TIBIAL STRESS INJURIES - AN ETIOLOGIC REVIEW FOR THE PURPOSES OF GUIDING MANAGEMENT

In the last 30 years, few advances have been made in the management of tibial stress injuries such as tibial stress fracture and medial tibi al stress syndrome (MTSS). Tibial overuse injuries are a recognised co mplication of the chronic, intensive, weight-bearing training commonly practised by athletic and military populations. Generally, the most e ffective treatment is considered to be rest, often for prolonged perio ds. This is a course of action that will significantly disrupt an acti ve lifestyle, and sometimes end activity-related careers entirely. The re is now considerable knowledge of the nature of tibial stress injuri es, such that presently accepted management practices can be criticall y evaluated and supplemented. Most recent investigations suggest that tibial stress injuries are a consequence of the repetitive tibial stra in imposed by loading during chronic weight-bearing activity. Evidence is presented in this article for an association between repeated tibi al bending and stress injury as a function of: (i) strain-related mode lling (in the case of MTSS), and (ii) a strain-related positive feedba ck mechanism of remodelling (in the case of stress fracture). Factors that influence the bending response of the tibia to loading are review ed. Finally, a guide for injury prevention and management based on res earch observations is presented.