1. MEDIAL TIBIAL STRESS SYNDROME Most common lower leg injury in sports Accounts for 6-16% of all running injuries and 50% of all lower leg injuries

2. 1. CAUSE: Related to training volume, training surface, physical conditi0n of the athlete,

3. Risk factors Increased pronation Increased muscular strength of the foot planter flexors Increased varus of the forefoot or hindfoot Abrupt increase in training intensity Inadequate calcium intake Hard or inclined surfaces Shoes Previous injuries

4. Involvement of the soleus muscle Disruption of the fibers of sharpey Repeditive stress eccentrically that fatigue the soleus which creates tibial bending or bowing over loading the bone-remodeling capabilities of the tibia

5. Role of pronation Increased pronation signifigant Maximum velosity of pronation showed greater correlation that pronation alone.

6. Prevention Insoles most promising in controlled trials, shock absorbing-pronation controlled Weak or fatigues muscles cannot absorb the shock it is transferred to the bone. Increase muscular strength. Shoes should be replaced every 600 miles Graduated running programs Decrease volume, increase intensity Stretching

7. Treatment Reduce inflammation Promote healing with HF24 and laser Kinesiontaping Orthotics Navicular, cuboid, talar and adjustments to the kinetic chain. Adjust head of fibula Check the SI joint Look for imbalance in the external rotators, iliopsoas, and adductors.

8. Navicular Drop Correlates with increase incidence of MTSS

9. Differential Diagnosis Shin Splints: tenoperiostial tearing with inflammation and pain. Usually along a diffuse area of the tibia and involving the posterior tibial muscle origin Stress Fractures: Usually point tenderness. Very localized.

10. Imageing: X-ray

11. Imaging: X-ray

12. Imaging X-ray

15. Bone Scan

16. Treatment