What to do with MTSS

Training for my One Mile Challenge has had one negative consequence.

I have developed a minor injury in my lower legs.

This is not the first time in my running career I have felt pain on the sides of my shins.

It is a common injury amongst runners (and also soldiers)¹.

This is not comforting.

There are various names for the condition, such as shin splints, but Medial Tibial Stress Syndrome (MTSS) is the most relevant. The pain along the inside of the shins is felt during running, walking and even resting.

The causes are not well understood but a number of factors could contribute¹, and include:

• heel-striking
• over-pronation (inward turning of the foot after landing)
• lower bone density
• higher Body Mass Index (BMI)
• previous history of MTSS-related injuries

Like with all running-related injuries, overtraining is most likely the cause of my recent issues. Too many miles, at a relatively fast pace, on hard surfaces, such as pavement, will overload the bones in the lower legs. The impact, therefore, should be reduced.

Many treatments have been studied, but none have been conclusively effective². So easily-applied practices are the most logical, and include:

• covering the affected area with kinesiology tape
• stretching and icing the affected area regularly
• strengthening the abductors³ and calf muscles
• resting (or cross-training to lower the impact of exercise)

These can be implemented in the short- and long-term.

I intend to prioritise the recovery of the affected area not least so that other more serious conditions, such as stress fractures, do not develop⁴.

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1 Moen, M.H., Tol, J.L., Weir, A., Steunebrink, M., and De Winter, T.C. (2009). “Medial Tibial Stress Syndrome: A Critical Review.” Sports Medicine, Volume 39 (7), pp. 523–546.
² Winters, M., Eskes, M, Weir, A., Moen, M.H., Backx, F.J.G., Bakker, E.W.P. (2013). “Treatment of Medial Tibial Stress Syndrome: A Systematic Review.” Sports Medicine, Volume 43 (12), pp. 1315-1333.
3 Becker, J., Nakajima, M., Wu, W. (2017). “A Prospective Study on Medial Tibial Stress Syndrome in Runners: 505 Board #326…” Medicine & Science in Sports & Exercise, Volume 49 (5S Suppl 1), p.141
⁴ Galbraith, R.M., and Lavallee, M.E. (2009). “Medial tibial stress syndrome: conservative treatment options.” Current Review of Musculoskeletal Medicine, Volume 2, pp. 127-133.