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Definition + Etiology
- Medial Tibial Periostitis (MTSS, MTTP): Overuse, overtraining, hard surface, poor shoe choice, bad warmup, bad biomechanics, Pes planus, tight posterior leg MMs (Soleus eccentrically resists pronation, overpronation = traction on attachments)
- CECS: Changes in mechanical properties of fascia
- Age: + children, - seniors
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CIs + Precautions
MTP (MTSS, MTTP): ?????????????????????
CECS: Acute = medical emergeancy
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S&S
MTP (MTSS, MTTP): Tenderness 5cm diffuse area at post-med margin of middle-distal 1/3rd of tibia. Pain on RRoM plantarflexion, passive soleus stretch or unilateral hopping. Pain decreases with warmup, returns after activity. Localized swelling possible. + women.
- CECS: Achy and tight in compartment
- No pain at rest. Pain gruadually builds during activity (10-15 mins), decreases at rest
- Swelling can comprimize blood supply, cause NN or MM damage
- MM weaknesss and parestesia possible
- MM herniation?
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H
- Nature/behavior of pain
- Change in exercise, shoe, repetitive ADLs.
- Health, diet
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O
- Local swelling, erythema, biomechanics of foot (pes planus, rigid cavus etc), lower leg, knee,
- Gait
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P
- Diffuse tenderness over 5cm area
- SH
- Pain in vertical orientation
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M
Soleus PRoM and RRoM pain
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Tx Goals
- Decr inflammation
- Adress underlying cause
- Rest from activity/modification
- pt Edu - retrain posture/gait
- Decr scar tissue formation, adhesions
- Balance MM/retrain proprioception
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Tx
- MFR, Soleus/FDL TrP/MFR + passive ankle movements
- Swedish
- jt mobes
- MLD, fine vibes, light strokes for inflammation
- Frictions in sub-acute
- Stimulate hypotonic MM
- Contract/Relax, PRoM
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Hydro
- Cool/cold for swelling
- DMH prior to Tx for chronic
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RemEx
- Proper warm, gruadual return to activity (start slow, go slow)
- Pain-free cross-training, MM balancing
- Gait re-education
- Change training surface
- Footwear change (every 300 miles)
- Pediatrist
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