Original paper
Endurance of the ankle joint plantar flexor muscles in athletes with medial tibial stress syndrome: A case-control study

https://doi.org/10.1016/j.jsams.2006.12.115Get rights and content

Summary

Medial tibial stress syndrome (MTSS) is a common overuse leg injury seen in athletes and can be recalcitrant to management. This cross-sectional study aimed to determine if there are differences in the isotonic endurance of the ankle joint plantar flexor muscles in athletes with MTSS compared to athletes without MTSS. The isotonic endurance of the ankle joint plantar flexors was measured in 30 participants diagnosed with MTSS, and 30 reference participants that were matched to MTSS participants on the basis of age (±5 years), gender, BMI (±5%) and type of sporting activity. The number of heel-rise repetitions of the participants in each group was compared for differences. There were no significant differences between participants with and without MTSS for age (p = 0.34), height (p = 0.40) or BMI (p = 0.27). The mean number of heel-rise repetitions performed by participants in the MTSS group was significantly less than the reference group (mean 23, S.D. 5.6, versus mean 33, S.D. 8.6; p < 0.001). These results suggest that athletes with MTSS have endurance deficits of the ankle joint plantar flexor muscles. Rehabilitation of athletes with MTSS should comprise training designed to enhance endurance of the lower limb musculature, including the ankle joint plantar flexors. It is not known whether a lack of endurance of the ankle joint plantar flexor muscles is the cause or effect of MTSS.

Section snippets

Participants

Two groups of participants were used in this study: those with MTSS and those without MTSS (reference group). The MTSS group consisted of 30 participants (16 male, 14 female), aged 17–47 years (mean 24.0, S.D. 5.7) who were recruited as patients from two sports medicine clinics in Melbourne, Victoria, Australia (Alphington Sports Medicine Clinic, Northcote, Victoria, Australia and La Trobe University Health Sciences Clinic, La Trobe University, Victoria, Australia). The reference group

Participant characteristics

Table 1 shows the major sports of the participants in each study group. Table 2 shows the mean ± S.D. (range) for age, height and BMI of each study group. There were no significant differences in age (t58 = 0.96, p = 0.34), height (t58 = −0.86, p = 0.40) or BMI (t58 = 1.12, p = 0.27) between groups.

Of the 30 participants with MTSS, 29 experienced bilateral limb involvement. The median (range) duration of symptoms was 15 (4–624) weeks. In the previous week of exercise, the mean ± S.D. (range) for pain on the

Discussion

The purpose of this study was to determine whether any differences in isotonic endurance of the ankle joint plantar flexor muscles existed between athletes with and without MTSS. In interpreting these findings, the reliability of the standing heel-rise test used to assess the isotonic endurance of the ankle joint plantar flexor muscles in this study must be considered. The standing heel-rise test was shown to have excellent test–retest reliability in both MTSS and reference study groups, with

Conclusion

This study demonstrated endurance deficits in the ankle joint plantar flexor muscles in athletes with MTSS. This suggests that rehabilitation of athletes with MTSS should comprise training designed to enhance endurance of the lower limb musculature, including the ankle joint plantar flexors. Future prospective studies are required to determine whether a lack of endurance of the ankle joint plantar flexor muscles is the cause or effect of MTSS.

Competing interests

The authors wish to declare no competing interests.

Practical implications

  • Athletes with medial tibial stress syndrome have reduced endurance of their calf muscles.

  • Treatment of athletes with medial tibial stress syndrome should comprise training programs that aim to restore the endurance of the lower limb musculature, including the calf muscles.

Acknowledgments

The authors would like to thank Practice Managers Dr Gaylene McKay (PhD; Alphington Sports Medicine Clinic, Northcote, Victoria, Australia) and Ms Lesley Newcombe (BPod(Hons); Head, Department of Podiatry, La Trobe University, Victoria Australia) for allowing patients of the respective clinics to be recruited for this study. The authors also wish to express their gratitude to Dr Hylton Menz (PhD; NHMRC Australian Clinical Research Fellow, Musculoskeletal Research Centre, School of

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