Most Common Marathon Training Injuries

Marathon season is accompanied by one constant question: “Is this normal?” 

Pain: no. Discomfort: yes. Losing your period: no. Taper anxiety: yes.

But what happens when “normal” gets confused for “common”? Red flags get dismissed, potentially dangerous behavior gets repeated (sometimes encouraged), and small problems get blown out of proportion. While the injuries listed below are common, that does not mean they should be ignored. If you recognize the warning signs, talk to a running specialist healthcare provider and/or come see us as soon as possible. 

This list is based off of my 7 years of working with runners during marathon season:

Bone Stress Fractures

Definition: Tiny cracks in the bone that can lead to anything from bone swelling to a full break

Typical Causes: The truth is all bones are under stress when running, so we can think of boney stress as somewhat normal, until excessive stress is applied to it (overtraining.) Bones break down while running and without enough rest in between stresses, are not able to recover.

Go Deeper: Not enough energy intake and too much energy output forces the body to redirect any available resources to vital organs and muscles. As such, the skeletal, cardiovascular, reproductive, gastrointestinal and endocrine systems can suffer. This leads to a host of symptoms commonly associated with RED-S (Relative energy deficiency in sport).

Warning Signs: Persistent pain; Worsening pain at night; Inability to hop on the affected limb; Previous history of a stress fracture.

See a Doctor If: You have a nagging pain in your hip, lower leg, foot, or quadricep after 1-2 runs. If rest is not helping this pain subside, it’s time to make an appointment to see us.

Stress fractures are extremely serious and need to be treated immediately to avoid bone fractures. 

Posterior Tibial Tendonitis

Definition: An overuse injury of the posterior tibialis muscle and tendon, which runs inside and under your calf. This will cause pain along the shin, ankle, or foot.

Typical Causes: Weakness in other muscles such as the glutes and calf muscles. Because it crosses the ankle to the foot, it is particularly susceptible to overuse with being on your feet and the impact of running. Beyond muscle weaknesses, this injury is also frequently caused by worn out shoes.

Warning Signs: Persistent pain along the inside of your calf 

See a Doctor If: After 1-2 runs and stretching your calves, you still have pain along the inside of your shin and/or ankle. Your training plan will need to be modified to help this pain subside. You can make an appointment with us to address your condition and your training plan.

Iliotibial Band Syndrome

Definition: Tightness and pain at the outside of your knee, with potential for tightness along the hip and thigh. 

Typical Causes: Too much running too soon, not enough strength work for glutes, thighs, and core, jumping right back into a training program after taking “time off.”

Go Deeper: The Iliotibial band runs from your hip to your knee and is a soft tissue structure that gets inflamed, damaged, and irritated with overuse just like any other tendon in the body. It “overworks” to provide stability to your legs when your core, glutes, and thighs become fatigued and are no longer able to provide enough muscular strength or endurance for long periods of running

Warning Signs: Sharp pain and the side of the knee 

See A Doctor If:  You have a sharp pain on the side of your knee that a) flares up every time you go down the stairs and/or b) will not subside with normal rest. You can make an appointment with us to address your condition and training plan.

This list is not an exhaustive list of all possible injuries during marathon training, but a snapshot of what I see the most. If you’re experiencing lingering pain, it is likely that you still need Physical Therapy. Our general rule is: make an appointment if your pain persists past stretching and foam rolling. 

If you have questions about your specific situation, schedule a free virtual consultation to chat with our running specialist physical therapist.