Effects of Extracorporeal Shockwave Therapy on Pain in Individuals with Medial Tibial Stress Syndrome
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Abstract
Background: Medial Tibial Stress Syndrome (MTSS) is a common overuse injury characterized by pain along the posteromedial border of the tibia. Extracorporeal Shockwave Therapy (ESWT) has been proposed as an effective non-invasive intervention for reducing pain and improving recovery. Objective: To evaluate the effectiveness of ESWT on pain in individuals with MTSS. Methods: A randomized controlled pre–post study was conducted on 30 participants, with 15 participants each in the experimental and control groups. The experimental group received ESWT along with conventional physiotherapy, whereas the control group received conventional management. Outcomes were assessed using the Numeric Pain Rating Scale (NPRS), Lower Extremity Functional Scale (LEFS), and MTSS score. Statistical significance was considered at p<0.05. Results: The experimental group demonstrated significant improvement in NPRS, LEFS, and MTSS scores following intervention (p<0.001). Post-treatment comparison between the experimental and control groups also showed significant differences in favour of the experimental group (p<0.0001). Conclusion: ESWT combined with conventional physiotherapy was effective in reducing pain and improving functional outcomes in individuals with MTSS and may be considered a useful adjunct in rehabilitation.
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References
Pillai PK, Thyagarajan M, Elayaperumal S. Risk Factors Associated With Medial Tibial Stress Syndrome In Runners: A Meta-Analysis. Journal of Neonatal Surgery. 2025. doi:10.52783/jns.v14.2824.
Leal LEAM, Tormem F. INCIDÊNCIA DA SÍNDROME DE ESTRESSE TIBIAL-MEDIAL EM ATLETAS AMADORES. Revista FT. 2025. doi:10.69849/revistaft/dt10202510072016.
Lee I, Jeon H, Ha S, Jeong H, Lee SY. How Medial Tibial Stress Syndrome Is Affected by Alignment, Range of Motion, Strength, and Gait Biomechanics: A Systematic Review and Meta-Analysis. Journal of Sport Rehabilitation. 2024. doi:10.1123/jsr.2024-0031.
Alessa M, et al. Highlights of Medial Tibial Stress Syndrome in Military Recruits: A Narrative Review. Cureus. 2024. doi:10.7759/cureus.75376.
Saad MA, Jamal J, Aldhafiri AT, Alkandari S. Medial Tibial Stress Syndrome: A Scoping Review of Epidemiology, Biomechanics, and Risk Factors. Cureus. 2025. doi:10.7759/cureus.81463.
Reinking MF, Austin T, Richter RR, Krieger M. Medial Tibial Stress Syndrome in Active Individuals: A Systematic Review and Meta-analysis of Risk Factors. Sports Health. 2016. doi:10.1177/1941738116673299.
Mattock J, Steele J, Mickle K. Lower leg muscle structure and function are altered in long-distance runners with medial tibial stress syndrome: a case control study. Journal of Foot and Ankle Research. 2021. doi:10.1186/s13047-021-00485-5.
Jasty N, Dyrek P, Kaur J, Ackerman KE, Kraus E, Heyworth BE. Evidence-Based Treatment and Outcomes of Tibial Bone Stress Injuries. Journal of the Pediatric Orthopaedic Society of North America. 2021. doi:10.55275/jposna-2021-372.
Ciszewski P, Drelichowska A, Azierski M. Shin Splints - a hidden epidemic among runners and athletes: a review of the current state of knowledge. Medical Science. 2025. doi:10.54905/disssi.v29i160.e79ms3571.
Galbraith R, Lavallee ME. Medial tibial stress syndrome: conservative treatment options. Current Reviews in Musculoskeletal Medicine. 2009. doi:10.1007/s12178-009-9055-6.
Crous Z. A systematic review of the conservative treatment options and their effectiveness in the treatment of medial tibial stress syndrome (MTSS). doi:10.51415/10321/4029.
Tenforde AS, et al. Best practices for extracorporeal shockwave therapy in musculoskeletal medicine: Clinical application and training consideration. PM&R. 2022. doi:10.1002/pmrj.12790.
Fiani B, Davati C, Griepp DW, Lee J, Pennington E, Moawad CM. Enhanced Spinal Therapy: Extracorporeal Shock Wave Therapy for the Spine. Cureus. 2020. doi:10.7759/cureus.11200.
Rau O, Cheng J, Jivanelli B, Tenforde A, Wyss J. Extracorporeal Shockwave Therapy for Tendinopathies Around the Hip and Pelvis: A Systematic Review. HSS Journal. 2025. doi:10.1177/15563316251332189.
Kuprinenko O, Tymruk-Skoropad K. Rehabilitation and Prevention of the Medial Tibial Stress Syndrome in Military Personnel. Art of Medicine. 2023. doi:10.21802/artm.2023.2.26.224.
Deshmukh NS, Phansopkar P. Medial Tibial Stress Syndrome: A Review Article. Cureus. 2022. doi:10.7759/cureus.26641.
Becker J, Wu W. Factors Contributing to Medial Tibial Stress Syndrome in Runners: A Prospective Study. Medicine & Science in Sports & Exercise. 2018. doi:10.1249/MSS.0000000000001674.
Naderi A, Bagheri S, Ahoor FR, Moen M, Degens H. Foot Orthoses Enhance the Effectiveness of Exercise, Shockwave, and Ice Therapy in the Management of Medial Tibial Stress Syndrome. Clinical Journal of Sports Medicine. 2021. doi:10.1097/JSM.0000000000000926.
Naderi A, Mohammadi MF, Heidaralizadeh A, Moen M. Effects of Integrating Lower-Leg Exercises Into a Multimodal Therapeutic Approach on Medial Tibial Stress Syndrome Management Among Recreational Runners: A Randomized Controlled Study. Orthopaedic Journal of Sports Medicine. 2025. doi:10.1177/23259671241311849.
Xue X, et al. Effect of extracorporeal shockwave therapy for rotator cuff tendinopathy: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2024. doi:10.1186/s12891-024-07445-7.
Feeney KM. The Effectiveness of Extracorporeal Shockwave Therapy for Midportion Achilles Tendinopathy: A Systematic Review. Cureus. 2022. doi:10.7759/cureus.26960.
Burton I. Combined extracorporeal shockwave therapy and exercise for the treatment of tendinopathy: A narrative review. Sports Medicine and Health Science. 2021. doi:10.1016/j.smhs.2021.11.002.
Bielewicz J, Daniluk B, Kamieniak P. VAS and NRS, Same or Different? Are Visual Analog Scale Values and Numerical Rating Scale Equally Viable Tools for Assessing Patients after Microdiscectomy? Pain Research and Management. 2022. doi:10.1155/2022/5337483.