title: Medial tibial pain pressure threshold algometry in runners.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, London, UK.
authors.forename: Osama
authors.initials: O
authors.lastname: Aweid
authors.forename: Rosa
authors.initials: R
authors.lastname: Gallie
authors.forename: Dylan
authors.initials: D
authors.lastname: Morrissey
authors.forename: Tom
authors.initials: T
authors.lastname: Crisp
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
authors.forename: Peter
authors.initials: P
authors.lastname: Malliaras
authors.forename: Nat
authors.initials: N
authors.lastname: Padhiar
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D058923:Medial Tibial Stress Syndrome / Q000503:physiopathology*; D008875:Middle Aged; D015588:Observer Variation; D010147:Pain Measurement; D017288:Pain Threshold; D010173:Palpation; D011312:Pressure; D015203:Reproducibility of Results; D012420:Running / Q000293:injuries*; D011795:Surveys and Questionnaires