Treatment of medial tibial stress syndrome according to the fascial distortion model: a prospective case control study

Christoph Schulze, Susanne Finze, Rainer Bader, Andreas Lison, Christoph Schulze, Susanne Finze, Rainer Bader, Andreas Lison

Abstract

Medial tibial stress syndrome (MTSS) is a common problem among athletes and soldiers. There is no proven theory that could explain the pathophysiology of shin splints. The therapies described so far are time-consuming and involve a high risk of relapse. The method according to the fascial distortion model (FDM) addresses local changes in the area of the lower leg fascia. It is suited to reduce pain and functional impairments associated with this symptom complex by applying targeted manual techniques. 32 patients (male: 30; female: 2) participated in this study. Visual analogue scale (VAS) was used for the quantification of pain. Scores were also given to rate the maximum painless exercise tolerance of the patients. Subsequently treatment of the crural fascia was performed. Patients retested ability of running and jumping. Therapy was continued until full exercise tolerance or painlessness was reached. A significant reduction of the VAS pain score from 5.2 to 1.1 could be achieved (P < 0.001). The impairment of exercise tolerance could be reduced from 7 to 2 points (P < 0.001). The duration of treatment was 6.3 (SD: 4.3) days on average. The FDM therapy is a potential effective method for acute treatment of MTSS.

Figures

Figure 1
Figure 1
Score of pain in visual analogue scale.
Figure 2
Figure 2
Running distance in shin splint score.
Figure 3
Figure 3
Velocity in shin splint score.
Figure 4
Figure 4
Jumping in shin splint score.
Figure 5
Figure 5
Shin splint score in total.

References

    1. Bates P. Shin splints: a literature review. British Journal of Sports Medicine. 1985;19(3):132–137. doi: 10.1136/bjsm.19.3.132.
    1. Yates B., White S. The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. The American Journal of Sports Medicine. 2004;32(3):772–780. doi: 10.1177/0095399703258776.
    1. Puranen J. The medial tibial syndrome. Exercise ischaemia in the medial fascial compartment of the leg. Journal of Bone and Joint Surgery. British. 1974;56(4):712–715.
    1. Mubarak S. J., Gould R. N., Lee Y. F., Schmidt D. A., Hargens A. R. The medial tibial stress syndrome. A cause of shin splints. The American Journal of Sports Medicine. 1982;10(4):201–205. doi: 10.1177/036354658201000402.
    1. Moen M. H., Tol J. L., Weir A., Steunebrink M., Winter T. C. D. Medial tibial stress syndrome: a critical review. Sports Medicine. 2009;39(7):523–546. doi: 10.2165/00007256-200939070-00002.
    1. Beck B. R. Tibial stress injuries. An aetiological review for the purposes of guiding management. Sports Medicine. 1998;26(4):265–279. doi: 10.2165/00007256-199826040-00005.
    1. Devas M. B. Stress fractures of the tibia in athletes or shin soreness. The Journal of Bone and Joint Surgery B. 1958;40(2):227–239.
    1. Sharma J., Golby J., Greeves J., Spears I. R. Biomechanical and lifestyle risk factors for medial tibia stress syndrome in army recruits: a prospective study. Gait & Posture. 2011;33(3):361–365. doi: 10.1016/j.gaitpost.2010.12.002.
    1. Reshef N., Guelich D. R. Medial tibial stress syndrome. Clinics in Sports Medicine. 2012;31(2):273–290. doi: 10.1016/j.csm.2011.09.008.
    1. Bandholm T., Boysen L., Haugaard S., Zebis M. K., Bencke J. Foot medial longitudinal-arch deformation during quiet standing and gait in subjects with medial tibial stress syndrome. Journal of Foot and Ankle Surgery. 2008;47(2):89–95. doi: 10.1053/j.jfas.2007.10.015.
    1. Moen M. H., Bongers T., Bakker E. W., Zimmermann W. O., Weir A., Tol J. L., Backx F. J. G. Risk factors and prognostic indicators for medial tibial stress syndrome. Scandinavian Journal of Medicine and Science in Sports. 2012;22(1):34–39. doi: 10.1111/j.1600-0838.2010.01144.x.
    1. Plisky M. S., Rauh M. J., Heiderscheit B., Underwood F. B., Tank R. T. Medial tibial stress syndrome in high school cross-country runners: incidence and risk factors. The Journal of Orthopaedic and Sports Physical Therapy. 2007;37(2):40–47. doi: 10.2519/jospt.2007.2343.
    1. Mulford D., Taggart H. M., Nivens A., Payrie C. Arch support use for improving balance and reducing pain in older adults. Applied Nursing Research. 2008;21(3):153–158. doi: 10.1016/j.apnr.2006.08.006.
    1. Winters M., Eskes M., Weir A., Moen M. H., Backx F. J. G., Bakker E. W. P. Treatment of medial tibial stress syndrome: a systematic review. Sports Medicine. 2013;43(12):1315–1333. doi: 10.1007/s40279-013-0087-0.
    1. Yeung S. S., Yeung E. W., Gillespie L. D. Interventions for preventing lower limb soft-tissue running injuries. Cochrane Database of Systematic Reviews. 2011;(7)CD001256
    1. Moen M. H., Rayer S., Schipper M., Schmikli S., Weir A., Tol J. L., Backx F. J. G. Shockwave treatment for medial tibial stress syndrome in athletes; a prospective controlled study. British Journal of Sports Medicine. 2012;46(4):253–257. doi: 10.1136/bjsm.2010.081992.
    1. Moen M. H., Bongers T., Bakker E. W., Weir A., Zimmermann W. O., van der Werve M., Backx F. J. The additional value of a pneumatic leg brace in the treatment of recruits with medial tibial stress syndrome; a randomized study. Journal of the Royal Army Medical Corps. 2010;156(4):236–240. doi: 10.1136/jramc-156-04-06.
    1. Galbraith R. M., Lavallee M. E. Medial tibial stress syndrome: conservative treatment options. Current Reviews in Musculoskeletal Medicine. 2009;2(3):127–133. doi: 10.1007/s12178-009-9055-6.
    1. European Fascial Distortion Model Association . Das Fasziendistorsionsmodell (FDM) nach Stephan Typaldos D.O. Die Typaldos-Methode. 1st. Bramsche, Germany: Rasch Druckerei; 2012.
    1. Bouché R. T., Johnson C. H. Medial tibial stress syndrome (tibial fasciitis): a proposed pathomechanical model involving fascial traction. Journal of the American Podiatric Medical Association. 2007;97(1):31–36. doi: 10.7547/0970031.
    1. Stickley C. D., Hetzler R. K., Kimura I. F., Lozanoff S. Crural fascia and muscle origins related to medial tibial stress syndrome symptom location. Medicine and Science in Sports and Exercise. 2009;41(11):1991–1996. doi: 10.1249/MSS.0b013e3181a6519c.
    1. Fink M., Schiller J., Buhck H. Efficacy of a manual treatment method according to the fascial distortion model in the management of contracted (“Frozeno”) shoulder. Zeitschrift fur Orthopadie und Unfallchirurgie. 2012;150(4):420–427. doi: 10.1055/s-0032-1314996.
    1. Stein C. Untersuchung der Wirksamkeit einer manuellen Behandlungstechnik nach dem Faszien-Distorsions-Modell bei schmerzhaft eingeschränkter Schulterbeweglichkeit - Eine explorativ-prospektive, randomisierte und kontrollierte klinische Studie. Medizinische Hochschule Hannover; 2008.
    1. .
    1. Andrish J. T., Bergfeld J. A., Walheim J. A prospective study on the management of shin splints. Journal of Bone and Joint Surgery - Series A. 1974;56(8):1697–1700.
    1. Craig D. I. Medial tibial stress syndrome: evidence-based prevention. Journal of Athletic Training. 2008;43(3):316–318. doi: 10.4085/1062-6050-43.3.316.
    1. Aoki Y., Yasuda K., Tohyama H., Ito H., Minami A. Magnetic resonance imaging in stress fractures and shin splints. Clinical Orthopaedics and Related Research. 2004;(421):260–267.
    1. Spitz D. J., Newberg A. H. Imaging of stress fractures in the athlete. Radiologic Clinics of North America. 2002;40(2):313–331. doi: 10.1016/S0033-8389(02)00010-6.
    1. Moen M. H., Schmikli S. L., Weir A., Steeneken V., Stapper G., de Slegte R., Tol J. L., Backx F. J. G. A prospective study on MRI findings and prognostic factors in athletes with MTSS. Scandinavian Journal of Medicine and Science in Sports. 2014;24(1):204–210. doi: 10.1111/j.1600-0838.2012.01467.x.

Source: PubMed

3
Tilaa