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Hashim M, Alhazani FA, AlQarni AS, Albogami MA, Alomar AO, Alsultan AS. Medial Tibial Stress Syndrome (Shin Splint): Prevalence, Causes, Prevention, and Management in Saudi Arabia. Cureus 2024; 16:e59441. [PMID: 38826935 PMCID: PMC11140428 DOI: 10.7759/cureus.59441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
Background/aims Medial tibial stress syndrome (MTSS), also known as "shin splint", is most often described as exertional leg pain along the shinbone (tibia), which occurs due to the inflammation of the muscles, tendons, and bone tissue in this area. This study aims to assess the prevalence, risk factors, and their association with the development of MTSS, as well as the effective treatments that reduce pain and improve functions among the Saudi general population. Materials and method The present cross-sectional study was conducted on the general population of Saudi Arabia through an electronic survey over a period of three months. The study sample of 443 patients was deemed and considered. The study included participants from the general population in Saudi Arabia above the age of 18. A structured self-response questionnaire was given to the participants after institutional research ethical approval was obtained for the study. Results Among the 443 participants, the majority were male (n = 228, 51.5%), aged 18-29 (n = 227, 51.2%), and residing in the central region of Saudi Arabia (n = 398, 89.8%). Most participants reported engaging in sporting activities (n = 211, 47.6%), with high-intensity training being the most common (n = 93, 44.1%). Only a small proportion (n = 8, 1.8%) reported a previous diagnosis of MTSS. Analysis revealed associations between MTSS prevalence and certain demographic factors, including walking surface preferences and engagement in specific sports. Treatment strategies for MTSS included rest, ice application, physiotherapy, and pain-relieving medication, with varying degrees of satisfaction and recurrence rates among participants. Conclusion The study provides valuable insights into the prevalence, risk factors, management, and preventive measures related to MTSS among the Saudi general population. While certain demographic factors and exercise practices were associated with MTSS prevalence, effective treatment options such as rest, physiotherapy, and appropriate footwear were reported. Moreover, adherence to preventive measures such as stretching, proper footwear selection, and gradual training progression may help mitigate the risk of MTSS development.
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Affiliation(s)
- Majdi Hashim
- Department of Orthopedics, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, SAU
| | - Faisal A Alhazani
- College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, SAU
| | - Ayedh S AlQarni
- College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, SAU
| | - Mazen A Albogami
- College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, SAU
| | - Abdulrahman O Alomar
- College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, SAU
| | - Abdullah S Alsultan
- College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, SAU
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Nye NS, Grubic T, Kim M, O'Connor F, Deuster PA. Universal Training Precautions: A Review of Evidence and Recommendations for Prevention of Exercise-Related Injury, Illness, and Death in Warfighters and Athletes. J Athl Train 2023; 58:232-243. [PMID: 35724358 PMCID: PMC10176841 DOI: 10.4085/1062-6050-0400.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Facing pressure to train for victory, warfighters and athletes encounter numerous health risks that are directly related to their regular physical training. The concept of universal training precautions (UTPs) signifies universal processes designed to prevent unnecessary bodily harm, including injury, illness, and death, during physical training programs. Although no formal guidelines exist for collectively implementing a defined set of UTPs to address a broad scope of exercise-related health risks, recommendations and guidelines have been published relating to preventing sudden death during high school sports and collegiate conditioning sessions. A long list of critical topics must be considered as UTPs, including physical fitness factors, transition-period accommodation, hydration, environmental factors and acclimatization, appropriate recovery, use of medications and dietary supplements, and importantly, leadership. In this article, we outline in detail, with corresponding Strength of Recommendation Taxonomy ratings, what should be considered universal recommendations to minimize the risk of warfighters and athletes coming to harm when participating in group physical activities.
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Affiliation(s)
| | - Tyler Grubic
- Aviation Survival Training Center, NAS Patuxent River, MD
| | - Michael Kim
- Sports Medicine Clinic, Fort Belvoir Community Hospital, VA
| | | | - Patricia A. Deuster
- USU/MEM Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Silver Spring, MD
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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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Warne JP, Gruber AH, Cheung R, Bonacci J. Training and technique choices predict self-reported running injuries: An international study. Phys Ther Sport 2021; 48:83-90. [PMID: 33395617 DOI: 10.1016/j.ptsp.2020.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aim of this study was to describe the self-reported injury, training, and running technique choices of regular runners in four international regions. DESIGN AND SETTING 756 participants began an expert derived self-report online survey in Ireland, USA, Hong Kong and Australia. PARTICIPANTS 325 participants completed the survey (age = 38 ± 10 years; weight = 68.0 ± 13.1 kg; height = 1.70 ± 0.10 m). MAIN OUTCOME MEASURES Descriptive statistics are reported examining injury incidence and location; shoe and orthosis choices; and training and technique practices. A backwards logistic regression was implemented to examine associations between injury and training choices. RESULTS 68.3% reported having an injury in the last year. 81.45% of these injuries were believed to be running related. A large variation in training and footwear choices were observed for respondents. The regression (P ≤ 0.001) explained 20% of the variance in injury selection (Nagelkerke R2) and was able to identify 73% of cases accurately. Associated injury factors included competitive running, running on more than one surface, younger age, having a lower running age, and a higher proportion of running at an easy intensity. CONCLUSIONS The high amount of variability in runner's choices highlights the lack of consistent information being presented to them and may be the reason for the high injury incidence.
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Affiliation(s)
- Joe P Warne
- Department of Applied Science, Technological University Dublin- Tallaght Campus, Dublin, Ireland; Setanta College, Thurles Chamber of Commerce, Tipperary, Ireland.
| | - Allison H Gruber
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Roy Cheung
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong; School of Health Sciences, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Jason Bonacci
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Waurn Ponds, VIC, 3216, Australia
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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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Bunn PDS, Terra BDS, Souza MP, Amaral VPDS, Rodrigues AI, Magno KAB, Alves DDS, da Silva EB. The effect of different physical therapy procedures in ultramarathons. MOTRIZ: REVISTA DE EDUCACAO FISICA 2020. [DOI: 10.1590/s1980-6574202000010153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Priscila dos Santos Bunn
- Marinha do Brasil, Centro de Educação Física Almirante Adalberto Nunes, Brasil; Universidade do Estado do Rio de Janeiro, Brasil; Programa de Pós-Graduação em Desempenho Humano Operacional, Brasil
| | | | - Márcio Puglia Souza
- Marinha do Brasil, Centro de Educação Física Almirante Adalberto Nunes, Brasil
| | | | - Allan Inoue Rodrigues
- Marinha do Brasil, Centro de Educação Física Almirante Adalberto Nunes, Brasil; Universidade do Estado do Rio de Janeiro, Brasil
| | | | - Daniel de Souza Alves
- Marinha do Brasil, Centro de Educação Física Almirante Adalberto Nunes, Brasil; Programa de Pós-Graduação em Desempenho Humano Operacional, Brasil
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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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Abstract
Running is one of the most popular sports worldwide, with running events attracting hundreds of thousands of runners of all age groups. Running is an effective way to improve health but is also associated with a high risk of injuries. Up to 50% of regular runners report having more than one injury each year. Some injuries are caused by an accident but most are caused by overuse. The most frequent diagnoses are patellofemoral pain syndrome, tibial stress syndrome (shin splint), Achilles tendinopathy, iliotibial band friction syndrome (runner's knee), plantar fasciitis and stress fractures of the metatarsals and tibia. The knee is the most frequently injured joint in runners at all distances. Hamstring injuries are typically acute resulting in a sudden, sharp pain in the posterior thigh. Hip injuries are less common but it can be more difficult to make the correct diagnosis and treatment is more complex. Clinicians confronted by runners with shin pain must distinguish between stress fractures of the tibia, tibial stress syndrome (shin splints) and chronic exertional compartment syndrome. Foot and ankle injuries are the most common injuries reported by long distance and marathon runners. Excess body weight and the number of kilometers run per week are high risk factors for injuries. The roles of other factors, such as shoes, stretching and biomechanics are less clear. A detailed anamnesis and physical examination are important for the correct diagnosis or the necessity for further diagnostic imaging and subsequent therapy.
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Kim T, Park JC. Short-term effects of sports taping on navicular height, navicular drop and peak plantar pressure in healthy elite athletes: A within-subject comparison. Medicine (Baltimore) 2017; 96:e8714. [PMID: 29145309 PMCID: PMC5704854 DOI: 10.1097/md.0000000000008714] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Medial tibial stress syndrome (MTSS) is one of the most common exercise-induced leg pain. The navicular drop (ND) was identified as a risk factor for MTSS. This study aimed to evaluate the short-term effects of sports taping applied to the supporting lower leg during sitting, standing, walking, and jogging to restrict the ND in healthy elite athletes.Twenty-four healthy elite athletes without a history of exercise-induced pain or injuries in the lower limbs participated in this study (median age: 21.00 years; 1st--3rd quartiles; 19.25-22.00). The 4 taping conditions were used: rigid taping (RT), kinesiology taping (KT), placebo taping (PT), and non-taping (NT). The order of taping techniques was randomly assigned. Normalized navicular height (NH), ND, and normalized ND evaluated using 3-dimensional motion analysis, and normalized peak plantar pressure (PP) were compared in 4 taping conditions during sitting, standing, walking, and jogging.During sitting, the normalized NH of RT is higher than that of NT, KT, and PT (χ = 17.30, P = .001), while during jogging, the normalized NH of RT is higher than that of NT and PT (χ = 10.55, P = .014). The normalized peak PP of NT is higher than that of PT (χ = 8.871, P = .031) in the lateral midfoot region.This study showed the RT technique maintained NH during sitting and jogging, and the RT technique could be an effective preventive and treatment strategy for MTSS.
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Affiliation(s)
- Taegyu Kim
- Department of Marine Sports, Pukyong National University, Busan
| | - Jong-Chul Park
- Department of Sport Science, Korea Institute of Sport Science, Seoul, Republic of Korea
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Kozinc Ž, Šarabon N. Effectiveness of Movement Therapy Interventions and Training Modifications for Preventing Running Injuries: A Meta-Analysis of Randomized Controlled Trials. J Sports Sci Med 2017; 16:421-428. [PMID: 28912661 PMCID: PMC5592295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 07/28/2017] [Indexed: 06/07/2023]
Abstract
Runners are at relatively high risk for sustaining an overuse injury. While many risk factors have been documented so far, previous reviews have mostly failed to identify effective interventions to lower injury risk in runners. To review the high-quality evidence on two types of preventive interventions - movement therapy interventions and training-modification interventions, regarding running-related injury prevention. Pubmed (MEDLINE), PEDro and Cochrane Central Register of Controlled Trials databases were searched in April 2017, with no date or language restrictions, using following search terms: running injury prevention, running injury therapy, running injury incidence, running injury exercise and running injury risk. Studies were included if they were a randomized controlled trial or prospective cohort study, investigated the effects of movement therapy or training modification interventions, contained a population of runners or other populations, involved in running (e.g. military recruits), and reported lower extremity injury incidence rates specific to running. In total, 4935 citations were identified, 69 of which were retrieved for full-text evaluation. Seven articles met the inclusion criteria and were included in meta-analysis. Two separate meta-analyses were carried out for both intervention types. First meta-analysis showed no preventive effects of movement therapy interventions, with an overall risk ratio of 0.98 (p = 0.81, I2 = 42 %). The second meta-analysis showed no overall preventive effect of training modifications, with an overall risk ratio of 0.78 (p = 0.35, I2 = 79%). No evidence was found to support the preventive effects of movement therapy or training modification. This may primarily be due to non-optimal intervention designs, such as using inappropriate placebo exercises. Preventive programs may also be more effective when carried out prior to running program onset.
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Affiliation(s)
- Žiga Kozinc
- University of Primorska, Faculty of Health Sciences, Polje 42, 6310 Izola, Slovenia
| | - Nejc Šarabon
- University of Primorska, Faculty of Health Sciences, Polje 42, 6310 Izola, Slovenia
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Newman P, Waddington G, Adams R. Shockwave treatment for medial tibial stress syndrome: A randomized double blind sham-controlled pilot trial. J Sci Med Sport 2017; 20:220-224. [DOI: 10.1016/j.jsams.2016.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 06/19/2016] [Accepted: 07/13/2016] [Indexed: 02/02/2023]
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Winkelmann ZK, Anderson D, Games KE, Eberman LE. Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review. J Athl Train 2016; 51:1049-1052. [PMID: 27835043 DOI: 10.4085/1062-6050-51.12.13] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Reference/Citation: Hamstra-Wright KL, Bliven KC, 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. 2015;49(6):362-369. CLINICAL QUESTION What factors put physically active individuals at risk to develop medial tibial stress syndrome (MTSS)? DATA SOURCES The authors performed a literature search of CINAHL, the Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE from each database's inception to July 2013. The following key words were used together or in combination: armed forces, athlete, conditioning, disorder predictor, exercise, medial tibial stress syndrome, militaries, MTSS, military, military personnel, physically active, predictor, recruit, risk, risk characteristic, risk factor, run, shin pain, shin splints, and vulnerability factor. STUDY SELECTION Studies were included in this systematic review based on the following criteria: original research that (1) investigated risk factors associated with MTSS, (2) compared physically active individuals with and without MTSS, (3) was printed in English, and (4) was accessible in full text in peer-reviewed journals. DATA EXTRACTION Two authors independently screened titles or abstracts (or both) of studies to identify inclusion criteria and quality. If the article met the inclusion criteria, the authors extracted demographic information, study design and duration, participant selection, MTSS diagnosis, investigated risk factors, mean difference, clinical importance, effect size, odds ratio, and any other data deemed relevant. After the data extraction was complete, the authors compared findings for accuracy and completeness. When the mean and standard deviation of a particular risk factor were reported 3 or more times, that risk factor was included in the meta-analysis. In addition, the methodologic quality was assessed with an adapted checklist developed by previous researchers. The checklist contained 5 categories: study objective, study population, outcome measurements, assessment of the outcome, and analysis and data presentation. Any disagreement between the authors was discussed and resolved by consensus. MAIN RESULTS A total of 165 papers were initially identified, and 21 original research studies were included in this systematic review. More than 100 risk factors were identified in the 21 studies. Continuous data were reported 3 or more times for risk factors of body mass index (BMI), navicular drop, ankle plantar-flexion range of motion (ROM), ankle-dorsiflexion ROM, ankle-eversion ROM, ankle-inversion ROM, quadriceps angle, hip internal-rotation ROM, and hip external-rotation ROM. As compared with the control group, significant risk factors for developing MTSS identified in the literature were (1) greater BMI (mean difference [MD] = 0.79, 95% confidence interval [CI] = 0.38, 1.20; P < .001), (2) greater navicular drop (MD = 1.9 mm, 95% CI = 0.54, 1.84 mm; P < .001), (3) greater ankle plantar-flexion ROM (MD = 5.94°, 95% CI = 3.65°, 8.24°; P < .001), and (4) greater hip external-rotation ROM (MD = 3.95°, 95% CI = 1.78°, 6.13°; P < .001). Ankle-dorsiflexion ROM (MD = -0.01°, 95% CI = -0.96, 0.93; P = .98), ankle-eversion ROM (MD = 1.17°, 95% CI = -0.02, 2.36; P = .06), ankle-inversion ROM (MD = 0.98°, 95% CI = -3.11°, 5.07°; P = .64), quadriceps angle (MD = -0.22°, 95% CI = -0.95°, 0.50°; P = .54), and hip internal-rotation ROM (MD = 0.18°, 95% CI = -5.37°, 5.73°; P = .95), were not different between individuals with MTSS and controls. CONCLUSIONS The primary factors that appeared to put a physically active individual at risk for MTSS were increased BMI, increased navicular drop, greater ankle plantar-flexion ROM, and greater hip external-rotation ROM. These primary risk factors can guide health care professionals in the prevention and treatment of MTSS.
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Affiliation(s)
- Zachary K Winkelmann
- Neuromechanics, Interventions, and Continuing Education Research (NICER) Laboratory, Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute
| | | | - Kenneth E Games
- Neuromechanics, Interventions, and Continuing Education Research (NICER) Laboratory, Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute
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Zimmermann WO, Helmhout PH, Beutler A. Prevention and treatment of exercise related leg pain in young soldiers; a review of the literature and current practice in the Dutch Armed Forces. J ROY ARMY MED CORPS 2016; 163:94-103. [DOI: 10.1136/jramc-2016-000635] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 05/26/2016] [Accepted: 05/29/2016] [Indexed: 01/28/2023]
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Luedke LE, Heiderscheit BC, Williams DB, Rauh MJ. ASSOCIATION OF ISOMETRIC STRENGTH OF HIP AND KNEE MUSCLES WITH INJURY RISK IN HIGH SCHOOL CROSS COUNTRY RUNNERS. Int J Sports Phys Ther 2015; 10:868-876. [PMID: 26618066 PMCID: PMC4637921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND High school cross country runners have a high incidence of overuse injuries, particularly to the knee and shin. As lower extremity strength is modifiable, identification of strength attributes that contribute to anterior knee pain (AKP) and shin injuries may influence prevention and management of these injuries. PURPOSE To determine if a relationship existed between isometric hip abductor, knee extensor and flexor strength and the incidence of AKP and shin injury in high school cross country runners. MATERIALS/METHODS Sixty-eight high school cross country runners (47 girls, 21 boys) participated in the study. Isometric strength tests of hip abductors, knee extensors and flexors were performed with a handheld dynamometer. Runners were prospectively followed during the 2014 interscholastic cross country season for occurrences of AKP and shin injury. Bivariate logistic regression was used to examine risk relationships between strength values and occurrence of AKP and shin injury. RESULTS During the season, three (4.4%) runners experienced AKP and 13 (19.1%) runners incurred a shin injury. Runners in the tertiles indicating weakest hip abductor (chi-square = 6.140; p=0.046), knee extensor (chi-square = 6.562; p=0.038), and knee flexor (chi-square = 6.140; p=0.046) muscle strength had a significantly higher incidence of AKP. Hip and knee muscle strength was not significantly associated with shin injury. CONCLUSIONS High school cross country runners with weaker hip abductor, knee extensor and flexor muscle strength had a higher incidence of AKP. Increasing hip and knee muscle strength may reduce the likelihood of AKP in high school cross country runners. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Lace E. Luedke
- Department of Kinesiology, University of Wisconsin –Oshkosh, Oshkosh, WI, USA
| | - Bryan C. Heiderscheit
- Department of Orthopedics and Rehabilitation, Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA
| | | | - Mitchell J. Rauh
- Doctor of Physical Therapy Program, San Diego State University, San Diego, CA
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Franklyn M, Oakes B. Aetiology and mechanisms of injury in medial tibial stress syndrome: Current and future developments. World J Orthop 2015; 6:577-589. [PMID: 26396934 PMCID: PMC4573502 DOI: 10.5312/wjo.v6.i8.577] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 05/31/2015] [Accepted: 07/27/2015] [Indexed: 02/06/2023] Open
Abstract
Medial tibial stress syndrome (MTSS) is a debilitating overuse injury of the tibia sustained by individuals who perform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, in most cases it is also an injury involving underlying cortical bone microtrauma, although it is not clear if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and magnetic resonance imaging (MRI) can both be used for the diagnosis of MTSS, but the patient’s history and clinical symptoms need to be considered in conjunction with the imaging findings for a correct interpretation of the results, as both imaging modalities have demonstrated positive findings in the absence of injury. However, MRI is rapidly becoming the preferred imaging modality for the diagnosis of bone stress injuries. It can also be used for the early diagnosis of MTSS, as the developing periosteal oedema can be identified. Retrospective studies have demonstrated that MTSS patients have lower bone mineral density (BMD) at the injury site than exercising controls, and preliminary data indicates the BMD is lower in MTSS subjects than tibial stress fracture (TSF) subjects. The values of a number of tibial geometric parameters such as cross-sectional area and section modulus are also lower in MTSS subjects than exercising controls, but not as low as the values in TSF subjects. Thus, the balance between BMD and cortical bone geometry may predict an individual's likelihood of developing MTSS. However, prospective longitudinal studies are needed to determine how these factors alter during the development of the injury and to find the detailed structural cause, which is still unknown. Finite element analysis has recently been used to examine the mechanisms involved in tibial stress injuries and offer a promising future tool to understand the mechanisms involved in MTSS. Contemporary accurate diagnosis of either MTSS or a TSF includes a thorough clinical examination to identify signs of bone stress injury and to exclude other pathologies. This should be followed by an MRI study of the whole tibia. The cause of the injury should be established and addressed in order to facilitate healing and prevent future re-occurrence.
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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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Bonasia DE, Rosso F, Cottino U, Rossi R. Exercise-induced leg pain. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2015; 2:73-84. [PMID: 29264244 PMCID: PMC5730650 DOI: 10.1016/j.asmart.2015.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/11/2015] [Accepted: 03/27/2015] [Indexed: 12/03/2022]
Abstract
Exercise-induced leg pain is a common condition in athletes and in people involved in recreational sports. The diagnosis is not always straightforward: many conditions may cause exercise-induced leg pain. The aim of the present review is to provide a complete discussion of the most common pathologies related to this condition. Particular attention is dedicated to the history and the physical examination, which are fundamental for requesting the correct diagnostic tests or imaging techniques necessary for a precise diagnosis.
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Affiliation(s)
- Davide Edoardo Bonasia
- Department of Orthopaedics and Traumatology, AO Città della Salute e della Scienza, Torino, Italy
| | - Federica Rosso
- Department of Orthopaedics and Traumatology, AO Mauriziano Umberto I, Torino, Italy
| | - Umberto Cottino
- Department of Orthopaedics and Traumatology, University of Torino, Torino, Italy
| | - Roberto Rossi
- Department of Orthopaedics and Traumatology, AO Mauriziano Umberto I, Torino, Italy
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Abstract
Pediatric overuse injury is a common complaint presenting to pediatricians. Overuse injury can affect the soft tissues or bone, and results from an imbalance between training and load to the tissues and recovery time. In the skeletally immature athlete, physeal and apophyseal tissue is particularly vulnerable to overuse resulting in different patterns of injury compared to adults. Awareness of age-dependent patterns of overuse is necessary for proper recognition, treatment, and prevention of injury. This article reviews the most common pediatric overuse injuries with emphasis on risk factors, diagnosis, and treatment. Guidelines for prevention are included, as this is the key component for successful management of overuse injury in pediatric athletes.
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Treatment of medial tibial stress syndrome according to the fascial distortion model: a prospective case control study. ScientificWorldJournal 2014; 2014:790626. [PMID: 25379543 PMCID: PMC4212583 DOI: 10.1155/2014/790626] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 09/08/2014] [Accepted: 09/09/2014] [Indexed: 12/21/2022] Open
Abstract
Medial tibial stress syndrome (MTSS) is a common problem among athletes and soldiers. There is no proven theory that could explain the pathophysiology of shin splints. The therapies described so far are time-consuming and involve a high risk of relapse. The method according to the fascial distortion model (FDM) addresses local changes in the area of the lower leg fascia. It is suited to reduce pain and functional impairments associated with this symptom complex by applying targeted manual techniques. 32 patients (male: 30; female: 2) participated in this study. Visual analogue scale (VAS) was used for the quantification of pain. Scores were also given to rate the maximum painless exercise tolerance of the patients. Subsequently treatment of the crural fascia was performed. Patients retested ability of running and jumping. Therapy was continued until full exercise tolerance or painlessness was reached. A significant reduction of the VAS pain score from 5.2 to 1.1 could be achieved (P < 0.001). The impairment of exercise tolerance could be reduced from 7 to 2 points (P < 0.001). The duration of treatment was 6.3 (SD: 4.3) days on average. The FDM therapy is a potential effective method for acute treatment of MTSS.
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Sabeti V, Khoshraftar Yazdi N, Bijeh N. The relationship between shin splints with anthropometric characteristics and some indicators of body composition. J Sports Med Phys Fitness 2014; 59:1195-1199. [PMID: 25286885 DOI: 10.23736/s0022-4707.16.05156-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Medial tibial stress syndrome (MTSS), commonly known as "shin splints," is a frequent injury of the lower extremity and one of the most common causes of exertional leg pain in athletes. The aim of this study was to study the relationship between Shin splints, anthropometric characteristics and some indicators of body composition. METHODS In this descriptive-comparative study, 35 students of physical education were evaluated in two groups: Shin Splints group ([N.=17], mean [±SD] height and weight, 161.52±5.32 and 56.85±9.30 respectively) and healthy group ([N.=18], mean [±SD] height and weight, 162.75±3.85 and 54.73±6.36 respectively). Anthropometric and body composition characteristic of both groups were studied under identical conditions. Independent t-test was performed in order to analyze the data. RESULTS No significant differences were found in anthropometric parameters (thigh length, leg length, foot length and leg circumference) body composition (the amount of minerals and body fat percentage) between the healthy group and the Shin Splints group (P>0.05). CONCLUSIONS According to the results of this study, anthropometric characteristics and body composition indicators may not be regarded as a risk factor for shin splints.
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Affiliation(s)
- Vajiheh Sabeti
- Department of Physical Education, Ferdowsi University of Mashhad, Mashhad, Iran
| | | | - Nahid Bijeh
- Faculty of Sport Sciences, Ferdowsi University of Mashhad, Mashhad, Iran
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22
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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: 82] [Impact Index Per Article: 7.5] [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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GERYCH DAVID, TVRZNIK ALES, PROKESOVA EVA, NEMECKOVA ZUZANA, JELEN KAREL. ANALYSIS OF PEAK PRESSURE, MAXIMAL FORCE, AND CONTACT AREA CHANGES DURING WALKING AND RUNNING WITH CONVENTIONAL AND SHOCK-ABSORBING INSOLES IN THE COMBAT BOOTS OF THE CZECH ARMY. J MECH MED BIOL 2013. [DOI: 10.1142/s0219519413500425] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The aim of this study was to determine changes of peak pressure, maximal force, and contact area in five foot regions with two different insoles during walking and running, thereby obtaining data contributing to optimization of footwear and reduction of lower leg injury. Twenty-six male soldiers participated in the study. Peak pressure, maximal force, and contact area were measured in five foot regions (lateral and medial heel, midfoot, lateral and medial forefoot, big toe, and toes 2, 3, 4, and 5) with two different insoles (conventional vs. custom molded shock-absorbing insoles) during a walking speed of 5 km/h and running speeds of 8 and 12 km/h using the Pedar-X tensometric system (Novel, St. Paul, MN). Measurements revealed that the shock-absorbing insoles significantly (p < 0.05) attenuated the peak pressures in heel and forefoot region and increased the contact area in the midfoot region which indicates a successful redistribution of forces that arise during the contact phase in walking and running. Shock-absorbing insoles hence may contribute to better plantar pressure distribution during walking and running, and effectively prevent lower leg injuries.
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Affiliation(s)
- DAVID GERYCH
- Sports Research Institute of Czech Armed Forces, Podbabská 1590/3, Prague 6, Czech Republic
- Department of Anatomy and Biomechanics, Faculty of Physical Education and Sport, Charles University in Prague, Prague 6, Czech Republic
| | - ALES TVRZNIK
- Sports Research Institute of Czech Armed Forces, Podbabská 1590/3, Prague 6, Czech Republic
| | - EVA PROKESOVA
- Sports Research Institute of Czech Armed Forces, Podbabská 1590/3, Prague 6, Czech Republic
| | - ZUZANA NEMECKOVA
- Sports Research Institute of Czech Armed Forces, Podbabská 1590/3, Prague 6, Czech Republic
| | - KAREL JELEN
- Department of Anatomy and Biomechanics, Faculty of Physical Education and Sport, Charles University in Prague, Prague 6, Czech Republic
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Lopes AD, Hespanhol LC, Yeung SS, Costa LOP. What are the main running-related musculoskeletal injuries? A Systematic Review. Sports Med 2013; 42:891-905. [PMID: 22827721 PMCID: PMC4269925 DOI: 10.1007/bf03262301] [Citation(s) in RCA: 401] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Musculoskeletal injuries occur frequently in runners and despite many studies about running injuries conducted over the past decades it is not clear in the literature what are the main running-related musculoskeletal injuries (RRMIs). Objective The aim of this study is to systematically review studies on the incidence and prevalence of the main specific RRMIs. Methods An electronic database search was conducted using EMBASE (1947 to October 2011), MEDLINE (1966 to October 2011), SPORTDiscus™ (1975 to October 2011), the Latin American and Caribbean Center on Health Sciences Information (LILACS) [1982 to October 2011] and the Scientific Electronic Library Online (SciELO) [1998 to October 2011] with no limits of date or language of publication. Articles that described the incidence or prevalence rates of RRMIs were considered eligible. Studies that reported only the type of injury, anatomical region or incomplete data that precluded interpretation of the incidence or prevalence rates of RRMIs were excluded. We extracted data regarding bibliometric characteristics, study design, description of the population of runners, RRMI definition, how the data of RRMIs were collected and the name of each RRMI with their rates of incidence or prevalence. Separate analysis for ultra-marathoners was performed. Among 2924 potentially eligible titles, eight studies (pooled n = 3500 runners) were considered eligible for the review. In general, the articles had moderate risk of bias and only one fulfilled less than half of the quality criteria established. Results A total of 28 RRMIs were found and the main general RRMIs were medial tibial stress syndrome (incidence ranging from 13.6% to 20.0%; prevalence of 9.5%), Achilles tendinopathy (incidence ranging from 9.1% to 10.9%; prevalence ranging from 6.2% to 9.5%) and plantar fasciitis (incidence ranging from 4.5% to 10.0%; prevalence ranging from 5.2% to 17.5%). The main ultra-marathon RRMIs were Achilles tendinopathy (prevalence ranging from 2.0% to 18.5%) and patellofemoral syndrome (prevalence ranging from 7.4% to 15.6%). Conclusion This systematic review provides evidence that medial tibia stress syndrome, Achilles tendinopathy and plantar fasciitis were the main general RRMIs, while Achilles tendinopathy and patellofemoral syndrome were the most common RRMIs for runners who participated in ultra-marathon races. Electronic Supplementary Material Supplementary material is available for this article at 10.1007/BF03262301 and is accessible for authorized users.
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Affiliation(s)
- Alexandre Dias Lopes
- />São Paulo Running Injury Group (SPRunIG), São Paulo, Brazil
- />Masters in Physical Therapy, Universidade Cidade de São Paulo-UNICID, Rua Cesário Galeno, 448/475, São Paulo, SP — CEP: 03071-000 Brazil
| | - Luiz Carlos Hespanhol
- />São Paulo Running Injury Group (SPRunIG), São Paulo, Brazil
- />Masters in Physical Therapy, Universidade Cidade de São Paulo-UNICID, Rua Cesário Galeno, 448/475, São Paulo, SP — CEP: 03071-000 Brazil
| | - Simon S. Yeung
- />Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Leonardo Oliveira Pena Costa
- />São Paulo Running Injury Group (SPRunIG), São Paulo, Brazil
- />Masters in Physical Therapy, Universidade Cidade de São Paulo-UNICID, Rua Cesário Galeno, 448/475, São Paulo, SP — CEP: 03071-000 Brazil
- />Musculoskeletal Division, The George Institute for Global Health, Sydney, New South Wales Australia
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Gallo RA, Plakke M, Silvis ML. Common leg injuries of long-distance runners: anatomical and biomechanical approach. Sports Health 2012; 4:485-95. [PMID: 24179587 PMCID: PMC3497945 DOI: 10.1177/1941738112445871] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
CONTEXT Long-distance running (greater than 3000 m) is often recommended to maintain a healthy lifestyle. Running injury rates increase significantly when weekly mileage extends beyond 40 miles cumulatively. With the development of running analysis and other diagnostic tests, injuries to the leg secondary to bone, musculotendinous, and vascular causes can be diagnosed and successfully managed. EVIDENCE ACQUISITION Searches used the terms running, injuries, lower extremity, leg, medial tibial stress syndrome, compartment syndrome, stress fractures, popliteal artery entrapment, gastrocnemius soleus tears, and Achilles tendinopathy. Sources included Medline, Google Scholar, and Ovid from 1970 through January 2012. RESULTS Tibial stress fractures and medial tibial stress syndrome can sometimes be prevented and/or treated by correcting biomechanical abnormalities. Exertional compartment syndrome and popliteal artery entrapment syndrome are caused by anatomic abnormalities and are difficult to treat without surgical correction. CONCLUSION Leg pain due to bone, musculotendinous, and vascular causes is common among long-distance runners. Knowledge of the underlying biomechanical and/or anatomic abnormality is necessary to successfully treat these conditions.
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Affiliation(s)
- Robert A. Gallo
- Department of Orthopedics and Rehabilitation, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Michael Plakke
- Department of Orthopedics and Rehabilitation, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Matthew L. Silvis
- Department of Orthopedics and Rehabilitation, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania
- Department of Family and Community Medicine, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Bennett JE, Reinking MF, Rauh MJ. The relationship between isotonic plantar flexor endurance, navicular drop, and exercise-related leg pain in a cohort of collegiate cross-country runners. Int J Sports Phys Ther 2012; 7:267-278. [PMID: 22666641 PMCID: PMC3362985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
PURPOSE The purpose of this study was to examine the relationships between isotonic ankle plantar flexor endurance (PFE), foot pronation as measured by navicular drop, and exercise-related leg pain (ERLP). BACKGROUND Exercise-related leg pain is a common occurrence in competitive and recreational runners. The identification of factors contributing to the development of ERLP may help guide methods for the prevention and management of overuse injuries. METHODS Seventy-seven (44 males, 33 females) competitive runners from five collegiate cross-country (XC) teams consented to participate in the study. Isotonic ankle PFE and foot pronation were measured using the standing heel-rise and navicular drop (ND) tests, respectively. Demographic information, anthropometric measurements, and ERLP history were also recorded. Subjects were then prospectively tracked for occurrence of ERLP during the 2009 intercollegiate cross-country season. Multivariate logistic regression analysis was used to examine the relationships between isotonic ankle joint PFE and ND and the occurrence of ERLP. RESULTS While no significant differences were identified for isotonic ankle PFE between groups of collegiate XC runners with and without ERLP, runners with a ND >10 mm were almost 7 times (OR=6.6, 95% CI=1.2-38.0) more likely to incur medial ERLP than runners with ND <10 mm. Runners with a history of ERLP in the month previous to the start of the XC season were 12 times (OR=12.3, 95% CI=3.1-48.9) more likely to develop an in-season occurrence of ERLP. CONCLUSION While PFE did not appear to be a risk factor in the development of ERLP in this group of collegiate XC runners, those with a ND greater than 10 mm may be at greater odds of incurring medial ERLP. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Jason E. Bennett
- Rocky Mountain University of Health Professions, Provo, UT, USA. Author was a Doctoral student at time of the study in the Graduate Program in Orthopaedic & Sports Science
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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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