| Age / Sex | 28-year-old female |
| Activity Level | Competitive distance runner, 40-50 miles per week |
| Primary Complaint | Bilateral medial tibial pain during and after running, progressively limiting mileage |
| Duration of Symptoms | 2 years, recurring with every training increase |
| Previous Treatments | Rest periods (multiple), custom orthotics, compression sleeves, ice massage, physical therapy |
| Diagnosis | Medial tibial stress syndrome (MTSS) driven by excessive foot pronation and hip-dominant gait compensation |
Background
This 28-year-old competitive runner had been battling shin splints for two years. The pattern was always the same: she would rest until the pain subsided, gradually rebuild her mileage, and within three to four weeks of reaching her target volume, the shin pain would return. She had tried custom orthotics, changed shoes three times, and completed two rounds of physical therapy focused on calf strengthening and tibialis posterior exercises. Nothing broke the cycle.
She was training for a qualifying race and could not afford another setback. Her running coach referred her to our clinic after hearing about our gait analysis approach.
Assessment Findings
Gait analysis using AiM methodology revealed significant findings that explained the recurrent pattern. Her right foot was excessively pronating through midstance, but this was not a foot problem. Her right hip lacked adequate internal rotation, which meant the femur was not rotating over the planted foot correctly. The foot was compensating by collapsing inward to create the motion the hip could not provide. This excessive pronation overloaded the medial tibial structures with every stride.
Additionally, her left ankle had a dorsiflexion restriction from a poorly rehabilitated sprain years earlier. This was altering her stride symmetry and creating abnormal loading patterns on both shins. Her DNS assessment showed she was a chest breather with poor core stabilization during dynamic activities, meaning her lower extremities were absorbing forces that a stable trunk should have been managing.
Treatment Protocol
Phase 1 Weeks 1-2 | Focused shockwave therapy (F-ESWT) to both medial tibial borders to stimulate periosteal healing and reduce pain. Left ankle joint mobilization to restore dorsiflexion. DNS breathing retraining and core activation in developmental positions. Running volume reduced to 50% with gait cues initiated. |
Phase 2 Weeks 2-4 | Continued F-ESWT. AiM-based gait retraining targeting hip internal rotation timing and ankle rocker mechanics. Progressive hip mobility work to restore femoral rotation. DNS single-leg stability progressions. Running volume gradually increased with new gait pattern. |
Phase 3 Weeks 4-6 | Full return to training volume with corrected gait mechanics. Speed work reintroduced. Final F-ESWT session. Independent maintenance program for hip mobility and ankle dorsiflexion. |
Progress Timeline
| Months 1–6 (Pre-Treatment) | Took multiple rest periods from running. Fitted for custom orthotics and used compression sleeves. Applied ice massage after activity. Completed a round of physical therapy focused on calf strengthening. Pain returned each time training resumed. |
| ▸ Treatment at City Integrative Rehabilitation | |
| Week 1 | First F-ESWT session. Ankle mobilization restored 8 degrees of dorsiflexion. Reduced running volume with initial gait cues. |
| Week 2 | Shin pain during running reduced by approximately 50%. Gait retraining progressing well with improved hip rotation awareness. |
| Week 3 | Running 30 miles pain-free. AiM gait corrections becoming more automatic. Core stability during running noticeably improved. |
| Week 4 | Back to 40 miles. No shin pain. Foot pronation visibly reduced on video analysis without orthotics. |
| Week 6 | Full training volume restored at 50 miles per week. Speed work resumed. Zero shin pain. Gait analysis showed symmetrical loading patterns. Cleared for race preparation. |
Outcome
After two years of the same frustrating cycle, this runner returned to full competitive training in six weeks without shin pain. The breakthrough was identifying that her shin splints were a symptom of gait dysfunction, not a local tissue problem. A hip that could not rotate and an ankle that could not dorsiflex were creating compensatory pronation that overloaded the tibia with every stride. Focused shockwave therapy accelerated the tibial healing while AiM gait retraining and DNS core work addressed the biomechanical causes. She went on to complete her qualifying race without incident.
This case study represents a real patient treated at City Integrative Rehabilitation. Details have been modified to protect patient privacy. Individual results may vary.