Randomized Controlled Trial of Laser Therapy Versus Conventional Therapy in the Treatment of Medial Tibial Stress Syndrome

Abstract

Introduction: Medial tibial stress syndrome (MTSS) can induce defective biomechanics and cause sacroiliac (SI) joint stress. The purpose of this study was to investigate whether successful therapy of MTSS normalizes SI joint stress. Methods: Fifty-three patients with MTSS and SI joint stress confirmed by nuclear scintigraphy were enrolled in this prospective trial. Patients were randomly assigned to receive laser therapy or conventional therapy. Patients in the laser therapy group underwent 15 laser sessions over a 5-day period (60 seconds in duration, three times per day). The SI ratio was measured using quantitative sacroiliac scintigraphy (QSS) before and after therapy. Outcome measures included Lower Extremity Functional Scale (LEFS). Generalized estimating equation models were used to evaluate the associations of LEFS. We adjusted for the correlations between QSS and different parts of the SI joint, and adjusted for potential confounders as well. Results: Age, body weight, and duration did not correlate with QSS or lateralization. There was no significant difference in QSS and laterality of MTSS. However, the LEFS measured after therapy were significantly increased 38.45 (P < 0.0001) from LEFS measured before therapy. The QSS was significantly lower after therapy (P < 0.0001), indicating that successful therapy of MTSS has a buttom-up effect on SI joint stress (P < 0.0001). There was also a significant association between the middle part and the lower part of the SI joint. The QSS for the middle part on both sides was significantly higher than that for the lower part (P = 0.0250). Conclusion: SI joint stress due to bottom-up processing of MTSS can be normalized after successful therapy of MTSS by either laser therapy or conventional therapy.