Avoid injuries during marathon training: 15 expert tips

Whether you’ve signed up for your first marathon or are on the brink of doing so (do it), you probably have a long list of questions about training for this 26.2-mile endeavour.

While marathon training can bring bountiful physical and mental benefits, it’s important to understand that this pursuit can also lead to aches, pains and more serious injuries if not undertaken sensibly. In fact, a 2021 study published in the Clinical Journal of Sport Medicine found that 30% of marathoners reported race-related injuries, while more recent research published in the British Journal of Sports Medicine, which looked at the injury rate of runners taking part in the New York City Marathon, found that 40% of runners reported an injury while training for the marathon. In addition, 16% said they got injured either during or immediately after that same race.

Experience plays a part in injury risk, too. According to Brett Woyshner, owner of Woysh Lab in Florida, most injuries occur in novice runners. ‘That’s people zero to two years into their running journey who aren’t quite as familiar with how to train and where to start,’ he says.

But if you’re new to the marathon world, don’t be deterred – we have more than a dozen tips from experts on how to identify the causes and symptoms of running-related ailments, and how to avoid injuries during marathon training in the first place.


Common causes of marathon-related injuries

‘Far and away, training errors are the most common cause of injury in marathoners,’ says Sara Filmalter, a family medicine physician at Mayo Clinic in Florida.

In other words, not sticking to or being inconsistent with a training plan could easily put you on the path to injury. ‘Examples of this would be rapidly increasing weekly training volume, ignoring or skipping progressive increases in weekly mileage, or lacking of variety in running workouts,’ says Courtney Burnett of Bespoke Physical Therapy in New York City. Burnett adds that she’s seen many runners who have committed to the weekend long runs but neglected the rest of their training plan – to their detriment.

In addition to mileage mishaps, not paying attention to your running nutrition and omitting strength training and recovery days from your routine can also increase your risk of injury.


Common injuries for first-time marathon runners

There does appear to be some correlation between new runners and certain types of injuries. ‘It seems to be those gradual onset, soft tissue-related injuries, like tendonitis or bursitis,’ says Todd McGrath, sports medicine specialist at the Hospital for Special Surgery in New York City.

In terms of specific body parts, Woyshner most often sees runners with issues related to the Achilles tendon, anterior (front) knee, patellar tendon, IT band and lateral (outside) hip.

Filmalter says that the knee is the most often injured body part in runners training for a full marathon, followed by the foot. ‘In my clinical and personal experience, the most common diagnoses include patellofemoral pain syndrome (also known as runner’s knee), IT band syndrome, plantar fasciitis, Achilles tendonitis and stress fractures,’ she says.

Burnett sees the same complaints in marathon runners, as well as ankle sprains, medial tibial stress syndrome (also known as shin splints) and muscle pulls or strains of the quadriceps, hamstrings and calves.


15 tips for avoiding injuries during marathon training

While all of the above might sound quite daunting, a few simple strategies can help you to avoid injuries during your marathon training. Here’s what the experts suggest…

1. Decide whether you’re really ready to commit

    ‘Pulling from my own experience, one of the hardest parts of marathon training is the high level of commitment and consistency it calls for,’ says Burnett. That said, she believes embracing a positive mindset is key. ‘We often see runners getting sidelined by injuries while training because they are having difficulty adhering to a training plan – because, for example, they “don’t have enough time” – or they didn’t realise the impact nutrition, hydration, recovery and sleep would have in the grand scheme of things,’ she says.

    She recommends setting aside some time to be real with yourself and whether you’re truly willing to give 100% in all aspects of marathon training. ‘If you are, great! You’re off to a wonderful start. But if not, you may need to do some serious reflection on what it is you will be risking if you can’t fully commit to a plan,’ she says.

    2. Pick a solid training plan

    ‘Runners can decrease their chance of injury by following a well thought training plan,’ says Filmalter, adding that injury can be a consequence of both overtraining and undertraining.

    Specifically, you’ll want a plan that builds mileage appropriately and mixes various types of running with rest days. Luckily, we have a wealth of marathon training plans for beginners, improvers and speedy PB chasers alike – so no matter what your aim or ability, we’ve got you covered.

    3. Do an old injury audit

    While searching for your marathon training plan, Burnett suggests that you also think back to any injuries you’ve had to deal with in the past. Building in some targeted exercises to bolster any weak areas can be a great way to start off on the right foot – perhaps literally. If you’ve had plantar fasciitis in the past, for example, work on some foot-strengthening exercises every week during your training. Or, if you’ve previously experienced knee pain, maybe it’s time to add banded glute work to your schedule.

    ‘If you’re unsure whether a past injury may impact your training, definitely take a trip to your local physio,’ suggests Burnett. ‘We can help you to identify any areas of weakness or imbalance and set you up with a plan to tackle these areas before you start increasing your weekly mileage.’

    4. Invest in the right gear

    Never underestimate the transformative power of proper running shoes.

    ‘You’d be surprised by the number of clients I’ve had who try to run in old or ill-fitting shoes, or who insist on wearing a certain running shoe brand that isn’t right for their unique needs,’ says Burnett. ‘Well-made running shoes might seem like a big splurge in the beginning, but considering how much time you will spend in them, a good pair of running shoes is a worthwhile investment.’

    5. Train for your training

    It’s important to build a solid endurance base before you start your training plan, so the first week’s mileage is already a comfortable distance for you.

    ‘A lot of my patients run the New York City Marathon in November, so they should start training with a focus on the marathon in May or June,’ says McGrath. (That’s about 20 to 24 weeks of marathon training compared to the usual 16 to 18 weeks.) ‘That’s a really important thing to do so you come into [marathon training] relatively fit.’

    6. Strengthen key muscles

    ‘Strength training is an often ignored but extremely important aspect of successful race completion,’ says Filmalter. In addition to working on any weaknesses you’ve experienced before, Filmalter also suggests doing exercises to stabilise your hips, as weakness in the hips is a frequent culprit underlying running injuries. ‘Strengthening hip abductors and external rotators can help to prevent injury.’

    You’ll also want to follow an all-encompassing strength training plan, too, that incorporates bodyweight moves or gym-based exercises – or, ideally, both.

    7. Take actual rest days

    When some runners see a rest day on their training plan, they simply ignore this and crack on with some extra miles regardless – even though proper rest days are crucial.

    ‘In my experience, endurance athletes don’t like staying still for too long,’ says Burnett. ‘While you need to put the physical work in to improve your skill as a runner, rest days allow your body to repair and rebuild muscle and adapt to the stress of training to build stamina and strength.’ Burnett says that rest days can also help to reduce the mental fatigue that may come with training.

    8. Lean into the running community

    ‘As a novice runner in particular, it can be really helpful to immerse yourself within the running community and learn as much as you can from the experience of people around you,’ says Woyshner. And while your marathon training journey is going to be different to that of the runner next to you, you can still take that knowledge and adapt it for yourself.

    Running with others – whether that’s friends, colleagues or a local running club – comes with lots of other benefits, too, like accountability and support.

    9. Go for a gait analysis

    Whether they’re new to the game or have years of running experience in the bank, Woyshner recommends that all runners should consider a gait analysis to help them understand how their body moves.

    ‘It takes 20 minutes and involves assessing your mobility, strength and control when you run,’ he says. ‘That gives me an idea of, okay, if this person ramps up their intensity too quickly, I can bet you that their pain is going to show up in their lateral hip just by the way that they’re moving,’ he explains. You might also find that your knees ‘collapse’ inward as you run or that you’re a ‘bouncer’, which means that you move too much vertically compared to horizontally. With this knowledge from a gait analysis, you can then incorporate appropriate exercises into your schedule to help you sidestep injuries.

    10. Consider your stride length

    Another injury-prevention tip Woyshner gives over and over to runners is to increase their cadence and shorten their stride length.

    ‘I’ll tell them to try to contact the ground as much as they possibly can within a set number of minutes [to increase their cadence], and to get comfortable with how quickly they do this,’ he says. ‘If you think of going on a skateboard, you never want to land your foot too far in front of you – you want that foot right underneath your body to propel yourself forward.’

    Your cadence is a metric that’s unique to you, and you can get a sense of it via a running watch or simply by counting your steps per minute. Woyshner says that your ‘ideal’ cadence will vary based on a number of factors, but 150 to 160 steps per minute is a good general rule of thumb for newer runners. For some runners, that number may go up to 180.

    11. Keep tabs on your data

    Speaking of running watches, Woyshner – like many runners and fitness-philes – is a big fan of them. ‘I love these wearables because they can track your weekly mileage and your stress, whether that’s work-related or from a long, intense run,’ he says.

    That said, even if you don’t own a running watch that provides you with such data, you can still do your own self-audit in the morning. If, for example, you have an eight-mile run on your training plan but have been dealing with minor knee pain for the past three days, slept for five hours and are experiencing a lot of stress at work, your injury risk is going to skyrocket, says Woyshner. Adjust your plans accordingly or consider swapping the eight-mile run for a rest day.

    12. Try to get more sleep

    A study published in the Journal of Pediatric Orthopaedics found that student athletes who slept less than eight hours a night were 1.7 times more likely to get injured compared to those who slept for eight hours or longer.

    ‘Once you get into eight or nine hours of sleep, the likelihood of injury decreases,’ says Woyshner, explaining that he has ‘the sleep talk’ with clients all the time – that’s how crucial it is.

    McGrath also emphasises this aspect of training. ‘Don’t sacrifice sleep for running,’ he says. ‘It will be detrimental to your training overall if you start skipping the amount of sleep you need to train more.’ While eight hours a night is a good goal, even more may be useful during marathon training.

    13. Understand your nutritional needs

    As a runner, you don’t need to overthink your nutrition – just make sure you’re topping up on plenty of macronutrients (including protein, carbohydrate and fats) and not dieting in the middle of marathon training.

    Stress fractures, in particular, can crop up when your body doesn’t have enough energy to support all of the physiological functions to keep you in optimal health. ‘When you’re not getting the energy to support your training load, your body takes it from somewhere and the bones are one of the spots that it goes through to get that energy,’ says McGrath. ‘That’s why your bones can get weak, because they don’t turn over quite as quickly if you’re nutritionally or calorically deficient.’

    If you want to get more specific than that, then you could have your blood levels checked with your doctor to make sure you’re not deficient in anything that could contribute to injury risk, like Vitamin D. ‘There’s some debate on this statement, but, in general, we do like athletes to be a little bit higher than the minimum cut-off range [for Vitamin D],’ says McGrath.

    14. Embrace lower intensity runs

    There’s a general rule of thumb that 80 percent of your running should be at a lower intensity and 20 percent at a higher intensity. Like many other running experts and sports professionals, Woyshner says this is a good rule to follow if you want to avoid getting injured while training for your first marathon.

    In fact, Woyshner suggest that you could tip the scales even further in favour of lower-intensity runs as you prepare for your marathon. ‘To avoid and manage injuries while ramping up your training, duration and intensity should be inversely proportional,’ he says. In other words, as your time spent running increases, the intensity of those runs – or your pace – should go down. For example, if you’re increasing your weekly mileage from 10 miles to 15 miles, those extra five miles should all be completed at a lower intensity.

    15. Have fun!

    The biggest marathon training tip McGrath has to offer is this: enjoy the experience. ‘You’re outdoors, you’re running, and it’s probably a bucket list item for most runners,’ he says. ‘So, take advantage of it, have fun with it, don’t take it so seriously and don’t get so hung up on the weekly mileage that you end up getting hurt or injured.’


    What to do if you get injured during marathon training

    All of this said, if you do end up getting hurt mid-marathon training, don’t panic. ‘Your body is undergoing a great magnitude of new stimuli and stressors, especially if this is your first marathon – so a few aches here and there are of no surprise,’ says Burnett.

    Still, it’s best to reach out to your doctor or physical therapist sooner rather than later if you are concerned. ‘Oftentimes, clients do not reach out until things get really bad and then end up missing out on a great window of opportunity for intervention,’ says Burnett.

    McGrath agrees: ‘If there’s any concern or question, it’s always better to have it looked at and find out that it’s nothing versus delaying it and it becoming a bigger problem.’ If you have little, nagging aches and pains, it’s worth switching running for a few days of easy training – such as indoor cycling, swimming or using the elliptical – or to rest completely to see if things improve.

    Signs of a bigger problem that deserve immediate attention include:

    • Recurring pain
    • Pain that progressively worsens
    • Pain that interferes with your training plan
    • Pain that persists beyond several days
    • Pain that is sharp, stabbing or pinpointed

    ‘After ruling out any serious injury or pathology, the right physical therapist can provide a combination of movements to reduce pain and inflammation, as well as strength training exercises to improve the body’s capacity to absorb stress and keep you on pace for your race,’ says Burnett.

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