Síndrome de estrés tibial medial en deportistas: una mirada global en diagnóstico y tratamiento
DOI:
https://doi.org/10.59856/arch.soc.chil.med.deporte.v68i2.69Palabras clave:
Síndrome de estrés tibial medial, Periostitis, Lesión deportiva, Lesión por sobrecarga, Lesión de piernaResumen
El síndrome de estrés tibial medial es una de las formas más comunes de dolor de pierna inducido por el ejercicio, a pesar de ello, aun no existe consenso para el manejo clínico. El objetivo de esta revisión es describir el estado actual del diagnóstico y tratamiento de síndrome de estrés tibial medial en deportistas. La búsqueda de artículos fue realizada en las bases PubMed, LILACs y Cochrane desde Mayo 2016 hasta Mayo de 2022. A pesar de que se han descrito números factores de riesgo, la etiología aún no está completamente establecida. El diagnóstico se basa en la historia y exploración física con una alta fiabilidad, pero se debe tener en cuenta el diagnóstico diferencial por la alta frecuencia de lesiones asociadas. Hay múltiples tratamientos descritos que incluyen modificación de la actividad, terapia física, reentrenamiento de la carrera, ortesis, nutrición para la rehabilitación, ondas de choque, proloterapia y entrenamiento neuromuscular. A pesar de varios resultados prometedores, ninguno de estos tratamientos se sustenta en evidencia científica sólida.
Referencias
Mattock JPM, Steele JR, Mickle KJ. Are Leg Muscle, Tendon and Functional Characteristics Associated with Medial Tibial Stress Syndrome? A Systematic Review. Sport Med - Open [Internet]. 2021;7(1). Available from: https://doi.org/10.1186/s40798-021-00362-2
Kuwabara A, Dyrek P, Olson EM, Kraus E. Evidence-Based Management of Medial Tibial Stress Syndrome in Runners. Curr Phys Med Rehabil Reports [Internet]. 2021; Available from: https://doi.org/10.1007/s40141-021-00326-3
Winters M. The diagnosis and management of medial tibial stress syndrome. Unfallchirurg [Internet]. 2020 Jan 16;123(S1):15–9. Available from: http://link.springer.com/10.1007/s00113-019-0667-z
Saeki J, Nakamura M, Nakao S, Fujita K, Yanase K, Ichihashi N. Muscle stiffness of posterior lower leg in runners with a history of medial tibial stress syndrome. Scand J Med Sci Sports [Internet]. 2018 Jan 3;28(1):246–51. Available from: https://onlinelibrary.wiley.com/doi/10.1111/sms.12862
Menéndez C, Batalla L, Prieto A, Rodríguez MÁ, Crespo I, Olmedillas H. Medial Tibial Stress Syndrome in Novice and Recreational Runners: A Systematic Review. Int J Environ Res Public Health [Internet]. 2020 Oct 13;17(20):7457. Available from: https://www.mdpi.com/1660-4601/17/20/7457
Winkelmann ZK, Anderson D, Games KE, Eberman LE. Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review. J Athl Train [Internet]. 2016 Dec 1;51(12):1049–52. Available from: https://meridian.allenpress.com/jat/article/51/12/1049/112744/Risk-Factors-for-Medial-Tibial-Stress-Syndrome-in
Winters M, Bakker EWP, Moen MH, Barten CC, Teeuwen R, Weir A. Medial tibial stress syndrome can be diagnosed reliably using history and physical examination. Br J Sports Med. 2018;52(19):1267–72.
Mattock J, Steele JR, Mickle KJ. A protocol to prospectively assess risk factors for medial tibial stress syndrome in distance runners. BMC Sports Sci Med Rehabil [Internet]. 2018 Dec 22;10(1):20. Available from: https://bmcsportsscimedrehabil.biomedcentral.com/articles/10.1186/s13102-018-0109-1
Nikolaidis P, Rosemann T, Knechtle B. A Brief Review of Personality in Marathon Runners: The Role of Sex, Age and Performance Level. Sports [Internet]. 2018 Sep 18;6(3):99. Available from: https://www.mdpi.com/2075-4663/6/3/99
Mulvad B, Nielsen RO, Lind M, Ramskov D. Diagnoses and time to recovery among injured recreational runners in the RUN CLEVER trial. Srinivasan M, editor. PLoS One [Internet]. 2018 Oct 12;13(10):e0204742. Available from: https://dx.plos.org/10.1371/journal.pone.0204742
Kluitenberg B, van Middelkoop M, Diercks R, van der Worp H. What are the Differences in Injury Proportions Between Different Populations of Runners? A Systematic Review and Meta-Analysis. Sport Med [Internet]. 2015;45(8):1143–61. Available from: http://dx.doi.org/10.1007/s40279-015-0331-x
Dempster J, Dutheil F, Ugbolue UC. The Prevalence of Lower Extremity Injuries in Running and Associated Risk Factors: A Systematic Review. Phys Act Heal [Internet]. 2021 Jul 9;5(1):133–45. Available from: http://paahjournal.com/articles/10.5334/paah.109/
Kakouris N, Yener N, Fong DTP. A systematic review of running-related musculoskeletal injuries in runners. J Sport Heal Sci [Internet]. 2021 Sep;10(5):513–22. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2095254621000454
Stürznickel J, Jandl NM, Delsmann MM, von Vopelius E, Barvencik F, Amling M, et al. Bilateral Looser zones or pseudofractures in the anteromedial tibia as a component of medial tibial stress syndrome in athletes. Knee Surgery, Sport Traumatol Arthrosc [Internet]. 2021;29(5):1644–50. Available from: https://doi.org/10.1007/s00167-020-06290-0
Winters M, Burr DB, van der Hoeven H, Condon KW, Bellemans J, Moen MH. Microcrack-associated bone remodeling is rarely observed in biopsies from athletes with medial tibial stress syndrome. J Bone Miner Metab [Internet]. 2019;37(3):496–502. Available from: https://doi.org/10.1007/s00774-018-0945-9
Aicale R, Tarantino D, Maffulli N. Overuse injuries in sport: a comprehensive overview. J Orthop Surg Res [Internet]. 2018 Dec 5;13(1):309. Available from: https://josr-online.biomedcentral.com/articles/10.1186/s13018-018-1017-5
Hughes JM, Popp KL, Yanovich R, Bouxsein ML, Matheny RW. The role of adaptive bone formation in the etiology of stress fracture. Exp Biol Med [Internet]. 2017 May 5;242(9):897–906. Available from: http://journals.sagepub.com/doi/10.1177/1535370216661646
Alfayez SM, Ahmed ML, Alomar AZ. A review article of medial tibial stress syndrome. J Musculoskelet Surg Res [Internet]. 2017;1(1):10–5. Available from: http://www.journalmsr.com/article.asp?issn=2589-1219;year=2017;volume=1;issue=1;spage=10;epage=15;aulast=Jawadi%0Ahttp://www.journalmsr.com/temp/SaudiOrthopJ1110-2394577_003954.pdf
Reinking MF, Austin TM, Richter RR, Krieger MM. Medial Tibial Stress Syndrome in Active Individuals: A Systematic Review and Meta-analysis of Risk Factors. Sports Health. 2017;9(3):252–61.
Naderi A, Moen MH, Degens H. Is high soleus muscle activity during the stance phase of the running cycle a potential risk factor for the development of medial tibial stress syndrome? A prospective study. J Sports Sci [Internet]. 2020 Oct 17;38(20):2350–8. Available from: https://www.tandfonline.com/doi/full/10.1080/02640414.2020.1785186
Boer P-H, Schwellnus MP, Jordaan E. Chronic diseases and allergies are risk factors predictive of a history of Medial Tibial Stress Syndrome (MTSS) in distance runners: SAFER study XXIV. Phys Sportsmed [Internet]. 2023 Mar 4;51(2):166–74. Available from: https://www.tandfonline.com/doi/full/10.1080/00913847.2021.2021597
Mountjoy M, Sundgot-Borgen J, Burke L, Carter S, Constantini N, Lebrun C, et al. The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S). Br J Sports Med [Internet]. 2014 Apr 11;48(7):491–7. Available from: https://bjsm.bmj.com/lookup/doi/10.1136/bjsports-2014-093502
Bliekendaal S, Moen M, Fokker Y, Stubbe JH, Twisk J, Verhagen E. Incidence and risk factors of medial tibial stress syndrome: a prospective study in Physical Education Teacher Education students. BMJ Open Sport Exerc Med [Internet]. 2018 Oct;4(1):e000421. Available from: https://bmjopensem.bmj.com/lookup/doi/10.1136/bmjsem-2018-000421
Nielsen RØ, Parner ET, Nohr EA, Sørensen H, Lind M, Rasmussen S. Excessive Progression in Weekly Running Distance and Risk of Running-Related Injuries: An Association Which Varies According to Type of Injury. J Orthop Sport Phys Ther [Internet]. 2014 Oct;44(10):739–47. Available from: http://www.jospt.org/doi/10.2519/jospt.2014.5164
Loudon JK, Reiman MP. Lower extremity kinematics in running athletes with and without a history of medial shin pain. Int J Sports Phys Ther [Internet]. 2012;7(4):356–64. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22893855%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC3414067
Raissi GRD, Cherati ADS, Mansoori KD, Razi MD. The relationship between lower extremity alignment and Medial Tibial Stress Syndrome among non-professional athletes. BMC Sports Sci Med Rehabil [Internet]. 2009 Dec 11;1(1):11. Available from: https://bmcsportsscimedrehabil.biomedcentral.com/articles/10.1186/1758-2555-1-11
Tweed JL, Campbell JA, Avil SJ. Biomechanical Risk Factors in the Development of Medial Tibial Stress Syndrome in Distance Runners. J Am Podiatr Med Assoc [Internet]. 2008 Nov 1;98(6):436–44. Available from: https://japmaonline.org/doi/10.7547/0980436
Imhoff AB, Clatworthy M, Cohen M. The Sports Medicine Physician [Internet]. Rocha Piedade S, Imhoff AB, Clatworthy M, Cohen M, Espregueira-Mendes J, editors. Vol. 52, Medicine and science in sports and exercise. Cham: Springer International Publishing; 2019. 1639 p. Available from: http://link.springer.com/10.1007/978-3-030-10433-7
Vajapey S, Miller TL. Evaluation, diagnosis, and treatment of chronic exertional compartment syndrome: a review of current literature. Phys Sportsmed [Internet]. 2017;45(4):391–8. Available from: http://dx.doi.org/10.1080/00913847.2017.1384289
Ross MH, Smith MD, Mellor R, Durbridge G, Vicenzino B. Clinical Tests of Tibialis Posterior Tendinopathy: Are They Reliable, and How Well Are They Reflected in Structural Changes on Imaging? J Orthop Sport Phys Ther [Internet]. 2021 May;51(5):253–60. Available from: https://www.jospt.org/doi/10.2519/jospt.2021.9707
Pedowitz D, Beck D. Presentation, Diagnosis, and Nonsurgical Treatment Options of the Anterior Tibial Tendon, Posterior Tibial Tendon, Peroneals, and Achilles. Foot Ankle Clin [Internet]. 2017 Dec;22(4):677–87. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1083751517300827
Gaunder C, McKinney B, Rivera J. Popliteal Artery Entrapment or Chronic Exertional Compartment Syndrome? Case Rep Med [Internet]. 2017;2017:1–5. Available from: https://www.hindawi.com/journals/crim/2017/6981047/
Pruna R, Griffin S, Windt J, Coutts A, Brien JO, Wangensteen A, et al. Muscle Injury Guide: Prevention of and Return to Muscle Injury Guide. In: Ricard P, Andersen TE, Clarsen B, Alan M, editors. Barça Innovation Hub. 2020. p. 47.
Rajasekaran S, Finnoff JT. Exertional Leg Pain. Phys Med Rehabil Clin N Am [Internet]. 2016 Feb;27(1):91–119. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1047965115000765
Winters M, Bon P, Bijvoet S, Bakker EWP, Moen MH. Are ultrasonographic findings like periosteal and tendinous edema associated with medial tibial stress syndrome? A case-control study. J Sci Med Sport [Internet]. 2017 Feb;20(2):128–33. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1440244016301207
Moraux A, Gitto S, Bianchi S. Ultrasound Features of the Normal and Pathologic Periosteum. J Ultrasound Med [Internet]. 2019 Mar;38(3):775–84. Available from: https://onlinelibrary.wiley.com/doi/10.1002/jum.14762
Bourdon PC, Cardinale M, Murray A, Gastin P, Kellmann M, Varley MC, et al. Monitoring Athlete Training Loads: Consensus Statement. Int J Sports Physiol Perform [Internet]. 2017 Apr;12(s2):S2-161-S2-170. Available from: https://journals.humankinetics.com/view/journals/ijspp/12/s2/article-pS2-161.xml
Goolsby MA, Boniquit N. Bone Health in Athletes. Sport Heal A Multidiscip Approach [Internet]. 2017 Mar 30;9(2):108–17. Available from: http://journals.sagepub.com/doi/10.1177/1941738116677732
Wells KR, Jeacocke NA, Appaneal R, Smith HD, Vlahovich N, Burke LM, et al. The Australian Institute of Sport (AIS) and National Eating Disorders Collaboration (NEDC) position statement on disordered eating in high performance sport. Br J Sports Med [Internet]. 2020 Nov;54(21):1247–58. Available from: https://bjsm.bmj.com/lookup/doi/10.1136/bjsports-2019-101813
Vermeir P, Leye M De, Grymonprez R, Goethals A, Vermeir R, Bossche L Vanden, et al. 456 The impact of sleep on the recovery of sport injuries. In: Poster Presentations [Internet]. BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine; 2021. p. A173.3-A174. Available from: https://bjsm.bmj.com/lookup/doi/10.1136/bjsports-2021-IOC.417
Gao B, Dwivedi S, Milewski MD, Cruz AI. CHRONIC LACK OF SLEEP IS ASSOCIATED WITH INCREASED SPORTS INJURY IN ADOLESCENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS. Orthop J Sport Med [Internet]. 2019 Mar 1;7(3_suppl):2325967119S0013. Available from: http://journals.sagepub.com/doi/10.1177/2325967119S00132
Belinda R. Beck. Exercise-Induced Leg Pain. Med Sci Sport Exerc. 2002;34(5):S44.
Coyle EF, Martin WH, Sinacore DR, Joyner MJ, Hagberg JM, Holloszy JO. Time course of loss of adaptations after stopping prolonged intense endurance training. J Appl Physiol [Internet]. 1984 Dec 1;57(6):1857–64. Available from: https://www.physiology.org/doi/10.1152/jappl.1984.57.6.1857
Drew MK, Purdam C. Time to bin the term ‘overuse’ injury: is ‘training load error’ a more accurate term? Br J Sports Med [Internet]. 2016 Nov;50(22):1423–4. Available from: https://bjsm.bmj.com/lookup/doi/10.1136/bjsports-2015-095543
Sederberg M, HARRAST MA. Deep Water Running for Prevention and Rehabilitation of Running Injuries. In: Clinical Care of the Runner [Internet]. Elsevier; 2020. p. 131–40. Available from: https://linkinghub.elsevier.com/retrieve/pii/B9780323679497000136
Mendez-Rebolledo G, Figueroa-Ureta R, Moya-Mura F, Guzmán-Muñoz E, Ramirez-Campillo R, Lloyd RS. The Protective Effect of Neuromuscular Training on the Medial Tibial Stress Syndrome in Youth Female Track-and-Field Athletes: A Clinical Trial and Cohort Study. J Sport Rehabil [Internet]. 2021 Sep 1;30(7):1019–27. Available from: https://journals.humankinetics.com/view/journals/jsr/30/7/article-p1019.xml
Hegedus EJ, Stern B, Reiman MP, Tarara D, Wright AA. A suggested model for physical examination and conservative treatment of athletic pubalgia. Phys Ther Sport [Internet]. 2013 Feb;14(1):3–16. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1466853X12000508
Dicharry J. Kinematics and Kinetics of Gait: From Lab to Clinic. Clin Sports Med [Internet]. 2010 Jul;29(3):347–64. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0278591910000281
Naderi A, Degens H, Sakinepoor A. Arch-support foot-orthoses normalize dynamic in-shoe foot pressure distribution in medial tibial stress syndrome. Eur J Sport Sci [Internet]. 2019 Feb 7;19(2):247–57. Available from: https://www.tandfonline.com/doi/full/10.1080/17461391.2018.1503337
Braga UM, Mendonça LD, Mascarenhas RO, Alves COA, Filho RGT, Resende RA. Effects of medially wedged insoles on the biomechanics of the lower limbs of runners with excessive foot pronation and foot varus alignment. Gait Posture [Internet]. 2019 Oct;74:242–9. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0966636218316291
Jafarnezhadgero A, Alavi-Mehr SM, Granacher U. Effects of anti-pronation shoes on lower limb kinematics and kinetics in female runners with pronated feet: The role of physical fatigue. Boullosa D, editor. PLoS One [Internet]. 2019 May 14;14(5):e0216818. Available from: https://dx.plos.org/10.1371/journal.pone.0216818
Desmyttere G, Hajizadeh M, Bleau J, Begon M. Effect of foot orthosis design on lower limb joint kinematics and kinetics during walking in flexible pes planovalgus: A systematic review and meta-analysis. Clin Biomech [Internet]. 2018 Nov;59:117–29. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0268003318301062
Hilário BEB, de Oliveira ML, Barbosa PMM, Cunha DMS, dos Santos Rigobello G, Mendes JF, et al. Analysis of the use of insoles in the dynamic stability of the lower limbs in recreational runners: An exploratory study. Gait Posture [Internet]. 2022 Feb;92:435–41. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0966636221006457
Kosonen J, Kulmala J-P, Müller E, Avela J. Effects of medially posted insoles on foot and lower limb mechanics across walking and running in overpronating men. J Biomech [Internet]. 2017 Mar;54:58–63. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0021929017300702
Stellingwerff T, Heikura IA, Meeusen R, Bermon S, Seiler S, Mountjoy ML, et al. Overtraining Syndrome (OTS) and Relative Energy Deficiency in Sport (RED-S): Shared Pathways, Symptoms and Complexities. Sport Med [Internet]. 2021 Nov 28;51(11):2251–80. Available from: https://link.springer.com/10.1007/s40279-021-01491-0
Close GL, Sale C, Baar K, Bermon S. Nutrition for the Prevention and Treatment of Injuries in Track and Field Athletes. Int J Sport Nutr Exerc Metab [Internet]. 2019 Mar 1;29(2):189–97. Available from: https://journals.humankinetics.com/view/journals/ijsnem/29/2/article-p189.xml
Tenforde AS, Sayres LC, Sainani KL, Fredericson M. Evaluating the Relationship of Calcium and Vitamin D in the Prevention of Stress Fracture Injuries in the Young Athlete: A Review of the Literature. PM&R [Internet]. 2010 Oct;2(10):945–9. Available from: http://doi.wiley.com/10.1016/j.pmrj.2010.05.006
Paoloni JA, Milne C, Orchard J, Hamilton B. Non-steroidal anti-inflammatory drugs in sports medicine: guidelines for practical but sensible use. Br J Sports Med [Internet]. 2009 Oct 1;43(11):863–5. Available from: https://bjsm.bmj.com/lookup/doi/10.1136/bjsm.2009.059980
Staab JS, Kolb AL, Tomlinson RE, Pajevic PD, Matheny RW, Hughes JM. Emerging evidence that adaptive bone formation inhibition by non-steroidal anti-inflammatory drugs increases stress fracture risk. Exp Biol Med [Internet]. 2021 May 27;246(9):1104–11. Available from: http://journals.sagepub.com/doi/10.1177/1535370221993098
Gomez Garcia S, Ramon Rona S, Gomez Tinoco MC, Benet Rodriguez M, Chaustre Ruiz DM, Cardenas Letrado FP, et al. Shockwave treatment for medial tibial stress syndrome in military cadets: A single-blind randomized controlled trial. Int J Surg [Internet]. 2017 Oct;46:102–9. Available from: https://linkinghub.elsevier.com/retrieve/pii/S174391911731244X
Padhiar N, Curtin M, Aweid O, Aweid B, Morrissey D, Chan O, et al. The effectiveness of PROLOTHERAPY for recalcitrant Medial TIBIAL Stress Syndrome: a prospective consecutive CASE series. J Foot Ankle Res [Internet]. 2021 Dec 16;14(1):32. Available from: https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-021-00453-z
Dijksma I, Arslan IG, Etten‐Jamaludin FS, Elbers RG, Lucas C, Stuiver MM. Exercise Programs to Reduce the Risk of Musculoskeletal Injuries in Military Personnel: A Systematic Review and Meta‐Analysis. PM&R [Internet]. 2020 Oct 22;12(10):1028–37. Available from: https://onlinelibrary.wiley.com/doi/10.1002/pmrj.12360
Descargas
Publicado
Número
Sección
Licencia
Derechos de autor 2023 Archivos de la Sociedad Chilena de Medicina del Deporte
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.
Cómo citar
