Medial Tibial Stress Syndrome

CT may be more informative than X-ray for identifying stress fracture in some clinical cases. The rehabilitation framework for MTSS follows a progression of addressing knowledge and beliefs, restoring variability, building power, and then building capacity. A common presentation in MTSS involves increased hip internal rotation paired with an externally rotated tibia, creating excessive medial tibial stress. Stress fracture must be ruled out before beginning a rehabilitation program for medial tibial stress syndrome. Footwear modifications and arch supports are adjunct tools, not primary treatments, for achieving tibial rotation when movement alone is insufficient. Lunges are a useful exercise for MTSS because they allow the athlete to self-organize into the desired femoral-tibial rotational relationship. Three clinical tests can help identify possible stress fracture: tuning fork testing, ultrasound provocation, and a stethoscope tap test.