Common Marathon Injuries

Running a marathon is one of the ultimate challenges for runners, and it is both highly physically and mentally demanding. Runners spend months training and preparing for this test of endurance, and in some cases, this intense period of training can result in a number of potential injuries.

Injuries during training can be not only painful but very frustrating, leading to setbacks in training or in some cases preventing participation in the big day itself. Awareness of common marathon injuries, their causes and how to avoid them is an integral part of marathon preparation.

common marathon injuries

Runner’s Knee

This is perhaps one of the most frustrating and common marathon injuries amongst runners. Patellofemoral syndrome; or more colloquially termed runner’s knee, is typically characterised by a dull pain around the front of the knee, where the knee joint connects the femur and tibia bones. The kneecap itself may feel tender to touch and pain is often exacerbated during movement. It can sometimes cause sensations of weakness and instability and it may feel as though there is some sort of rubbing or grinding with some people hearing clicking sounds of the kneecap.

Runner’s knee can be a result of a number of factors. It is often associated with poor biomechanics and imbalances such as poor running stride and technique and a lack of adequate foot support. Other triggers are muscle weakness in the thighs, tight hamstrings, or a tight Achilles tendon. Excessive training can also exacerbate symptoms.

Rest, ice, compression and elevation, pain relief medication and physiotherapy are recommended forms of treatment. A physiotherapist can help to treat symptoms by introducing specific stretches, targeted strengthening exercises and hands-on manipulation techniques, as well as helping to evaluate running style, gait, and footwear. Shockwave therapy may also be useful. 

Achilles Tendinitis

Another painful disorder often associated with distance running is Achilles Tendonitis. The Achilles tendon is located at the back of the heel, its function is to connect two of the major calf muscles to the back of the heel. If the Achilles tendon becomes inflamed or injured, it can cause painful symptoms which may vary in intensity from mild to severe, in some cases, the heel may appear visibly swollen. Achilles tendinitis is often caused by overuse of the tendon, this becomes more likely during marathon training where runners increase the frequency and intensity of exercise.

Symptoms may worsen when walking, running, climbing stairs or when standing on tiptoes. Treatment is usually in the form of self-care, modified rest, pain relief medication and physiotherapy. Targeted exercises and stretches can help to strengthen the muscles of the surrounding area, and a physiotherapist will also be able to analyse biomechanics and determine if there are any other supportive changes that could be made in terms of running style, footwear and so forth.

Shin Splints – Medial Tibial Stress Syndrome

Shin Splints are a massive inconvenience to runners and one of the most common marathon injuries. They are caused by inflammation of the muscles, tendons, and bones around the tibia and are usually characterised by a dull aching pain along the shins that becomes progressively sharper, causing severe pain and discomfort when running.

Some runners develop shin splints due to overuse, unsuitable footwear, flat feet, muscular tightness or due to a muscle imbalance.

Ice and pain relief medication can be helpful to calm down any acute episodes and physiotherapy may be very useful in providing specific strengthening exercises and activities. Hands on manipulation may also help to relieve symptoms.

Plantar Fasciitis

Plantar fasciitis is inflammation of the plantar fascia; a tough band of fibrous tissue that runs along the sole of the foot, connecting the heel bone to the toes and supporting the arch of the foot. It plays an important role in normal foot biomechanics during walking and running. When inflamed or irritated, it causes pain around the arch of the foot, the heel, and the bottom of the foot. Some people may find the pain worse first thing in the morning.

There are a number of potential triggers for Plantar fasciitis, one of the most common is exercising on hard surfaces. This is more likely during marathon preparation as runners increase their training and are likely to run on roads and footpaths. Other associated causes include inappropriate footwear and a sudden increase in the level of activity. Recommended treatment usually includes physiotherapy, strengthening exercises and stretches with a review of training routine and technique, massage therapy, ice, pain relief medication and shockwave therapy.

Iliotibial Band Syndrome – ITB Syndrome

ITB syndrome describes an injury that produces painful symptoms typically felt around the outside of the knee. The iliotibial band is a thickened band of tissue that runs along the length of the outside of the thigh. Its function is to help keep the knee joint stable. Inflammation and irritation of the IT band occurs when the band rubs repeatedly against the thigh bone, causing painful symptoms which can hinder progress considerably during marathon preparation. Common symptoms include sharp pain around the outside of the knee; upon palpation, the knee may be tender and there may be visible swelling. Pain is often described as an aching or burning sensation, that worsens during movement and exercise.

Common causes of ITB syndrome include a sudden increase in exercise intensity, long-distance running and some types of ground, hard or uneven ground, for example. Tightness of the IT band, weak muscles, a discrepancy in leg length and running style may also play a role.  Treatment aims to reduce pain and inflammation via pain relief medication, ice, and physiotherapy.

Stress Fractures

This is a painful type of injury, characterised by a small crack or severe bruising to the bone. Stress fractures are usually the result of severe overuse and overload when the muscles are unable to absorb impact and transfer the overload of stress to the bone.

Stress fractures often occur as a result of a sudden increase in activity level, where the muscles are not strong enough, or adapted to tolerate the sudden increase in impact, and the bones also have not had sufficient time to strengthen and adapt to the increase in load, making them more susceptible to fractures. Osteoporosis and the menopause can also increase the likelihood of stress fractures and activities such as running or sports that involve a lot of jumping, are more commonly associated with stress fractures.

During marathon preparation, depending on the individual, doing too much too soon could potentially cause stress fractures to the weight bearing bones of the lower leg and foot. These are not only extremely painful but get worse over time and will inevitably delay or even bring training to a halt.  Treatment for stress fractures usually involves resting and refraining from activity until the bone has repaired itself.


Chafing on the inner thighs, groin, armpits and nipples can cause great discomfort during marathon running and training. To avoid the pain of chafing, lubricant can be applied to the skin before running, and any clothing with a seam on the inner thigh should be avoided. It is better to wear breathable tight-fitting clothes than looser clothes.

Muscular Strains, Tears & Cramps

During training, strains, tears and cramps of the muscles are commonly cited injuries that occur due to when they are pushed to work beyond their limits. Building muscular strength slowly and steadily with regular stretching and remaining well hydrated is key to avoiding muscle-related problems. Massage therapy can help to improve circulation, which is beneficial to the muscles during training, and physiotherapy can help to condition affected muscles.


Blisters, corns and bunions may sound small and insignificant, but they can quickly transform a steady run into a truly miserable experience and seriously hinder performance on the actual day. Suitable footwear, padding and bandages can help to ease the discomfort of blisters.

How Physiotherapy Can Help With Common Marathon Injuries

Physiotherapy can be invaluable during marathon training. A well-qualified physiotherapist can devise a tailored marathon training program to improve overall performance, providing specific strengthening exercises and stretches to help the body to safely manage the excessive load, enhance performance whilst reducing the risk of potential injuries and other problems. Sports massage and other therapies may be recommended throughout preparation, depending on individual requirements.

The bespoke training program will also include a thorough physical analysis of gait, body type, running style, foot pronation etc. helping to identify and subsequently improve any weak points or unhelpful habits such as poor posture, poor running style, inflexibility, joint-related problems and weak muscles. Individual lifestyle, occupation and day-to-day routine will also be taken into consideration when devising the training program.

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For help and advice on marathon training and how to avoid injuries, or for information on any of our other services, get in touch today.




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