Medial Tibial
Stress Syndrome }

Pathology

Medial tibial stress syndrome (MTSS) -  commonly known as ‘‘shin splints” – is a frequent overuse injury or repetitive-stress injury of the lower extremity.

The condition is one of the most common causes of exertional leg pain in athletes, and usually presents as diffuse pain of the lower extremity, along the middle-distal tibia associated with exertion. Early courses of MTSS are characterized by pain that (i) gets worse at the beginning of exercise, (ii) gradually subsides during training, and (iii) stops within minutes after exercise. Later, pain may present with less activity and may even occur at rest.

Diagnosis is based on the clinical features of the disease. Diagnostic imaging should be considered to rule out other causes of exertional leg pain, or to establish the diagnosis of MTSS when in doubt.

Training errors (“too much, too fast”) appear to be the most common factors involved in MTSS. The condition is most often found in runners, soccer and basketball players, and in dancers. Notably MTSS is almost always associated with biomechanical abnormalities of the lower extremity including knee abnormalities, tibial torsion, femoral anteversion, foot arch abnormalities or a leg-length discrepancy.

However, improper footwear (including worn-out shoes) can also contribute to shin splints. A variety of tibial stress injuries can be involved in MTSS including tendinopathy, periostitis, and dysfunction of the tibialis posterior, tibialis anterior and soleus muscles.  Women appear to be more affected than men, and have an approximately threefold risk for progression to stress fractures.

The treatment of MTTS should start with rest and ice in the acute phase, followed by low-impact and cross-training exercises during rehabilitation and a modified training program (decreased intensity, frequency, and duration, regular stretching and strengthening exercises, wearing proper-fitting shoes with good shock absorption). Orthotics, manual therapy, injections and acupuncture may also help to alleviate the symptoms. Patients not responding to conservative treatment for six months should then undergo radial shock wave therapy (RSWT). Surgery should also be considered for recalcitrant cases of MTSS.

Treatment Procedure

1. PALPATE
Locate the area of pain through palpation and biofeedback.

2. MARK
Mark the area of pain.

3. APPLY GEL
Apply coupling gel to transmit shock waves to the tissue.

4. APPLY SHOCK WAVES
Deliver Radial or Focused Shock Waves to the area of pain while keeping the applicator firmly in place on the skin.

Recommended Settings

Swiss
DolorClast }

  Treatment
Number of treatment sessions 3 to 5
Interval between two sessions 1 week
Air pressure Evo Blue® 2.5 to 4 bar
Air pressure Power+ 2 to 4 bar
Impulses 2000 - 3000 on the painful spot
Frequency 8Hz to 12Hz
Applicator 15mm
Skin pressure Light to moderate

Clinical Proof

Rompe JD, Caccio A, Furia JP, et al.
Low-energy extracorporeal shock wave as a treatment for medial tibial stress syndrome.
Am J Sports Med 2010 Jan; 38(1):125-32. Epub 2009 Sep 23
http://www.ncbi.nlm.nih.gov/pubmed/19776340

Risks

Side effects of Radial Shock Wave Therapy (RSWT®) using the Swiss DolorClast®

When performed properly, RSWT® with the Swiss DolorClast® has only minimal risks.
Typical device-related nonserious adverse events are:

  • Pain and discomfort during and after treatment (anesthesia is not necessary)
  • Reddening of the skin
  • Petechia
  • Swelling and numbness of the skin over the treatment area

These device-related nonserious adverse events usually disappear within 36h after the treatment.

 

Accordingly the following contraindications of RSWT® using the Swiss DolorClast® must be considered:

  • Treatment over air-filled tissue (lung, gut)
  • Treatment of pre-ruptured tendons
  • Treatment of pregnant women
  • Treatment of patients under the age of 18 years (except for Osgood-Schlatter disease and muscular dysfunction in children with spastic movement disorders)
  • Treatment of patients with blood-clotting disorders (including local thrombosis)
  • Treatment of patients treated with oral anticoagulations
  • Treatment of tissue with local tumors or local bacterial and/or viral infections
  • Treatment of patients treated with cortisone

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