Medial tibial stress syndrome (MTSS) is probably a more accurate description. 

How does it present?

It is categorised as diffuse pain along the posterior medial border of the tibia.  Warming up eases it slightly but mostly it presents after training and even the following morning.

What is it?

It is a stress injury to the bone. Particularly, traction on the medial boarder of the tibia from Soleus, Tibialis posterior, Flexor halucis longus and Flexor digitorum longus (deep posterior calf muscles) pulling on the periosteum (outer layer) of the bone due to different factors. It used to be argued that it was an inflammatory condition, but this has been largely moved away from in more recent years. 

If the pain is more focal, rather than localised, it may have led to a stress fracture, so its worth taking it seriously. 

What factors?

The foot has high arch (pes cavus) or low arch (pes planus) and excessive pronation of the ankle joint, both factors which affect shock absorption. The soleus muscle contracts to prevent pronation, couple that with repetitive impacts of running and you’ve got a lot of traction on the medial boarder where those muscles insert.

The muscles fail to provide adequate shock absorption due to fatiguing too easily. Yep, it’s a thing.

A change in running shoe, or indeed the wrong running shoe for your gait.

A change in surface.

Increasing your distance too quickly.

Being female…being female means certain injuries are more common, but I’ll get into that another time.

People carrying more weight – Higher body mass index.

Training errors.

Hip weakness and instability.

What can be done about it?

Ease off on the distance you are training and see if that helps – in an ideal world you should not increase your distance by more than 10% per week.

Swim or cycle temporarily – these are non-weight bearing activities that will maintain your CV fitness while you address your injury. 

Cross train – one mistake I made as a runner was, I ran, and nothing else. Cardio is great but I didn’t have the sufficient muscle strength to guard against this or any other injury. 

Avoid putting heat on the area – this will increase the local blood flow but also exacerbate the symptoms. Ice is a good pain killer.

Orthotics – once the underlying factor has been identified, orthotics may help, if its related to the foot, but caution should be used when introducing orthotics, and their use should be built up gradually. 

Identify the underlying factor in this injury. It could be poor foot and ankle mechanics causing this issue or it could be the hip complex impacting further down the kinetic chain. **Shameless plug** This is where your local sports therapist comes in handy. They can run a series of functional test and look at the gait mechanics of the foot to identify the underlying issue and then come up with a plan to address it and get you back to running strong.


Leave a Reply

Your email address will not be published. Required fields are marked *