Successful treatment of medial tibial stress syndrome in a collegiate athlete focusing on clinical findings and kinesiological factors contributing to pain.

Medial tibial stress syndrome (MTSS) is characterized by the presence of diffuse pain in the posteromedial portion of the medial border of the tibia. Current evidence from the literature has not established an effective treatment and has not been able to demonstrate effectiveness of numerous modalities commonly used to treat MTSS pain. CASE DESCRIPTION: This report describes an 18-year-old male collegiate soccer player who presented with pain along the distal medial tibial border bilaterally consistent with the diagnosis of medial tibial stress syndrome (MTSS). Treatment focused on correcting clinical and kinesiological findings likely contributing to the patient's condition including fascial mobilization, interferential currents (IFC), strengthening and stretching exercises. After 10 sessions over 10 weeks the patient was able to return to training and competition without pain.

Tratamento por ondas de choque extracorpórea na síndrome do estresse tibial: uma revisão da literatura / Treatment of medial tibial stress syndrome with extracorporeal shockwave treatment: a literature review

A síndrome do estresse tibial medial é uma lesão comum devido a sobrecarga mecânica, principalmente em atletas, devido a inflamação local e estresse ósseo. A terapia de ondas de choque (TOC) vem sendo utilizada como tratamento para esta patologia por seus efeitos analgésicos e anti-inflamatórios. Objetivo: Avaliar a eficácia da TOC no tratamento analgésico da síndrome do estresse tibial medial e medidas de funcionalidade. Métodos: Foi realizada uma revisão da literatura, sendo incluídos estudos clínicos em humanos. Resultados: 3 artigos preencheram os critérios de inclusão, incluindo 166 pacientes. Os trabalhos trouxeram uma ampla variedade de intervenções, tipos de aparelhos, frequência e energia utilizada, além de diferenças nas quantidades de sessões e tipos de ondas de choque utilizado no tratamento. Conclusão: Ainda não há evidências consistentes quanto ao uso da TOC no tratamento conservador da síndrome do estresse tibial medial, com estudos pequenos, de qualidade metodológica baixa. Os estudos inclusos no trabalho não relataram efeitos colaterais significativos

Medial tibial stress syndrome is a common injury due to mechanical overload, especially in athletes due to local inflammation and bone stress. Shockwave therapy (ESWT) has been used as a treatment for this pathology due to its analgesic and anti-inflammatory effects. Objective: To evaluate the effectiveness of ESWT in the analgesic treatment of medial tibial stress syndrome and measures of functionality. Methods: A review of the literature was conducted, with clinical studies in humans included. Results: 3 articles fulfilled the inclusion criteria, including 166 patients. The trials involved a wide variety of interventions, types of devices, frequency and energy used, as well as differences in the number of sessions and types of shock waves used in treatment. Conclusion: There is still no consistent evidence regarding the use of ESWT in the conservative treatment of medial tibial stress syndrome, with small studies of low methodological quality. Studies included in this review did not report significant side effects

Aproximación en la identificación de factores de riesgo extrínsecos del síndrome de estrés tibial interno en cadetes de la Escuela Militar Bogotá, Colombia / Approach in identifying extrinsic risk factors of the medial Tibial Stress syndrome on cadets of the Military Academy Bogotá, Colombia

El síndrome de estrés tibial interno es una enfermedad frecuente en el personal militar durante los primeros meses de su entrenamiento. Su etiología no es muy clara y en diferentes trabajos se han descrito varios factores intrínsecos de riesgo relacionados con este síndrome, pero poco se han enfocado en identificar factores extrínsecos de riesgo en el personal militar. Objetivo: Hacer una aproximación a la identificación de los factores extrínsecos de riesgo relacionados con el síndrome de estrés tibial interno en personal militar de primer y segundo nivel de la Escuela Militar de Cadetes “General José María Córdova”. Metodología: La muestra la conformaron100 cadetes de la facultades de Educación Física Militar, de Ingeniería Civil y de Ciencias Militares, que contestaron dos cuestionarios: en uno se buscó identificar la presencia de síntomas y signos activos del síndrome de estrés tibial interno y, en el otro, los factores de riesgo descritos en la literatura y aquellos que a consideración del investigador podrían relacionarse con este síndrome. Resultados: El 21 % de los cadetes presentó el síndrome de estrés tibial interno. Los factores extrínsecos de riesgo identificados fueron: percibir el calzado deportivo de dotación como similar al calzado particular y realizar “repetición de la actividad” como correctivo en la formación militar. Los factores protectores identificados en los cadetes fueron: correr menos de 10 km, tener un acumulado de 20 a 30 km utilizando el calzado de dotación, percibir el calzado de dotación como pesado o similar al calzado común, desarrollar los entrenamientos físicos de su formación militar sobre la grama y realizar el correctivo militar “trote alrededor de la escuela”. Conclusion: Se logró determinar que considerar el calzado deportivo de dotación como inadecuado para el entrenamiento deportivo y someterse al correctivo militar...

Introduction: The medial tibial stress syndrome (MTES) is a common condition in military personnel during the first months of their training. Its etiology is unclear and different studies have described several intrinsic risk factors associated with this syndrome, but few have focused on identifying extrinsic risk factors in military personnel. Objective: The central aim of the study was to make an approach to the identification of extrinsic risk factors related to MTES in first year academy military personnel. Methodes: The sample consisted of 100 first year military personnel attending the physical education, civil engineering and military science pregraduate majors. They answered two questionnaires, one sought to identify cadets who had symptoms and signs of active MTES, and the second questionnaire sought to identify risk factors described in the literature and those that the researcher considered to be related to this syndrome. Results: 21% of the military personnel had MTES, and the extrinsic risk factors identified in the cadets were: perceiving the military issued sneakers as usual to the regular footwear and performing “repetition of the activity” as a corrective measure as part of the military training. Protective factors identified in the military personnel were: running less than 10 km, to have a total accumulated of 20 to 30 km using military issued boots, to perceive military issued footwear as heavy or usual to common footwear, to do the physical military training over grass and to “run to the academy premises” as a corrective measure in their military training. Conclusions: It was possible to identify that the military personnel who perceived as inadequate the military issued sneakers to perform their sports training and the military ...

Os trigonum syndrome on bone SPECT/CT.

A 16-year-old female athlete presented with increased pain in the distal left lower extremity. A possible stress fracture or shin splint of the left tibia was first considered. A 3-phase bone scintigraphy showed a very small focus of increased activity in the posterior left foot. A diagnosis of os trigonum syndrome was made after SPECT/CT images pinpointed the activity at the left os trigonum.

What are the main running-related musculoskeletal injuries? A Systematic Review.

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.