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Medial Tibial Stress Syndrome: A Case Study

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Medial Tibial Stress Syndrome ... WNL Mild pain with tibialis posterior Neurological WNL Differential Diagnosis Stress fracture Chronic compartment syndrome ... – PowerPoint PPT presentation

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Title: Medial Tibial Stress Syndrome: A Case Study


1
Medial Tibial Stress Syndrome A Case Study
  • Mark Lewis
  • Clinic II

2
What is MTSS?
  • Overuse injury
  • Usually due to
  • Exercising on hard surfaces, uneven ground, or
    worn out/ill fitting shoes
  • Beginning an exercise program after a long period
    of time off
  • Increasing intensity or duration too quickly
  • Excessive uphill or downhill running
  • Poor running mechanics
  • Biomechanical inefficiencies
  • Pes planus (flat feet) / Over-pronation
  • Pes cavus (high arch)

3
Anatomy
4
Anatomy
  • Origin
  • Insertion
  • Nerve
  • Function

5
Background / History
  • Rowan womens lacrosse athlete
  • Gradual onset
  • Posteromedial pain (bilateral)
  • History of medial tibial stress syndrome
  • Shin splints

6
Assessment Results
  • Mild to moderate sharp pain during practice that
    goes away with rest
  • Located along the medial boarder of the tibia
    (bilateral)
  • Point tenderness along medial tibial boarders
    decreases with rest
  • No swelling or obvious deformities
  • Pes planus (functional)
  • Poor running mechanics
  • Faulty equipment
  • Improper training shoes

7
Assessment Results
  • Range of motion (ROM)
  • WNL
  • Strength (MMT)
  • WNL
  • Mild pain with tibialis posterior
  • Neurological
  • WNL

8
Differential Diagnosis
  • Stress fracture
  • Chronic compartment syndrome
  • Periostitis

9
Treatment
  • Stretching (pre and post)
  • Gastrocnemius and soleus
  • Quadriceps and hamstrings
  • Thera-band strengthening exercises
  • Plantarflexion, dorsiflexion, inversion, and
    eversion
  • Single-leg toe raises
  • Wall lean toe pumps

10
Treatment cont.
  • Ice-massage
  • Ice bag compression
  • Whirlpool
  • Friction massage
  • Ibuprofen
  • Tape techniques
  • Shin splint taping
  • X-arch and low-dye
  • Arch foam inserts

11
Uniqueness
  • Medial tibial stress syndrome is one of the most
    common lower leg injuries in sports. Studies have
    shown medial tibial stress syndrome to be
    responsible for as much as 50 of all lower leg
    injuries reported in select populations. Overuse
    of the muscle causes an irritation to the tendons
    and the attachment of these tendons to the bone.
  • This case was unique due to the numerous
    intrinsic and extrinsic factors leading to this
    pathology.

12
Prevention
  • Earlier training and conditioning
  • Improved mechanics
  • Proper equipment
  • Abnormalities
  • Strength and flexibility
  • Training surface consistency

13
Conclusion
  • Condition has improved
  • Treatment
  • Turf practice rather than indoor court/track
  • Complains of mild to sometimes moderate pain
    during practice
  • Has not missed any play time
  • Goal is to
  • Manage pain
  • Consistent treatment and awareness

14
Relating to Article
  • Most promising outcomes support the use of
    shock-absorbing insoles
  • Foam heel pads
  • Achilles tendon stretching
  • Footwear
  • Gradual running programs
  • Soleus strength and endurance training
  • Complete rest is key

15
Reference
  • Craig, Debbie, PhD. Medial Tibial Stress
    Syndrome Evidence Based
  • Prevention. Journal of Athletic Training. 2008
    43(3)316-318.
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