Medial tibial stress syndrome and shockwave therapy

NewsBot · Sep 24, 2009

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Low-Energy Extracorporeal Shock Wave Therapy as a Treatment for Medial Tibial Stress Syndrome
Jan D. Rompe, Angelo Cacchio, John P. Furia, Nicola Maffulli
American Journal of Sports Medicine (in press)

Background: Medial tibial stress syndrome (MTSS) is a pain syndrome along the tibial origin of the tibialis posterior or soleus muscle. Extracorporeal shock wave therapy (SWT) is effective in numerous types of insertional pain syndromes.

Hypothesis: Shock wave therapy is an effective treatment for chronic MTSS.

Study Design: Cohort study; Level of evidence, 3.

Methods: Forty-seven consecutive subjects with chronic recalcitrant MTSS underwent a standardized home training program, and received repetitive low-energy radial SWT (2000 shocks; 2.5 bars of pressure, which is equal to 0.1 mJ/mm2; total energy flux density, 200 mJ/mm2; no local anesthesia) (treatment group). Forty-seven subjects with chronic recalcitrant MTSS were not treated with SWT, but underwent a standardized home training program only (control group). Evaluation was by change in numeric rating scale. Degree of recovery was measured on a 6-point Likert scale (subjects with a rating of completely recovered or much improved were rated as treatment success).

Results: One month, 4 months, and 15 months from baseline, success rates for the control and treatment groups according to the Likert scale were 13% and 30% (P < .001), 30% and 64% (P < .001), and 37% and 76% (P < .001), respectively. One month, 4 months, and 15 months from baseline, the mean numeric rating scale for the control and treatment groups were 7.3 and 5.8 (P < .001), 6.9 and 3.8 (P < .001), and 5.3 and 2.7 (P < .001), respectively. At 15 months from baseline, 40 of the 47 subjects in the treatment group had been able to return to their preferred sport at their preinjury level, as had 22 of the 47 control subjects.

Conclusion: Radial SWT as applied was an effective treatment for MTSS
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Admin2 · Sep 24, 2009

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Extracorporeal Shock Wave Therapy

NewsBot · Mar 10, 2011

Shockwave treatment for medial tibial stress syndrome in athletes; a prospective controlled study
Moen, M. H., Rayer, S., Schipper, M., Schmikli, S., Weir, A., Tol, J. L., Backx, F. J. G.
Br J Sports Med doi:10.1136/bjsm.2010.081992

Objective The purpose of this study was to describe the results of two treatment regimens for medial tibial stress syndrome (MTSS); a graded running programme and the same running programme with additional shockwave therapy (extracorporeal shockwave therapy; ESWT).

Design A prospective observational controlled trial.

Setting Two different sports medicine departments.

Participants 42 athletes with MTSS were included.

Intervention Patients from one hospital were treated with a graded running programme, while patients from the other hospital were treated with the same graded running programme and focused ESWT (five sessions in 9 weeks).

Main Outcome Measures Time to full recovery (the endpoint was being able to run 18 min consecutively without pain at a fixed intensity).

Results The time to full recovery was significantly faster in the ESWT group compared with the patients who only performed a graded running programme, respectively 59.7±25.8 and 91.6±43.0 days (p=0.008).

Conclusions This prospective observational study showed that MTSS patients may benefit from ESWT in addition to a graded running programme. ESWT as an additional treatment warrants further investigation in a prospective controlled trial with the addition of randomisation and double blinding.
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NewsBot · Aug 6, 2016

SHOCKWAVE TREATMENT FOR MEDIAL TIBIAL STRESS SYNDROME; A RANDOMIZED DOUBLE BLIND SHAM-CONTROLLED PILOT TRIAL
Phil Newman, Gordon Waddington, Roger Adams
Journal of Science and Medicine in Sport ; Article in Press

Objectives
Up to 35% of runners develop medial tibial stress syndrome (MTSS) which often results in lengthy disruption to training and sometimes affects daily activities. There is currently no high quality evidence to support any particular intervention for MTSS. This study aims to investigate the effect of shockwave therapy for MTSS.

Design
A randomized, sham-controlled, pilot trial in a university-based health clinic including 28 active adults with MTSS.

Methods
Intervention included standard dose shockwave therapy for the experimental group versus sham dose for the control group, delivered during Week 1, 2, 3, 5 and 9.Main outcome measures were pain measured during bone and muscle pressure as well as during running using a numerical rating scale (0-10) and running was measured as pain-limited distance (m), at Week 1 (baseline) and Week 10 (post-intervention). Self-perception of change was measured using the Global Rating of Change Scale (-7 to +7) at Week 10 (post-intervention).

Results
Pain (palpation) was reduced in the experimental group by 1.1 out of 10.0 (95% CI −2.3 to 0.0) less than the control group. There were no other statistically significant differences between the groups.

Conclusions
Standard dose shockwave therapy is not more effective than sham dose at improving pain or running distance in MTSS. However, the sham dose may have had a clinical effect. Further investigation including a no intervention control is warranted to evaluate the effect of shockwave therapy in the management of MTSS.
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NewsBot · Sep 27, 2016

Shin Splints: Efficacy of Radial Extracorporeal Shock Wave
Therapy in Ballet Dancers. A Series Of Cases
Tutté ML, PhD; Galin G PT
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS); September. 2016, PP 22-24

Shin splints — also known as medial tibial stress syndrome, anterior compartment and
posteromedial compartment syndrome — have been widely studied in athletes, mostly in runners, but not in
dancers. This paper presents the results of treatment with radial extracorporeal shockwave therapy (rESWT) in
4 ballet dancers with shin splint diagnosis. Four patients were treated with two different rESWT devices after
the failure of different therapeutic modalities. They received 6 weekly sessions applied along the tibial shaft
(3,000p, 2.5b, 7Hz), and a stretching program. The Visual Analogue Scale (VAS) was used for pain
quantification during ballet training and a rating score to determine maximum painless jumping tolerance.
Mean decrease in pain VAS score was 4,8 points. Impairment of exercise tolerance was reduced from 3 to 1
points. Patients were able to continue with their normal training and performance schedules. Three were
asymptomatic after 6 months; one experienced some discomfort during high-intensity rehearsals, but was still
able to perform. rESWT was shown to be an effective, non-invasive treatment alternative for these patients,
achieving functional improvement and pain relief, allowing them to comply with their performance schedules.
Large-scale prospective trials are still required to elucidate the effectiveness of rESWT in these patients.
Keywords: dancers, medial tibial stress syndrome, shin splints, shock wave therapy.
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NewsBot · Aug 23, 2017

Treatment of Medial Tibial Stress Syndrome With Radial Soundwave Therapy in Elite Athletes: Current Evidence, Report on Two Cases, and Proposed Treatment Regimen
Amol Saxena et al
The Journal of Foot and Ankle Surgery; Volume 56, Issue 5, September–October 2017, Pages 985–989

Two case reports of high-level athletes with medial tibial stress syndrome (MTSS), 1 an Olympian with an actual stress fracture, are presented. Successful treatment included radial soundwave therapy, pneumatic leg braces, relative rest using an antigravity treadmill, and temporary foot orthoses. Radial soundwave therapy has a high level of evidence for treatment of MTSS. We also present recent evidence of the value of vitamin D assessment. Both patients had a successful outcome with minimal downtime. Finally, a suggested treatment regimen for MTSS is presented.
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NewsBot · Jun 5, 2022

Effect of extracorporeal shockwave therapy on medial tibial stress syndrome: a systematic review
Forogh, Bijan MD et al
Current Orthopaedic Practice: July/August 2022 - Volume - Issue - 10.1097/BCO.0000000000001127

Introduction:
This systematic review evaluates the available evidence for extracorporeal shockwave therapy (ESWT) use in the treatment of medial tibial stress syndrome (MTSS).

Method:
PubMed, EMBASE, Scopus, ISI Web of Science, and Cochrane Central Register of Controlled Trials (Cochrane CENTRAL) database searches were performed without a time limit in August 2021. Two independent researchers performed the search, screening, and final eligibility of the articles. Data were extracted using a customized spreadsheet, which included detailed information on patient characteristics, interventions, and outcomes. The methodological quality of the included studies was independently assessed by two reviewers using the Physiotherapy Evidence Database scale (PEDro).

Results:
Three studies were identified that compared 23, 12, and 22 participants in the intervention group with 19, 12, and 20 participants in the control group, respectively. The mean age of participants in these studies was 26.51 yr, and the mean duration of symptoms in the two studies that reported this was 16.36 mo. All studies used focus shockwave therapy.

Conclusions:
Extracorporeal shockwaves reduced pain and time to recovery and increased patient satisfaction. No study reported adverse effects. Based on the limited studies, ESWT may reduce pain and shorten recovery duration in MTSS. Further randomized clinical trials with sham control may substantiate these findings in other patient populations.
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