Load-induced medial leg pain in runners: a systematic review of non-invasive treatment approaches

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.