Medial tibial pain pressure threshold algometry in runners
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Pressure algometry (PA) may provide an objective and standardised tool in assessing palpation pain over the tibia. The purpose of this study was to analyse the intra-rater repeatability of PA and to determine whether tibial tenderness in healthy runners differ from runners with medial tibial stress syndrome (MTSS).
Pressure algometry was performed on 20 asymptomatic runners (40 legs) and 9 MTSS patients (14 symptomatic legs) at standardised locations along the medial border of the tibia. Intra-rater reliability was assessed in 10 randomly selected asymptomatic runners through repeated measurements 2 weeks later.
Intra-rater reliability was moderate to excellent (ICC 0.53–0.90) in asymptomatic runners. Pain pressure threshold (PPT) was significantly reduced at 2/9–5/9 of the distance from the medial malleolus to the medial tibial condyle (p = 0.002–0.022). There was evidence of a statistically significant association between both height and weight, and PPT from the 3/9 (r = 0.416, p = 0.008) to 7/9 (r = 0.334, p = 0.035) and 3/9 (r = 0.448, p = 0.004) to 6/9 (r = 0.337, p = 0.034) area, respectively. In both MTSS patients and healthy runners, there was evidence of lower PPT in females compared to males (p = 0.0001–0.049) and a negative association between age and PPT (p = 0.001–0.033). MTSS patients had significantly lower PPT at the 3/9 site (p = 0.048) compared to asymptomatic runners.
Pain pressure threshold algometry can be incorporated into MTSS clinical assessment to objectively assess pain and monitor progress. The presence of reduced medial tibial PPT in asymptomatic runners suggests that clinicians may not need to await resolution of medial tibia tenderness before allowing return to sport in MTSS patients.
Level of evidence
KeywordsMedial tibial stress syndrome MTSS Pressure algometry PA Pain pressure threshold PPT Algometry Prolotherapy
With thanks to the patients, the administrative and clinical team at the London Independent Hospital, and the Barts and the London Running Club.
Conflict of interest
The authors confirm that there is no conflict of interest.
This Study was approved by The Queen Mary Research Ethics Committee on the 24 June 2011 (QMREC2009/22) and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study.
- 9.Curtin MCT, Malliaras P, Padhiar N (2011) The effectiveness of prolotherapy in the management of recalcitrant medial tibial stress syndrome: a pilot study. Br J Sports Med 45(15):A16Google Scholar
- 15.Fredberg U, Bolvig L, Pfeiffer-Jensen M, Clemmensen D, Jakobsen BW, Stengaard-Pedersen K (2004) Ultrasonography as a tool for diagnosis, guidance of local steroid injection and, together with pressure algometry, monitoring of the treatment of athletes with chronic jumper’s knee and Achilles tendinitis: a randomized, double-blind, placebo-controlled study. Scand J Rheumatol 33(2):94–101PubMedCrossRefGoogle Scholar
- 16.Gaeta M, Minutoli F, Scribano E, Ascenti G, Vinci S, Bruschetta D, Magaudda L, Blandino A (2005) CT and MR imaging findings in athletes with early tibial stress injuries: comparison with bone scintigraphy findings and emphasis on cortical abnormalities. Radiology 235(2):553–561PubMedCrossRefGoogle Scholar
- 29.Rolke R, Baron R, Maier C, Tolle TR, Treede RD, Beyer A, Binder A, Birbaumer N, Birklein F, Botefur IC, Braune S, Flor H, Huge V, Klug R, Landwehrmeyer GB, Magerl W, Maihofner C, Rolko C, Schaub C, Scherens A, Sprenger T, Valet M, Wasserka B (2006) Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): standardized protocol and reference values. Pain 123(3):231–243PubMedCrossRefGoogle Scholar