Medial Tibial Stress Syndrome Prevention Program: Observed Biomechanical Differences On Lower Leg Musculature

Medial tibial stress syndrome (MTSS) is a prevalent injury in athletic populations. Confusion around the pathophysiology may contribute to poor prevention and management. PURPOSE: A prospective study was performed to assess the effect of a strengthening intervention and to observe the tissue differences that occur in the presence of MTSS. METHODS: In 26 collegiate track and field athletes, a 10 week resistance training program was implemented and followed by 10 weeks of a MTSS symptom survey. In the intervention (TX) (n = 14) and control group (CTR) (n = 12), tissue biomechanics of the lower leg musculature were measured at baseline, 10, and 20 weeks. A RMANOVA was performed for pre-post intervention and symptomatic (SX) vs asymptomatic (ASX) comparison across time points. Statistical significance set at ρ ≤ 0.05 and post hoc analysis was performed for significant results. RESULTS: Following the intervention, there was a statistically significant (p = 0.027, Cohen’s D = 1.125) 16.6% lower achilles (ACH) stiffness in the TX group. The MTSS intervention mitigated increases in ACH stiffness where the TX group increased a nonsignificant 8.8%, while the CTR group increased by 23.9% (p = 0.011). Increasing ACH stiffness from week 10 to 20 (17.9%) and lower lateral gastrocnemius (LG) stiffness at week 10 (28.6%) and 20 (37.9%) was found in those with MTSS while increasing AT stiffness from week 0 to 10 (26.5%) was found in the ASX group. A novel ratio comparing medial-lateral and antipode muscles found that the SX group saw medialization of stiffness over time via increases in TDH complex and medial gastrocnemius stiffness relative to the decreasing LG stiffness. The anterior-posterior ratio observed that ASX athletes began with low AT and high ACH stiffness while SX athletes began with high AT and low ACH stiffness at week 0. Both groups' ratios were similar by week 20. CONCLUSIONS: This prospective strengthening intervention resulted in adaptations opposite of those observed in the athletes who developed MTSS. Lower ACH stiffness at the start of season should be studied as a predictive tool while medialization of stiffness may be diagnostic for MTSS. Due to infrequent sampling and small study size, efficacy of the intervention in preventing MTSS could not be determined but further study is warranted.