REF-975 · Moen et al., 2012 · Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology, Vol. 4, article · Paper · PubMed

The treatment of medial tibial stress syndrome in athletes; a randomized clinical trial

B+moderate evidenceMeasured on a mixed groupWritten before October 2026, being re-checked

The only three earlier randomised trials on medial tibial stress syndrome (MTSS) were in military populations. This multi-centre trial asked whether three common treatments gave the same functional outcome in athletes in a non-military setting.

Athletes referred with MTSS were randomised to a graded running programme, the same programme plus stretching and strengthening exercises for the calves, or the same programme plus a sports compression stocking. Time to complete the running programme and general satisfaction with treatment did not differ significantly between the three groups.

Participants

n=74 athletes with MTSS (81 athletes were assessed for eligibility; 74 were included and randomised to three treatment groups). Referred by physical therapists and sports physicians. Sport, age and sex are not given in the abstract.

Protocol

Group one: graded running programme.
Group two: graded running programme plus stretching and strengthening exercises for the calves.
Group three: graded running programme plus a sports compression stocking.
Primary outcome: time to complete the running programme (able to run 18 minutes with high intensity). Secondary: general satisfaction with treatment. Intention-to-treat analysis.

Key Results

74 athletes randomised; 14 did not complete the study due to a lack of progress (18.9%).
Time to complete the running programme: not significantly different between the three groups.
General satisfaction with treatment: not significantly different between the three groups.

Practical Application

In 74 athletes with medial tibial stress syndrome randomised to a graded running programme alone, with added calf stretching and strengthening, or with a sports compression stocking, the time to complete the programme (able to run 18 minutes with high intensity) did not differ between the three groups, and 14 athletes (18.9%) did not complete the study for lack of progress. To "will calf exercises or compression socks get me back from shin splints faster?": not in this trial; the graded return to running was the common element in every group.
This is not proof that the graded programme works: every group followed it and no group was left untreated.
Nearly one in five did not progress. A runner whose shin pain does not ease under a graded return goes back to a clinician, not on to more additions.
Not from this paper; the base's own practice: the assistant does not name a diagnosis; localised bony tenderness or pain at rest or at night is a red flag for referral, and the return is gated by symptoms, not dates (SYNTH-73; REF-622).

Limitations

No untreated or wait-list control: the effect of the graded running programme itself is not tested.
The abstract reports no times to completion, group sizes or test statistics.
14 of 74 did not complete; the trial may be too small to detect a modest difference between additions.
The content of the running programme, the exercises and the stocking are not described in the abstract.
Written from the abstract and record metadata only (full text not read).
How this entry was checked and changed
Why this level

randomised, 74 athletes across three arms, intention-to-treat; no untreated control, 18.9% did not complete, and the abstract gives no times or statistics