Lower leg muscle structure and function are altered in long‐distance runners with medial tibial stress syndrome: a case control study
Abstract Background 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...
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| Format: | Article |
| Language: | English |
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Wiley
2021-01-01
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| Series: | Journal of Foot and Ankle Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13047-021-00485-5 |
| _version_ | 1827356243495223296 |
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| author | Joshua Mattock Julie R. Steele Karen J. Mickle |
| author_facet | Joshua Mattock Julie R. Steele Karen J. Mickle |
| author_sort | Joshua Mattock |
| collection | DOAJ |
| description | Abstract Background 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. Methods 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. Results 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. Conclusions 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. |
| first_indexed | 2024-03-08T04:56:57Z |
| format | Article |
| id | doaj.art-e4ad1d8e7cfe41caae2ba6fe05f0d379 |
| institution | Directory Open Access Journal |
| issn | 1757-1146 |
| language | English |
| last_indexed | 2024-03-08T04:56:57Z |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Foot and Ankle Research |
| spelling | doaj.art-e4ad1d8e7cfe41caae2ba6fe05f0d3792024-02-07T15:10:48ZengWileyJournal of Foot and Ankle Research1757-11462021-01-01141n/an/a10.1186/s13047-021-00485-5Lower leg muscle structure and function are altered in long‐distance runners with medial tibial stress syndrome: a case control studyJoshua Mattock0Julie R. Steele1Karen J. Mickle2Biomechanics Research LaboratoryUniversity of WollongongWollongongNSWAustraliaBiomechanics Research LaboratoryUniversity of WollongongWollongongNSWAustraliaSchool of Allied HealthHuman Services and SportLa Trobe UniversityMelbourneVICAustraliaAbstract Background 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. Methods 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. Results 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. Conclusions 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.https://doi.org/10.1186/s13047-021-00485-5Shin splintsInjury preventionMuscle strengthMuscle structureUltrasoundRunning |
| spellingShingle | Joshua Mattock Julie R. Steele Karen J. Mickle Lower leg muscle structure and function are altered in long‐distance runners with medial tibial stress syndrome: a case control study Journal of Foot and Ankle Research Shin splints Injury prevention Muscle strength Muscle structure Ultrasound Running |
| title | Lower leg muscle structure and function are altered in long‐distance runners with medial tibial stress syndrome: a case control study |
| title_full | Lower leg muscle structure and function are altered in long‐distance runners with medial tibial stress syndrome: a case control study |
| title_fullStr | Lower leg muscle structure and function are altered in long‐distance runners with medial tibial stress syndrome: a case control study |
| title_full_unstemmed | Lower leg muscle structure and function are altered in long‐distance runners with medial tibial stress syndrome: a case control study |
| title_short | Lower leg muscle structure and function are altered in long‐distance runners with medial tibial stress syndrome: a case control study |
| title_sort | lower leg muscle structure and function are altered in long distance runners with medial tibial stress syndrome a case control study |
| topic | Shin splints Injury prevention Muscle strength Muscle structure Ultrasound Running |
| url | https://doi.org/10.1186/s13047-021-00485-5 |
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