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.

Mitigating the Challenges of Ultramarathons

Never Wipe Your Ass with a Squirrel (2013) by Jason Robillard


This guide to ultrarunning is down-to-earth and unique. Robillard offers a fresh perspective on running factors such as distance and cut-off times, terrain and weather, and pacing and strategy. It is the purposeful physical advice and experimental mental training that stands out.

Calorie Consumption

Robillard urges runners not to be reliant on eating food during long runs as this can be a distraction and also dictate a certain pace range. Instead he advises eating as little as possible before and during training runs so runners can better utilise their fat stores to cope with extremely long distances.

However, when deciding to eat he explains that personal cravings should not be ignored, and that chia seeds can be a nutritious option on the go, as is adopted by the famous Tarahumaras.

Practice Every Aspect of Racing

Robillard encourages runners to take a systematic approach to replicating every running situation. For example, he advises runners to fall, on purpose, whilst running slowly in order to practice breaking the impact by rolling with arms out and elbows bent.

Enthusiasm to experiment is essential for runners if they are to understand what aspects help, and hinder, during an endurance event. Enjoyment and performance should both be enhanced as a result of understanding one’s individual responses to training stimuli.

His race strategies for ultramarathons also include walking, advocating that runners should become fast walkers. Walking enables runners to better survive harsh race conditions, by continuing to move forward.

Managing Pain

Robillard also outlines a no-nonsense attitude to pain.

Runners should accept, embrace and learn to enjoy the aches that occur during a race. His positivity originates from his belief that most pain is temporary and can be dealt with before it flares up. Writing a list of the regions that may hurt and a race strategy of fixing problems, long before setting off from the start line, can really help.

An effective technique is to train in every mood, especially when you do not feel like running, either through tiredness or hunger. Another is to speed up when in pain, if for no other reason than to respond differently to natural instincts, this breaks the monotony of running.


Although unconventional Robillard offers invaluable advice on how to view and tackle ultramarathons. Ultimately, he believes endurance challenges are akin to difficult life events; the sharper you react the more empowered you are to succeed.