Naderi Aynollah, Fallah Mohammadi Mohammad, Heidaralizadeh Aida, Moen Maarten H
Department of Physical Education and Sport Sciences, Faculty of Physical Education, Shahrood University of Technology, Shahrood, Semnan, Iran.
Department of Sports Sciences, Faculty of Humanities, Higher Education Institute of Shafagh, Tonekabon, Iran.
Orthop J Sports Med. 2025 Feb 6;13(2):23259671241311849. doi: 10.1177/23259671241311849. eCollection 2025 Feb.
Medial tibial stress syndrome (MTSS) can impair training and daily activities, underscoring the need for effective treatment. However, there's limited evidence on using lower-leg exercises for MTSS in recreational runners.
PURPOSE/HYPOTHESIS: The purpose of the present study was to determine whether adding lower-leg exercises to a multimodal therapeutic intervention improves the recovery from MTSS in recreational runners. It was hypothesized that adding lower-leg exercises to a multimodal therapeutic intervention would enhance its effect on foot posture and make MTSS recovery more effective than multimodal therapeutic interventions alone.
Randomized controlled trial; Level of evidence, 1.
A total of 40 recreational runners diagnosed with MTSS using history and physical examination (40% women; mean ± SD age, 23.9 ± 3.9 years) were then randomly divided into intervention (n = 20) and control (n = 20) groups. Both groups underwent a multimodal therapeutic intervention involving ice massage, foot orthoses, and extracorporeal shockwave therapy. The intervention group additionally received a tailored lower-leg exercise protocol involving stretching, strengthening, sensorimotor exercises, and foam roller myofascial release. Pain intensity, MTSS severity, perceived treatment effect, quality of life (QoL), and static and dynamic foot posture were assessed at baseline, 6-week, and 12-week follow-up evaluations.
A mixed model analysis of variance found no significant differences in pain intensity ( = .17) or MTSS severity ( = .30) between the intervention group and the control group. However, there were significant improvements in QoL ( = .003), static foot posture index (FPI) ( = .02), and dynamic arch index (DAI) ( < .001), for the intervention group. After 6 and 12 weeks, the intervention group displayed lower DAI scores than controls ( = .04 and = .02, respectively). By week 12, the intervention group exhibited significantly higher QoL scores ( = .02) and lower FPI scores ( = .04) compared with controls.
The study demonstrated that lower-leg exercises within a multimodal treatment positively affected foot posture and QoL, although they did not significantly alleviate pain or affect MTSS severity in recreational runners. Therefore, health care providers are encouraged to integrate these exercises into rehabilitation programs to improve foot posture and QoL for individuals with MTSS. However, future research should focus on larger sample sizes, objective measures, resting control groups, and longer follow-up periods to enhance the understanding of the effects of lower-leg exercises on MTSS management.
IRCT 20170114031942N5 (Iranian Registry of Clinical Trials).
胫骨内侧应力综合征（MTSS）会影响训练和日常活动，这凸显了有效治疗的必要性。然而，关于在普通跑步者中使用小腿锻炼来治疗MTSS的证据有限。
目的/假设：本研究的目的是确定在多模式治疗干预中加入小腿锻炼是否能改善普通跑步者MTSS的恢复情况。研究假设是，在多模式治疗干预中加入小腿锻炼会增强其对足部姿势的影响，使MTSS的恢复比单纯的多模式治疗干预更有效。
随机对照试验；证据等级为1级。
共有40名通过病史和体格检查被诊断为MTSS的普通跑步者（40%为女性；平均年龄±标准差为23.9±3.9岁），然后被随机分为干预组（n = 20）和对照组（n = 20）。两组都接受了包括冰敷按摩、足部矫形器和体外冲击波治疗的多模式治疗干预。干预组还额外接受了一个量身定制的小腿锻炼方案，包括拉伸、强化、感觉运动锻炼和泡沫轴肌筋膜放松。在基线、6周和12周的随访评估中，评估疼痛强度、MTSS严重程度、感知治疗效果、生活质量（QoL）以及静态和动态足部姿势。
方差混合模型分析发现，干预组和对照组在疼痛强度（P = 0.17）或MTSS严重程度（P = 0.30）方面没有显著差异。然而，干预组的生活质量（P = 0.003）、静态足部姿势指数（FPI）（P = 0.02）和动态足弓指数（DAI）（P < 0.001）有显著改善。在6周和12周后，干预组的DAI得分低于对照组（分别为P = 0.04和P = 0.02）。到第12周时，与对照组相比，干预组的生活质量得分显著更高（P = 0.02），FPI得分更低（P = 0.04）。
该研究表明，多模式治疗中的小腿锻炼对足部姿势和生活质量有积极影响，尽管它们并没有显著减轻普通跑步者的疼痛或影响MTSS的严重程度。因此，鼓励医疗保健提供者将这些锻炼纳入康复计划，以改善MTSS患者的足部姿势和生活质量。然而，未来的研究应侧重于更大的样本量、客观测量、静息对照组和更长的随访期，以加深对小腿锻炼对MTSS管理效果的理解。
IRCT 20170114031942N5（伊朗临床试验注册中心）
