Medial tibial stress syndrome, also known as load-induced medial leg pain (LIMP), is common in runners. This study evaluated the effectiveness of non-invasive, physical therapy-related interventions for LIMP. Searches were conducted in MEDLINE, Cochrane CENTRAL, SPORTDiscus, EMBASE, and Web of Science to June 2, 2025. Randomized trials including runners with LIMP comparing non-invasive interventions were eligible. Primary outcomes were pain and physical function; secondary outcomes included perceived improvement, quality of life, and lower-limb kinematics. Risk of bias was assessed using RoB 2, certainty of evidence with GRADE, and intervention reporting with TIDieR. A narrative synthesis was performed. Of 319 records, three trials (130 runners with LIMP) were included. Most were female (n = 80, 61.54%), with a mean age of 25.7 ± 4.4 years. Arch-support foot orthoses plus multimodal care reduced short-term pain versus sham, but effects were not sustained. Exercise additions were not superior to comparators. No consistent between-group differences were observed for function. Some interventions improved quality of life and biomechanics, without consistent clinical benefits. Evidence for non-invasive LIMP interventions in runners is limited and heterogeneous, with no clearly superior treatment. High-quality trials with standardized outcomes are needed. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD420251062879.

Objectives: The aim of this paper is to determine whether leg kinematics and the normal force generated during the stance phase of running differed between (i) long-distance runners with medial tibial stress syndrome (MTSS) or (ii) long-distance runners who were asymptomatic at baseline testing but developed MTSS compared to asymptomatic control participants. Methods: Lower-limb kinematics, normalised stance-phase forces and spatiotemporal outcome variables were compared between the limbs of MTSS symptomatic long-distance runners (n = 11) and matched asymptomatic controls (n = 11). Outcome variables were also compared between the limbs of long-distance runners who were asymptomatic at baseline but developed MTSS (n = 4) compared to asymptomatic control limbs. Results: In the case-control comparison, MTSS symptomatic participants demonstrated slower running speeds but no differences in stance-phase normal forces or kinematics compared to asymptomatic controls. In the case study, participants who developed MTSS during the study displayed substantially lower normal forces, less plantar flexion and a more vertical tibia than the asymptomatic controls. Conclusions: The slower running speeds observed among the MTSS symptomatic participants may be pain-related or reflect reduced plantar flexor propulsive capacity. The development of MTSS by Participants 1 and 2, despite lower normal forces and plantar flexion compared with asymptomatic controls, suggests that the tibial load tolerance may vary among individuals. Furthermore, the peak stance-phase force appears to have limited utility as a standalone screening tool for MTSS injury risk. Finally, further prospective research is required to investigate plantar flexor function, propulsive force capacity and the risk of MTSS development to substantiate these findings.

In sprint running, the starting block distance (SBD) directly influences an athlete's start performance, yet there is a lack of research exploring how block distance affects internal tibial load. Therefore, this study examined internal tibial loading in 28 elite sprinters using finite element analysis. Maximum principal stress, shear stress, total deformation, and bending moments were assessed under 3 front block distances (50%, 60%, and 70% of leg length). A 2-way analysis of variance evaluated the effects of gender, SBD, and their interaction. The results showed a significant main effect of gender on maximum principal stress (P < .001), tibial bending moment (P < .001), maximum shear stress (P < .001), and total deformation (P < .001). Furthermore, significant gender-by-SBD interactions for maximum principal stress (P = .001, ηp2=.16) and maximum shear stress (P = .02, ηp2=.05) indicated distinct mechanical responses between male and female athletes in response to SBD settings. This finding suggests that adopting block settings previously reported to optimize start performance (eg, front block distance [FB]/interblock spacing length [SL] 50/45) may inevitably increase internal tibial loading, potentially elevating the risk of cumulative injuries such as medial tibial stress syndrome.

A 28-year-old woman runner was referred for bilateral lower limb pain, associated with diffuse pelvic pain. 18 F-NaF PET/CT was performed. It revealed diffuse longitudinal uptake along the posteromedial cortical bone of both tibias, without abnormality on CT, highly suggestive of "shin splint" syndrome, also known as medial tibial stress syndrome (MTSS). The patient reported a significant reduction in pain following a decrease in training intensity. Our case suggests that 18 F-NaF PET/CT may be a relevant alternative to SPECT/CT in diagnosing "shin splint" syndrome, especially in times of molybdenum shortage.

Medial Tibial Stress Syndrome (MTSS) is an overuse pathological condition, characterized by pain and tenderness along the posteromedial border of the tibia. The duration and severity of symptoms, in some cases, may lead to marked functional impairment and undermine athletic performance.There is a lack of consensus across literature regarding several aspects of MTSS. The purpose of this narrative review is to synthesize current evidence and highlight key elements related to MTSS.Findings indicate that MTSS is a multifactorial condition involving periosteal traction, bone overload and impaired remodeling. Epidemiological data are heterogeneous, but MTSS remains prevalent among athletes and military personnel. Multiple intrinsic and extrinsic risk factors contribute to its onset. Diagnosis is primarily clinical, supported by imaging. Conservative management, consisting of rest, anti-inflammatory medications and physiotherapy, remains the cornerstone, while the evidence for surgical intervention is limited and methodologically weak.

Background/Objectives: Lower extremity injuries represent a major health concern in elite snowsport disciplines, where high mechanical loads, complex movement patterns, and demanding environmental conditions substantially increase injury risk. Understanding injury incidence and burden in this population is essential for developing sport- and sex-specific prevention strategies. This retrospective study determined lower extremity injury incidence and burden among elite snowsport athletes. Methods: Ninety-nine Turkish National Snowsport Teams Training Camp athletes (34 females; 65 males) consented to a review of their medical records for injury incidence. Overall, sex- and sport-specific injury incidence (number/10,000 h) and burden (weeks missing/10,000 h) were calculated. Results: Overall, medial tibial stress syndrome (MTSS) was the highest burden (9.5 ± 38.7), and ankle sprain (1.7 ± 0.4) was the highest-incident injury. However, injury incidence and burden patterns differed by sex and sport. Notably, medial tibial stress syndrome (MTSS) showed comparable incidence in female and male athletes but resulted in a substantial injury burden in both sexes, reflecting prolonged time-loss from training and competition and indicating a meaningful negative impact on athletic performance. Specifically, the highest-burden injury for women was anterior cruciate ligament (ACL) rupture (16.2 ± 64.5), and for men the most common injury was MTSS (9.7 ± 40.7). For cross-country skiers, MTSS had the highest burden and incidence. For all other sports, and across sexes, ankle sprain was the highest incidence injury-women (1.3 ± 3.0), men (2.0 ± 4.5), biathletes (2.3 ± 5.7), Alpine skiers (2.8 ± 4.5), ski jumpers (1.6 ± 3.1), and snowboarders (3.2 ± 4.7)-plus the highest-burden injury for biathletes (6.9 ± 14.3) and ski jumpers (6.0 ± 14.0). The highest burden injury for Alpine skiers was ACL damage (34.3 ± 87.2), and for snowboarders it was knee collateral ligament injury (27.8 ± 78.6). Moreover, patellar tendinitis, hamstring strains, calf strains, Achilles ruptures, anterior tibial pain, meniscus tears, and hip injuries were frequently observed in injury patterns. Conclusions: Ankle sprains were the most frequent lower extremity injury in elite snowsport athletes, whereas medial tibial stress syndrome (MTSS) and anterior cruciate ligament (ACL) injuries accounted for the greatest injury burden. Injury incidence and burden differed by sex and snowsport discipline.