CES CEx Sports Medicine Sports Performance sports performance PES

Addressing Medial Tibial Stress Syndrome: A CEx Perspective

DeWayne Smith, MS, NASM-CES, PES, FNS 1

The foot and ankle complex is responsible for withstanding a high amount of contact force through ground reactive forces.  Poor biomechanics can lead to a variety of other problems throughout the kinetic chain. Something commonly seen as a result of this in multisport athletes is Medial Tibial Stress Syndrome (MTSS). A triathlete training for the marathon portion of an iron distance triathlon easily sees 40 – 60 miles of running per week. If you take into account the number of steps this athlete takes per run, and the stress the foot ankle complex undergo as a result, you can appreciate the importance of addressing proper biomechanics throughout the entire kinetic chain.

 Over time, MTSS has become somewhat of a blanket term used to describe stress fractures, compartment syndrome, tibial periostitis, tibial fasciitis, and posterior tibial syndrome. In our approach to this syndrome, we look at it with a musculoskeletal focus. When a multisport athlete presents with medial tibial pain, it’s very important to first gain a brief history of the injury itself. Is this something that’s occurred in the past? When does this happen? Does the pain come and go? How old are the running shoes? How many miles is the athlete running per week? Is the athlete managing the inflammation? Has the athlete already seen a physician, and have more serious conditions such as compartment syndrome and stress fractures been ruled out?

Pain from MTSS originates from the medial border of the tibia. This area serves as the origin of the soleus and posterior tibialis. The soleus, also known as the “runner’s muscle,” is typically very well developed in runners; It’s responsible for plantarflexion while the knee is slightly flexed. The posterior tibialis is responsible for eccentrically slowing down ankle dorsiflexion and eversion (something this athlete undergoes with every step).  If these muscles are tight and overworked, or weak and underactive, their repetitive in-efficient use manifests itself as pain at the origin. Those with pronated and externally rotated feet fall Below is a sample CEx program for a multisport athlete that presented with MTSS. This athlete was found to overpronate excessively, had an increased Q angle, with slight valgus of the knees, and had limited ankle dorsiflexion.into a cycle of cumulative trauma. Faulty biomechanics create altered length tension relationships which in turn cause compensation and micro-trauma while running. As time and mileage pass, this repetitive micro-trauma manifests itself as pain. This is thought to be caused by the shearing away of the muscle from the tibia and/or inflammation creating pressure within the anterior compartment of the lower leg. Excessive ankle and foot pronation cause faulty movement elsewhere in the kinetic chain; So, it is important to perform a static postural and dynamic movement assessment in order to develop a comprehensive CEx program.

INHIBIT: SMR – Lateral gastrocnemius and peroneals, Biceps femoris (short head), TFL/ITB LENGTHEN : Gastrocnemius/Soleus,  Biceps femoris (short head), TFL/ITB ACTIVATE: Posterior tibialis, Anterior tibialis, gastrocnemius (medial head), gluteus medius INTEGRATE: Side lunge to single-leg touch down

Tags: CES Tags: CEx Tags: Sports Medicine Tags: Sports Performance Tags: sports performance Tags: PES

The Author

DeWayne Smith, MS, NASM-CES, PES, FNS