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.


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.

Why I Commit to Calf Raises

It is vital that as a runner you identify any weaknesses. Whether they are physical or mental you have the most to gain from overcoming, or at least reducing, their negative impact. A quick honest self-assessment is the first step in a process that should result in tangible rewards.

In my off-season I endeavour to discover any specific areas of my running that I could improve. Then I attempt to rectify them.

As a runner who wears barefoot shoes I spend increasingly more miles running with a forefoot strike. I find this especially efficient and comfortable when undertaking speed workouts, strides and racing short distances, such as the mile up to 5km.

Recently, I realised that my calf muscles are a limiting factor in my performances. The start of my running club career has revealed a susceptibility to pain in my lower leg. Although disappointed in my fragility after only a couple of tough speed sessions, I accepted that I should not dwell on it. Instead I will embrace the challenge and believe that I can achieve a new level of fitness.


After some research I found the calf raise exercise to be the most effective means of combating my vulnerability.

My commitment is to strengthen my calves by maintaining a daily routine of sets of 20 single leg steady repetitions whilst standing, at least twice a day. I intend to record my progress and aim to move to harder variations such as whilst on stairs and including hopping.

Calf raises also provide improvements in ankle strength and balance. Visualisations can also be completed during this straightforward exercise.