Date of Award


Degree Type

Selective Evidence-Based Medicine Review


Objective: The objective of this selective EBM review is to determine whether or not extracorporeal shock wave therapy is an effective treatment for improving pain in adults with medial tibial stress syndrome.

Study Design: Systematic review of two randomized controlled trials (RCTs) and a cohort study published in peer-reviewed journals from 2010-2017, all in the English language.

Data Sources: Two randomized controlled trials found through PubMed and a cohort study found through Google Scholar.

Outcomes Measured: Pain was measured using a numerical rating scale (0-10) and visual analog scale (VAS).

Results: Study by Newman et al. (J Sci Med Sport. 2017;20(3):220-224. doi: S1440- 2440(16)30140-2 [pii]) demonstrates pain improvement for bone pressure was only significant in the control group rather than the experimental group with a mean difference of 1.1 out of 10, 95% CI 0.0-2.3, (p= 0.05); with no significance shown for muscle pressure or running. Study by Gomez et al. (Int J Surg. 2017;46:102-109. doi: S1743-9191(17)31244-X [pii]) showed clinical and statistical significance with an NNT value of 2, (p= 0.001), and mean change from baseline of 4.61. Finally, study by Rompe et al. (Am J Sports Med. 2010;38(1):125- 132. doi: 10.1177/0363546509343804) showed pain improvement was statistically significant with (p <.001) and mean change from baseline of 5.4.

Conclusions: Evidence supporting the use of extracorporeal shock wave therapy for pain improvement in adults with MTSS was conflicting between the three articles studied in this systematic review. Two studies found this treatment statistically significant while one did not display any significance with shockwave therapy.