/00007256-200939070-00002] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Medial tibial stress syndrome (MTSS) is one of the most common leg injuries in athletes and soldiers. The incidence of MTSS is reported as being between 4% and 35% in military personnel and athletes. The name given to this condition refers to pain on the posteromedial tibial border during exercise, with pain on palpation of the tibia over a length of at least 5 cm. Histological studies fail to provide evidence that MTSS is caused by periostitis as a result of traction. It is caused by bony resorption that outpaces bone formation of the tibial cortex. Evidence for this overloaded adaptation of the cortex is found in several studies describing MTSS findings on bone scan, magnetic resonance imaging (MRI), high-resolution computed tomography (CT) scan and dual energy x-ray absorptiometry. The diagnosis is made based on physical examination, although only one study has been conducted on this subject. Additional imaging such as bone, CT and MRI scans has been well studied but is of limited value. The prevalence of abnormal findings in asymptomatic subjects means that results should be interpreted with caution. Excessive pronation of the foot while standing and female sex were found to be intrinsic risk factors in multiple prospective studies. Other intrinsic risk factors found in single prospective studies are higher body mass index, greater internal and external ranges of hip motion, and calf girth. Previous history of MTSS was shown to be an extrinsic risk factor. The treatment of MTSS has been examined in three randomized controlled studies. In these studies rest is equal to any intervention. The use of neoprene or semi-rigid orthotics may help prevent MTSS, as evidenced by two large prospective studies.
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Affiliation(s)
- Maarten H Moen
- Department of Sports Medicine of the University Medical Centre Utrecht and Rijnland Hospital, Leiderdorp, the Netherlands.
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Raissi GRD, Cherati ADS, Mansoori KD, Razi MD. The relationship between lower extremity alignment and Medial Tibial Stress Syndrome among non-professional athletes. BMC Sports Sci Med Rehabil 2009; 1:11. [PMID: 19519909 PMCID: PMC2700791 DOI: 10.1186/1758-2555-1-11] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Accepted: 06/11/2009] [Indexed: 12/12/2022]
Abstract
Objective To determine the relationship between lower extremity alignment and MTSS amongst non-professional athletes Design In a prospective Study, sixty six subjects were evaluated. Bilateral navicular drop test, Q angle, Achilles angle, tibial angle, intermalleolar and intercondylar distance were measured. In addition, runner's height, body mass, history of previous running injury, running experience was recorded. Runners were followed for 17 weeks to determine occurrence of MTSS. Results The overall injury rate for MTSS was 19.7%. The MTSS injury rate in girls (22%) was not significantly different from the rate in boys (14.3%). Most MTSS injuries were induced after 60 hours of exercise, which did not differ between boys and girls. There was a significant difference in right and left navicular drop (ND) in athletes with MTSS. MTSS had no significant correlation with other variables including Quadriceps, Tibia and Achilles angles, intercondylar and intermaleolar lengths and lower extremity lengths. Limitation All measurements performed in this study were uniplanar and static. The small sample size deemed our main limitation. The accurate assessment of participants with previous history of anterior leg pain for MTSS was another limitation. Conclusion Although a significant relationship between navicular drop and MTSS was found in this study; there was not any significant relationship between lower extremity alignment and MTSS in our sample study.
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Affiliation(s)
- Golam Reza D Raissi
- Iran University of Medical Sciences, Physical Medicine and Rehabilitation Department, Sports Medicine and Orthopedic Department, Tehran, Iran.
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