A Seldom Cause of Exercise-Related Leg Pain in a Young Soldier-Athlete: A Case Report

Chronic leg pain is a common problem for young soldier-athletes. Differential diagnosis of this issue is extensive and includes more common entities such as medial tibial stress syndrome and tibial stress fracture and other scarce causes. Therefore, making a correct diagnosis proves to be vital for appropriate care. This topic discusses the case of a 36-year-old soldier who was diagnosed with a schwannoma of the left tibial nerve as a rare cause of leg pain. Its literature is scarce and intends to add further data about recommendations for investigation and management for this kind of lesion.

Are Leg Muscle, Tendon and Functional Characteristics Associated with Medial Tibial Stress Syndrome? A Systematic Review

Background Medial tibial stress syndrome (MTSS) is a common overuse injury that lacks effective evidence-based treatment options. Reduced leg girth has been associated with MTSS development because it is hypothesised to impair the ability of the leg to modulate tibial loading generated during foot–ground contact. Measuring total leg girth, however, does not provide specific information about the structural composition or functional capacity of individual leg muscles. Consequently, uncertainty remains as to which specific muscles are compromised and contribute to MTSS development. Therefore, this paper aimed to systematically review the body of literature pertaining to how the structure and function of the leg muscles are thought to be associated with MTSS injury. Methods The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P). Medline, PubMed, SCOPUS, SPORTDiscus with Full-texts and Web of Science were searched until March 2021 to identify articles in which lower limb muscle structural or functional variables associated with MTSS injury were investigated. Results Seventeen studies, which were predominately case–control in design and captured data from 332 individuals with MTSS symptoms and 694 control participants, were deemed appropriate for review. The average Downs and Black Quality Assessment score was 71.7 ± 16.4%, with these articles focussing on leg girth, tendon abnormalities, muscle strength and endurance, shear modulus and neuromuscular control. Of the risk factors assessed in the 17 studies, decreased lean leg girth and higher peak soleus muscle activity during propulsion were most strongly correlated with MTSS development. Individuals with MTSS also displayed deficits in ankle plantar flexor endurance, greater isokinetic concentric eversion strength, increased muscle shear modulus and altered neuromuscular recruitment strategies compared to asymptomatic controls. Conclusions Future prospective studies are required to confirm whether decreased lean leg girth and higher peak soleus muscle activity during propulsion are associated with MTSS development and to elucidate whether these structural and functional differences in the leg muscles between MTSS symptomatic and asymptomatic controls are a cause or effect of MTSS.

A ATUAÇÃO DA FISIOTERAPIA NA PREVENÇÃO DA SÍNDROME DO ESTRESSE TIBIAL MEDIAL EM CORREDORES

Medial tibial stress syndrome is a common injury due to mechanical overload, especially in athletes, causing local inflammation and bone stress. Street running has become increasingly popular, being one of the most practiced physical activities in recent years. The aim of this research is to identify how the assistance of sports physiotherapy professionals would contribute to the care offered to the runner with regards to the prevention of the syndrome. The methodology present in this study is based on a literature review research. The role of the physiotherapist is essential to prevent medial tibial stress, since this professional will be able to guide the runner during his activity. Once injured, the initial treatment requires resting and caring and a pause in the running activity, so that the physiotherapist can treat the injury, and in this way, the runner progressively tends to return to training and running.