How to Stay Pain-Free During Marathon Training


These expert tips will keep your body running like a well-oiled machine.

David Jaewon Oh

Odds are good that the marathon (or half) you were planning to run this year was pushed to a new date due to the pandemic. Even though you may have to adjust your training, you can still expect all the usual challenges of marathon training including some pains and niggles.

We hate to say it, but it doesn’t matter if you’ve run a dozen marathons or if you’ve just signed up for your first race, at some point during 42.2 km, it’s going to hurt. In fact, recent research based on a survey of 1,251 runners found that most runners experience moderate to severe pain during a marathon, regardless of their biological sex and only weakly related to their marathon race experience, pain during training, and race effort.

This is not to scare you, but rather to help you prepare. You can also anticipate some level of discomfort during a training block from shin splints, and calf soreness to knee aches and even bruised toenails.

But marathon training and racing don’t have to be so painful—especially if you help prep your body for the effort properly. Some of us are hardly plagued by nagging aches or full-blown injuries, and it’s not just stellar genetics and biomechanics that make the difference (though those certainly help). We tapped physical therapists, coaches, and wellness experts to find the best ways to prevent, treat, and eradicate pain.

1. Get a Body Assessment

When you think about it, running is basically like hopping on one leg over and over. So, before you subject your body to a whole lot of impact, consider a Functional Movement Screening (FMS). 

“This is a prerequisite for movement,” says Corinne Croce, DPT, co-founder of Body Evolved, a studio in New York City that bridges the gap between physical therapy and personal training. “We’re really looking at your range of motion, joint by joint, how your body moves. You have to own something passively to have the capability to own it actively.”

When you run, your bigger, stronger muscles compensate for weaknesses and imbalances. A therapist will work you through the major movement patterns: squatlunge, hinge, push, pull, and carry—isolating these exercises so problem areas are revealed. For example, how do your hip, knee, and ankle function in a squat? “If your ankles collapse, running isn’t going to go too well for you over time,” Croce says.

Book one or two sessions with a specialist to get a program tailor-made to your body. Most clinics are offering virtual physical therapy sessions. Reach out to a local or not-so-local space and see if you’re eligible for a one-on-one consultation.

2. Put a Prehab Plan in Place

Physical therapy is almost always reactive; you seek treatment when you’ve pushed too far or too hard—when you’ve developed IT-band syndromeplantar fasciitis, or Achilles tendinitis. What you want to do at the onset of marathon training is be proactive and incorporate “prehab”—a plan that addresses your body’s particular weaknesses and your sport’s demands—before you get injured or experience pain.

With running, you’re dealing with repetitive stress. “The biggest problem we see is people overtrain running and don’t have a strength-training regimen in place,” Croce says. “Physical therapy gives you the capacity to move well, and strength training allows you to use that capacity efficiently so you build a strong foundation,” she adds. 

physical or manual therapist can get your stiff ankle or wonky knee tracking properly so you can perform exercises that will support your joints and make you a stronger, more efficient runner. Also, be sure to diversify your workouts by cross-training (try these activities) to further your fitness without overtaxing your lower body. If you can’t meet with a therapist, commit to a prehab program you can do at home or in the gym. (You can start with the mobility workout of our 30-day Cross-Training challenge). Again, telehealth is surging right now. Make an appointment with a therapist to get some prehab exercises.

3. Commit to the Holy Trinity: Nutrition, Hydration, and Sleep

It never seems groundbreaking, but getting the proper fuel, hydration, and sleep is of utmost importance to minimising pain and injury, says Karli Alvino, CPT, run coach at Mile High Run Club in New York City. 

After a gruelling interval workout or long run, you need recovery foods that’ll reduce inflammation and refuel depleted energy stores, ultimately curbing how long you’re sore and hobbling post-run. When you sleep, all those micro-tears in your muscles get a chance to repair.

But when you’re deprived, that sleep debt can cause muscle breakdown, increases in the stress hormone cortisol, and drops in testosterone and growth hormone levels, according to research published in Medical Hypotheses. What’s more, dehydration can make you more sensitive to pain, found a study published in Psychophysiology. Ensure that you’re drinking plenty of fluids throughout the day, before, and after runs. (These cool bottles can help).

4. Make Mobility a Priority

Mobility affords you a more robust range of running dynamics: powerful knee drive, fluid hip extension, and proper ankle dorsiflexion, says Sinéad Burns, a manual therapist at Performix House in New York City. But don’t confuse it for flexibility. 

Mobility demands muscle coordination and strength, which pay dividends across injury and pain prevention. To do this, add mobility drills (here is a 15-minute workout to try) to your warmup, cooldown, and recovery days. “When you stimulate a muscle, it has a better ability to be active and you gain better access to it,” Croce says. “Your brain needs input for your body to change, so if you just hit your hip flexors with a percussive massage device without doing any mobility drills, not much will happen,” Croce explains.

“But if you follow it up with activation drills, you’ve given your brain a lot of input. To put it in practice with, say, your hip flexors, use a self-massage tool then go through dynamic drills like half-kneeling hip flexor stretch, fire hydrants, hip circles, and clamshells with a resistance band. This mobilizes the muscles such that your brain is more attuned to them.

5. Fall in Love With Foam Rolling

The rule of thumb for foam rolling, Alvino says, is: “Do it all the time. Before a run, after a run, as much as you can tolerate.” There are loads of foam rollers to choose from; find ones in varying sizes (short for body-specific work) and densities (soft if you have a low pain tolerance), with trigger-point features like ridges and knobs that’ll help break up knots.

“Foam rollers provide greater depth and tension because you can lengthen a muscle,” Croce says. “It pulls the fascia through, whereas massage guns are more for local focus points.” 

You might be inclined to use percussion devices such as TheraGun or Hypervolt more because they require less effort than a foam roller, but you get less out of them. They’re more passive ways of working the tissue. Explore the length of your muscles, stopping along restrictions to work out knots. Only spend 10 to 30 seconds on any one spot, then move on, Alvino recommends. 

You can come back to a hot spot, but going overboard can aggravate a muscle more than it can help. Aim for 1 to 2 minutes per body part overall. For hard-to-reach areas like your feet and hip flexors, use a lacrosse or tennis ball, Alvino says. If you have calf or hamstring pain, roll out the arches of your feet; if you’re struggling with runner’s knee or IT band issues, target your glute medius and piriformis (they run along the outside of your butt).

6. Go Back to the Basics With Ice and Heat

“Ice and heat are an underappreciated modality that’s very accessible to the masses, Alvino says. To prime your body, start with 10 minutes of heat—either with heating pads or Salonpas pain patches for problem areas—then do a proper warmup and your workout. 

Post-run, ice muscles with whatever you’ve got on hand—a bag of frozen peas or ice cubes in a seal-proof bag—just make sure you surround it with a thin towel or pillowcase so it’s not directly on your skin. Start with 10 minutes of ice; over time, you can increase to 20 minutes, but that’s the max.

And here’s the fine print: You want to ice immediately—not after you’ve cooled down and commuted home. “When your muscles are really warm, they lose their form, and you’re more susceptible to injury,” Alvino says. “Ice will reduce pain and inflammation, and bring them back to a normal resting state, which is naturally protective.”

7. Get Body Work Done

A physical or manual therapist can do active release therapy and functional range release (deep-tissue work in tandem with stretching and active movement) to target specific pain points, breaking up scar tissue, regaining range of motion, and improving muscle dysfunction, Croce says. This is particularly helpful at the beginning of a training block so you can fix idiosyncrasies before they become problematic.

Massage is helpful on a more global scale. Don’t assume you need to get a deep tissue massage. “If you’re holding your breath or clenching your jaw, your body will trigger a fight-or-flight response and tighten up,” Croce says. 

Acupuncture is also great for addressing tightness and pain. “Chinese medicine believes pain is the result of stagnation in the body,” says Gabriel Sher, director of acupuncture at ORA wellness studio in New York City. “Acupuncture works by inserting needles in specific points to increase blood flow to the area, decreasing inflammation, and speeding up the recovery time.” 

If you’re experiencing low-back pain, needles might be placed in your glutes or upper back to hit trigger points and cause muscles that are tugging on your back to relax. Burns likes to assess a runner’s condition and combine multiple modalities like massage, cupping, and acupuncture to unstick tendons, ligaments, and fascia in one session. But overall, if you’re trying one modality, give it about three to four sessions to see how your body responds. Practitioners will get into deeper layers of tissue each session, and your body needs an accumulation of treatments to result in positive change. “Don’t expect miracles, expect progress,” Croce says. Do bodywork once a month or every six to eight weeks if possible.