From the Guidelines
Treatment for medial tibial stress syndrome (MTSS) should prioritize a gradual return to running, addressing biomechanical abnormalities, and incorporating strength training, as outlined in the most recent guidelines 1. The primary goal is to reduce the risk of recurrence and promote a successful return to running. To achieve this, it is essential to address the five key components prior to introducing running: resolution of bony tenderness, pain-free walking, evidence of radiological healing, strength and functional tests, and identification of contributing factors 1.
- Key considerations for the return-to-running process include:
- Gradually introducing walk-run intervals, progressing running distance ahead of speed and intensity, with symptom provocation as a key consideration 1
- Addressing biomechanical abnormalities, such as hip adduction and rearfoot eversion angles, through running gait analysis and retraining 1
- Incorporating strength training to address muscle imbalances and improve lower extremity bone mass, including exercises like calf raises, toe curls, and plyometric training 1
- Using proper footwear with good arch support and considering orthotic inserts if necessary
- Cross-training with low-impact activities to maintain fitness while healing It is crucial to individualize the return-to-running program, taking into account the athlete's risk profile and managing the risk by balancing their interests and reinjury prevention 1. By following these guidelines and prioritizing a gradual and structured return to running, athletes can reduce their risk of recurrence and promote a successful recovery from MTSS.
From the Research
Treatment Options for Medial Tibial Stress Syndrome
- Conservative treatment options are mostly based on expert opinion and clinical experience 2
- Various treatments have been described in the literature, but it remains unclear which treatment is most effective 3
- Iontophoresis, phonophoresis, ice massage, ultrasound therapy, periosteal pecking, and extracorporeal shockwave therapy (ESWT) could be effective in treating MTSS when compared with control 3
- Low-energy laser treatment, stretching and strengthening exercises, sports compression stockings, lower leg braces, and pulsed electromagnetic fields have not been proven to be effective in treating MTSS 3
Multimodal Therapeutic Interventions
- Adding arch-support foot-orthoses (ASFO) to a multimodal therapeutic intervention, including ice massage, ankle muscle exercises, and extracorporeal shockwave therapy, can lead to an earlier diminishment of pain and MTSS severity, and improved physical function and perceived therapeutic effects 4
- A multimodal therapeutic intervention can include a combination of treatments such as rest, ice, and pain medications, as well as physical therapy strategies like strengthening and enhancing flexibility in the lower extremities, proprioceptive training, and mobilization techniques 5, 6
Physical Therapy Perspectives
- Comprehensive physical therapy interventions can be effective in the management of MTSS among novice runners 6
- Thorough clinical assessments and customized rehabilitation programs are essential in addressing underlying issues and fostering recovery 6
- A progressive loading program designed to facilitate tissue healing and reduce the likelihood of recurrence can be an effective component of a physical therapy intervention 6