








































DISABLEMENT MODEL CASE STUDY 

 

37 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                      Volume 3 – Issue 3 – November 2020 
 

The Effects of the MyoKinesthetic System on Medial Tibial Stress 
Syndrome in the Physically Active: A Case Study 
Rodrigo E. Martinez, DAT, LAT, ATC*; Evelyn Benitez-Lopez, DAT, ATC†; Lindsey Larkins, DAT, CSCS, PRT-C‡ 
* Florida International University, Miami, FL; †East Los Angeles College, Monterey Park, CA; ‡ University of Idaho, Moscow, ID    
 

 
ABSTRACT 

Medial tibial stress syndrome (MTSS) is a common pathology 
in physically active people and one of many overuse leg 
injuries present in weight bearing athletes, with the highest 
prevalence in runners. Researchers have extensively 
explored treatment for MTSS, but a long-lasting and 
effective treatment option has not been established. This case 
report aimed to explore the effects of The MyoKinesthetic 
SystemTM (MYK), a form of manual therapy, on two athletes 
diagnosed with MTSS.  Patient one is a 19-year-old male 
rugby player with a previous history of MTSS, who reported 
leg pain while running which progressed to constant pain. 
Patient two is a 24-year-old female collegiate soccer patient 
who reported increasing leg pain while running, with no 
previous history of MTSS. After being diagnosed with MTSS, 
both patients’ posture was evaluated using the MYK postural 
analysis to identify and treat the primary nerve root 
dysfunction (i.e., S1). Each patient received a total of six MYK 
treatment sessions over a two-week period. Treatment 
included manual stimulation via tactile feedback of each 
muscle innervated by the primary dysfunctional nerve root. 
Treatments were performed bilaterally with alternating 
patterns of 4-10 passive and active movements. 
Implementation of manual therapy resulted in long-term, full 
resolution of symptoms without modifying or restricting 
athletic participation. Both patients reported a decrease in 
pain and an increase in function across six treatment sessions 
without curtailing activity. Manual therapy techniques such as 
MYK may be a suitable treatment option for physically active 
patients with MTSS. The outcomes of this case report suggest 
that MYK may help improve and ultimately resolve MTSS 
pain and dysfunction in patients involved in weight bearing 
physical activity. Future studies should continue to examine 
the effectiveness of these techniques via randomized clinical 
trials. 

Key Phrases 
Manual techniques, patient-reported outcomes, injury risk 
reduction 
 
Correspondence 
Dr. Rodrigo E. Martinez, Florida International University, 
11200 SW 8th Street, AHC3-331, Miami, FL 33199. 
E-mail: matinr@fiu.edu   
 
 
 
 
 

Full Citation 
Martinez RE, Benitez-Lopez E, Larkin L. The effects of the 
myokinesthetic system on medial tibial stress syndrome in the 
physically active: a case study. Clin Pract Athl Train. 
2020;3(3):37-45. 
https://doi.org/10.31622/2020/000.3.3.6.      
 
Submitted: January 15, 2020 Accepted: April 31, 2020 
 

INTRODUCTION 

Medial tibial stress syndrome (MTSS), also 

known as “shin splints”, is a lower extremity  
pathology reported during repetitive weight 
bearing activities such as running 1-2  and other 
ballistic sports such as basketball, tennis and track 
and field.3 Signs and symptoms include dull, 
aching or diffuse pain in the distal 2/3 of the 
posteromedial tibia.4 Pain is usually absent during 
moments of inactivity, but will increase during 
physical activity, and palpation of the 
posteromedial tibia can elicit pain.5 Conflicting 
etiologies and numerous predisposing factors 
make it difficult to identify a singular root cause.3 
Differences in pronation, plantar flexion, hip 
internal and external rotation, when compared 
bilaterally, are examples of intrinsic risk factors 
contributing to the development of MTSS.3,6 
Imbalances in any of the aforementioned risk 
factors can alter mechanics along the lower 
extremity kinetic chain.3 With these subtle 
variations in posture, a patient may develop pain 
and experience decreased function.  
 
Current conservative interventions (e.g., rest, ice, 
massage, stretching, strengthening) used to treat 
MTSS address the patient’s local area of pain, but 
none focus on reducing intrinsic risk factors, 
specifically those that affect posture. A suggested 
approach to treatment is to view the body as a 
whole, emphasizing the need for a global 
assessment, as opposed to focusing on the local 

mailto:matinr@fiu.edu
https://doi.org/10.31622/2020/000.3.3.6


The Effects of the MyoKinesthetic System on Medial Tibial Stress Syndrome in the Physically Active: A Case Study 
 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                      Volume 3 – Issue 3 – November 2020  

area of pain.7-8 The MyoKinesthetic SystemTM 
(MYK) is a global manual therapy treatment 
model developed by Dr. Michael Uriarte. The 
treatment paradigm is designed to assess and 
balance the nervous system by treating the 
muscles innervated by specific nerve pathways.9 
The purpose of MYK is to evaluate postural 
imbalances and treat neuromuscular dysfunction 
as a method to restore allostasis, or homeostasis 
within reasonable fluctuation.9-10 Once postural 
imbalances are identified, the clinician can 
provide a patient specific treatment to improve 
postural dysfunctions, while decreasing pain and 
restoring function. Limited evidence exists on MYK, 
however, previous published works include a 
comprehensive overview of MYK, its positive 
effects on low back pain,11 disc herniations,12 
chronic knee osteoarthritis,13 and MTSS.14  

Identification and implementation of a treatment 
that not only addresses the physical manifestation 
of pain, but addresses potential contributing 
causes is needed. The purpose of this case report 
is to present two instances of competitive athletes 
diagnosed with MTSS, who were treated 
successfully with MYK. This study was approved 
by the Institutional Review Board of University of 
Idaho following the Helsinki Declaration. All 
participants signed an informed consent prior to 
their inclusion. 

PATIENT INFORMATION 

Patient One 

A nineteen-year-old male club rugby athlete 
complaining of bilateral shin pain reported to a 
musculoskeletal pain clinic. Previous history 
included MTSS seven years ago with no other 
lower extremity injuries or complaints. The prior 
bout of MTSS was of slow onset, aggravated only 
with repetitive activity (e.g., mile runs). Pain 
subsided when the patient refrained from physical 
activity and felt no need to seek any other form 
of treatment. Signs and symptoms of the new 
complaint included bilateral dull and diffused 
pain over the distal ⅔ posteromedial aspect of 
the tibia during physical activity and upon 
palpation. The patient had been experiencing 

pain for over a month, which progressed slowly 
from pain with running, to pain during and after 
activity, and finally to constant pain. Upon 
questioning, the patient reported a gradual 
increase in physical activity, which included 
running on turf and concrete. The patient’s pain 
was measured by utilizing the Numeric Pain Rating 
Scale (NPRS). At initial evaluation, the patient 
reported his worst pain was 7/10 bilaterally 
while running, best pain 0/10 while seated, and 
current pain 1/10 while walking. Function was 
measured by the Lower Extremity Functional Scale 
(LEFS) and disablement was assessed using the 
Disablement in the Physically Active (DPA) Scale. 
Initial scores were 47/80 and 41/64, on the LEFS 
and DPA scales, respectively.  

Patient Two 

A twenty-four year old female collegiate soccer 
athlete complaining of bilateral shin pain 
reported to her athletic trainer. The patient was 
otherwise healthy without current or past injuries 
to the lower extremity. The patient did not report 
a specific mechanism of injury; she stated running 
produced constant pain for the past four weeks 
with gradual worsening. The patient attempted to 
treat her symptoms with ice and stretching, 
reporting minimal to no improvement. The patient 
was initially evaluated mid-competition season 
with signs and symptoms that included aching and 
diffused pain along the distal ⅔ posteromedial 
border of both tibia during weight bearing 
physical activities (i.e., running), and pain with 
palpation. The patient's pain was measured with 
the NPRS. At intake, her worst pain was 10/10 
bilaterally while running, best pain was 0/10 at 
rest, and current pain 3/10 while walking. 
Function was measured by the LEFS and 
disablement was assessed using the DPA scale. 
Initial scores were 59/80 and 36/64, on the LEFS 
and DPA scales, respectively.  

INTERVENTION 

Each patient was evaluated and treated at their 
respective clinics by a single clinician for the 
duration of their care. In both cases, an orthopedic 
examination was completed to determine 



The Effects of the MyoKinesthetic System on Medial Tibial Stress Syndrome in the Physically Active: A Case Study 
 

 

39 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                      Volume 3 – Issue 3 – November 2020  

diagnosis per established guidelines,4 as outlined 
in Table 1, and to rule out the presence of a stress 
fracture. Physical impairments may result from 
postural compensations and/or dysfunctions within 
the nervous system, therefore, the MYK postural 
analysis was used on each patient to assess and 
identify a primary nerve root dysfunction.9-10 The 
clinicians performed a static postural assessment 
by observing the patient’s upper extremities, 
torso, and lower extremities in standing, seated, 
and prone positions. The clinicians used the 
posture assessment chart (Table 2) to connect 
postural imbalances to specific nerve root 
pathways innervating specific groups of muscles. 
The nerve pathway containing the greatest 
number of imbalances was identified as the 
primary dysfunctional nerve root at the time of 
assessment. Treatment was performed on the 
primary dysfunctional nerve root as determined 
through the postural assessment.9-10  

 

 
 
At intake, both cases’ postural assessments 
indicated the S1 nerve root as the primary 
dysfunction due to it having the highest number of 
associated imbalanced postures. The 
administration of one treatment took 
approximately ten minutes. Treatment included 
manual stimulation of each muscle innervated by 
the S1 nerve root, applied bilaterally with 
alternating patterns of 4-10 passive movement 
repetitions immediately followed by 4-10 active 
repetitions. In theory, the passive motions (Figure 
1) are performed to clear muscle memory, 

followed by active movements (Figure 2) to re-
establish proper neuromuscular firing patterns.9 
Stimulation was applied during the passive and 
active muscle lengthening motions by using light or 
deep compressions, glides, or cross-friction. The 
combination of simultaneous movement and tactile 
feedback stimulates several ascending sensory 
tracts and improves communication between the 
CNS and the muscles innervated by the 
corresponding nerve root.  
 
 During each visit, both patients received a 
treatment session that consisted of two S1 
treatment bouts. After each treatment bout, the 
patients walked for two minutes to allow the CNS 
to interpret and adjust to the feedback received 
during treatment. A second S1 treatment was 
administered immediately following the two-
minute walk. The session ended with a second two-
minute walk. This treatment protocol was used at 
subsequent visits. Discharge criteria was met after 
patients received a total of twelve MYK S1 
treatments completed in six sessions over two 
weeks. Patients continued their sporting activities 
while undergoing MYK treatments and through the 
15-day follow-up. During this time, both patients 
refrained from additional therapy.   
 

OUTCOME MEASURES  

The MYK posture analysis chart (Table 2) was 
utilized to assess and log each patient's posture. 
Additionally, patient reported outcomes measures 
collected that included the NPRS, the LEFS, the 
DPA scale, and the Global Rating of Change 
(GRoC) scales. When a minimal amount of change 
needed to indicate importance to the clinician and 
patient, also known as the minimal clinical 
important difference (MCID) achieved, it was 
noted in Table 3. The NPRS is an 11-point scale, 
by which a score of zero indicates no pain and ten 
represents the worst pain imaginable, as 
perceived by the patient. A change in two points 
on the NPR scale indicates an MCID.15 The LEFS is 
a 20-item questionnaire used to assess a person’s 
ability to perform activities of daily living. Each 
item is scored by the patient; a score of 4 
indicates no difficulty with the listed task while a  

Table 1. Signs and symptoms used for 
MTSS Diagnosis (Yates & White, 2004) 

Pain 
History  

Pain with activity lasting hours 
or days after activity. No 
history of paraesthesia. 

Location  

Pain along the posteromedial 
border of the tibia that was 
spread out over an area of 5 
cm.  

Palpation  
Diffuse tenderness over the 
distal 2/3 posteromedial 
border of tibia.   



The Effects of the MyoKinesthetic System on Medial Tibial Stress Syndrome in the Physically Active: A Case Study 
 

 

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Table 2. The MyoKinesthetic ™ System Postural Assessment Chart (Uriarte, 2010) 
POSTURE CHART 

HEAD    LUMBAR SPINE   
Flexed   _____ (C1-T1)  Flexed   _____ (L1-L5) 
Extended  _____ (C1-C3)  Extended  _____ (L1-L2) 
Rotated   _____ (C1-T1)  Rotated   _____ (L1-L5) 
Laterally Flexed  _____ (C1-T1)  Laterally Flexed  _____ (L1-L2) 
       
SCAPULA    HIP   
Elevated  _____ (C3-C4)  Flexed/Ant Rot  _____ (L5-S1) 
Depressed  _____ (C3-C5)  Extended/Post Rot  _____ (L1-L5) 
Protracted (AB)  _____ (C3-C5)  Abducted   _____ (L2-L3) 
Retracted (AD)  _____ (C5-C8)  Adducted  _____ (L4-L5) 
Upward Rotated  _____ (C3-C8)  Laterally Rotated   _____ (L2-S1) 
Downward Rotated  _____ (C3-C7)  Medially Rotated   _____ (L5-S1) 
       
SHOULDER     KNEE   
Flexed   _____ (C5-C8)  Flexed   _____ (L3-L4) 
Extended  _____ (C5-C8)  Extended  _____ (S1) 
Depressed (AB)  _____ (C5-C8)  Externally Rotated  _____ (L2-L3, S1) 
Elevated (ADD)  _____ (C5-C6)  Internally Rotated   _____ (S1) 
Medially Rotated  _____ (C5-C6)     
Laterally Rotated   _____ (C5-C8)     
       
ELBOW    ANKLE   
Flexed   _____ (C7-C8)  Plantar Flexed  _____ (L4) 
Extended  _____ (C5-C7)  Dorsiflexed  _____ (S1-S2) 
    Everted  _____ (L4) 
FOREARM    Pronated  _____ (L4) 
Supinated   _____ (C6-T1)  Inverted  _____ (L5-S1) 
Pronated  _____ (C5-C6)  Supinated  _____ (L5-S1) 
       
WRIST    BIG TOE   
Flexed   _____ (C6-C8)  Flexed   _____ (L5) 
Extended  _____ (C5-T1)  Extended  _____ (S1-S2) 
Radial Deviated   _____ (C7-C8)  Abducted/Varus  _____ (S1-S2) 
Ulnar Deviated   _____ (C6-C7)  Adducted/Valgus  _____ (L5-S1) 
       
THUMB    TOES   
Flexed   _____ (C7-T1)  Flexed  _____ (L5) 
Extended  _____ (C6-T1)  Extended   _____ (S1-S2) 
Abducted  _____ (C8-T1)     
Adducted  _____ (C6-T1)     
       
FINGER       
Flexed   _____ (C6-T1)     
Extended  _____ (C7-T1)     
Abducted  _____ (C8-T1)     
Adducted  _____ (C8-T1)     

 
"Reprinted from Myokinesthetic System: Lower Body, Lumbar, and Sacral Plexus, 4th edition, Micharl Uriarte), 
Posture Chart, pg. 146, 1998, with permission from Elsevier ." 

  



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score of 0 identifies a task that is impaired. An 
MCID on the LEFS is an increase of nine points.16 
The DPS scale is a 16-item questionnaire 
measuring impairments, functional limitations, 
disability and quality of life. A score ≤ 23 is 
expected in healthy individuals. An established 
MCID on the DPA scale of nine for acute injuries 
and six for persistent injuries is the standard used 
to indicate meaningful change.17 The GRoC is a 
visual 11-point scale used to quantify a patient’s 

perceived progress over time (e.g., improvements, 
digressions). An MCID for the GRoC is an increase 
of two points.18 

Outcomes were collected at regular intervals, as 
outlined in Table 3, and patients were considered 
for discharge when meeting the following criteria:  

• NPRS ≤ 2 average of best, worst, current, 
forty-eight hours after last treatment  

• LEFS ≥ 70 

Figure 1: Start and End Positions for Passive Dorsiflexion 

Figure 2: Start and End Positions for Active Dorsiflexion 



The Effects of the MyoKinesthetic System on Medial Tibial Stress Syndrome in the Physically Active: A Case Study 
 

 

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• DPA scale ≤ 23 within the last forty-eight 
hours  

• GroC ≥ 4 from intake to twenty-four 
hours after final treatment  

 
RESULTS 
 
Patient One 
 
After the first week of treatment (three treatment 
sessions), the patient achieved MCID for the NPRS, 
LEFS, DPA Scale, and reported a GRoC score of 
3/5 (Table 3). Treatment continued for an 
additional week (three treatment sessions), until 
the patient experienced resolution of pain and 
met discharge criteria. Minimal clinical important 
differences were achieved for all NRS, LEFS, and 
DPA scale scores taken between intake and 
discharge, and a one-point increase on the GRoC 
at the time of discharge. At the fifteen-day 
follow-up, the patient remained pain free and 
continued to report improvements in function while 
remaining physically active. The patient reported 
no pain, no dysfunction, and a GRoC of five at 
six-month follow-up. Table 3 contains initial, 
discharge and fifteen-day follow-up results of the 
postural assessment and how it changed over the 
course of treatment.  
 
Patient Two 
 
After the first week of treatment (three treatment 
sessions), the patient improved scores for the 
NPRS, LEFS, and DPA Scale.  Minimal clinically 
important difference scores were achieved for 
both the NPRS and DPA scale, and an initial GRoC 
score of 3/5 was reported (Table 3). Treatment 
continued for an additional week (three treatment 
sessions), until the patient’s symptoms improved 
and discharge criteria were met. Minimal clinical 
important differences were achieved for all 
outcome measures between intake and discharge, 
and a one-point increase on the GRoC at the time 
of discharge. At the fifteen-day follow-up the 
patient continued to experience decreases in pain 
and reported improvement in function while 
remaining physically active and participating in 
soccer activities. At the six-month follow-up, the 

patient reported no pain, no dysfunction, and a 
GRoC of five. Table 3 includes a summary of 
outcome measures across all time points, and 
postural assessment results for initial, discharge 
and fifteen-day follow-up.  
 
DISCUSSION 
 
In this case report, MYK was effective in reducing 
pain and restoring function in an accelerated time 
frame for two athletes suffering from MTSS, 
without being removed from activity. Clinically 
significant results were achieved in both cases as 
measured by the NPRS, DPA Scale and LEFS after 
treating exclusively with this technique. Minimal 
clinically important differences were achieved in 
both cases across all collected outcome measures 
within three treatment sessions and again at 
discharge. Minimal clinically important differences 
were achieved in both cases across all collected 
outcome measures within three treatment sessions 
and again at discharge. Patient 1 remained pain 
free and self-reported excellent outcome 
measures at fifteen-day and six-month follow-ups. 
Patient 2 was fully functional with soccer activities 
and met discharge criteria with an average NPRS 
score of 1/10 at discharge. At the fifteen-day 
follow-up her average NPRS score was 0.33/10, 
the patient reported her worst pain (1/10) was 
re-produced only during particularly vigorous 
soccer activity. At the six-month follow-up, patient 
two reported being pain free and fully functional.  
 
Currently, clinicians have various options to treat 
patients with MTSS. The evidence supporting 
traditional treatments (e.g., rest, ice, stretching, 
and strengthening exercises) is not promising, as 
pain and dysfunction recur with activity.2,19 The 
use of limited activity in combination with 
traditional treatments and a gradual return to 
play progression can take up to one-hundred 
days for the patient to report resolution of 
symptoms.19 Rest alone can take up to six weeks 
until a patient is pain free.20 In this case report, 
two patients experienced significant improvement 
of symptoms in two weeks without activity 
limitations, and maintained long-term results. 
 



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A previous history of MTSS has been linked to high 
recurrence rates.2,21-22 Biomechanical, as well as 
structural abnormalities, are associated with lower 
extremity injuries causing dysfunctions along the 
kinetic chain.20, 23-25 A visual observation of 
standing postures can help detect anomalies such 
as genu varum, pes planus, hyperpronated foot, 
increased forefoot and rear foot arch, which has 
been associated as intrinsic risk factors in patients 
with MTSS.20,25-27 The changes brought about by 
the MYK treatment may have reduced intrinsic risk 
factors as they relate to posture and movement, 
resulting in long-term results.  
 
The patients experienced clinically significant 
improvements across all measures (i.e., self-
reported pain, disablement, and function) meeting 
discharge criteria after two weeks of treatment; 
compared to rest alone that may take up to six 
weeks.20 At the end of the two-week treatment  

 
period, both patients experienced changes in 
previously dysfunctional postures. Within the S1 
nerve root, patient 1 corrected two dysfunctional 
postures and patient 2 corrected four. Although 
patient 1 experienced fewer changes in posture, 
his pain was still eliminated. In patient 2, some 
postures within the S1 nerve root remained 
present at discharge, however enough postures 
were corrected to contribute to a combined 
positive effect on the system resulting in 
decreased pain and increased function. 
Theoretically, the summation of positional 
variations could have reduced stress loads in the 
lower kinetic chain. Additionally, changes may 
continue during activity as the CNS configures 
afferent and efferent communication, correcting 
unbalanced patterns until allostasis has been 
achieved. Corrected patterns may continue to 
have a positive impact on symptoms as the body 

Table 3. Patient Outcomes 
Patient One 

Outcome Intake 1 week Discharge 15 day 
Follow-up 

6 month 
Follow-up 

NPRS Ave.: 
Worse 
Current 
Best  

2.66 
7 
1 
0 

1 
3 
0 
0 

0 
0 
0 
0 

0 
0 
0 
0 

0 
0 
0 
0 

DPA Scale 41 16 2 0 0 
LEFS 47 64 73 80 80 

GRoC - 3 4 5 5 
MYK Posture  S1 - C5 C6 - 

Patient Two 

Outcome Intake 1 week Discharge 15 day 
follow up 

6 month 
follow up 

NPRS Ave.: 
Worse 
Current 
Best  

4.33 
10 
3 
0 

1.66 
3 
2 
0 

1 
3 
0 
0 

0.33 
1 
0 
0 

0 
0 
0 
0 

DPA Scale 36 9 6 0 0 
LEFS 59 66 77 80 80 

GRoC - 3 4 4 5 
MYK Posture  S1 - C7/C8  C7/C8 - 

NPRS- Numeric Pain Rating Scale; DPA scale- Disablement in the Physically Active Scale; 
LEFS- Lower Extremity Functional Scale; GroC- Global Rating of Change; MYK- 
Myokinesthetic 
*= Minimally Clinically Important Difference 



The Effects of the MyoKinesthetic System on Medial Tibial Stress Syndrome in the Physically Active: A Case Study 
 

 

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continues to move, even if treatments are no 
longer administered.  
 
Several limitations to the study warrant discussion. 
Internal validity may have been compromised as 
patient 1 reported a self-bias. The patient stated 
that he did not believe the treatment would 
resolve his condition, which might have resulted in 
delayed healing and extended treatment time. 
External validity is low since these two patients 
may not be generalized to larger populations. 
Further investigation into the effects of MYK with 
rest on MTSS is warranted. A larger-scale trial is 
needed to explore how postural changes affect 
the long- and short-term effects of MTSS.  
 
CLINICAL BOTTOM LINE 
 
The exact etiologies of MTSS are unknown, but 
risk factors associated with this syndrome are 
numerous. Conservative treatments focus on the 
local area of pain and do not address intrinsic risk 
factors. The MyoKinesthetic System, in comparison 
to traditional treatments, addresses postural risk 
factors to help prevent and/or decrease the signs 
and symptoms associated with the syndrome. As 
the number of risk factors decreased in both 
patients so did pain intensity. The results of this 
case report provide evidence of the short and 
long-term effects of MYK to decrease pain in two 
patients presenting with MTSS while remaining 
physically active. Through this case report we 
found that posture indeed may be an outward 
expression of the nervous system, encouraging 
clinicians to consider addressing structural 
compensations. A full-scale investigation of MYK is 
needed to determine its ability to effectively treat 
and address postural risk factors that lead to 
MTSS. 
 
REFERENCES 

1. Brewer RB, Gregory AM. Chronic lower leg 
pain in athletes: a guide for the differential 
diagnosis, evaluation, and treatment. Sport 
Health. 2012; 4(2):121-127. 
https://doi.org/10.1177%2F19417381114
26115. 

2. Schulze C, Finze S, Bader R, Lison A. Treatment 

of medial tibial stress syndrome according to 
the fascial distortion model: a prospective 
case control study. Sci World J. 2014. 
https://doi.org/10.1155/2014/790626. 

3. Hubbard TJ, Mullis Carpenter E, Cordova ML. 
Contributing factors to medial tibial stress 
syndrome: a prospective investigation. Med 
Sci Sport Exer. 2009; 41(3):490-496. 
https://doi.org/10.1249/MSS.0b013e3181
8b98e6. 

4. Yates B, White S. The incidence and risk 
factors in the development of medial tibial 
stress syndrome among naval recruits. Am J 
Sport Med. 2004; 32(3):772-780. 
https://doi.org/10.1177/0095399703258
776. 

5. Burrus MT, Werner BC, Starman JS, et al. 
Chronic leg pain in athletes. Am J Sport Med. 
2015; 43(6):1538-1547. 
https://doi.org/10.1177/0363546514545
859.  

6. Moen MH, Bongers T, Bakker EW, et.al. Risk 
factors and prognostic indicators for medial 
tibial stress syndrome. Scand J Med Sci Sport. 
2012; 22:34-39. 
https://doi.org/10.1111/j.1600-
0838.2010.01144.x.  

7. Cook G. Movement: Functional Movement 
Systems: Screening Assessment, and Corrective 
Strategies. Santa Cruz, CA: On Target 
Publications; 2010. 

8. Total Motion Release. Research & Evidence 
2018. https://tmrseminars.com/research-
evidence. Accessed November 19, 2018. 

9. Uriarte M. MyoKinesthetic system: lower body 
lumbar and sacral plexus. 4th ed. 2010. 

10. Brody K, Baker RT, Nasypany A, May J. The 
MyoKinesthetic system, part I: a clinical 
assessment and matching treatment 
intervention. Int J Athl Ther Train. 2015; 
20(4):5–9. 
https://doi.org/10.1123/ijatt.2014-0131.  

11. Brody K, Nasypany A, Baker RT, May J. 
Analysis of patient outcomes using the 
MyoKinesthetic System for the treatment of 
low back pain: a case series. J Chiropr Med. 
2017; 16(2):111‐121. 
https://doi.org/10.1016/j.jcm.2017.01.002
.  

12. Hansen-Honeycutt J, Nasypany, A, Baker, RT. 
Treatment utilizing a Muscle Energy Technique 
and the MyoKinesthetic System on patients 

https://doi.org/10.1177%2F1941738111426115
https://doi.org/10.1177%2F1941738111426115
https://doi.org/10.1155/2014/790626
https://doi.org/10.1249/MSS.0b013e31818b98e6
https://doi.org/10.1249/MSS.0b013e31818b98e6
https://doi.org/10.1177/0095399703258776
https://doi.org/10.1177/0095399703258776
https://doi.org/10.1177/0363546514545859
https://doi.org/10.1177/0363546514545859
https://doi.org/10.1111/j.1600-0838.2010.01144.x
https://doi.org/10.1111/j.1600-0838.2010.01144.x
https://doi.org/10.1123/ijatt.2014-0131
https://doi.org/10.1016/j.jcm.2017.01.002
https://doi.org/10.1016/j.jcm.2017.01.002


The Effects of the MyoKinesthetic System on Medial Tibial Stress Syndrome in the Physically Active: A Case Study 
 

 

45 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                      Volume 3 – Issue 3 – November 2020  

with a diagnosed disc injury. Int J Athl Ther 
Train. 2016; 22(4):6-12. 
https://doi.org/10.1123/ijatt.2016-0013 

13. Stevenson VF, Baker RT, May J, Nasypany A. 
Using the MyoKinesthetic System to treat 
bilateral chronic knee pain: a case study. J 
Chiropr Med. 2016; 15(4):294‐298. 
https://doi.org/10.1016/j.jcm.2016.07.002
.  

14. Martinez RE, Lopez EB, Cox RW, et al. 
Exploring treatment of medial tibial stress 
syndrome via posture and the MyoKinesthetic 
system. J Bodyw Mov Ther. 2020; 24(1):82‐
87. 
https://doi.org/10.1016/j.jbmt.2019.06.00
4.  

15. Krebs EE, Carey SC, Weinberger M. Accuracy 
of the pain numeric rating scale as a screening 
test in primary care. J Gen Intern Med. 2007; 
22(10):1453–1458. 
https://doi.org/10.1007/s11606-007-
0321-2.  

16. Yeung TSM, Wessel J, Stratford P, 
Macdermid J. Reliability, validity, and 
responsiveness of the lower extremity 
functional scale for inpatients of an 
orthopaedic rehabilitation ward. J Orthop 
Sports Phys Ther. 2009; 39(6):468-477. 
https://doi.org/10.2519/jospt.2009.2971.   

17. Vela LI, Denegar CR. The disablement in the 
physically active scale, part II: the 
psychometric properties of an outcomes scale 
for musculoskeletal injuries. J Athl Train. 2010; 
45(6):630-641. 
https://doi.org/10.4085/1062-6050-
45.6.630.  

18. Kamper SJ, Maher CG, Mackay G. Global 
rating of change scales: A review of strengths 
and weaknesses and considerations for 
design. J Man Manip Ther. 2009; 17(3):163-
170. 
https://doi.org/10.1179/jmt.2009.17.3.16
3.   

19. Moen MH, Holtslag L, Bakker E. The treatment 
of medial tibial stress syndrome in athletes; a 
randomized clinical trial. Sport Med Arthrosc 
Rehabil Ther Technol. 2012; 4:12. 
https://doi.org/10.1186/1758-2555-4-12.   

20. Galbraith RM, Lavallee ME. Medial tibial 
stress syndrome: conservative treatment 
options. Curr Rev Musculoskelet Med. 2009; 
2:127-133. 

https://doi.org/10.1007/s12178-009-
9055-6.   

21. Newman P, Witchalls J, Waddington G, 
Adams R. Risk factors associated with medial 
tibial stress syndrome in runners: A systematic 
review and meta-analysis. Open Access J 
Sports Med. 2012; (4):229-241. 
https://doi.org/10.2147/OAJSM.S39331.  

22. Reinking MF. Exercise related leg pain (ERLP): 
a review of the literature. N Am J Sport Phy 
Ther. 2007; 2(3):170-180.  

23. Cosca DD, Navazio F. Common problems in 
endurance athletes. Am Fam Physician. 2007; 
76(2):237-244.  

24. Neal BS, Griffiths IB, Dowling GJ, et al. Foot 
posture as a risk for lower limb overuse injury: 
A systematic review and meta-analysis. J Foot 
Ankle Res. 2014; 7(55). 
https://doi.org/10.1186/s13047-014-
0055-4.   

25. Reinking MF, Austin TM, Hayes AM. Exercise 
related leg pain in collegiate cross-country 
athletes: extrinsic and in intrinsic risk factors. J 
Orthop Sport Phy Ther. 2007; 37(11):670-
678. 
https://doi.org/10.2519/jospt.2007.2534.   

26. Bennett JE, Reinking MF, Pluemer B, et al. 
Factors contributing to the development of 
medial stress syndrome in high school runner. 
J Orthop Sport Phy Ther. 2001; 31(9):504-
510. 
https://doi.org/10.2519/jospt.2001.31.9.5
04.   

27. Sommer HM, Vallentyne SW. Effect of foot 
posture on the incidence of medial tibial stress 
syndrome. Med Sci Sports Exerc. 1995; 
27(6):800-804.  

 

 

https://doi.org/10.1123/ijatt.2016-0013
https://doi.org/10.1016/j.jcm.2016.07.002
https://doi.org/10.1016/j.jcm.2016.07.002
https://doi.org/10.1016/j.jbmt.2019.06.004
https://doi.org/10.1016/j.jbmt.2019.06.004
https://doi.org/10.1007/s11606-007-0321-2
https://doi.org/10.1007/s11606-007-0321-2
https://doi.org/10.2519/jospt.2009.2971
https://doi.org/10.4085/1062-6050-45.6.630
https://doi.org/10.4085/1062-6050-45.6.630
https://doi.org/10.1179/jmt.2009.17.3.163
https://doi.org/10.1179/jmt.2009.17.3.163
https://doi.org/10.1186/1758-2555-4-12
https://doi.org/10.1007/s12178-009-9055-6
https://doi.org/10.1007/s12178-009-9055-6
https://doi.org/10.2147/OAJSM.S39331
https://doi.org/10.1186/s13047-014-0055-4
https://doi.org/10.1186/s13047-014-0055-4
https://doi.org/10.2519/jospt.2007.2534
https://doi.org/10.2519/jospt.2001.31.9.504
https://doi.org/10.2519/jospt.2001.31.9.504

