I would appreciate management opinions on the following case.
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14 year old multi-eventer with a 3 year history of tibial stress # ( 6 in total) over the anterior aspect of the left tibial mid-shaft. Recur on pole vaulting training, and running training.
She goes into POP for 6 weeks, followed by Rest and Ice Rx. She returns to activity only to break down again.
Mechanically, of note she ahs a slight genuvarum/tibiovarum, and moderately ligament lax. she has no soft tissue tightness of any lower limb muscle group, and all resisted musculature strength was normal.
Her rcsp is mildly pronated, and not at EROM.
She is a forefoot striker when she runs/pole vaults. She cannot change her technique, as she is right handed ( with respect to carrying the pole).
I cannot determine a mechanical cause to her recurrence, or a mechanical solution, so can I beg some advice from the forum?
I will enclose an X-ray tomorrow
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