Treatment of Medial Tibial Stress Syndrome: A Systematic Review
Winters M, Eskes M, Weir A, Moen MH, Backx FJG, Bakker EWP. Sports Med. 2013 August 27. [EPub ahead of print]
Take Home Message: More quality research needs to be conducted to support evidence-based practice in the management of medial tibial stress syndrome.
Medial tibial stress syndrome (MTSS) is a common injury prevalent in runners, jumpers, and military personnel. Repetitive overload on the tibia can cause bone microdamage, leading to widespread tibial pain. Treatment methods can be conservative or surgical; however, the most effective treatment for MTSS is unknown. This study systematically reviewed the literature to determine the effectiveness of conservative and surgical treatments for MTSS. Following an extensive literature search, the authors selected eleven studies. Inclusion criteria for this review were: randomized and non-randomized clinical trials that included participants with exercise-induced pain consistent with MTSS and measurable outcomes of recovery time and pain improvement. Of the included studies, none evaluated surgical treatments. These studies included 11 conservative treatments: 1) iontophoresis, 2) phonophoresis, 3) ice massage, 4) ultrasound, 5) low-energy laser treatment, 6) periosteal pecking, 7) stretching and strengthening exercises, 8) a sports compression stocking, 9) lower leg braces, 10) extracorporeal shockwave therapy (ESWT), and 11) pulsed electromagnetic field. The two studies that assessed the effect of ESWT on MTSS were the only studies that reported a significant reduction in pain or recovery time. The trial by Rompe et al found a reduction of pain in participants who received ESWT treatment in combination with a home exercise program compared with control participants who only completed the home exercise program. Another observational study by Moen et al found that participants in a graded running program were able to complete it significantly faster when receiving ESWT treatments compared with patients who did not receive ESWT. Analysis of all included trials revealed a strong risk of bias and poor methodological quality. The authors concluded there is no evidence of high quality to support the use of any intervention on MTSS.
Currently there is not enough quality evidence to positively recommend any specific treatment for the management of MTSS. This systematic review revealed the need for more research to be conducted with quality methodology to determine the effectiveness of various treatments. Of all the interventions for MTSS reported in the literature, ESWT appears to be potentially beneficial. Practitioners often rely on evidence-based medicine to guide their clinical decisions but in the case of MTSS, one specific management strategy cannot be justified over another. This forces clinicians to rely heavily on their experience to make clinical decisions and develop treatment plans while encouraging further research in this area.
Questions for Discussion: What method(s) of treatment have you found most useful for MTSS? Do you believe conservative methods or surgical methods yield better results?
Written by: Laura Marley
Reviewed by: Lisa Chinn and Jeffrey Driban
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