Treatment of Medial Tibial
Stress Syndrome: A Systematic Review

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.

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.

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?

by: Laura Marley
by: Lisa Chinn and Jeffrey Driban


Risk Factors for Medial Tibial Stress Syndrome and Tibial Stress Fractures in Runners

Winters M, Eskes M, Weir A, Moen MH, Backx FJ, & Bakker EW (2013). Treatment of Medial Tibial Stress Syndrome: A Systematic Review. Sports Medicine (Auckland, N.Z.) PMID: 23979968