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-Three phased rehab

-Individualized and specific

-RTP anywhere from 2 - 6 weeks

Medial Tibial Stress Syndrome

Rehab Plan

Sample Problem List

-Pain during and after exercise

-Antalgic gait and impaired functional mobility

-Decreased ROM and flexibility of gastroc, soleus, and hamstring

-Weak foot intrinsic muscles

-Inadequate knowledge of condition and contributing factors

Phase 1

Overall Goals

Goals: reduce pain, increase ROM, maintain CV fitness

Initial Steps: Reduce activity, weight bearing, and stress on area

Ensure: proper biomechanics

Modalities:

-Ice cup

-Soft tissue massage

Potential Exercises:

-Stretching (gastroc, soleus, hamstring)

-PROM of hip, knee, and ankle

-Short foot exercises

-Joint mobilizations of foot

-Toe box/alphabets

-Aquatic therapy

-Achieve normal gait and proper biomechanics

-Return to play in a pain free state

-Maintain CV fitness

-Strengthen foot intrinsics

-Patient Education

Progression:

-Pain free weight bearing

-Ability to perform light activity

-Proper biomechanics

Phase 3

Phase 2

Goals: Begin running progression, strengthen surrounding musculature, and maintain CV fitness

Goals: Full return to play, normal gait and biomechanics, normal strength

Running Progression: begin at 50% and bump up 10% per week as tolerated

Emphasize: ECCENTRICS

Exercises:

-Ankle manuals and strengthening

-Short foot exercises

-Plyometrics

-Calf raises and shuttle squats

-Heel/Toe walking

-Star drills

-Balancing exercises

-AROM of LL and hip with weight

Modalities: Cryotherapy

By the end of this phase athlete should have made a complete RTP!

Exercises:

-Stretching

-Ankle manuals

-Short foot exercises

-AROM activities of lower leg

-Plyometrics

-Calf raises and shuttle squats

Progression:

-Tolerate 75% intensity

-Full AROM of lower limb

-Stronger foot intrinsics

-Pain free

Weights should be increased as tolerated to build strength

Cross training should be done once per week

Overview of Injury

Following Return to Play...

Once full RTP is made, athlete should continue to:

-Cross train weekly

-Strengthening and stretching (using eccentrics)

-Monitoring pain during and after activity

-Take time off if pain begins to present again

-More commonly known as shin splints

-Due to poor control of eccentric contractions and improper force absorption

-Presents as pain along the medial border of the tibia

-Can progress to stress fracture if not cared for

-Combination of muscle tightness and soreness, as well as of osteoclastic activity outpacing osteoblastic activity

MTSS is caused by improper force absorption and eccentric exercises should be practiced!

Anatomy, Risk Factors and Assessment

-Deals with muscles in compartments of lower leg and tibia

-Athlete will present with pain in lower leg

-Diffuse or pin point, worsens with activity

-History should be taken

-Training surface, volume, nutrition

-Biomechanics evaluated

-Special tests completed

-Percussion test

-Tuning fork

-Hop test

Found most commonly in:

-Runners

-Females

-High training volume

-Hard surfaces

-Improper footwear

-Poor biomechanics

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