***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Overwhelming evidence shows the quality of reporting of r and omised controlled trials ( RCTs ) is not optimal . Without transparent reporting , readers can not judge the reliability and validity of trial findings nor extract information for systematic review s. Recent method ological analyses indicate that inadequate reporting and design are associated with biased estimates of treatment effects . Such systematic error is seriously damaging to RCTs , which are considered the gold st and ard for evaluating interventions because of their ability to minimise or avoid bias . A group of scientists and editors developed the CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to improve the quality of reporting of RCTs . It was first published in 1996 and up date d in 2001 . The statement consists of a checklist and flow diagram that authors can use for reporting an RCT . Many leading medical journals and major international editorial groups have endorsed the CONSORT statement . The statement facilitates critical appraisal and interpretation of RCTs . During the 2001 CONSORT revision , it became clear that explanation and elaboration of the principles underlying the CONSORT statement would help investigators and others to write or appraise trial reports . A CONSORT explanation and elaboration article was published in 2001 alongside the 2001 version of the CONSORT statement . After an expert meeting in January 2007 , the CONSORT statement has been further revised and is published as the CONSORT 2010 Statement . This up date improves the wording and clarity of the previous checklist and incorporates recommendations related to topics that have only recently received recognition , such as selective outcome reporting bias . This explanatory and elaboration document-intended to enhance the use , underst and ing , and dissemination of the CONSORT statement-has also been extensively revised . It presents the meaning and rationale for each new and up date d checklist item providing examples of good reporting and , where possible , references to relevant empirical studies . Several examples of flow diagrams are included . The CONSORT 2010 Statement , this revised explanatory and elaboration document , and the associated website ( www.consort-statement.org ) should be helpful re sources to improve reporting of r and omised trials Background The only three r and omized trials on the treatment of MTSS were all performed in military population s. The treatment options investigated in this study were not previously examined in athletes . This study investigated if functional outcome of three common treatment options for medial tibial stress syndrome ( MTSS ) in athletes in a non-military setting was the same . Methods The study design was r and omized and multi-centered . Physical therapists and sports physicians referred athletes with MTSS to the hospital for inclusion . 81 athletes were assessed for eligibility of which 74 athletes were included and r and omized to three treatment groups . Group one performed a grade d running program , group two performed a grade d running program with additional stretching and strengthening exercises for the calves , while group three performed a grade d running program with an additional sports compression stocking . The primary outcome measure was : time to complete a running program ( able to run 18 minutes with high intensity ) and secondary outcome was : general satisfaction with treatment . Results 74 Athletes were r and omized and included of which 14 did not complete the study due a lack of progress ( 18.9 % ) . The data was analyzed on an intention-to-treat basis . Time to complete a running program and general satisfaction with the treatment were not significantly different between the three treatment groups . Conclusion This was the first r and omized trial on the treatment of MTSS in athletes in a non-military setting . No differences were found between the groups for the time to complete a running program . Trial registration CCMO ; The effect of low-energy laser therapy on shin splints was examined in a r and omized study with an unblinded design . Constripts from the Jutl and Dragoon regiment with shin splints were given either active laser treatment ( 40 mW in 60 sec per cm tender tibia edge ) or placebo laser .  All patients were exempted from normal duty concerning activities like running and march . Forty-nine patients participated in the study , 23 in the laser group and 26 in the control group . From the start the study was design ed to be double-blind , but by accident the code was broken towards the end of the study . We found no significant differences between the groups regarding pain visual analog score and readiness to return to active duty after 14 days Objective The purpose of this study was to describe the results of two treatment regimens for medial tibial stress syndrome ( MTSS ) ; a grade d running programme and the same running programme with additional shockwave therapy ( extracorporeal shockwave therapy ; ESWT ) . Design A prospect i ve observational controlled trial . Setting Two different sports medicine departments . Participants 42 athletes with MTSS were included . Intervention Patients from one hospital were treated with a grade d running programme , while patients from the other hospital were treated with the same grade d running programme and focused ESWT ( five sessions in 9 weeks ) . Main Outcome Measures Time to full recovery ( the endpoint was being able to run 18 min consecutively without pain at a fixed intensity ) . Results The time to full recovery was significantly faster in the ESWT group compared with the patients who only performed a grade d running programme , respectively 59.7±25.8 and 91.6±43.0 days ( p=0.008 ) . Conclusions This prospect i ve observational study showed that MTSS patients may benefit from ESWT in addition to a grade d running programme . ESWT as an additional treatment warrants further investigation in a prospect i ve controlled trial with the addition of r and omisation and double blinding Objective To study the additional effect of a pneumatic leg brace with st and ard rehabilitation for the treatment of  medial tibial stress syndrome ( MTSS ) in recruits . Methods In a single blinded r and omized study , 15 recruits ( age 17 - 22 ) followed a rehabilitation programme consisting of leg exercises and a grade d running programme . Recruits performed daily exercises and ran three times a week . The running programme consisted of 6 consecutive phases . One group was , after r and omization , additionally provided with a pneumatic leg brace . Follow-up was provided every other week . Days to completing the running programme  was the primary outcome measure , the Sports Activity Rating Scale ( SARS ) score and satisfaction with the treatment were secondary outcome measures . Results In total 14 recruits completed the rehabilitation programme . No differences were found in the number of days until phase six of the running schedule was finished between the brace and the control group ( Brace 58.8 ± 27.7 ( mean ± SD ) vs Non-Brace 57.9 ± 26.2 ( mean ± SD , p = 0.57 ) . Also no differences were found in the SARS scores between the groups . Overall satisfaction with the treatment was 6.4 ± 1.1 ( mean ± SD ) on a 1 - 10 scale for the brace group and 7.1 ± 0.7 ( mean ± SD ) for the control group ( p = 0.06 ) . Comfort of the brace was assessed as 4.8 ± 1.3 ( mean ± SD ) on a 1 - 10 scale . Conclusions No additional large effect of the pneumatic leg brace could be found in recruits and wearing of the brace was not feasible , since the wearing comfort was low OBJECTIVE The purpose of this study was twofold : to determine whether asymptomatic distance runners exhibit cortical tibial abnormalities on CT and to determine the diagnostic accuracy of CT in athletes with medial tibial stress syndrome . MATERIAL S AND METHODS A cross-sectional study with high-resolution CT of both tibiae was performed on 41 subjects : 20 asymptomatic distance runners , 11 distance runners with unilateral or bilateral pain due to medial tibial stress syndrome ( 14 painful tibiae ) , and 10 volunteers not involved in a sport . The group was composed of 13 women and 28 men , ranging in age from 18 to 26 years . A total of 82 tibiae , 14 painful and 68 painless , were evaluated . On the basis of CT findings , tibiae were classified in three groups , and correlation between CT classification and symptoms was made . RESULTS Among distance runners , the presence of CT abnormalities was found in 14 ( 100 % ) of 14 painful tibiae in patients with medial tibial stress syndrome and in 8 ( 16.6 % ) of 48 painless tibiae . The difference was statistically significant ( p < 0.001 , Fisher 's exact test ) . Sensitivity , specificity , positive predictive value , negative predictive value , and accuracy of CT in diagnosing medial tibial stress syndrome were 100 % , 88.2 % , 63.6 % , 100 % , and 90.2 % , respectively . CONCLUSION High-resolution CT has high diagnostic accuracy in depicting medial tibial stress syndrome . Cortical abnormalities can also be seen in some asymptomatic distance runners Purpose To identify the incidence of medial tibial stress syndrome ( MTSS ) in a group of naval recruits undergoing a 10-week basic training period and to determine potential risk factors . Method One hundred and twenty-four recruits ( 84 men and 40 women ) were followed prospect ively during basic training .  Anthropometric and lower limb biomechanical data were recorded at the start of the program along with injury history and previous sporting activity for the 3 months prior to enlisting . Recruits were monitored during training for development of medial tibial strees syndrome and were asked to complete an exit interview at the end of the program . Results Forty recruits ( 22 men and 18 women ) developed medial tibial stress syndrome , giving an incidence of 35 % . A significant relationship existed between gender and medial tibial stress syndrome ( P= .012 ) , with female recruits more likely to develop medial tibial stress syndrome than male recruits ( 53 % vs 28 % ) . A risk estimate revealed a relative risk of 2.03 . The biomechanical results indicated a more pronated foot type ( P= .002 ) in the medial tibial stress syndrome group when compared to the control group . A risk estimate established that recruits with a more pronated foot type had a relative risk of 1.70 . Conclusion Identifying a pronated foot type prior to training may help reduce the incidence of medial tibial stress syndrome by early intervention to control abnormal pronation . Findings of a higher incidence of medial tibial stress syndrome  among female recruits require further investigation Diagnosis and management strategies for shin splints in active duty military population s closely resemble those in civilian athletic population s. There is a paucity of evidence supporting the use of many of these interventions . The purpose of this study was to present data on the Shin Saver orthosis as a treatment for  shin splints in an active duty military population and to review current condition management . Twenty-five subjects diagnosed with shin splints by a U.S. Army physical therapist were r and omly assigned to a shin orthosis treatment group or a control group . There was no significant difference between treatment and control groups in days to finish a 0.5-mile run pain free . Visual analog scales for pain at intake versus after 1 week of relative rest revealed no significant improvement in symptoms in either group . Current best- practice guidelines support a treatment program of rest , cryotherapy , and a graduated walk-to-run program Background Although the exact cause of medial tibial stress syndrome is unclear , changes in bone metabolism are likely to be involved . Hypothesis Localized low bone mineral density at the junction of the middle and distal thirds of the tibia in patients with medial tibial stress syndrome develops in conjunction with the symptoms ; these changes are reversible and are not inherited . Study Design Prospect i ve cohort study . Methods  Bone mineral density in 14 adult male athletes with long-st and ing medial tibial stress syndrome was measured when they were symptomatic and after recovery ( mean follow-up , 5.7 years ) . Repeat measurements were also made prospect ively in 13 nonathlete control subjects and single measurements were made in 18 healthy athletes .  Results Bone mineral density was 9 % ± 11 % higher in the proximal tibia but 11 % ± 12 % lower in the tibial region corresponding to pain in patients when compared with nonathlete control subjects . It increased by 19 % ± 11 % in the region of pain after recovery from symptoms and , at follow-up , was no lower than in nonathlete control subjects . Conclusion Athletes with medial tibial stress syndrome and increased scintigraphic uptake regain normal tibial bone mineral density after recovery from symptoms . Initially localized low bone mineral density is not an inherited condition , but instead may develop in conjunction with the symptoms 
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Conclusion None of the studies are sufficiently free from method ological bias to recommend any of the treatments investigated .
Of those examined , ESWT appears to have the most promise