Antibiotic leftovers in primary health care: an approach to economic impact and pharmaceutical care.

In recent years, running has emerged as one of the most widely practiced and highly popular forms of physical activity. Survey data show that participation in the Berlin Marathon increased from only 244 runners in its inaugural 1974 event (236 men and 8 women) to 40,641 participants in 2018, with male runners accounting for the majority (28,373 participants) (). However, behind this dramatic rise in participation lies a substantial risk of running-related injury. reported that the cumulative incidence of running injuries ranges from 5.6% to 14.8%, with most injuries occurring in the lower extremities—particularly the lower leg (prevalence 5.4–12.3%), knee (2.7–9.3%), and foot/toes (2.5–7.1%). When specific injury types are considered, medial tibial stress syndrome (MTSS) is especially prevalent, with an incidence as high as 9.4% (). Longitudinal studies further indicate a high recurrence rate for MTSS, reaching 79.3% (). Recurrent MTSS episodes substantially impair exercise quality and overall quality of life in affected runners. Consequently, identifying effective interventions to reduce the risk of MTSS recurrence and promote comprehensive recovery in this population has become a pressing challenge in contemporary sports medicine. Clarifying the pathomechanical mechanisms underlying MTSS is a prerequisite for developing effective intervention strategies. Existing evidence indicates that excessive tibial load is the most direct contributor to MTSS (). In addition, several biomechanical factors have been shown to elevate the risk of developing this condition. For example, reported that a greater ankle plantarflexion angle may be associated with the occurrence of MTSS, with a coefficient of 0.7 (0.5–0.9). A cohort study by further demonstrated that elevated soleus activity during the push-off phase increases the risk of developing MTSS by 5%. Similarly, a systematic review by revealed a significant pooled effect when greater hip external rotation was considered a risk factor for MTSS. Beyond biomechanical determinants, psychological factors also warrant attention. Because tibial pain is the primary symptom in individuals with MTSS, persistent and recurrent pain may induce fear and anxiety related to movement and movement-induced discomfort, ultimately contributing to kinesiophobia (; ). This psychological condition has been linked to reductions in muscle strength, impaired postural control, and diminished proprioception during movement (), thereby exacerbating existing biomechanical risk factors. For instance, found that kinesiophobia reduces individuals’ positional awareness during ankle plantarflexion, which may potentially alter plantarflexion angle during running. Furthermore, reported that kinesiophobia also influences hip rotational patterns. Taken together, the development of MTSS appears to result from the combined influence of biomechanical and psychological factors. Therefore, intervention strategies for MTSS should address both motor control optimization and the mitigation of kinesiophobia to achieve more substantial and sustained rehabilitation outcomes. With growing clarity regarding the mechanisms underlying MTSS, the field has increasingly turned toward exercise-based preventive strategies aimed at reducing the risk of this condition. examined the effects of combining multimodal rehabilitation training with arch-support orthotic insoles on pain perception and recovery outcomes in individuals with MTSS. Their findings indicated that this approach effectively alleviated pain and symptom severity in patients with MTSS, while also producing notable improvements in physical function and perceived treatment benefit. implemented a 6-week neuromuscular training program in adolescent female track-and-field athletes. This program integrated jumping, landing, and running drills alongside strength, endurance, agility, balance, and core-stability exercises, with MTSS incidence monitored throughout the competitive season. The results showed that the control group experienced an MTSS incidence of 5.96 cases per 1,000 h, whereas the neuromuscular training group reported only 0.82 cases, corresponding to a relative risk of 0.17. investigated the effects of gait retraining—delivered through biofeedback and/or task-specific exercises—on MTSS incidence. Compared with controls, gait retraining substantially reduced the immediate risk of MTSS, with an adjusted hazard ratio of 0.25. By week 20 of the intervention, an average of 14 individuals needed to receive gait retraining for one runner to remain free from MTSS.