A 25-year-old businessman initiated a running program with a goal to get into shape and lose weight. The program consisted of running 2 miles 4 to 5 times per week and he continued this regimen for 4 weeks. He initially noted medial shin pain after 2 weeks of running that occurred near the end of his runs or with cool-down walking. When the pain started to interfere with his desired exercise program, he self-referred to an outpatient physical therapy clinic for evaluation and treatment. Signs, symptoms, and history are consistent with medial tibial stress syndrome (MTSS). The individual's main goal is to return to pain-free running and improve his fitness.
Based on the patient's suspected diagnosis, what do you anticipate may be the contributing factors to the condition?
What examination signs may be associated with this diagnosis?
What are the most appropriate physical therapy interventions?
What are possible complications that may limit the effectiveness of physical therapy?
EXTRINSIC RISK FACTORS: Characteristics of an individual's training or competition schedule that may influence the likelihood of developing MTSS (e.g., training regimen, shoe selection, training surface or terrain, type of sport)
INTRINSIC RISK FACTORS: Characteristics of the individual that may influence the likelihood of developing MTSS (e.g., sex, lower extremity strength, hip ROM, body mass index, navicular drop)
MEDIAL TIBIAL STRESS SYNDROME: Overuse injury that primarily occurs with a rapid increase in frequency, intensity, and duration of impact activities (usually running); marked by diffuse tenderness >5 cm in length along the posteromedial border of the tibia of one or both legs, and most commonly affects the middle to distal thirds of the tibia
Describe medial tibial stress syndrome and identify potential risk factors that may result in this condition.
Provide appropriate patient education regarding MTSS.
Design and prescribe appropriate resistance exercises to treat MTSS.
Prescribe alternate aerobic activities aimed to improve fitness that minimize lower extremity loads and risk for further injury.
Discuss an appropriate plan for increasing activity and returning to impact activities while preventing a recurrence of the condition.
PT considerations during management of the individual with a diagnosis of medial tibial stress syndrome:
- General physical therapy plan of care/goals: Differential diagnosis; decrease pain; protect from further progression of the injury; provide education regarding diagnosis and prognosis; increase muscular flexibility and lower extremity strength; minimize lower extremity deconditioning (strength and endurance) without interrupting healing; encourage low-impact aerobic conditioning to maintain or increase aerobic fitness; aid in managing progression back to running by educating patient on training variables (frequency, intensity, type, duration) and recommended progression each week to reduce likelihood of further injury
- Physical therapy interventions: Patient education regarding functional anatomy and injury pathomechanics; modalities and manual therapy to decrease ...