Effect of hip abductors training on pelvic drop and knee valgus in runners with medial tibial stress syndrome: a randomized controlled trial.

Researchers in Egypt tested whether adding hip abductor strength training to standard physiotherapy could help runners dealing with medial tibial stress syndrome, or MTSS, a painful overuse injury of the inner shin. They enrolled 40 recreational runners aged 25 to 35 who had experienced MTSS for at least a month, then split them into two groups: one received standard physical therapy alone, while the other got the same therapy plus eight weeks of targeted hip abductor exercises. Using video analysis and computer software, they measured two specific movement patterns known to contribute to MTSS: how much the pelvis drops to one side during running, and how much the knee caves inward.

After eight weeks, the group that did the extra hip work showed meaningful reductions in both of these movement faults, while the standard therapy group showed some improvement in pelvic drop but actually got worse in their knee alignment. The findings suggest that strengthening the hip muscles that stabilize the pelvis may address a root cause of the injury rather than just treating the symptoms.

Researchers looked at whether a specific type of hip strengthening exercise could help runners with shin pain from medial tibial stress syndrome. They found that runners who did eight weeks of targeted hip abductor exercises alongside regular physiotherapy showed better improvements in how their body moved during running compared to those who did standard therapy alone.

The hip exercises appeared to help control the way the pelvis and knee moved, two movement patterns that contribute to shin pain. This suggests that shin pain in runners may sometimes stem from weakness higher up in the hip, rather than just a problem in the shin itself.

The study was fairly small and included only recreational runners of a particular age and fitness level, so it is not yet clear how broadly these results apply. The improvement shown was real but took eight weeks of consistent training to achieve.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This randomized controlled trial adds to growing evidence that hip abductor weakness may be a modifiable contributor to MTSS in runners. The intervention was straightforward: supplementing standard care with functional hip abductor strengthening over eight weeks led to measurable reductions in frontal plane projection angle (dynamic knee valgus) and contralateral pelvic drop angle compared to standard therapy alone.

The control group did improve somewhat in pelvic stability but did not show the same knee alignment improvements, and their frontal plane projection angle actually increased, suggesting that standard care alone may be insufficient for addressing dynamic knee valgus in this population. The study was single-blind and used objective motion analysis via 2D video, which strengthens the findings, though the sample size was modest and participants were limited to recreational runners aged 25 to 35 with normal BMI.

The eight-week timeframe is clinically relevant, but longer-term follow-up data on symptom recurrence and sustained movement changes would add valuable context. This work supports the biomechanical rationale for hip-focused intervention in MTSS but does not yet indicate whether this approach reduces actual injury recurrence or accelerates return to running.