Medial Tibial Stress Syndrome:

An Evidence-based Approach to Maximise Successful Treatment Outcomes

Free 2-hour cpd webinar for australian podiatrists

A recording of the live webinar from the 3rd of December, 2020, is available below.

CPD Hours for recording: Certificates are only available to those who attended the live event. In order to claim CPD hours for the recording, please ensure you keep notes or a log of this webinar.

Overview:

Medial tibial stress syndrome (MTSS), or more commonly referred to as "shin splints" is an injury of the lower leg that is common in runners. An often poorly understood injury, MTSS can be an extremely frustrating injury to treat for both the sufferer and the podiatrist.

After suffering from the injury, William McNamara, MD and Benjamin Lindsay invented the Solushin, a clinically-trialled medical device that serves as an adjunct to current MTSS treatments. Currently found on the legs of professional athletes and weekend warriors around Australia, this new product was designed with leading physicians, podiatrists and physiotherapists with the goal of pain management in the short-term, and a quicker return to pain-free running when used alongside load management.

In this webinar, William and Benjamin will discuss MTSS, how to identify and diagnose MTSS, highlight the best evidence for the management of the injury, and how the Solushin ties into current clinical practice including an overview of the clinical studies and how to best prescribe the device.

Commonly Asked Questions

When to use orthotics/do they work?

Yes, orthotics are shown to work as discussed in the webinar. There is level 1 evidence for neoprene insoles (shock absorbers) and semi-rigid custom orthotics (addresses over pronation or other biomechanics deficits).

So, when to use them? Insoles "couldn't hurt" to help with shock absorption and load management; however, orthotics are a better option if you have identified underlying biomechanical issues. As always, we need to emphasis that orthotics alone are likely not going to solve your patients injury, but should be used in a combination of load management, strengthening, the Solushin and other treatment modalities as required.

How early do you prescribe the Solushin?

In our double-blinded randomised controlled trial, patients had symptoms for at least 6-weeks to match the inclusion criteria. This was largely due to subject motivation (as shown, it is extremely difficult to find healthy subjects to participate in sports medicine studies).

Now the Solushin is on the market, early intervention is becoming paramount. Not only do your patients benefit from short-term pain management and relief, but in the medium to long-term, a quicker return to pain-free running.

If the patient has previous history of MTSS, we also recommend utilising the Solushin as part of a preventative program.

What if patients already have great dorsiflexion?

Having great dorsiflexion is not common in MTSS sufferers, which is partly why the device focuses on improving dorsiflexion. Our prospective cohort study also showed greater gains in ankle range of motion (ROM) when their initial ROM was poor. So, would the patient still benefit from using the Solushin?

Whether the patient is currently achieving 5% of 80% of their maximal dorsiflexion range, there are still potential gains for the patient to make. It is no surprise that those achieving less of their maximal range see quicker improvements compared to those closer to their maximal range.

If a patient appears to have great ankle ROM:

1. Re-check examination findings (e.g. knee to wall with heel on ground)

2. Address load management

3. Address biomechanics

4. Thoroughly examine for "trigger points" as per webinar

The Solushin has continued to demonstrate positive outcomes, even on patients with a great initial ankle ROM. While it may be due to the benefit of the rod along the posteromedial border of the tibia, the offloading of the soleus origins may also be providing soft-tissue benefits, irrespective of the patients ankle ROM. This is something we are continuing to explore.

Do you have any recommended exercises?

It is imperative to assess the individual patient before prescribing exercises. Some common stretches and strengthening exercises target: calves, tibialis anterior, tibialis posterior, flexor hallicus longs, peroneals, core and hip abductors. For more, check out

"Medial tibial stress syndrome: conservative treatment options" by Gailbraith et al. This is referenced throughout the webinar.

How do you design load management programs?

The load management program is a tailored and methodical approach for an athletes return to load. It is important to factor in distance, frequency, intensity and surfaces. You should also minimise rest.

Given the athletes capabilities, you want them exercising with minimal rest at a point of no pain or minimal pain - the severity score referenced in the webinar is a brilliant guide. If you would like a copy of an example load management program, please contact the team with the form below.

Where is the Solushin available?

The Solushin is available via Briggate Medical Supplies. We recommend you purchase a pair of larges or extra-larges as clinical samples to demonstrate acute effects on patients. You can then order the patients respective size. Please note: as a class 1 medical device listed on the ARTG for single-patient use, it is against laws and regulations to treat multiple patients with 1 Solushin medical device.