The Diagnosis and Management of Medial Tibial Stress Syndrome – An Evidence Update

Review written by Shruti Nambiar info

Key Points

  1. Medial tibial stress syndrome (MTSS) is an exertional pain syndrome with an unclear pathophysiology. Two theories that might explain the cause of pain in this condition are fasciopathy and bone stress reaction to the bone overload.
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Medial tibial stress syndrome (MTSS) is defined as “exercise-induced pain along the postero-medial tibial border, and recognisable pain is provoked on palpation of the postero-medial border over a length of ≥ 5 consecutive centimeters” (1). MTSS is commonly seen among runners. There is a lack of strong evidence to support theories of pathophysiology and subsequent treatment strategies that should be adopted for athletes suffering from MTSS. Therefore, this literature review aimed to provide an update on the clinical diagnosis and management strategies for athletes with MTSS.

Chronic exertional compartment syndrome can be a co-existing pathology with MTSS.
These updated guidelines rightly emphasize the need to focus on patient education given the long duration of expected recovery, and to manage patient/athlete expectations as rehab progresses.


This literature review is based on information extracted from a wide range of research studies. The review included data from over 30 references.

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