In active populations with medial tibial stress syndrome (MTSS), is extracorporeal shockwave therapy an effective treatment to reduce pain? A computerized search was conducted in October 2021. Inclusion criteria consisted of participants 18+ years old with diagnosed MTSS for 21+ days, where pain was in the posterior medial aspect of the tibia. Exclusion criteria involved patients with tibial fractures, compartment syndrome, and prior treatment of MTSS with extracorporeal shockwave therapy. Results were measured by the number of days athletes could complete the running protocol pain-free according to the Likert scale (p = .008), visual analog scale (p = .001), and Roles and Maudsley scale (RMS; p = .002). The third study showed no statistical significance in pain reduction or self-perception of change in symptoms on the Numerical Rating Scale (NRS; p = .05). Using the Strengthening the Reporting of Observational studies in Epidemiology scale, one study received a 17/22 since no biases were addressed, lack of participant status in each stage of the study, no numbers or analysis reported in each group, and no explanation of external validity or funding. The single-blind randomized controlled trial received a 10/11 using the Physiotherapy Evidence Database scale and one level of evidence. The double-blind sham randomized controlled trial received an 11/11 and one level of evidence (LOE). The research appraised would mostly agree the use of extracorporeal shockwave therapy could reduce pain in MTSS in active populations. The strength of recommendation is B.