Marathon Training: 8 Common Running Injuries (and What to Do About Them)
Updated: Oct 12
Somewhere around week eight of marathon training, something starts to hurt.
It might be a knee that grumbles on the stairs, a heel that complains first thing in the morning, or a shin that aches halfway round your long run. If that's you, you're in good company. Running injuries are common in marathon training, and most of them are manageable without giving up your race.
I'm Ben, a physiotherapist who works with runners. Every marathon season I see the same handful of problems, and nearly all of them come back to the same cause. This guide covers the eight I treat most often, how to recognise each one, and how to tell when you can keep running and when to get it looked at.
Why running injuries happen in marathon training
Most running injuries are overuse injuries. They don't come from one bad step. They build up when the load on a tissue rises faster than that tissue can adapt.
Your heart and lungs get fitter in weeks. Tendons, bones and cartilage take months. That gap is where trouble starts: you feel fit enough to run further, so you do, and the slower tissues can't keep up.
The usual triggers are:
Too much, too soon. A big jump in weekly mileage or in your long run.
Too fast, too often. Adding speed work or hills on top of rising mileage.
Not enough recovery. Poor sleep, a stressful week at work, or no easy days.
A sudden change. New shoes, a new surface, or a switch from treadmill to road.
A missed strength routine. Stronger muscles take load off tendons and joints.
The good news is that the fix is usually about adjusting your training, not stopping it.
My approach comes down to three things: manage the load, build strength progressively (plyometrics included), and return to running in graded steps. You'll see that pattern in every injury below.
Knee pain in runners
Knee pain is the complaint I hear most from marathon runners. "Knee pain" isn't a diagnosis, though. Where it hurts tells you a lot about what's going on.
1. Runner's knee (patellofemoral pain)
A dull ache around or behind the kneecap. It's often worse on stairs, on downhills, when squatting, or after sitting with your knees bent for a long time.
What helps: shorten your runs for a couple of weeks, avoid steep downhills, and strengthen your quads and hips. Taking slightly shorter, quicker steps can reduce the load on the kneecap.
2. IT band syndrome
A sharp or burning pain on the outside of the knee. IT band syndrome has a tell-tale pattern: it comes on at a predictable point in a run, gets worse if you push on, and eases once you stop. Downhill running usually aggravates it.
What helps: manage the load first. Cut your runs to just short of the distance where pain starts, and skip downhills and cambered roads for now. Then build hip and leg strength progressively, and step your distance back up gradually.
3. Patellar tendinopathy
Pain at the front of the knee, just below the kneecap, right where the tendon attaches. Patellar tendinopathy tends to be sore at the start of a run, eases as you warm up, then aches afterwards. Hills, speed sessions and jumping make it worse.
What helps: ease back on hills and fast running, and start loading the tendon with slow, heavy strength work such as leg press, squats and wall sits. Tendons need load to recover. Complete rest usually leaves them weaker.
Hip pain in runners
Hip pain in runners can come from several different structures. As with the knee, where it hurts tells you a lot.
4. Gluteal tendinopathy
Pain on the outside of the hip, over the bony point you can feel at the side. Gluteal tendinopathy often hurts when you lie on that side at night, climb stairs, or stand with your weight hitched onto one leg.
What helps: avoid stretching it. Stretches that pull the leg across the body, and sitting with your legs crossed, compress the tendon and tend to make it worse. Sleep with a pillow between your knees, reduce hills, and build up hip strength gradually.
A word on other hip pain
Pain in the groin or deep at the front of the hip is a different story. If it comes on during running and is getting worse, or it hurts to hop on that leg, stop running and get it assessed. Occasionally this is a bone stress injury, and those need proper assessment as well as proper rest.
Lower leg, ankle and foot pain
5. Shin splints
A diffuse ache along the inner edge of the shin bone, usually spread over several centimetres. Shin splints (medial tibial stress syndrome) are most common in newer runners and after a sharp rise in mileage. They often ease as you warm up in the early stages.
What helps: reduce your mileage, swap a run or two for cycling or swimming, and strengthen your calves. One warning: if the pain is in one small spot you can put a finger on, or it hurts at rest or at night, get it checked. That pattern can point to a stress fracture.
6. Achilles tendinopathy
Pain and stiffness in the tendon at the back of the ankle. Achilles tendinopathy is typically stiff first thing in the morning and for the first few minutes of a run, then loosens up. Hills and speed work are the usual culprits.
What helps: cut back hills and fast sessions, and begin calf raises, building up to slow, heavy ones. Like the patellar tendon, the Achilles responds to progressive loading, not rest. Expect this one to take weeks to months, so start early.
7. Plantar fasciopathy
Pain under the heel, at its worst with the first steps out of bed or after sitting for a while. Plantar fasciopathy is the current name for what most people know as plantar fasciitis.
What helps: supportive shoes around the house instead of bare feet, calf stretches, and heel raises with your toes propped up on a rolled towel. Reduce running to a level that doesn't leave your heel worse the next morning.
8. Calf strains and tightness
Not every calf problem is a tendon problem. A sudden grab or pull in the calf mid-run is likely a muscle strain. Ease off for a few days, walk normally, and return with short, easy runs once you can do single-leg calf raises without pain.
Can I keep running? A simple pain rule
You don't have to be pain-free to run. Use this as a guide:
Pain at 0 to 3 out of 10 that settles within 24 hours: generally fine to carry on.
Pain at 4 to 5 out of 10, or still sore the next morning: reduce distance or pace, and swap a run for cross-training.
Pain above 5, pain that makes you limp, or pain getting worse week on week: stop running and get it assessed.
How to avoid running injuries during marathon training
Build gradually. Increase your weekly mileage and your long run in small steps, and take an easier week every third or fourth week.
Keep easy runs easy. Most of your weekly running should be at a pace where you can hold a conversation.
Strength train twice a week. Calf raises, squats, lunges and hip work, adding weight over time. Once that feels solid, add plyometrics such as hops and skips to prepare your tendons for impact.
Change one thing at a time. Don't add hills, speed and new shoes in the same week.
Respect recovery. Sleep and food are part of your training plan.
Act early. A niggle caught in week two is a small adjustment. The same niggle in week ten can cost you the race.
When to see a physio
Book an assessment if:
Pain has lasted more than two weeks despite easing back.
You're limping, or changing the way you run to avoid pain.
There's swelling, or pain at night or at rest.
Pain is in one precise spot on a bone.
Your race is less than eight weeks away and you're not sure what to do.
Don't let a niggle decide your marathon
Most running injuries are fixable, and most runners I see still make their start line. The earlier we catch it, the more of your training plan we can keep.
If something's bothering you, book a running injury assessment at Ben Lombard Physiotherapy. We'll work out what's going on, adjust your plan, and get you to race day.
This article is general information and isn't a substitute for an individual assessment.
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