Common marathon injuries and how to avoid them

Matthew Piff Matthew Piff Regional Physiotherapy Lead
Training for a marathon is a lengthy process and puts a lot of strain on your body. Sometimes following even the best laid plans can result in injury or pain. Matthew Piff, Regional Physiotherapy Lead, covers 5 of the most common marathon training and racing injuries and how you might be able to avoid them.

When training for a marathon, injuries often happen, but this doesn’t need to derail your goal. Following some simple but effective training methods and routines injury can be avoided.

5 common marathon training injuries

Anterior knee pain

Anterior knee pain or ‘runners knee’ is often described as pain at the front of the knee, around the knee cap. It's caused by numerous factors related to training, but is often down to overloading of tissues, resulting in pain.

Anterior knee pain can be caused by muscle weakness, tendon overload, poor running technique or a mixture of all three. Anterior knee pain can be acute and if caught early can largely be managed with a short period of rest (to reduce symptoms) and a graded return to exercise.

Persistent pain will be best managed by a referral to a physiotherapist to establish the cause and put in place a rehab programme to enable a return to training pain free.

ITB syndrome

ITB (Iliotibial Band) syndrome is a common overuse injury, where pain and inflammation occurs on the outside of the knee due to the compression of the ITB over the bony structures. This often occurs due to poor or altered running technique and muscle weakness around the knee and hip.

Addressing running technique and biomechanics can be very important in reducing symptoms. Strengthening the glute and thigh muscles can also improve your body’s ability to cope with the stress of running.

If ITB pain is not managed correctly the problem can become persistent, affecting your ability to run and compete. In this case it's advised to see a physiotherapist, who can assess and direct you on the best treatment and recovery options.

Shin splints (MTSS)

Shin splints (medial tibial stress syndrome) is another overuse injury that typically presents with a worsening ache to sharp pain upon running. It's usually felt down the front of the shin, worsening the further you run.

Causes of shin splints can be multifactorial, but often relates to muscle imbalances, weakness and altered running biomechanics. Poor fitting and unsupportive footwear can also have a significant impact. It often occurs in those new to running or in those that have rapidly increased their running load.

Ice therapy, stretching and rest can be beneficial self-management strategies, but persisting pain needs to be assessed by a physiotherapist, to establish the cause and best treatment options. It's important to note that if your pain is worsening, then seeing a healthcare professional is recommended to rule out the occurrence of a bone stress injury.

Achilles tendinopathy

Tendons transfer the force generated by muscles to a joint, enabling movement. In running, the Achilles tendon is under significant load over and over again. Interesting fact: the Achilles takes up to 7 times your body weight in load every step!

Achilles tendinopathy is a common injury suffered by marathon runners and is caused by sustained overload to the tendon. It's characterised by dull or sharp pain in the tendon, often with an associated swelling (lump) in the tendon itself.

Acute pain in the Achilles should not be ignored. Rest to allow the pain to settle and return to running gradually, without causing further pain. Persistent symptoms should always be assessed by a physiotherapist to enable return to running quickly and avoid further injury to the tendon.

Plantar fasciitis

The plantar fascia is a band of soft tissue running from your heel to the base of your toes. Its purpose is to provide support and protection to the arch of your foot.

Plantar fasciitis is a condition where this tissue becomes inflamed. It's characterised by pain under your heel tracking into the arch of your foot. The pain is often worse on initial walking or running and often goes away as the tissue ‘warms up’.

Pain is often persistent and can become too painful to run on. It can be caused by training overloads (spikes), poor fitting footwear or changes in running surface. Treating this early helps with quicker outcomes, so don’t ignore and see a physiotherapist to establish the best treatment options.

Hints and tips to help stay injury free

Avoiding injury can be difficult when training for a marathon. The repetitive nature of the exercise, the high loads your body’s tissues experience and the sheer amount of training needed, makes it difficult to stay injury free.

However, there are some good habits and training techniques that can support you and give you the best chance to stay injury free.

  • Follow a well-structured training programme. This should be spread over a long period, enabling you to gradually increase your training load (mileage), enabling you to gradually build fitness, preparing your body for race day
  • Avoid training spikes. Follow your structured plan and listen to your body. Over-training is one of the main causes of marathon training injuries. It's important that your programme gradually builds your mileage or time on your feet. Muscles and tendons tend to respond well to gradual increases in training load and often don’t cope well with significant changes
  • Incorporate strength training into your programme. Evidence supports the use of strength training for endurance performance. In other words, runner shouldn’t just run to improve, they need to lift some weights. Evidence is strongly supporting strengthening in endurance athletes and shows good support for its use in injury prevention
  • Eat a balanced diet. Nutrition is also vital to fuel our body for the stress of training. Marathon training will consume vast amounts of energy, so make sure you are replacing this. A balanced diet is key, including good amounts of carbohydrates (for energy) and protein (for soft tissue repair)
  • Recover well. Rest is essential for the body to recover from training. This is when your body adapts and repairs itself from the rigours of exercise. Make sure your plan incorporates this and listen to your body. Good quality sleep is also vital to recovery and overall wellbeing. The average adult should get 8 hours sleep per night. Make sure your room is dark, noise free and a cool temperature for the best sleep.

Following the good habits and training advice above can best prepare your body for the training ahead, but it's important to realise this is not a guarantee. Injuries happen and it is about how we treat these and recover, will ultimately help keep you on track and achieve your goals.

If you're concerned about a persistent pain, or want to ensure you avoid injury by training in the best way for your body, our physiotherapists can help.

Last updated Wednesday 15 February 2023

First published on Wednesday 31 August 2022