[pct-l] Shin splints?

[Yoshihiro Murakami]

Dear Susan

I am just searching the papers on the stretching effect. So, I have
just searched the shin splints papers. The following two papers are
impressive.

1. The use of neoprene or semi-rigid orthotics may help prevent MTSS,
as evidenced by two large prospective studies. by Moen MH, et.
al.(2009)

2. .The most encouraging evidence for effective prevention of shin
splints involves the use of shock-absorbing insoles. However, there
are serious flaws in study design. by Thacker SB, et. al.(2002).



Moen MH, Tol JL, Weir A, Steunebrink M, De Winter TC.  Medial tibial
stress syndrome: a critical review.  Sports Med. 2009;39(7):523-46. .
Abstract
Medial tibial stress syndrome (MTSS) is one of the most common leg
injuries in athletes and soldiers. The incidence of MTSS is reported
as being between 4% and 35% in military personnel and athletes. The
name given to this condition refers to pain on the posteromedial
tibial border during exercise, with pain on palpation of the tibia
over a length of at least 5 cm. Histological studies fail to provide
evidence that MTSS is caused by periostitis as a result of traction.
It is caused by bony resorption that outpaces bone formation of the
tibial cortex. Evidence for this overloaded adaptation of the cortex
is found in several studies describing MTSS findings on bone scan,
magnetic resonance imaging (MRI), high-resolution computed tomography
(CT) scan and dual energy x-ray absorptiometry. The diagnosis is made
based on physical examination, although only one study has been
conducted on this subject. Additional imaging such as bone, CT and MRI
scans has been well studied but is of limited value. The prevalence of
abnormal findings in asymptomatic subjects means that results should
be interpreted with caution. Excessive pronation of the foot while
standing and female sex were found to be intrinsic risk factors in
multiple prospective studies. Other intrinsic risk factors found in
single prospective studies are higher body mass index, greater
internal and external ranges of hip motion, and calf girth. Previous
history of MTSS was shown to be an extrinsic risk factor. The
treatment of MTSS has been examined in three randomized controlled
studies. In these studies rest is equal to any intervention. The use
of neoprene or semi-rigid orthotics may help prevent MTSS, as
evidenced by two large prospective studies.


Thacker SB, Gilchrist J, Stroup DF, Kimsey CD.
The prevention of shin splints in sports: a systematic review of literature.
Med Sci Sports Exerc. 2002 Jan;34(1):32-40.

Abstract
PURPOSE:
To review the published and unpublished evidence regarding risk
factors associated with shin splints, assess the effectiveness of
prevention strategies, and offer evidence-based recommendations to
coaches, athletes, and researchers.
METHODS:
We searched electronic data bases without language restriction,
identified citations from reference sections of research papers
retrieved, contacted experts in the field, and searched the Cochrane
Collaboration. Of the 199 citations identified, we emphasized results
of the four reports that compared methods to prevent shin splints. We
assessed the methodologic quality of these reports by using a
standardized instrument.
RESULTS:
The use of shock-absorbent insoles, foam heel pads, heel cord
stretching, alternative footwear, as well as graduated running
programs among military recruits have undergone assessment in
controlled trials. There is no strong support for any of these
interventions, and each of the four controlled trials is limited
methodologically. Median quality scores in these four studies ranged
from 29 to 47, and serious flaws in study design, control of bias, and
statistical methods were identified.
CONCLUSION:
Our review yielded little objective evidence to support widespread use
of any existing interventions to prevent shin splints. The most
encouraging evidence for effective prevention of shin splints involves
the use of shock-absorbing insoles. However, serious flaws in study
design and implementation constrain the work in this field thus far. A
rigorously implemented research program is critically needed to
address this common sports medicine problem.



-- 
Sincerely
--------------- --------------------------------------
Hiro    ( Yoshihiro Murakami  村上宣寛 )
facebook  http://www.facebook.com/completewalker
Blogs  http://completewalker.blogspot.jp/
Photo  https://picasaweb.google.com/104620544810418955412/
Backpacking since about 1980 in Japan
JMT, 2009, 2010, 2011(half).
------------------------------------------------------