How to Avoid Injuries During Marathon Training, According to Experts

Physical therapists and doctors offer advice to keep you from getting sidelined ahead of race day.

2023 boston marathon
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Whether you just signed up for your first marathon, or you’re considering doing so, you probably have a lot of questions. While training for 42.2 comes with tons of physical and mental benefits, the pursuit can also lead to aches, pains, and more serious injuries.

In fact, one 2021 study out of the Mayo Clinic, found that 30 percent of marathoners reported race-related injuries. And separate research found that 40 percent of runners reported an injury during training for the New York City Marathon and 16 percent said they got injured during or immediately after the same marathon.

One more bummer before we get into the good stuff (stick with us!): Most injuries occur in novice runners, per Brett Woyshner, P.T., D.P.T., owner of Woysh Lab LLC in Tampa, Florida. “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 on to the happier news! We have more than a dozen tips from experts on how to avoid injuries during marathon training. First, we’ll dive a little deeper into how first-time marathoners end up sidelined, along with the most common types of injuries among them.

The Most Common Causes of Marathon-Related Injuries

“Far and away, training errors are the most common cause of injury in marathoners,” says Sara Filmalter, M.D., a family medicine physician at Mayo Clinic in Florida and one of the authors of the Mayo Clinic study on injury rates.

To get more specific, poor adherence to or inconsistency with a training program—or simply undertraining—could lead to injury, per Courtney Burnett, P.T., D.P.T., with Bespoke Physical Therapy in New York City. “Examples of this would be rapidly increasing weekly training volume, ignoring or skipping progressive increases in weekly mileage, lower peak weekly training mileage, or a lack of variety in running workouts,” she says. Burnett adds that she’s seen many runners be super committed to their weekend long runs while neglecting the rest of the training plan—to their detriment.

Woyshner agrees that ramping up mileage too quickly is the easiest way to get hurt. Biomechanical issues, including mishaps in form, can also be to blame, he adds.

Other culprits, according to Burnett: not paying attention to nutrition and not integrating strength training and recovery days into your training.

The Common Types of Injuries for First-Time Marathoners

There do appear to be some commonalities between types of injuries and novice runners, according to the experts. “It seems to be those gradual onset soft tissue-related injuries, like tendonitis, bursitis, that sort of thing,” says Todd McGrath, M.D., primary sports medicine physician at Hospital for Special Surgery in New York City.

In terms of specific body parts, Woyshner most often sees runner clients with issues related to the achilles tendon, anterior (front) knee, patellar tendon (connects knee cap to shin bone), IT band (runs along outside of leg), 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 injuries to the foot. “In my clinical and personal experience, the most common diagnoses include patellofemoral pain syndrome (a.k.a. runner’s knee), iliotibial (IT) band syndrome, plantar fasciitis, Achilles tendonitis, and stress fractures,” she says.

Finally, Burnett adds that injuries to the knee and ankle regions followed by the hip are most common for marathon runners she sees. This includes ankle sprains, Achilles tendonitis, medial tibial stress syndrome (a.k.a. shin splints), runner’s knee, IT band syndrome, bone stress fractures, and muscle pulls or strains of the quadriceps, hamstrings, and calves.

15 Tips for Avoiding Injury While Training for Your First Marathon

All that might sound like a lot, but a few simple strategies will help you avoid injuries during marathon training. Here’s what the experts suggest:

1. Decide If 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 program (i.e., ‘I don’t have enough time’), or they did not realize the impact nutrition, hydrationrecovery, 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 percent in all aspects of marathon training. “If you are, great! You are 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 program,” she says.

2. Pick a Solid Training Plan

“Runners can decrease their chance of injury by following a well-thought-out training plan,” says Filmalter, adding that injury can occur with both overtraining or undertraining.

Specifically, you’ll want a plan that ramps up mileage appropriately and builds in various run types with rest days.

3. Do an Old Injury Audit

While you’re spending some time reflecting and researching training plans, also consider any past injuries you’ve dealt with, says Burnett. Factoring in some targeted exercises to bolster those areas can be a great way to start off on the right foot, maybe literally: If you’ve had plantar fasciitis in the past, for example, work on some foot-strengthening exercises every week during your training. If you’ve experience knee pain, maybe it’s time to add banded glute work to your schedule.

“If you are unsure if a past injury may impact your training, definitely take a trip to your local physical therapist,” Burnett suggests. “We can help you identify any areas of weakness or imbalance and set you up with a program to tackle these areas before you start increasing your weekly mileage.”

4. Invest in the Right Gear

“Be sure to have proper running shoes,” Burnett emphasizes. “You’d be surprised by the number of clients I’ve had who try to run on old or ill-fitting shoes or insist on a certain running shoe brand that isn’t right for their unique needs,” she says. “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 an endurance base so that the first week’s mileage is already a comfortable distance when training starts. “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 training compared to the usual 16 to 18 weeks.) “That’s a really important thing to do so that you come into [race training] relatively fit.”

6. Strengthen Key Muscles

“Strength training is an often ignored and extremely important aspect of successful race completion,” says Filmalter. In addition to any specific body parts you’ve historically had issues with, hip stabilizer weakness is a frequent culprit underlying running injuries, she says. “Strengthening hip abductors and external rotators can help to prevent injury.”

And of course, you’ll want to have a holistic strength-training plan in place, whether that’s bodyweight moves or a gym-based routine.

7. Take Actual Rest Days

“In my experience, endurance athletes don’t like staying still for too long,” says Burnett. Some people might see a rest day on their training plan but decide to get in some extra kilometres anyway, but proper rest days are crucial: “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, adding that rest days can also help 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 with the running community and learn as much as you can from people’s experience around you,” says Woyshner, whether you run with friends or join a local run club. “Your experience is going to be different from the person next to you, but the more knowledge you’re able to learn from someone else’s journey, you can take that and adapt it for yourself as you’re starting your running journey.”

Not to mention, running with others comes with a lot of other benefits, including accountability and support.

9. Go for a Gait Analysis

Woyshner recommends every runner, whether you’re new or experienced, consider a gait analysis to get familiar with how your body moves.

You can also search for a gait analysis near you more generally—Woyshner recommends looking for a “3D” analysis, which uses three cameras to show the body moving in all three planes of motion. Or check with local physical therapists and other movement specialists like doctors or trainers. (He cautions against getting a gait analysis at a running shoe store where you’ll be less likely to be helped by someone with a background in biomechanics.)

“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. From there, he prescribes exercises they can do to avoid this fate.

Other takeaways that he might give a client include that their knees are “collapsing” inwards when they run, or that they’re a “bouncer” (they move too much vertically compared to horizontally), or that they overstride. With this knowledge from a gait analysis, you can incorporate appropriate exercises into your schedule to help you sidestep aches, pains, and injuries.

10. Consider Your Stride Length

Speaking of overstriding, while Woyshner reiterates that a gait analysis is super individualized, one tip he finds himself giving over and over to help runners prevent injury is to increase their cadence and shorten their stride.

“I’ll tell them to try to contact the ground as much as they possibly can within X minutes [this would increase your cadence number], getting comfortable with how quickly they contact the ground,” 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.”

While this is also a metric unique to each individual, you can get a sense of your cadence via wearables or just by counting your steps per minute. Woyshner says that “ideal” cadence will vary based on a number of factors but somewhere in the 150 to 160 steps per minute range would be a good general rule of thumb. That number may go up to 180 for some people.

11. Keep Tabs On Your Data

Speaking of wearables, Woyshner is a big fan of them, whether it’s Apple Watch, Oura Ring, Whoop, or something else. “I love wearables because they can track your weekly mileage and your stress, whether that’s work-related or from a long intense run,” he says.

Woyshner uses his Whoop data to adjust his runs and workouts based on his recovery score, which may help prevent injuries. “If I wake up tomorrow and my Whoop shows a red recovery and I have a 16-kilometre run planned, I’m going to listen,” he says, adding that in this case, he may just run 8 kilometres and then ride the bike for a half hour.

Even if you don’t have a wearable that gives you this type of score, you can do your own self-audit in the morning. For example, if you have a 12 kilometre run on your schedule but you’ve been dealing with minor knee pain for the past three days, slept five hours, and have been crazy-stressed at work, your injury risk is going to skyrocket, he says. Adjust your plans accordingly or consider swapping the 12-kilometre run for a rest day.

12. Sleep More Than Usual If You Can

A 2014 study in the Journal of Pediatric Orthopaedics found that student athletes sleeping 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,” Woyshner says, explaining that he has “the sleep talk” with clients all the time—that’s how crucial it is.

McGrath also emphasizes 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

“I typically recommend paying attention to what you’re eating, trying to eat a well-balanced diet, and don’t skip out on macronutrients unless you have some medical reason or personal beliefs around that,” says McGrath.

You don’t need to overthink it: Make sure you get plenty of energy (read: calories and macronutrients including protein, carbs, and fats) and don’t diet in the middle of marathon training, he says.

Stress fractures, in particular, can crop up because of low energy availability, which is when your body doesn’t have enough energy to support all of the physiological functions that keep you optimally healthy. “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,” McGrath says. “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, 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 cutoff range [for vitamin D],” says McGrath.

14. Embrace Low-Intensity Runs

There’s a general rule of thumb (outlined in Matt Fitzgerald’s book) that 80 percent of your running should be at a lower intensity and 20 percent should be at a higher intensity. Woyshner agrees this is a good rule to follow for injury prevention while training for your first marathon.

He adds that you may even want to tip the scales further in favor of lower-intensity runs as you ramp up your mileage. “To avoid and manage injuries while ramping up training, duration and intensity should be inversely proportional,” says Woyshner. In other words, as your time running ramps up, the intensity of those runs (or pace) should go down. For example, if you’re increasing your weekly mileage from 16 kilometres to 24 kilometres, those extra 8 kilometres should all be at a low intensity.

15. Have Fun!

The biggest tip McGrath has to offer: 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 get too hung up on the mileage week to week and end up getting yourself hurt or injured.”

What to Do If You Get Injured While Training for Your First Marathon

All of this said, if you do end up getting hurt, don’t panic, says Burnett. “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,” she says.

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

McGrath adds that if you have little nagging aches and pains, you can take a couple of days of easy training (think swimming or cycling) or completely off 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 program
  • 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, and strength training to improve the body’s capacity to absorb stress [to] help you overcome an injury and keep you ‘on pace for your race,’” Burnett says.

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