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Low-Energy Extracorporeal Shock Wave Therapy as a Treatment for Medial Tibial Stress Syndrome

Jan D. Rompe, MD; Angelo Cacchio, MD; John P. Furia, MD and Nicola Maffulli, MD, MS, PhD

DOI: 10.1177/0363546509343804 Am J Sports Med 2010 38: 125 originally published online September 23, 2009

United Kingdom

85% of patients return to active sports faster

study-7

Medial tibial stress syndrome (MTSS) is a pain syndrome along the tibial origin of the tibialis posterior or soleus muscle. Extracorporeal shock wave therapy (SWT) is effective in numerous types of insertional pain syndromes. 

Hypothesis: 

Shock wave therapy is an effective treatment for chronic MTSS. 
Design: Cohort study; Level of evidence, 3.

Methods:

Forty-seven consecutive subjects with chronic recalcitrant MTSS underwent a standardized home training program, and received repetitive low-energy radial SWT (2000 shocks; 2.5 bars of pressure, which is equal to 0.1 mJ/mm2 ; total energy flux density, 200 mJ/mm2 ; no local anesthesia) (treatment group). Forty-seven subjects with chronic recalcitrant MTSS were not treated with SWT, but underwent a standardized home training program only (control group). Evaluation was by change in numeric rating scale. Degree of recovery was measured on a 6-point Likert scale (subjects with a rating of completely recovered or much improved were rated as treatment success).

Results:

One month, 4 months, and 15 months from baseline, success rates for the control and treatment groups according to the Likert scale were 13% and 30% (P < .001), 30% and 64% (P < .001), and 37% and 76% (P < .001), respectively. One month, 4 months, and 15 months from baseline, the mean numeric rating scale for the control and treatment groups were 7.3 and 5.8 (P < .001), 6.9 and 3.8 (P < .001), and 5.3 and 2.7 (P < .001), respectively. At 15 months from baseline, 40 of the 47 subjects in the treatment group had been able to return to their preferred sport at their preinjury level, as had 22 of the 47 control subjects.

Conclusion:

Radial SWT as applied was an effective treatment for MTSS

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