TMTS syndrome is the number one cause of running injuries worldwide and you’ve probably never heard of it…

So what is TMTS syndrome? And why haven’t you heard of it before?

TMTS (Too Much Too Soon) Syndrome is a guaranteed recipe for disaster in virtually every endeavour known to man (a little too dramatic? – I don’t think so). And you haven’t heard of it before because I invented the term by adding syndrome to a well known phrase. Anyway let’s put this in the perspective of running and injury.

The most common type of injury runners experience is the overuse injury. This generally is as a result of doing “too-much-too-soon” and is frequently linked to a lack of patience or general body-awareness.

Too Much Too Soon Syndrome

Let me tell you a story about a novice runner:

Once upon a time a naïve runner – let’s call him Dave – I mean Steve (no it’s not me – how dare you think that!), decided he wanted to run his first full marathon. So, without too much thought or research he hastily put together a training plan. The plan ramped up the distance and number of runs all at once and had no ‘recovery or down-time’ built in.

It wasn’t long before Steve started to get a niggle in his soleus (lower calf) area. But, he was on a mission and so couldn’t stop training. After all – he was raising money for charity and didn’t want to let anyone down. Then one morning run on a hill climb he felt a ping in his soleus – like someone had snapped an elastic band against it (but on the inside). ‘Oh dear & Shucks!’ he exclaimed, but carried on to finish his run regardless.

For the next few days he massaged & stretched the now constantly painful area and started doing some strengthening exercises. After a week or so the pain had eased (a bit) but was not gone completely. As the clock was ticking and the marathon race date was starting to loom large, he decided to once again press on with his training.

On a beautiful sunny morning he popped on his running shoes and headed out the door again. Without warming up, because that was something that he’d never done. He would just start off a bit slower and pick-up the pace. Initially the soleus niggled and grumbled, but then started to settle down. Though at no point did it stop hurting completely.

For some inexplicable reason Steve decided that he would push the pace uphill to make the run more challenging. As he started to accelerate – BANG!! – he felt a sharp, severe pain in his soleus. Akin to being shot with an airgun pellet at close range (something he’d experienced as a child!). He had no choice but to stop running. He now couldn’t even walk without limping heavily. He looked down to see a bruise and swelling developing in front of his eyes.

Steve never made it to the start line for his marathon and had to stop running for several months. To allow what was now a full-blown injury time to heal. But he learned the lesson on the virtue of patience and a properly constructing training plan with rest days and down-weeks included.

Don’t be like Steve, Plan your training properly, Don’t push yourself if you have a ‘niggle’ and seek professional help from a physiotherapist or sports injury specialist if you have concerns that a niggle is deteriorating or not getting better.

A fundamental reason to build your patience is the fact that different elements of the human body adapt to training at different rates.

If we think of the human runner’s body like a car:

The Runner’s Chassis (Musculoskeletal System – muscle, bone, tendons, ligaments & cartilage)

The graph below gives details of the average time it takes for the Musculoskeletal system to adapt to regular repeated exercise.

As you can see there are some impressive gains for muscle, bone and ligaments in as little as 5 to 6 weeks. But the rate of gain then slows and adaptations don’t reach their maximum potential for approx 10 to 12 months. As for tendon and cartilage, that only reaches about 70 – 80% of it’s potential adaptation after 2 years. Full adaptation could take as long as 3 years or more!

These figures are averages, as with all averages there are outliers– i.e. those that adapt quicker or slower than the average. But they’re useful as a guideline and something you should be mindful of when you begin a running program. Also these adaptations tend to take longer as you age. Because after the age of 30, key hormone productions slows down – namely testosterone (yes in women too) and human growth hormone.

Similar timescales apply to repair following injury – depending on the severity of the injury and the tissue that’s been damaged. Which is a likely reason why many runners get a “recurring” injury – as they don’t allow enough time to fully recover before returning to a full-on training schedule.

The musculoskeletal system is not the only thing that adapts and improves following regular exercise. As before it can change and adapt the infrastructure that supports and facilitates those changes has to be upgraded and improved too. On the whole these changes happen much more quickly.

The Runner’s Engine (Cardiovascular, Respiratory, Energy & Neural/Nervous Systems) changes in the following ways:

  • The heart walls thicken, the left ventricle increases in size, stroke volume increases. More capilliaries (smallVeins/Arteries) are formed in the muscles and lungs – to get more oxygenated blood to the exercising muscles.
  • Red Blood Cell count increases – these little fellas are needed to transport oxygen to the muscles and remove CO2. 
  • Lung capacity and efficiency improves, as does the strength and endurance of the diaphragm.
  • Increased Mitochondria – these are organelles found inside most cells (especially muscles) and they’re responsible for producing the energy for muscles to work.

Here’s a good video that gives a brief explanation of what they do (click the image to watch):

  • Improved Neural connections – running requires co-ordination of feet, legs, hips, torso, arms and head – the whole shebang. So the correct sequence of firing Neural synapses and engagement of nerves to send signals to activate the right muscles in the right order are essential for optimum performance.

These changes mean that you can feel great and experience big improvements in as little as 1 – 3 months. However, this is potential danger territory…

Beware TMTS syndrome is looming large at this point.

As even though you may be feeling great and there is no doubt that your aerobic fitness will have improved dramatically – your musculoskeletal system has probably only reached half of it’s potential.

Or to put it another way, you’ve upgraded your runner’s engine – but your chassis is still a work in progress and has a way to go before it can cope fully with what your engine can now throw at it.

Push-on too much at this point, by increasing mileage, the number of runs you complete every week or the intensity of your runs and you could damage that running chassis. The result could well be muscle, tendon or ligament damage or even a potential stress-fracture of a bone.

TMTS Syndrome doesn’t just apply to beginners.

If you don’t perform a warm-up before you run – that’s classic TMTS syndrome territory too and a potential injury waiting to happen. A warm-up must also be appropriate for the work-out that follows it. So, a 10 minute slow jog is not an appropriate warm-up for a sprint or speed session, as it does very little to get your body ready for what is required of it when you run fast.

So what’s the BEST tactic to help you avoid TMTS Syndrome and potential injury? = PATIENCE

  • Always make changes to your running GRADUALLY and in a measured way – being mindful of the fact that your engine can out perform your chassis. Especially in the early stages of training or after a long break (due to illness/injury or general apathy).
  • Make sure you warm-up before EVERY run
  • Remember that improvement is NEVER straightforward, linear and smooth. There are always ups and downs.
  • Get used to how your body feels and be aware of any little niggles that could be warning signs of an injury. Be willing to back-off your training for a while until things improve.

Best Wishes & Happy Running,

Coach D

About the author 

Coach D

Hi, I'm Dave. I'm a UK Athletics qualified and licensed Coach in Running Fitness (CiRF), Endurance Event Group Coach and Certified Running Technique Coach. I coach groups and individuals of all abilities both online and in person.

I particularly enjoy coaching beginner and improver runners in the 40+ age range.

I'm also a regular recreational runner and I've been competing in races from 5k to marathon distance for over 30 years.

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