Load-induced medial leg pain in runners: A systematic review of non-invasive treatment approaches
- Journal
- Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine (Q1)
- Published
- 15 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Ana Izabel Teles, João Pedro da Silva Carto, Koulla Parpa, Mabliny Thuany, Gabriela Souza de Vasconcelos
- PMID
- 42462658
- DOI
- 10.1016/j.ptsp.2026.101962
Why clinicians should know about it
- Picked for Orthopedics and Sports Medicine (top studies of the week, 19 July 2026).
Abstract
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.