Conceptualisation of a region-based group of musculoskeletal pain conditions as 'tibial loading pain' and systematic review of effects of load-modifying interventions

Thorlene Egerton; David Donkin; Sia Kazantzis; Hannah Ware; Sonya Moore

doi:10.1016/j.jsams.2021.07.008

Conceptualisation of a region-based group of musculoskeletal pain conditions as 'tibial loading pain' and systematic review of effects of load-modifying interventions

J Sci Med Sport. 2022 Jan;25(1):46-52. doi: 10.1016/j.jsams.2021.07.008. Epub 2021 Jul 21.

Authors

Thorlene Egerton¹, David Donkin², Sia Kazantzis³, Hannah Ware⁴, Sonya Moore⁵

Affiliations

¹ Physiotherapy Department, The University of Melbourne, Australia; Centre for Health, Exercise & Sports Medicine, The University of Melbourne, Australia.
² Physiotherapy Department, The University of Melbourne, Australia; Department of Health Professions, Macquarie University, Australia.
³ Physiotherapy Department, The University of Melbourne, Australia.
⁴ Physiotherapy Department, The University of Melbourne, Australia; The Melbourne Sports Medicine Centre, Australia.
⁵ Physiotherapy Department, The University of Melbourne, Australia. Electronic address: sonya.moore@unimelb.edu.au.

PMID: 34366244
DOI: 10.1016/j.jsams.2021.07.008

Abstract

Objectives: Conceptualisation of a clinically-relevant group of conditions as a region-based, load-related musculoskeletal pain condition ('tibial loading pain') to enable identification of evidence of treatment effect from load-modifying interventions.

Design: Systematic review and evidence synthesis based on a developed and justified theoretical position.

Methods: Musculoskeletal pain localised to the tibial (shin) region and consistent with clinical presentations of an exercise/activity-related onset mechanism, was conceptualised as a group of conditions ('tibial loading pain') that could be reasoned to respond to load modifying interventions. Five databases were searched for randomized controlled studies investigating any load-modifying intervention for pain in the anterior-anteromedial lower leg (shin). Study quality was evaluated (Risk of Bias Tool Version 2) and level of certainty for the findings assessed.

Results: Six studies reporting seven comparisons were included. Interventions included braces, anti-pronation taping, compression stocking and a stretch + strengthening programme. All included studies were assessed as having unclear or high risk of bias. The review found no evidence of beneficial effect from any of the load-modifying interventions on symptoms, physical performance or biomechanical measures, apart from a possible benefit of anti-pronation 'kinesio' taping. There was very low certainty evidence that kinesio taping improves pain and pain-free hopping distance after one week. The braces were associated with minor adverse effects and problems with acceptability.

Conclusions: None of the treatments investigated by the included studies can be recommended. Conceptualisation of the problem as regional, primarily loading-related pain rather than as multiple distinct pathoanatomically-based conditions, and clearer load-modifying hypotheses for interventions are recommended.

Keywords: Athletic injuries; Medial tibial stress syndrome; Overuse injury; Shin pain; Sports injuries; Tibia.

Publication types

Review
Systematic Review

MeSH terms

Athletic Tape*
Braces
Concept Formation
Humans
Musculoskeletal Pain* / therapy