Treatment of Medial Tibial Stress Syndrome: A Systematic Review
- Marinus WintersAffiliated withRehabilitation, Nursing Science and Sports Department, University Medical Centre UtrechtDivision of Clinical Methods and Public Health, Academic Medical Centre, University of Amsterdam Email author
- , Michel EskesAffiliated withDivision of Clinical Methods and Public Health, Academic Medical Centre, University of AmsterdamDivision of Education, Research and Quality, SOMT Centre for Musculoskeletal Therapies
- , Adam WeirAffiliated withDepartment of Sports Medicine, Medical Centre Haaglanden
- , Maarten H. MoenAffiliated withSports Physician Group, Saint Lucas Andreas HospitalBergman Clinics
- , Frank J. G. BackxAffiliated withRehabilitation, Nursing Science and Sports Department, University Medical Centre Utrecht
- , Eric W. P. BakkerAffiliated withDivision of Clinical Methods and Public Health, Academic Medical Centre, University of Amsterdam
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Medial tibial stress syndrome (MTSS) is a common exercise-induced leg injury among athletes and military personnel. Several treatment options have been described in the literature, but it remains unclear which treatment is most effective.
The objective of this systematic review was to assess the effectiveness of any intervention in the treatment of MTSS.
Published or non-published studies, reporting randomized or non-randomized controlled trials of any treatment in subjects with MTSS were eligible for inclusion. Treatments were assessed for effects on pain, time to recovery or global perceived effect.
Computerized bibliographic databases (MEDLINE, CENTRAL, EMBASE, CINAHL, PEDro and SPORTDiscus) and trial registries were searched for relevant reports, from their inception to 1 June 2012. Grey literature was searched for additional relevant reports.
The Cochrane Risk of Bias Tool was used to appraise study quality of randomized clinical trials (RCTs) whereas the Newcastle Ottawa Scale was used to appraise non-randomized trials. The ‘levels of evidence’, according to the Oxford Centre for Evidence-Based Medicine, addressed the impact of the assessed trials. Two reviewers independently performed the search for articles, study selection, data extraction and appraised methodological quality.
Eleven trials were included in this systematic review. All RCTs revealed a high risk of bias (Level 3 of evidence). Both non-randomized clinical trials were found to be of poor quality (Level 4 of evidence). RCTs, studying the effect of a lower leg brace versus no lower leg brace, and iontophoresis versus phonophoresis, were pooled using a fixed-effects model. No significant differences were found for lower leg braces (standardized mean difference [SMD] −0.06; 95 % CI −0.44 to 0.32, p = 0.76), or iontophoresis (SMD 0.09; 95 % CI −0.50 to 0.68, p = 0.76). Iontophoresis, phonophoresis, ice massage, ultrasound therapy, periosteal pecking and extracorporeal shockwave therapy (ESWT) could be effective in treating MTSS when compared with control (Level 3 to 4 of evidence). Low-energy laser treatment, stretching and strengthening exercises, sports compression stockings, lower leg braces and pulsed electromagnetic fields have not been proven to be effective in treating MTSS (level 3 of evidence).
None of the studies are sufficiently free from methodological bias to recommend any of the treatments investigated. Of those examined, ESWT appears to have the most promise.
- Treatment of Medial Tibial Stress Syndrome: A Systematic Review
Volume 43, Issue 12 , pp 1315-1333
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- 1. Rehabilitation, Nursing Science and Sports Department, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
- 2. Division of Clinical Methods and Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- 3. Division of Education, Research and Quality, SOMT Centre for Musculoskeletal Therapies, Amersfoort, The Netherlands
- 4. Department of Sports Medicine, Medical Centre Haaglanden, Leidschendam, The Netherlands
- 5. Sports Physician Group, Saint Lucas Andreas Hospital, Amsterdam, The Netherlands
- 6. Bergman Clinics, Naarden, The Netherlands