Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 22, Issue 7, pp 1549–1555 | Cite as

Medial tibial pain pressure threshold algometry in runners

  • Osama Aweid
  • Rosa Gallie
  • Dylan Morrissey
  • Tom Crisp
  • Nicola Maffulli
  • Peter Malliaras
  • Nat Padhiar



Pressure algometry (PA) may provide an objective and standardised tool in assessing palpation pain over the tibia. The purpose of this study was to analyse the intra-rater repeatability of PA and to determine whether tibial tenderness in healthy runners differ from runners with medial tibial stress syndrome (MTSS).


Pressure algometry was performed on 20 asymptomatic runners (40 legs) and 9 MTSS patients (14 symptomatic legs) at standardised locations along the medial border of the tibia. Intra-rater reliability was assessed in 10 randomly selected asymptomatic runners through repeated measurements 2 weeks later.


Intra-rater reliability was moderate to excellent (ICC 0.53–0.90) in asymptomatic runners. Pain pressure threshold (PPT) was significantly reduced at 2/9–5/9 of the distance from the medial malleolus to the medial tibial condyle (p = 0.002–0.022). There was evidence of a statistically significant association between both height and weight, and PPT from the 3/9 (r = 0.416, p = 0.008) to 7/9 (r = 0.334, p = 0.035) and 3/9 (r = 0.448, p = 0.004) to 6/9 (r = 0.337, p = 0.034) area, respectively. In both MTSS patients and healthy runners, there was evidence of lower PPT in females compared to males (p = 0.0001–0.049) and a negative association between age and PPT (p = 0.001–0.033). MTSS patients had significantly lower PPT at the 3/9 site (p = 0.048) compared to asymptomatic runners.


Pain pressure threshold algometry can be incorporated into MTSS clinical assessment to objectively assess pain and monitor progress. The presence of reduced medial tibial PPT in asymptomatic runners suggests that clinicians may not need to await resolution of medial tibia tenderness before allowing return to sport in MTSS patients.

Level of evidence



Medial tibial stress syndrome MTSS Pressure algometry PA Pain pressure threshold PPT Algometry Prolotherapy 



With thanks to the patients, the administrative and clinical team at the London Independent Hospital, and the Barts and the London Running Club.

Conflict of interest

The authors confirm that there is no conflict of interest.

Ethical standards

This Study was approved by The Queen Mary Research Ethics Committee on the 24 June 2011 (QMREC2009/22) and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Osama Aweid
    • 1
  • Rosa Gallie
    • 1
  • Dylan Morrissey
    • 1
  • Tom Crisp
    • 2
  • Nicola Maffulli
    • 1
  • Peter Malliaras
    • 1
  • Nat Padhiar
    • 1
    • 2
  1. 1.Centre for Sports and Exercise MedicineBarts and The London School of Medicine and DentistryLondonUK
  2. 2.John King Centre for Leg PainBMI The London Independent HospitalLondonUK

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