1. KAYLA CUNNINGHAM Medial Tibial Stress Syndrome

2. The Patient 20 year old, female College basketball player Began to feel severe discomfort on the medial aspect of her right shin Complained that her shin ached most of the time, more intense after practice or a game Overuse and repetitive stress had caused severe point tenderness along the medial edge of the tibia Further evaluation showed the athlete had over-pronated feet, x-ray ruled out stress fracture Came to me at the start of her preseason preparation

3. Phase I: Inflammation Goals Goals: reduce inflammation, pain, point tenderness Treatment Treatment: o RICE and NSAIDS o Avoid weight bearing activities o Ice massage of tibialis anterior muscle o LowDye taping/orthotics Exercises Exercises: o Static, daily stretching of the anterior and posterior muscles o General body maintenance: cardio endurance (riding stationary bike, running in water), upper body strength (lifting weights for biceps, triceps, traps), core strength, lower body strength (lifting weights for quads, hamstrings) (if it doesn’t aggravate the injury) Criteria for advancement Criteria for advancement: o Decreased inflammation o Decreased point tenderness

4. Phase II: Proliferation Goals Goals: return to jogging, and running Treatment Treatment: o Ice shin after exercise o Transverse friction massage: tibialis anterior muscle o Wear LowDye taping or orthotics when weight bearing Exercises Exercises: o Ankle range of motion exercises (alphabets, circles, plantar/dorsiflexion) o Toe raises, heel and toe walking o Thera-band exercises (plantar/dorsiflexion) o Towel gathering exercise, marble pickup exercise o General body maintenance (cardio, upper, lower, core) o Progressive weight bearing strengthening program o Heel toe walking, fast walking, jogging, running o Running sprints/suicides; cutting, shuffling, and jumping drills Criteria for advancement Criteria for advancement o Increased flexibility and strength of foot flexor muscles o Be able to run and jump without pain

5. Phase III: Remodeling Goals Goals: return to full-court basketball Treatment Treatment: o Continue taping or orthotics for foot pronation o Continue to ice after exercise Exercises Exercises: o Continue static stretching Criteria for advancement Criteria for advancement: o Leg is symptom free after prolonged activity o Leg and ankle have full strength and range of motion o Hyper-pronation controlled to prevent reoccurrence

6. The End! The athlete has returned to play Continues to tape before practice and games Continues to ice after exercise By strengthening the calf and shin muscles and keeping up flexibility, her pain has disappeared. She has been back to playing full-court basketball for almost a month, and feels 100% better. She is in the middle of her competitive season and feels and like herself again; happy and pain free.