Lower leg muscle structure and function are altered in long-distance runners with medial tibial stress syndrome: a case control study
Tóm tắt
Medial tibial stress syndrome (MTSS) is a common lower leg injury experienced by runners. Although numerous risk factors are reported in the literature, many are non-modifiable and management of the injury remains difficult. Lower leg muscle structure and function are modifiable characteristics that influence tibial loading during foot-ground contact. Therefore, this study aimed to determine whether long-distance runners with MTSS displayed differences in in vivo lower leg muscle structure and function than matched asymptomatic runners. Lower leg structure was assessed using ultrasound and a measure of lower leg circumference to quantify muscle cross-sectional area, thickness and lean lower leg girth. Lower leg function was assessed using a hand-held dynamometer to quantify maximal voluntary isometric contraction strength and a single leg heel raise protocol was used to measure ankle plantar flexor endurance. Outcome variables were compared between the limbs of long-distance runners suffering MTSS (n = 20) and matched asymptomatic controls (n = 20). Means, standard deviations, 95 % confidence intervals, mean differences and Cohen’s d values were calculated for each variable for the MTSS symptomatic and control limbs. MTSS symptomatic limbs displayed a significantly smaller flexor hallucis longus cross-sectional area, a smaller soleus thickness but a larger lateral gastrocnemius thickness than the control limbs. However, there was no statistical difference in lean lower leg girth. Compared to the matched control limbs, MTSS symptomatic limbs displayed deficits in maximal voluntary isometric contraction strength of the flexor hallucis longus, soleus, tibialis anterior and peroneal muscles, and reduced ankle plantar flexor endurance capacity. Differences in lower leg muscle structure and function likely render MTSS symptomatic individuals less able to withstand the negative tibial bending moment generated during midstance, potentially contributing to the development of MTSS. The clinical implications of these findings suggest that rehabilitation protocols for MTSS symptomatic individuals should aim to improve strength of the flexor hallucis longus, soleus, tibialis anterior and peroneal muscles along with ankle plantar flexor endurance. However, the cross-sectional study design prevents us determining whether between group differences were a cause or effect of MTSS. Therefore, future prospective studies are required to substantiate the study findings.
Tài liệu tham khảo
Clanton TO, Solcher BW. Chronic leg pain in the athlete. Clin Sports Med. 1994. https://doi.org/10.1016/S0278-5919(20)30283-0.
Newman P, Witchalls J, Waddington G, Adams R. Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis. Open Access J Sports Med. 2013. https://doi.org/10.2147/OAJSM.S39331.
Moen MH, Tol JL, Weir A, Steunebrink M, De Winter TC. Medial tibial stress syndrome a critical review. Sports Med. 2009. https://doi.org/10.2165/00007256-200939070-00002.
Winters M, Eskes M, Weir A, Moen MH, Backx FJG, Bakker EWP. Treatment of Medial Tibial Stress Syndrome: A Systematic Review. Sports Med. 2013;43:1315–33.
Burne SG, Khan KM, Boudville PB, Mallet RJ, Newman PM, Steinman LJ, et al. Risk factors associated with exertional medial tibial pain: a 12 month prospective clinical study. Br J Sports Med. 2004. https://doi.org/10.1136/bjsm.2002.004499.
Madeley LT, Munteanu SE, Bonanno DR. Endurance of the ankle joint plantar flexor muscles in athletes with medial tibial stress syndrome: a case-control study. J Sci Med Sport. 2007. https://doi.org/10.1016/j.jsams.2006.12.115.
Yuksel O, Ozgurbuz C, Ergun M, Islegen C, Taskiran E, Denerel N, et al. Inversion/eversion strength dysbalance in patients with medial tibial stress syndrome. J Sport Sci Med. 2011;10:737–42.
Saeki J, Nakamura M, Nakao S, Fujita K, Yanase K, Morishita K, et al. Ankle and toe muscle strength characteristics in runners with a history of medial tibial stress syndrome. J Foot Ankle Res. 2017. https://doi.org/10.1186/s13047-017-0197-2.
Cook JL, Docking SI. “Rehabilitation will increase the ‘capacity’of your… insert musculoskeletal tissue here….” Defining ‘tissue capacity’: a core concept for clinicians. Br J Sports Med. 2015. https://doi.org/10.1136/bjsports-2015-094849.
Yates B, White S. The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. Am J Sports Med. 2004. https://doi.org/10.1177/0095399703258776.
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. 2018. https://doi.org/10.1186/s13102-018-0109-1.
Crofts G, Angin S, Mickle KJ, Hill S, Nester CJ. Reliability of ultrasound for measurement of selected foot structures. Gait Posture. 2013. https://doi.org/10.1016/j.gaitpost.2013.05.022.
Weiss LW, Clark FC. Ultrasonic protocols for separately measuring subcutaneous fat and skeletal muscle thickness in the calf area. Phys Ther. 1985;65:477–81.
Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: Erlbaum Associates; 1988. p. 25–6.
Moen MH, Bongers T, Bakker EW, Zimmermann WO, Weir A, Tol JL, et al. Risk factors and prognostic indicators for medial tibial stress syndrome. Scand J Med Sci Sports. 2012. https://doi.org/10.1111/j.1600-0838.2010.01144.x.
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. 2020. https://doi.org/10.1080/02640414.2020.1785186.
Edama M, Onishi H, Kubo M, Takabayashi T, Yokoyama E, Inai T, et al. Gender differences of muscle and crural fascia origins in relation to the occurrence of medial tibial stress syndrome. Scand J Med Sci Sports. 2017. https://doi.org/10.1111/sms.12639.
Tsao H, Danneels LA, Hodges PW. ISSLS prize winner: Smudging the motor brain in young adults with recurrent low back pain. Spine. 2011. https://doi.org/10.1097/BRS.0b013e31821c4267.
Dakin CJ, Héroux ME, Luu BL, Inglis JT, Blouin J-S. Vestibular contribution to balance control in the medial gastrocnemius and soleus. J Neurophysiol. 2016. https://doi.org/10.1152/jn.00512.2015.
Clement D. Tibial stress syndrome in athletes. J Sports Med. 1974. https://doi.org/10.1177/036354657400200203.
Phuah AH, Schache AG, Crossley KM, Wrigley TV, Creaby MW. Sagittal plane bending moments acting on the lower leg during running. Gait Posture. 2010. https://doi.org/10.1016/j.gaitpost.2009.10.009.
Scott SH, Winter DA. Internal forces of chronic running injury sites. Med Sci Sports Exerc. 1990;22:357–69.
Dorn TW, Schache AG, Pandy MG. Muscular strategy shift in human running: dependence of running speed on hip and ankle muscle performance. J Exp Biol. 2012. https://doi.org/10.1242/jeb.064527.
Schünke M, Schulte E, Schumacher U. Thieme atlas of anatomy: general anatomy and musculoskeletal system. 1st ed. Ross LM, Lamperti ED, editors. New York: Thieme Medical Publishers; 2006:453.
Hubbard TJ, Carpenter EM, Cordova ML. Contributing factors to medial tibial stress syndrome: a prospective investigation. Med Sci Sports Exerc. 2009. https://doi.org/10.1249/MSS.0b013e31818b98e6.