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. 2025 Feb 6;13(2):23259671241311849.
doi: 10.1177/23259671241311849. eCollection 2025 Feb.

Effects of Integrating Lower-Leg Exercises Into a Multimodal Therapeutic Approach on Medial Tibial Stress Syndrome Management Among Recreational Runners: A Randomized Controlled Study

Aynollah Naderi  1 , Mohammad Fallah Mohammadi  2 , Aida Heidaralizadeh  2 , Maarten H Moen  3   4   5
Affiliations

Effects of Integrating Lower-Leg Exercises Into a Multimodal Therapeutic Approach on Medial Tibial Stress Syndrome Management Among Recreational Runners: A Randomized Controlled Study

Aynollah Naderi et al. Orthop J Sports Med. .

Abstract

Background: Medial tibial stress syndrome (MTSS) can impair training and daily activities, underscoring the need for effective treatment. However, there's limited evidence on using lower-leg exercises for MTSS in recreational runners.

Purpose/hypothesis: The purpose of the present study was to determine whether adding lower-leg exercises to a multimodal therapeutic intervention improves the recovery from MTSS in recreational runners. It was hypothesized that adding lower-leg exercises to a multimodal therapeutic intervention would enhance its effect on foot posture and make MTSS recovery more effective than multimodal therapeutic interventions alone.

Study design: Randomized controlled trial; Level of evidence, 1.

Methods: A total of 40 recreational runners diagnosed with MTSS using history and physical examination (40% women; mean ± SD age, 23.9 ± 3.9 years) were then randomly divided into intervention (n = 20) and control (n = 20) groups. Both groups underwent a multimodal therapeutic intervention involving ice massage, foot orthoses, and extracorporeal shockwave therapy. The intervention group additionally received a tailored lower-leg exercise protocol involving stretching, strengthening, sensorimotor exercises, and foam roller myofascial release. Pain intensity, MTSS severity, perceived treatment effect, quality of life (QoL), and static and dynamic foot posture were assessed at baseline, 6-week, and 12-week follow-up evaluations.

Results: A mixed model analysis of variance found no significant differences in pain intensity (P = .17) or MTSS severity (P = .30) between the intervention group and the control group. However, there were significant improvements in QoL (P = .003), static foot posture index (FPI) (P = .02), and dynamic arch index (DAI) (P < .001), for the intervention group. After 6 and 12 weeks, the intervention group displayed lower DAI scores than controls (P = .04 and P = .02, respectively). By week 12, the intervention group exhibited significantly higher QoL scores (P = .02) and lower FPI scores (P = .04) compared with controls.

Conclusion: The study demonstrated that lower-leg exercises within a multimodal treatment positively affected foot posture and QoL, although they did not significantly alleviate pain or affect MTSS severity in recreational runners. Therefore, health care providers are encouraged to integrate these exercises into rehabilitation programs to improve foot posture and QoL for individuals with MTSS. However, future research should focus on larger sample sizes, objective measures, resting control groups, and longer follow-up periods to enhance the understanding of the effects of lower-leg exercises on MTSS management.

Registration: IRCT 20170114031942N5 (Iranian Registry of Clinical Trials).

Keywords: injury prevention; lower-leg pain; medial tibial stress syndrome; medical aspects of sports; physical therapy/rehabilitation; running.

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Conflict of interest statement

The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval for this study was obtained from Shahroud University of Medical Sciences (IR.SHMU.REC.1396.168).

Figures

Figure 1.
Figure 1.
CONSORT (Consolidated Standards of Reporting Trials) flow diagram of participants’ enrollment, randomization, follow-up, and analysis.
Figure 2.
Figure 2.
Standardized effect size related to between-group comparisons for each dependent variable (A) at week 6 and (B) at week 12. DAI, dynamic arch index; FPI, foot posture index; MTSS, medial tibial stress syndrome; PI, pain intensity; QoL, quality of life.
Figure 3.
Figure 3.
Perceived treatment effect by participants of each group at the 6th and 12th weeks.
See this image and copyright information in PMC

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