Sports Medicine

, Volume 43, Issue 12, pp 1315–1333 | Cite as

Treatment of Medial Tibial Stress Syndrome: A Systematic Review

  • Marinus Winters
  • Michel Eskes
  • Adam Weir
  • Maarten H. Moen
  • Frank J. G. Backx
  • Eric W. P. Bakker
Systematic Review

Abstract

Background

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.

Objective

The objective of this systematic review was to assess the effectiveness of any intervention in the treatment of MTSS.

Study Selection

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.

Data Sources

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.

Study Appraisal

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.

Results

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).

Conclusion

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.

Supplementary material

40279_2013_87_MOESM1_ESM.docx (57 kb)
Supplementary material (DOCX 57 kb)

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Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Marinus Winters
    • 1
    • 2
  • Michel Eskes
    • 2
    • 3
  • Adam Weir
    • 4
  • Maarten H. Moen
    • 5
    • 6
  • Frank J. G. Backx
    • 1
  • Eric W. P. Bakker
    • 2
  1. 1.Rehabilitation, Nursing Science and Sports DepartmentUniversity Medical Centre UtrechtUtrechtThe Netherlands
  2. 2.Division of Clinical Methods and Public Health, Academic Medical CentreUniversity of AmsterdamAmsterdamThe Netherlands
  3. 3.Division of Education, Research and QualitySOMT Centre for Musculoskeletal TherapiesAmersfoortThe Netherlands
  4. 4.Department of Sports MedicineMedical Centre HaaglandenLeidschendamThe Netherlands
  5. 5.Sports Physician GroupSaint Lucas Andreas HospitalAmsterdamThe Netherlands
  6. 6.Bergman ClinicsNaardenThe Netherlands

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