Preventive interventions for medial tibial stress syndrome: Systematic review and meta-analysis

Abstract

Background: Several randomized clinical trials have investigated preventive interventions for Medial Tibial Stress Syndrome (MTSS), but their findings remain controversial.

Research question: Which interventions are effective in preventing MTSS?

Methods: This systematic review included randomized clinical trials evaluating preventive strategies for MTSS. In December 2023, we conducted a literature search in CAPES Periodicals portal, PUBMED, Web of Science, OVID, ScienceDirect Journals, Directory of Open Access Journals (DOAJ), and PEDro, identifying 4192 records. A total of 12 studies with 8197 participants met the inclusion criteria, with 10 eligible for meta-analysis. The risk of bias was assessed using the PEDro scale and the certainty in the scientific evidence rated through the GRADE system.

Results: Meta-analyses indicated that neuromuscular training (four studies, 3887 individuals, 95 %CI Odds Ratio 0.13, 0.64) and overpronation insoles (four studies, 1047 individuals, 95 %CI Odds Ratio 0.10, 1.0) are effective in preventing MTSS, with high and moderate certainty of evidence, respectively. In contrast, shock-absorbing insoles showed no significant effect (two studies, 1571 individuals, 95 %CI Odds Ratio 0.28, 1.08), with high certainty of evidence. There is no evidence supporting the use of static stretching programs or special socks for MTSS prevention. The methodological quality of the included studies varied.

Significance: Neuromuscular training and overpronation insoles are recommended for MTSS prevention, whereas shock-absorbing insoles should not be used for this purpose.

Keywords: Insoles; Neuromuscular training; Prevention; Shin splints; Tibial periostitis.