Randomized Controlled Trial of Laser Therapy Versus Conventional Therapy in the Treatment of Medial Tibial Stress Syndrome
DOI:
https://doi.org/10.12974/2313-0954.2016.03.02.1Keywords:
Sacroiliac joint stress, laser, scintigraphy, kinematic chain, medial tibial stress syndrome, medial tibial traction periostitis, dynamic knee valgus.Abstract
Introduction: Medial tibial stress syndrome (MTSS) can induce defective biomechanics and cause sacroiliac (SI) joint stress. The purpose of this study was to investigate whether successful therapy of MTSS normalizes SI joint stress.
Methods: Fifty-three patients with MTSS and SI joint stress confirmed by nuclear scintigraphy were enrolled in this prospective trial. Patients were randomly assigned to receive laser therapy or conventional therapy. Patients in the laser therapy group underwent 15 laser sessions over a 5-day period (60 seconds in duration, three times per day). The SI ratio was measured using quantitative sacroiliac scintigraphy (QSS) before and after therapy. Outcome measures included Lower Extremity Functional Scale (LEFS). Generalized estimating equation models were used to evaluate the associations of LEFS. We adjusted for the correlations between QSS and different parts of the SI joint, and adjusted for potential confounders as well.
Results: Age, body weight, and duration did not correlate with QSS or lateralization. There was no significant difference in QSS and laterality of MTSS. However, the LEFS measured after therapy were significantly increased 38.45 (P < 0.0001) from LEFS measured before therapy. The QSS was significantly lower after therapy (P < 0.0001), indicating that successful therapy of MTSS has a buttom-up effect on SI joint stress (P < 0.0001). There was also a significant association between the middle part and the lower part of the SI joint. The QSS for the middle part on both sides was significantly higher than that for the lower part (P = 0.0250).
Conclusion: SI joint stress due to bottom-up processing of MTSS can be normalized after successful therapy of MTSS by either laser therapy or conventional therapy.
References
Fournier PE.
[Tibial periostitis ("medial tibial stress syndrome")]. Rev Med Suisse Romande 2003; 123(6): 369-70.
Brukner P and Khan K. Clinical Sports Medicine, third ed. ed. McGraw Hill, North Ryde, Australia 2007.
Moen MH, Tol JL, Weir A, Steunebrink M and De Winter TC. Medial tibial stress syndrome: a critical review. Sports Med 2009; 39(7): 523-46. http://dx.doi.org/10.2165/00007256-200939070-00002
Sobhani V, Shakibaee A, Khatibi Aghda A, Emami Meybodi MK, Delavari A and Jahandideh D. Studying the relation between medial tibial stress syndrome and anatomic and anthropometric characteristics of military male personnel. Asian J Sports Med 2015; 6(2): e23811. http://dx.doi.org/10.5812/asjsm.23811
Williams C, O'Brien B and Duffy G. Asymptomatic periostitis of the navicular and fifth metatarsal bones in a high jumper. Clin Nucl Med 1998; 23(9): 613-4. http://dx.doi.org/10.1097/00003072-199809000-00011
Hod N, Ashkenazi I, Levi Y, Fire G, Drori M, Cohen I, et al. Characteristics of skeletal stress fractures in female military recruits of the Israel defense forces on bone scintigraphy. Clin Nucl Med 2006; 31(12): 742-9. http://dx.doi.org/10.1097/01.rlu.0000246632.11440.70
Craig DI. Current developments concerning medial tibial stress syndrome. Phys Sportsmed 2009; 37(4): 39-44. http://dx.doi.org/10.3810/psm.2009.12.1740
Griebert MC, Needle AR, McConnell J and Kaminski TW. Lower-leg Kinesio tape reduces rate of loading in participants with medial tibial stress syndrome. Phys Ther Sport 2016; 18: 62-7. http://dx.doi.org/10.1016/j.ptsp.2014.01.001
Schulze C, Finze S, Bader R and Lison A. Treatment of medial tibial stress syndrome according to the fascial distortion model: a prospective case control study. Scientific World J 2014; 790626.
Nissen LR, Astvad K and Madsen L.
[Low-energy laser therapy in medial tibial stress syndrome].
[Article in Danish] Ugeskr Laeger 1994; 5; 156(49): 7329-31.
Chang CC, Ku CH, Hsu WC, Hu YA, Shyu JF and Chang ST. Five-day, low-level laser therapy for sports-related lower extremity periostitis in adult men: a randomized, controlled trial. Lasers Med Sci 2014; 29(4): 1485-94. http://dx.doi.org/10.1007/s10103-014-1554-z
Loudon JK and Dolphino MR. Use of foot orthoses and calf stretching for individuals with medial tibial stress syndrome. Foot Ankle Spec 2010; 3(1): 15-20. http://dx.doi.org/10.1177/1938640009355659
Craig DI. Medial tibial stress syndrome: evidence-based prevention. J Athl Train 2008; 43(3): 316-8. http://dx.doi.org/10.4085/1062-6050-43.3.316
Yeung SS, Yeung EW and Gillespie LD. Interventions for preventing lower limb soft-tissue running injuries. Cochrane Database Syst Rev 2011; 6(7): CD001256. http://dx.doi.org/10.1002/14651858.cd001256.pub2
Fogarty S. Massage treatment and medial tibial stress syndrome; A commentary to provoke thought about the way massage therapy is used in the treatment of MTSS. J Bodyw Mov Ther 2015; 19(3): 447-52. http://dx.doi.org/10.1016/j.jbmt.2014.11.003
Rompe JD, Cacchio A, Furia JP and Maffulli N. Low-energy extracorporeal shock wave therapy as a treatment for medial tibial stress syndrome. Am J Sports Med 2010; 38(1): 125-32. http://dx.doi.org/10.1177/0363546509343804
Reshef N and Guelich DR. Medial tibial stress syndrome. Clin Sports Med 2012; 31(2): 273-90. http://dx.doi.org/10.1016/j.csm.2011.09.008
Winters M, Eskes M, Weir A, Moen MH, Backx FJ and Bakker EW. Treatment of medial tibial stress syndrome: a systematic review. Sports Med 2013; 43(12): 1315-33. http://dx.doi.org/10.1007/s40279-013-0087-0
Eshed I, Kushnir T, Livneh A, Langevitz P, Ben-Zvi I, Konen E, et al. Exertional leg pain as a manifestation of occult spondyloarthropathy in familial Mediterranean fever: an MRI evaluation. Scand J Rheumatol 2012; 41(6): 482-6. http://dx.doi.org/10.3109/03009742.2012.698301
Samuelson DR and Cram RL. The three-phase bone scan and exercise induced lower-leg pain. The tibial stress test Clin Nucl Med 1996; 21(2): 89-93. http://dx.doi.org/10.1097/00003072-199602000-00001
Shikare S, Samsi AB and Tilve GH. Bone imaging in sports medicine. J Postgrad Med 1997; 43(3): 71-2.
Jimenez CE. Advantages of diagnostic nuclear medicine part 1: musculoskeletal disorders. Phys Sportsmed 1999; 27(12): 44-72. http://dx.doi.org/10.3810/psm.1999.11.1103
Flynt L and Balon HR. 17-year-old runner with shin pain. J Nucl Med Technol 2014; 42(3): 238-9. http://dx.doi.org/10.2967/jnmt.113.135897
Yüksel O, Ozgürbüz C, Ergün M, Işlegen C, Taskiran E, Denerel N, et al. Inversion/Eversion strength dysbalance in patients with medial tibial stress syndrome. J Sports Sci Med 2011; 10(4): 737-42. eCollection 2011.
Moen MH, Schmikli SL, Weir A, Steeneken V, Stapper G, de Slegte R, et al. A prospective study on MRI findings and prognostic factors in athletes with MTSS. Scand J Med Sci Sports 2014; 24(1): 204-10. http://dx.doi.org/10.1111/j.1600-0838.2012.01467.x
Chang ST, Ku CH and Cherng SC. Evidence-based correlation between anti-streptolysin O serum titer and sacroiliac joint disorder. J Rheumatol 2007; 34(8): 1746-52. Epub 2007 Jul 1.
Chang CC, Chu HY, Chiang SL, Li TY and Chang ST. Impairment of static upright posture in subjects with undifferentiated arthritis in sacroiliac joint in conjunction with elevation of streptococcal serology. J Back Musculoskelet Rehabil 2009; 22(1): 33-41. doi: 10.3233/BMR-2009-0217.
Bozkurt MF, Uğur O, Ertenli I and Carner B. Combined use of bone and bone marrow scintigraphies for the diagnosis of active sacroiliitis. Ann Nucl Med 2001; 15(2): 117-21. http://dx.doi.org/10.1007/BF02988601
Huang JY, Tsai MF, Kao PF and Chen YS. Automatic computer- aided sacroiliac joint index analysis for bone scintigraphy. Comput Methods Programs Biomed 2010; 98(1): 15-26. http://dx.doi.org/10.1016/j.cmpb.2009.07.010
Franklyn M, Oakes B, Field B, Wells P and Morgan D. Section modulus is the optimum geometric predictor for stress fractures and medial tibial stress syndrome in both male and female athletes. Am J Sports Med 2008; 36(6): 1179-89. http://dx.doi.org/10.1177/0363546508314408
Fredericson M, Bergman AG, Hoffman KL and Dillingham MS. Tibial stress reaction in runners. Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Am J Sports Med 1995; 23(4): 472-81. http://dx.doi.org/10.1177/036354659502300418
Neal BS, Griffiths IB, Dowling GJ, Murley GS, Munteanu SE, Franettovich Smith MM, et al. Foot posture as a risk factor for lower limb overuse injury: a systematic review and metaanalysis. J Foot Ankle Res 2014; 7(1): 55. http://dx.doi.org/10.1186/s13047-014-0055-4
Reinking MF, Austin TM, Bennett J, Hayes AM and Mitchell WA. Lower extremity overuse bone injury risk factors in collegiate athletes: a pilot study. Int J Sports Phys Ther 2015; 10(2): 155-67.
Eshed I, Rosman Y, Livneh A, Kedem R, Langevitz P, Ben-Zvi I, et al. Exertional leg pain in familial Mediterranean fever: a manifestation of an underlying enthesopathy and a marker of more severe disease. Arthritis Rheumatol 2014; 66(11): 3221-6. http://dx.doi.org/10.1002/art.38797
Khamis S and Yizhar Z. Effect of feet hyperpronation on pelvic alignment in a standing position. Gait Posture 2007; 25(1): 127-34. Epub 2006 Apr 18. http://dx.doi.org/10.1016/j.gaitpost.2006.02.005
Geraci MC Jr and Brown W. Evidence-based treatment of hip and pelvic injuries in runners. Phys Med Rehabil Clin N Am 2005; 16(3): 711-47. http://dx.doi.org/10.1016/j.pmr.2005.02.004
Kim W, João F, Tan J, Mota P, Vleck V, Aguiar L, et al. The natural shock absorption of the leg spring. J Biomech 2013; 46(1): 129-36. Epub 2012 Nov 28. http://dx.doi.org/10.1016/j.jbiomech.2012.10.041
Love C, Din AS, Tomas MB, Kalapparambath TP and Palestro CJ. Radionuclide bone imaging: an illustrative review. Radiographics 2003; 23(2): 341-58. http://dx.doi.org/10.1148/rg.232025103
Clinton SC, George SE, Mehnert M, Fitzgerald CM and Chimes GP. Pelvic floor pain: physical therapy versus injections. PM and R 2011; 3(8): 762-70. http://dx.doi.org/10.1016/j.pmrj.2011.07.006
Betsch M, Schneppendahl J, Dor L, Jungbluth P, Grassmann JP, Windolf J, et al. Influence of foot positions on the spine and pelvis. Arthritis Care Res (Hoboken) 2011; 63(12): 1758-65. http://dx.doi.org/10.1002/acr.20601
Yamaguchi S, Sasho T, Kato H, Kuroyanagi Y and Banks SA. Ankle and subtalar kinematics during dorsiflexionplantarflexion activities. Foot Ankle Int 2009; 30(4): 361-6. http://dx.doi.org/10.3113/FAI.2009.0361
Moen MH, Bongers T, Bakker EW, Zimmermann WO, Weir A, et al. Risk factors and prognostic indicators for medial tibial stress syndrome. Scand J Med Sci Sports 2012; 22(1): 34-9. http://dx.doi.org/10.1111/j.1600-0838.2010.01144.x
Pietrzak M. Diagnosis and management of acute medial tibial stress syndrome in a 15 years old female surf life-saving competitor. Int J Sports Phys Ther 2014; 9(4): 525-39.
Graci V and Salsich GB. Trunk and lower extremity segment kinematics and their relationship to pain following movement instruction during a single-leg squat in females with dynamic knee valgus and patellofemoral pain. J Sci Med Sport 2015; 18(3): 343-7. Epub 2014 Apr 26. http://dx.doi.org/10.1016/j.jsams.2014.04.011
Krenner BJ. Case report: comprehensive management of medial tibial stress syndrome. J Chiropr Med 2002; 1(3): 122-4. http://dx.doi.org/10.1016/S0899-3467(07)60019-6
Duval K, Lam T and Sanderson D. The mechanical relationship between the rear foot, pelvis and low-back. Gait Posture 2010; 32(4): 637-40. http://dx.doi.org/10.1016/j.gaitpost.2010.09.007
Namey TC, McIntyre J, Buse M and LeRoy EC. Nucleographic studies of axial spondarthritides I. Quantitative sacroiliac scintigraphy in early HLA-B27-associated sacroiliitis. Arthritis Rheum 1977; 20(5): 1058-64. http://dx.doi.org/10.1002/art.1780200504
Kaçar G, Kaçar C, Karayalçin B, GüngoÅNr F, Tuncer T and Erkiliç M. Quantitative sacroiliac joint scintigraphy in normal subjects and patients with sacroiliitis. Ann Nucl Med 1998; 12(3): 169-73. http://dx.doi.org/10.1007/BF03164785
Muche B, Bollow M, François RJ, Sieper J, Hamm B and Braun J. Anatomic structures involved in early- and latestage sacroiliitis in spondylarthritis: a detailed analysis by contrast- enhanced magnetic resonance imaging. Arthritis Rheum 2003; 48(5): 1374-84. http://dx.doi.org/10.1002/art.10934
Snijders CJ, Vleeming A and Stoeckart R. Transfer of lumbosacral load to iliac bones and legs Part 1: Biomechanics of self-bracing of the sacroiliac joints and its significance for treatment and exercise. Clin Biomech (Bristol, Avon) 1993; 8(6): 85-94. http://dx.doi.org/10.1016/0268-0033(93)90002-Y
Snijders CJ, Vleeming A and Stoeckart R. Transfer of lumbosacral load to iliac bones and legs Part 2: loading of the sacroiliac joints when lifting in a stooped posture. Clin Biomech (Bristol, Avon) 1993; 8(6): 295-301. http://dx.doi.org/10.1016/0268-0033(93)90003-Z
Li H, Huang W, Xu Y and Lian G. On the squeeze flow of a bingham fluid between two rigid spheres. Particul Sci Technol: An Intern J 2004; 22(1): 1-20. http://dx.doi.org/10.1080/02726350490422383