Case Study: Strengthening of Tibialis Anterior in Medial Tibial Stress Syndrome

Abstract

Background: Medial Tibial Stress Syndrome (MTSS) is a common overuse condition of the lower limb associated with repetitive tibial loading, muscular fatigue, and pain along the tibial border. Tibialis anterior strengthening may improve dorsiflexor control and reduce symptoms during impact activities.

Objective: To describe the effect of a structured tibialis anterior strengthening programme on pain, dorsiflexor strength, ankle dorsiflexion range of motion, and Zumba-related functional ability in a young female with MTSS.

Case Presentation: A 22-year-old female student presented with left anterior and medial lower-leg pain that increased during Zumba, particularly during jumping and lateral shifting. Symptoms began insidiously after increasing exercise intensity and progressed to pain during walking. Examination revealed tenderness along the medial tibia, mild swelling, reduced ankle dorsiflexion range, dorsiflexor weakness, and pain intensity of 7/10 on the Visual Analogue Scale (VAS).

Physiotherapy Management: The patient received a 4-week tibialis anterior focused programme, 5 sessions per week, including seated tibialis raises, isometric dorsiflexion holds, resisted dorsiflexion with a resistance band/TheraBand, kettlebell toe raises, and front-foot raise walking. Exercise dose was progressed from pain-free activation to resisted and functional dorsiflexion work with monitoring of pain, swelling, and technique.

Results: After 4 weeks, pain reduced from 7/10 to 2/10 on VAS, FAAM-Sports score improved from 6/32 (18.75%) to 19/32 (59.38%), dorsiflexor MMT improved from 3/5 to 4+/5, and ankle dorsiflexion range increased from 8 degrees to 14 degrees.

Conclusion: Tibialis anterior strengthening was associated with reduced pain and improved functional tolerance in this MTSS case. The findings support the inclusion of targeted dorsiflexor strengthening as part of conservative MTSS rehabilitation, while recognising that broader management of calf flexibility, training load, footwear, and biomechanics may be needed for full recovery.