Marathon Running Injuries

Running a marathon is quite an achievement and whether you have done several or are just about to embark on your first marathon it is important to know how to manage and avoid injury along the way! In the last 10–15 years, there has been a dramatic increase in popularity of running marathons, since 2000 there have been many more running events created globally and particularly ones that are focused at women. Unfortunately one of the downsides of running is the risk of injury, some studies have reported an injury incidence rate of 90% in those training for a marathon (reported in the journal of Sports Medicine in 2007). Sudden increases in intensity of training or load particularly once 40miles/week is reached increases the risk of injury. It has been recognised that following a graded training programme and allowing for plenty of recovery reduces the likelihood of injury.


The most common injuries are often associated with the knee, anterior knee pain (otherwise known as patellofemoral syndrome), Iliotibial band friction (ITB) syndrome, other injuries include tibial stress fractures, plantar fasciitis, Achilles tendonitis and meniscal injuries of the knee. We are going to discuss a few tips and pointers that prevent anterioir knee pain and ITB syndrome developing.

What is Anterior Knee Pain?

Anterior knee pain is pain that develops at the front of the knee or patella (around the kneecap), it is often a dull achey pain often felt behind, below or at the sides of the patella.

There are many different types of anterior knee pain:

  • Patella tendinitis – patella tendon becomes inflamed and tender (situated under the knee joint and inserts into the tibia)
  • Patella maltracking – instability and poor tracking of the patella (kneecap) on the knee joint
  • Quadricep tendinitis – pain and tenderness over the quadriceps tendon attachment to the patella
  • Lateral compression syndrome – patella tracks more to the outside of the knee (pulling on the kneecap)
  • Chondromalcia patella – softening of cartilage under the kneecap.

Often the cause is related to an individual’s biomechanics and the patella (kneecap) is unable to effectively move properly therefore causing friction/rubbing. This can occur due to:

  • Tightness or weakness in the surrounding muscle groups
  • Overload/too steep an increase in running mileage or activity
  • Type of exercise – loading/weight bearing/jumping
  • Kneecap is in abnormal position (poor alignment)
  • Flat feet/poor foot biomechanics

Other risk factors include:

  • Excessive weight
  • Previous injury/trauma to kneecap
  • Teenagers – (growth spurts)
  • Over exercise

How to help with AKP:

  • Rest
  • Improving lower limb biomechanics – seek professional help – Podiatry for assessment of foot posture/insoles if required
  • Good training shoes – suitable for sport
  • Strengthening areas of weakness – particularly pelvic instabilities – glut muscle work
  • Stretch tight areas e.g. hip flexors, hamstring, quads, calfs and ITB
  • Alter your programme – DO NOT overtrain/overload
  • Core strengthening – add Pilates as part of you training programme for reconditioning and improving muscular balance
  • Seek medical/physio advice
  • Swelling – GP anti-inflammatories
  • Weight loss if over-weight
  • Taping


  • Deep knee bends/squats
  • Downstairs can aggravate
  • Downhill running
  • Standing or sitting for prolonged periods

If you have been experiencing any of the above why not come and see us in clinic for assessment with either physio or podiatry or possibly both! The good news is AKP is reversible and can be significantly improved with adjustment to your exercise routine and advice, the correct exercises for rehabilitation and muscular balance and alignment can make a big difference.

What is ITB syndrome?

Iliotibial band (ITB) syndrome is the most common cause of lateral knee pain in runners. It is caused by repetitive friction of the ITB over the lateral epicondyle and is classed as an overuse injury.


  • Excesive running in the same directione.g. track/downhill
  • Increased load and mileage
  • Weakness in gluteal muscles (Imbalances in muscles and poor control around the pelvis)
  • Altered lower limb biomechanics
  • Excessive soft tissue tightness and myofascial restrictions

How to help with ITBS:

  • Reduce inflammation (PRICE) medication if required
  • Stretching programmes
  • Soft tissue and myofascial release
  • Strengthening and improving muscular balances
  • Activity modifications/revision of training programmes
  • Appropriate footwear/podiatry assessment if required
  • Stride length and gait changes

With any of these type of injuries it is important that at the early stages of feeling a niggle you seek professional advice as what is a small problem initially can build to be a problem that will prevent you from running the marathon longer term. “Pushing through it” is not really an option when it comes to marathon training. It is much easier to get on top of the issues early doors and prehabilitate rather than waiting for the injury to potentially get worse.

Pilates – Strengthen those Hips!

More often than not with running injuries related to lower limb biomechanics there is some degree of weakness or instability around the pelvis/hip therefore it is important to strengthen. Use the following exercises to help strengthen around the hip.


1. Side leg kick – level 2:

side lying make sure you are in neutral spine, bend the bottom leg and lift the top leg out straight, float the leg forwards pointing the toes and then float the leg back in the same plane of movement flexing the foot.  Repeat x 15 (both sides)






IMG_8419 2. Squat with magic circle/resistance:

standing with your feet approx hip width apart, imagine you are sitting on a chair. As you squat gently press into the circle/resistance band and you should feel your gluts working as well as your quads. Repeat x 10







IMG_83433. Single leg Scooter – standing on one leg only extend the other leg behind you – focusing on your deep abdominals and keeping your lower back and pelvis in alignment. Push the leg back behind you as if you are pushing into the wall. Repeat this x 10 on one side then do the other side.

This exercise is great for hip stability, core and balance control – a real winner!




As all professional runners will tell you injury prevention is as much a part of the training programme as running itself! Everyone is individual too and we all have very different lower limb biomechanics so what works for one won’t necessarily work for another.  A consultation to get to the bottom of your specific issues is always recommended so your physiotherapist or podiatrist can devise an individualised home exercise programme or intervention just for you. For further information or appointments visit our website: