Medial Tibial Pain Research Articles

Dry Needling with Fascial Winding in Nontraumatic Medial Tibial Shin Pain

Shin pain is common term used to describe pain and discomfort localized on medial side of the lower leg. A significant association has been discovered between shin pain with distance runners and proving the impact of the physical demands inherent in these physical activities. Contraction of the deep leg flexors during running leads to stress transfer to the tibial fascial attachment, i.e. deep crural fascia at the medial tibial crest which results in fascial dysfunction resulting in shin pain and discomfort. Herein, we report a case of medial tibial shin pain due to fascial dysfunction in a 26-year-old male athletic who was initially treated with physical therapy, and it was failed to ease the patient’s problems completely. Dry needling with fascial winding relieved his symptoms. Dry needling with fascial winding can be a viable therapeutic option for the treatment of nontraumatic medial tibial shin pain.

Bilateral Medial Tibial Pain Managed Using Gait Retraining For An In-Season Soccer Player

Bilateral Medial Tibial Pain Managed Using Gait Retraining For An In-Season Soccer Player

Shin Splint: A Review.

Medial tibial stress syndrome (MTSS), usually referred to as "shin splints," is a common overuse injury of the lower extremities affecting a large percentage of athletes. A variety of factors can lead to shin splints, including overtraining, poor footwear, muscular imbalances at the ankle, overtight or weak triceps surae muscles, imbalances at the thoracolumbar complex, and a body mass index (BMI) above 30. Injuries present with diffuse palpable pain that is often described as a dull ache following exercise. The pain is often alleviated by resting. Often, athletes complain of tenderness along the posteromedial edge of the tibia and pain along the middle to distal third of the posteromedial border of the tibia following an exercise session. The pain caused by a shin splint should be categorized according to its location and cause, such as lower medial tibial pain caused by periostitis or upper lateral tibial pain caused by raised compartment pressure. In order to prevent MTSS or shin splints, it is important to avoid excessive stress. The main objectives of shin splint treatment are to relieve pain and to enable the patient to return to normal activities without pain. To prevent shin splints, repetitive stress should be avoided. In this paper, we review what is known about the pathophysiology of shin splintsyndrome, present evidence regarding risk factors associated with shin splints, assess the effectiveness of prevention strategies, and make recommendations for prevention. The purpose of this study is to assess the effectiveness of interventions to prevent shin splints.

Femoral neck stress fracture and medial tibial stress syndrome following high intensity interval training: A case report and review of literature

BACKGROUNDFemoral and tibial stress injuries are commonly found in long distance running athletes. Stress fractures have rarely been reported in athletes performing high intensity interval training (HIIT) exercise. The objective of this study was to report a case of a patient who presented with medial tibial stress syndrome and femoral neck stress fracture after performing HIIT exercises. CASE SUMMARYA 26 year old female presented with bilateral medial tibial pain. She had been performing HIIT exercise for 45 min, five times weekly, for a seven month period. Her tibial pain was gradual in onset, and was now severe and worse on exercise, despite six weeks of rest. Magnetic resonance imaging (MRI) revealed bilateral medial tibial stress syndrome. As she was taking norethisterone for birth control, a dual energy X-ray absorbitometry scan was performed which demonstrated normal bone mineral density of her lumbar spine and femoral neck. She was managed conservatively with analgesia and physiotherapy, but continued to exercise against medical advice. She presented again six months later with severe right hip pain. MRI of her right hip demonstrated an incomplete stress fracture of her subtrochanteric region. Her symptoms resolved with strict rest and physiotherapy. CONCLUSIONHIIT may cause stress injury of the tibia and femur in young individuals.

Is lower extremity vein pathology a risk factor for the development of osteoarthritis of the knee joint?

The aim of the workwas to assess the relationship between venous insufficiency and osteoarthritis of the knee joint.Materials and Methods. The study included 214 knee joints from April 2018 to March 2021 in 107 subjects (19 men, 88 women), mean age of patients was 54.6 ± 8.6 years (range, 40 to 73 years). The study group included 61 patients diagnosed with knee osteoarthritis; the control group included 46 healthy volunteers without knee joint disease complaints. Demographic and clinical characteristics of all study participants were taken into account. The venous system of the lower extremities was assessed by ultrasound Doppler imaging. The results were assessed by standard radiography based on the Kellgren-Lawrence classification and ultrasonography. Pain severity was assessed using the Likert scale, and functioning was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).Results. Venous insufficiency was detected in 40.9% of patients in the group of patients with knee osteoarthritis and in 15.2% of the control group (p=0.007). There was no statistically significant difference in cartilage thickness and Kellgren-Lawrence classification for the presence of venous insufficiency (p>0.05). However, the percentage of radiological medial tibial sclerosis was higher in patients with venous insufficiency in the osteoarthritis group (60%, p>0.05). Overall WOMAC scores were similar in both groups, whereas WOMAC pain scale scores were higher in patients with deep venous insufficiency (p>0.05).Discussion. Previously, researchers have found that patients with knee OA develop symptoms of chronic VH more frequently than their healthy peers, that VH and OA share common risk factors, and that the risk of these diseases increases with age. Our results showed no difference in the incidence of VN between groups after correction depending on age. Our results are consistent with the literature in that deep venous system lesions increase the risk of intraosseous hypertension to a greater extent than superficial venous system lesions.Conclusion. The evidence of increased radiological medial tibial sclerosis and higher WOMAC pain scale scores in patients with venous lesions in osteoarthritis create the hypothesis that venous pathology may affect the intraosseous bone microenvironment, leading to pain and early subchondral bone lesions, which manifest as subchondral sclerosis.

Foot strike patterns and running-related injuries among high school runners: a retrospective study.

There is a possible relationship between foot strike patterns and running-related injuries; however, this relationship among high school runners remains uninvestigated. Therefore, this retrospective cohort study examined this relationship among high school runners. Overall, 123 male Japanese high school runners participated in this study and completed a questionnaire regarding their characteristics, running habits, and running-related injury histories. We filmed their habitual high-intensity training sessions from a lateral side. Participants' foot strike patterns were visually classified, and they were divided into the non-rearfoot strike (forefoot strike and midfoot strike) and rearfoot strike groups. An independent sample t-test or Welch's t-test was used to compare participant characteristics, running habits, the number of running-related injuries in the past 1 year, and the running speed at the filmed training sessions between both groups. A χ2 test was used to examine the relationship between running-related injury histories and foot strike patterns in both groups. The number of running-related injuries in the past 1 year was not significantly different between both groups; however, running-related injury incidence was significantly associated with non-rearfoot strike (P<0.05). Furthermore, non-rearfoot strike was significantly associated with a history of achillodynia (P<0.05). Other running-related injuries, such as medial tibial pain, lateral knee pain, and heel pain, were not significantly associated with foot strike patterns. Our study revealed that rearfoot strike runners did not have a higher risk of running-related injury compared to that of non-rearfoot strike runners, and that non-rearfoot strike was associated with achillodynia.

Relationship Between Jump-Landing Kinematics and Lower Extremity Overuse Injuries in Physically Active Populations: A Systematic Review and Meta-Analysis.

Lower extremity overuse injuries are common in athletes participating in sports with repeated bouts of landing manoeuvres. Biomechanical alterations during landing may be associated with these types of injuries. The objective of this systematic review with meta-analysis was to summarise and determine the relationship between kinematic alterations during a landing task and the development of lower extremity overuse injuries in physically active populations. PubMed, Embase, Web of Science, CINAHL, and SPORTDiscus were consulted up to and including February 2020. Cohort, cross-sectional or case-control studies were included if they investigated the relationship between three-dimensional (3D) landing kinematics in physically active populations and either new incidence or a history of lower extremity overuse injuries. Twenty-three studies that investigated 3D landing kinematics in subjects with either patellar tendinopathy (PT), patellofemoral pain (PFP), exertional medial tibial pain (EMTP) or groin overuse injury met the inclusion criteria. Based on this systematic review, there is evidence for decreased knee flexion range of motion (ROM) and increased knee abduction ROM during landing as risk factors for PFP. For PT, risk factors are poorly understood. Furthermore, the meta-analysis demonstrated significantly greater hip adduction at initial contact (IC) (p = 0.02), greater knee internal rotation at IC (p < 0.001), greater peak knee external rotation (p = 0.05) and less ankle dorsiflexion at peak vertical ground reaction force (vGRF) (p = 0.05) in subjects with knee overuse injuries compared to healthy controls. There is evidence of increased trunk, hip and knee transversal ROM as risk factors for EMTP. Groin injuries are associated with greater pelvic and hip frontal and transversal plane ROM in the injured group compared to the healthy controls. The results of this systematic review and meta-analysis provide preliminary evidence for impaired landing kinematics associated with lower extremity overuse injuries. Excessive frontal and transversal plane movements during landing manoeuvres might increase impact and tensile forces resulting in lower extremity overuse injuries. This systematic review was registered in the PROSPERO international prospective register of systematic reviews (ID = CRD42019135602).

The Use of Orthotic Insoles to Prevent Lower Limb Overuse Injuries: A Critically Appraised Topic.

Overuse injuries are common in physically active populations. Lower limb overuse injuries can occur anywhere in the lower-extremity and include injuries such as medial tibial stress syndrome, plantar fasciitis, and anterior knee pain. One reason that overuse injuries have received attention is because they have both short- and long-term consequences on health and burden the lives of physically active people. Over the years, a variety of approaches have been proposed for prevention of lower limb overuse injury that addresses various intrinsic or extrinsic risk factors. One extrinsic risk factor is footwear and the use of orthotic insoles to prevent injury. To date, there is no consensus as to whether these supports prevented lower limb overuse injuries. A critical appraisal of recent studies examining the injury prevention capabilities of orthotic insoles was completed. The long-term objective of this research is to help identify effective strategies for preventing injuries in physically active people.

Effects of kinesiotaping versus non-steroidal anti-inflammatory drugs and physical therapy for treatment of pes anserinus tendino-bursitis: A randomized comparative clinical trial

ABSTRACTObjective: Pes anserinus tendino-bursitis is a condition caused by repetitive friction over the bursa or direct trauma to knee joint and it presents with proximal medial tibial pain and swelling. The aim of this study is to determine the effects of kinesiotaping in comparison with naproxen and physical therapy in treatment of pes anserinus tendino-bursitis.Methods: In a randomized comparative clinical trial 56 patients with clinical diagnosis of pes anserinus tendino-bursitis were randomly assigned to kinesiotaping and naproxen/physical therapy (28 patients in each group). Kinesiotaping on the tender area in the form of space-correction (lifting) technique was used and repeated for three times with a one-week interval. Another group received naproxen (250mg TID for 10 days) and ten sessions of daily physical therapy. The visual analog scale (VAS) was used for evaluation of pain. The depth of swelling of the area was measured with sonography before and after treatment. Wilcoxon signed ranks test has been used for determining the influence of interventions on pain (VAS) and swelling scores in each group. The ANCOVA (Analysis of covariance) test was applied for comparing the influence of interventions on VAS and swelling scores after adjustment for co-variables.Results: At end of the study, 27 patients remained in the kinesiotaping group and 19 patients in naproxen/physical therapy group. Treatment with kinesiotaping significantly decreased the pain (P=0.0001) and swelling scores (P=0.0001) in comparison with naproxen/physical therapy after adjustment for baseline characteristics. Kinesiotaping was safe without any complications except for a mild local skin irritation in one patient.Conclusion: Kinesiotaping is more effective than naproxen plus physical therapy in reduction of pain and swelling in patients with pes anserinus tendino-bursitis.Clinical trial registration: www.ClinicalTrials.gov identifier is NCT01680263

Differentiating Occult Propionibacterium acnes Infection From Aseptic "Biologic" Interference Screw Hydrolysis After Anterior Cruciate Ligament Reconstruction: Introducing a Novel Culture Protocol for Detecting Low-Virulence Organisms.

Historically, arthroscopic anterior cruciate ligament (ACL) reconstruction has a low rate of infection, with a reported prevalence of 0.14% to 5.7%.12,14,21 While uncommon, these infections generally occur early and are characterized by either cellulitis at the graft insertion site and/or septic arthritis.5 Subacute infections are less well characterized. Although bioabsorbable interference screws have the potential advantages of osseointegration, limited postoperative imaging artifact, and decreased hardware removal rates, the potential for acting as the nidus for a sterile abscess, which can both mimic and/or set the stage for infection, exists.2 Typically, distinguishing a sterile abscess from infection is clinically apparent. However, we describe 2 patients with subacute postsurgical medial tibial pain in which this distinction was not evident. Application of a novel culture protocol taken from the prosthetic joint infection literature6 identified infection by a low-virulence organism and directed therapeutic treatment.

Static foot pronation as a risk factor for lower limb overuse injury: A systematic review and meta-analysis

Background: Static foot pronation has long been considered as a risk factor for lower limb overuse injuries, such as Medial Tibial Stress Syndrome, Patellofemoral Pain and Stress Fractures. However, no single source available has systematically appraised and summarised the literature to evaluate this proposed relationship. The aim of this systematic review was to investigate static foot pronation as a risk for lower limb overuse injury. Methods: A systematic search was performed across multiple electronicdatabases (Medline, CINAHL, EmbaseandSportDiscus) to identify prospective studies that investigated static foot pronation (measured quantitatively) as a risk factor for lower limb overuse injury. Studies were assigned into one or both of two groups based on the method of assessing foot posture: (i) static foot pronation assessment or (ii) dynamic foot function assessment. This review presents the results of the studies from (i) static foot pronation assessment. Two reviewers appraised the included studies using an adapted version of the Epidemiological Appraisal Instrument (EAI).Wherepossible, effectswere expressed as standardisedmean differences (SMD) or risk ratios (RR), with 95% confidence intervals, for continuous and nominal scaled data, respectively. Results: Twenty-one studies were included and the appraisal assessment indicated that most studies were of moderate quality. Static foot pronation was a small but significant risk factor for the development of both Medial Tibial Stress Syndrome and Patellofemoral Pain. Static foot pronation variables associatedwith development of lower limb overuse injuries included Navicular Drop, the Foot Posture Index and Calcaneal Eversion Angle. Significant effects ranged from SMDs of 0.28–0.62 for continuous scaled measures and from RRs of 0.97–1.25 for nominal scaled measures. Several non-significant findings were also reported for a pooled group of Unspecified Lower Extremity Injury, Foot and Ankle Injury and Stress Fractures. Discussion: Findings were limited and in some cases inconsistent, however, differences inmeasures of static foot pronationwere identified to increase the riskof lower limboveruse injury, although the significance is small in effect. It is unclear at this stage whether these risk factors can bemeasured reliably in clinic orwhether they will be predictive of dynamic function. As a result, they should be considered as part of a multifactorial injury risk assessment and not used as stand alone measures.

Running retraining in the management of lower limb injury: Combining current evidence with international expert opinion

Background: Static foot pronation has long been considered as a risk factor for lower limb overuse injuries, such as Medial Tibial Stress Syndrome, Patellofemoral Pain and Stress Fractures. However, no single source available has systematically appraised and summarised the literature to evaluate this proposed relationship. The aim of this systematic review was to investigate static foot pronation as a risk for lower limb overuse injury. Methods: A systematic search was performed across multiple electronicdatabases (Medline, CINAHL, EmbaseandSportDiscus) to identify prospective studies that investigated static foot pronation (measured quantitatively) as a risk factor for lower limb overuse injury. Studies were assigned into one or both of two groups based on the method of assessing foot posture: (i) static foot pronation assessment or (ii) dynamic foot function assessment. This review presents the results of the studies from (i) static foot pronation assessment. Two reviewers appraised the included studies using an adapted version of the Epidemiological Appraisal Instrument (EAI).Wherepossible, effectswere expressed as standardisedmean differences (SMD) or risk ratios (RR), with 95% confidence intervals, for continuous and nominal scaled data, respectively. Results: Twenty-one studies were included and the appraisal assessment indicated that most studies were of moderate quality. Static foot pronation was a small but significant risk factor for the development of both Medial Tibial Stress Syndrome and Patellofemoral Pain. Static foot pronation variables associatedwith development of lower limb overuse injuries included Navicular Drop, the Foot Posture Index and Calcaneal Eversion Angle. Significant effects ranged from SMDs of 0.28–0.62 for continuous scaled measures and from RRs of 0.97–1.25 for nominal scaled measures. Several non-significant findings were also reported for a pooled group of Unspecified Lower Extremity Injury, Foot and Ankle Injury and Stress Fractures. Discussion: Findings were limited and in some cases inconsistent, however, differences inmeasures of static foot pronationwere identified to increase the riskof lower limboveruse injury, although the significance is small in effect. It is unclear at this stage whether these risk factors can bemeasured reliably in clinic orwhether they will be predictive of dynamic function. As a result, they should be considered as part of a multifactorial injury risk assessment and not used as stand alone measures.

Contralateral Risk Factors Associated with Exertional Medial Tibial Pain in Women

This study aimed to prospectively analyze the role of factors on the contralateral side of the kinetic chain in the development of exertional medial tibial pain (EMTP). Eighty-one female physical education students were tested at the beginning of their first academic year. Within the testing protocol, contralateral isokinetic hip muscle strength and full-body kinematic parameters during a single-leg drop jump were evaluated. Online questionnaires were administered weekly, and personal interviews were conducted every 3 months to assess injury follow-up. EMTP was diagnosed by an experienced medical doctor. Cox regression analysis was used to identify the potential risk factors for the development of EMTP. After exclusion of subjects with diagnosed bilateral EMTP, 11 subjects were included in the EMTP group. Fifty-three subjects did not develop any lower extremity overuse injury and were included in the control group. The leg not at risk within subjects who developed EMTP was compared with an uninjured leg of those in the control group. Increased transverse plane motion for the contralateral lower leg segment during landing phase was found to be a significant predictor (P = 0.012) for EMTP. Analysis of the isokinetic data did not reveal altered hip muscle strength parameters for the leg not at risk within the EMTP group. Impaired dynamic joint stability or accessory movements were found in the transverse plane of the contralateral lower leg segment of EMTP subjects. This contralateral instability might have contributed to altered movement patterns within the kinetic chain function of EMTP subjects. No contralateral hip muscle strength parameters were found to predict EMTP in this study.

Contribution of a Muscle Fatigue Protocol to a Dynamic Stability Screening Test for Exertional Medial Tibial Pain

Background: Enhancing the accuracy of a risk factor screening test is an important element of sports injury prevention. Purpose: To determine the effect of muscle fatigue on a screening tool for those at risk of exertional medial tibial pain (EMTP). Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: Sixty-nine female students in a physical education program with a mean age of 19.24 ± 0.86 years were tested at the beginning of their first academic year and followed for 1 to 2 years. Participants completed an online questionnaire every week and a retrospective control questionnaire every 3 months, which were used to assess injury follow-up. A diagnosis of EMTP was made by an experienced medical doctor. A Cox regression analysis was used to identify the potential risk factors by comparing prefatigue and postfatigue data between uninjured participants and those with EMTP. Both the leg that developed EMTP and the contralateral leg were compared with legs of a matched control group. Results: During injury follow-up, 21 female participants were diagnosed with EMTP. Results of the comparison between uninjured versus EMTP participants, respectively, are as follows: For the leg at risk in the nonfatigued state, only increased range of motion in the transverse plane (ROMT) of the hip during landing could be identified as a risk factor (8.44° ± 2.94° vs 11.69° ± 3.41°; P = .002). In the fatigued state, increased ROMT of the hip and pelvis during landing (hip: 8.04° ± 2.34° vs 9.36° ± 3.22°; P = .038; pelvis: 6.99° ± 2.20° vs 8.58° ± 3.13°; P = .040) and increased ROMT of the thorax during pushoff (8.83° ± 2.74° vs 10.69° ± 3.20°; P = .036) could be identified. For the leg not at risk for EMTP, increased ROMT of the knee during landing (10.96° ± 3.12° vs 14.07° ± 4.88°; P = .023) and decreased ROMT of the pelvis during pushoff (8.16° ± 3.48° vs 6.47° ± 2.47°; P = .034) were identified in the nonfatigued state but were not significant in the fatigued state. Conclusion: Adding a muscle fatigue protocol to the single-legged drop jump as a screening test for EMTP risk factors may enhance the possibility of identifying the leg at risk in a predisposed athlete and might determine the proximal risk factors for that leg at risk more thoroughly.

EXPLORATION OF CONTRALATERAL RISK FACTORS ASSOCIATED WITH THE DEVELOPMENT OF EXERTIONAL MEDIAL TIBIAL PAIN IN WOMEN

BackgroundThere is a significant lack of studies looking into the role of contralateral factors in the kinetic chain of subjects predisposed to exertional medial tibial pain (EMTP).DesignHip muscle strength and...

THE CONTRIBUTION OF A FATIGUE PROTOCOL TO A DYNAMIC STABILITY SCREENING TEST FOR EXERTIONAL MEDIAL TIBIAL PAIN

BackgroundThe development of accurate measurement techniques to detect risk factors for common injuries should be of concern to health care professionals.ObjectiveTo determine the contribution of a fatigue protocol to a...

The role of proximal dynamic joint stability in the development of exertional medial tibial pain: a prospective study

ObjectiveTo prospectively determine risk factors contributing to the development of exertional medial tibial pain (EMTP).MethodsData were prospectively collected on healthy female students in physical education, who were freshmen in 2010–2011...

The Role of Hip Abductor and External Rotator Muscle Strength in the Development of Exertional Medial Tibial Pain: A Prospective Study

The Role of Hip Abductor and External Rotator Muscle Strength in the Development of Exertional Medial Tibial Pain: A Prospective Study

The longitudinal relationship between changes in body weight and changes in medial tibial cartilage, and pain among community-based adults with and without meniscal tears

IntroductionMeniscal tears are commonly found on MRI and increase the risk for radiographic knee osteoarthritis (OA). While meniscectomy is recommended when knee pain is severe or functionally disabling, it is...

Medial tibial pain pressure threshold algometry in runners

Pressure algometry (PA) may provide an objective and standardised tool in assessing palpation pain over the tibia. The purpose of this study was to analyse the intra-rater repeatability of PA and to determine whether tibial tenderness in healthy runners differ from runners with medial tibial stress syndrome (MTSS). Pressure algometry was performed on 20 asymptomatic runners (40 legs) and 9 MTSS patients (14 symptomatic legs) at standardised locations along the medial border of the tibia. Intra-rater reliability was assessed in 10 randomly selected asymptomatic runners through repeated measurements 2 weeks later. Intra-rater reliability was moderate to excellent (ICC 0.53-0.90) in asymptomatic runners. Pain pressure threshold (PPT) was significantly reduced at 2/9-5/9 of the distance from the medial malleolus to the medial tibial condyle (p = 0.002-0.022). There was evidence of a statistically significant association between both height and weight, and PPT from the 3/9 (r = 0.416, p = 0.008) to 7/9 (r = 0.334, p = 0.035) and 3/9 (r = 0.448, p = 0.004) to 6/9 (r = 0.337, p = 0.034) area, respectively. In both MTSS patients and healthy runners, there was evidence of lower PPT in females compared to males (p = 0.0001-0.049) and a negative association between age and PPT (p = 0.001-0.033). MTSS patients had significantly lower PPT at the 3/9 site (p = 0.048) compared to asymptomatic runners. Pain pressure threshold algometry can be incorporated into MTSS clinical assessment to objectively assess pain and monitor progress. The presence of reduced medial tibial PPT in asymptomatic runners suggests that clinicians may not need to await resolution of medial tibia tenderness before allowing return to sport in MTSS patients.