Psychologically informed patient education combined with exercise intervention is associated with improvements in tibial loading regulation, joint kinematics, and kinesiophobia in runners with medial tibial stress syndrome: a randomized controlled trial

Zhang Zh, M Koorosh Li, Ting Fan, Y W Sun

Objective This study aimed to examine the effects and potential mechanisms of an exercise intervention (EI) combined with psychologically informed patient education (PE) on tibial loading and associated risk factors in runners with Medial Tibial Stress Syndrome (MTSS). The aim was to identify a more effective intervention approach to reduce tibial loading. Methods A total of 104 participants were randomized to either the EI + PE group or the EI-only group ( n = 52 per group). Ultimately, 87 participants (EI + PE: n = 44; EI: n = 43) completed the 8-week intervention and 3-month follow-up assessments and were included in the final per-protocol analysis. Tibial load and associated biomechanical risk factors were assessed at baseline, immediately post-intervention, and at follow-up, followed by further statistical analyses. Results After 8 weeks, both EI and EI + PE groups showed significant reductions in tibial load (EI: –2.21, p = 0.031; EI + PE: –2.45, p = 0.008) and ankle plantarflexion angle (EI: –1.95, p = 0.008; EI + PE: –2.35, p < 0.001). At 3 months, reductions were sustained in EI, while further decreases occurred in EI + PE. Both groups showed significant increases in the estimated forces of the gluteus medius (mean change = 0.03, p = 0.046) and tibialis anterior (mean change = 0.10, p = 0.001). Only the EI + PE intervention elicited reductions in estimated soleus force (−0.23, p = 0.003) and Tampa Scale for kinesiophobia (TSK) scores (−7.27, p < 0.001). Conclusion Among male recreational runners aged 18–30 years with a weekly running distance exceeding 20 km, EI + PE intervention was associated with reductions in tibial loading and ankle plantarflexion angle immediately after the intervention, with these parameters showing further reductions at the three-month follow-up compared with the EI group. Moreover, the EI + PE intervention was associated with increased model-derived contributions of the gluteus medius and tibialis anterior, reduced model-derived contribution of the soleus, and substantially lower TSK scores; however, whether these changes translate into clinically meaningful benefits remains to be confirmed in future studies.