Medial Tibial Stress Syndrome Prevention

Efficacy of a Lower Leg Strengthening Program in the Prevention of MTSS in Collegiate XC Runners

This randomized controlled trial investigated whether a 10-week heavy resistance training program reduced the incidence of medial tibial stress syndrome (MTSS) in collegiate indoor track and field athletes. Twenty-six athletes from Rowan University were randomly assigned to a treatment group (resistance training plus regular training) or a control group (regular training only). Muscle mechanical properties-including tone, stiffness, elasticity, stress relaxation time, and creep-were measured by MyotonPro device (non-invasive) at baseline, post-intervention, and at the end of the season. A 10-week observational follow-up during the indoor season included weekly MTSS symptom surveys. Differences in MTSS incidence and muscle properties were analyzed between groups.

Study Overview

• Status: Completed
• Conditions: Medial Tibial Stress Syndrome
• Intervention / Treatment: Other: Resistance Training

• Study Type: Interventional
• Enrollment (Actual): 26
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • New Jersey
    • Glassboro, New Jersey, United States, 08028
      • Rowan University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Collegiate athletes on the Indoor Track and Field team.
• Athletes must participate in at least one of the following:
• 60m-800m events (including hurdles)
• jumping events (including pole vault)

Exclusion Criteria:

• Subjects who have a history of musculoskeletal or neurologic conditions
• Who take medications that affect muscle tone
• Who have a body mass index >30.0 kg/m2 were excluded to screen to prevent adipose tissue from skewing the measurements.
• Any subject with any fractures, sprains, or strains of the lower extremities were excluded.
• Any subject with active MTSS, stress fracture, or other lower leg pathology symptoms at the time the initial survey was administered were excluded.
• Any athlete who does not participate in the 60m-800m events (including hurdles), or who does not participate in jumping events (including pole vault) were excluded.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Resistance Training Intervention; Participants who received the heavy resistance training intervention in addition to their regular training.	Other: Resistance Training; Participants performed a 10-week resistance training program, completing exercises twice daily for Weeks 1-2 and three times daily for Weeks 3-10, with 5 sessions per week for Weeks 1-7 and 6 sessions per week for Weeks 8-10. The program included exercises such as standing broad jumps, resisted ankle abduction, single-leg eccentric plantar flexion, and ankle rockers. Participants' muscle properties were assessed at the start and end of the intervention, with adherence monitored via remote video confirmation.
No Intervention: Regular Training; Participants who continued their regular training without the additional intervention.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Subjective Medial Tibial Stress Syndrome Symptoms	Medial Tibial Stress Syndrome (MTSS) Score Survey	Through the running season -- approximately 11 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Myotonometry Oscillation frequency	Represents the intrinsic tension of the muscle in its passive state, essentially the muscle's "tone".	From enrollment through the end of data collection -- approximately 25 weeks
Myotonometry dynamic stiffness	Measures the resistance of the tissue to deformation when subjected to an external force.	From enrollment through the end of data collection -- approximately 25 weeks
Myotonometry logarithmic decrement	Indicates the elasticity of the muscle	From enrollment through the end of data collection -- approximately 25 weeks
Myotonometry mechanical stress relaxation time	Measures the time it takes for the muscle to return to its original shape after being deformed.	From enrollment through the end of data collection -- approximately 25 weeks
Myotonometry creep	Describes the gradual elongation of the muscle under constant tensile stress over time.	From enrollment through the end of data collection -- approximately 25 weeks

Collaborators and Investigators

• Sponsor: Rowan University
• Investigators: Principal Investigator: Jennifer A Longo, PhD, Rowan University

Study record dates

Study Major Dates

• Study Start (Actual): September 14, 2023
• Primary Completion (Actual): February 14, 2024
• Study Completion (Actual): February 14, 2024

Study Registration Dates

• First Submitted: May 11, 2025
• First Submitted That Met QC Criteria: November 25, 2025
• First Posted (Actual): December 1, 2025

Study Record Updates

• Last Update Posted (Actual): December 1, 2025
• Last Update Submitted That Met QC Criteria: November 25, 2025
• Last Verified: May 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Nervous System Diseases; Muscular Diseases; Wounds and Injuries; Neuromuscular Diseases; Leg Injuries; Medial Tibial Stress Syndrome; Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Therapeutics; Physical Therapy Modalities; Patient Care; Exercise Therapy; Rehabilitation; Aftercare; Continuity of Patient Care; Physical Conditioning, Human; Exercise; Resistance Training
• Other Study ID Numbers: Pro-2023-75

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No