This is the 3rd article in my series on marathon training and its all about how to prevent, recognise and treat running injuries. Marathon training is an incredible journey, but it’s important to remember that running puts stress on your body. While running injuries can happen to anyone, there are steps you can take to minimize your risk and effectively manage them when they do occur. You can read about the preventative measures listed below in more detail in the previous articles in this series. Article 1  is about getting fit before embarking on marathon training. Article 2 is about the benefits of having a marathon plan. You can also read my (Very long) post on the 7 Principles for Running Injury Free.

Preventing Running Injuries:

• Gradual Progression: This is the cornerstone of any successful training plan. Gradually increase your weekly mileage and intensity over time to allow your body to adapt. The 10% rule is an easy one to follow – don’t increase your weekly mileage by more than 10%. For example, if you currently run 20 miles per week, aim to increase your weekly mileage by no more than 2 miles the following week.
• Prioritize Easy Runs: Most of your weekly mileage should consist of easy runs at a conversational pace. These runs help build your aerobic base and allow your body to recover. Again, the rule of thumb here is 80% of your runs should be easy.
• Strength Training: Incorporate strength training exercises into your routine, such as squats, lunges, glute bridges, and calf raises. This helps build muscle strength and stability, which can reduce your risk of a running injury. The ideal strength program for runners is actually heavier weights and lower reps, which is a surprise to most runners, but this needs to be managed carefully, and it’s always best to get advice from a professional, especially if you are new to the gym
• Cross-Training: Include low-impact activities like swimming, cycling, or yoga in your training schedule. This helps improve overall fitness and provides a break from the repetitive stress of running.
• Proper Footwear: Invest in high-quality running shoes that provide adequate support and cushioning. Replace your shoes regularly to ensure they are providing the necessary support
• Listen to Your Body: Pay attention to any aches or pains. Don’t ignore them! Rest when you need it, and don’t hesitate to adjust your training plan if necessary. The older we get the more recovery time we may need. You should also prioritise sleep.
• Warm-up and Cool-down: Always warm up before each run with light cardio and dynamic stretches. Cool down with gentle stretching after each run.
• Proper Nutrition and Hydration: Fuel your body with a balanced diet and stay hydrated throughout the day.

Recognizing Overtraining:

Overtraining occurs when the demands placed on your body exceed its ability to recover. Common signs and symptoms include:

• Persistent fatigue: Feeling unusually tired even after rest.
• Decreased performance: Finding it harder to maintain your usual pace or complete workouts.
• Increased resting heart rate: Your heart rate is higher than normal when you are at rest.
• Changes in sleep patterns: Difficulty falling asleep, frequent waking, or poor sleep quality.
• Increased susceptibility to illness: Frequent colds, flu, or other infections.
• Changes in mood: Increased irritability, anxiety, or depression.
• Loss of appetite or significant weight loss.
• Muscle soreness that doesn’t improve with rest.

If you experience several of these symptoms, it’s crucial to reduce your training load or take a complete break from exercise for a few days or weeks.

Common Running Injuries:

Despite your best efforts, it is an unfortunate reality that injuries are a really common experience for many marathon runners. Below is a very brief list of some of the most common ones to look out for

Foot and Ankle Injuries:

• Plantar Fasciitis: Pain in the bottom of the foot, often worse in the morning.
  – Recovery: Rest, ice, stretching (especially calf stretches), supportive footwear, and potentially orthotics.
• Metatarsalgia: Pain in the ball of the foot.
  -Recovery: Rest, ice, supportive footwear, metatarsal pads, and strengthening exercises for the foot.
• Achilles Tendonitis: Pain and stiffness in the Achilles tendon.
  -Recovery: Rest is crucial. Ice the affected area regularly. Gentle stretching exercises for the calf muscles can be helpful. Supportive footwear can provide relief. In some cases, physical therapy may be necessary.
• Shin Injuries:
  -Stress Fractures: A tiny crack in the bone caused by repetitive stress (These can occur in the feet too). Often presents with sharp, localized pain, especially during weight-bearing activities.
  -Medial Tibial Stress Syndrome (MTSS): Inflammation of the tissues surrounding the tibia (shinbone). Pain is typically more diffuse and may feel like an ache or soreness along the shinbone (used to be called shin splints).
  -Recovery: For both, rest is crucial. Ice, compression, and elevation may be helpful. Differentiating between stress fractures and MTSS can be challenging and often requires imaging studies like X-rays or bone scans. If you experience persistent shin pain, it’s crucial to consult with a healthcare professional for proper diagnosis and treatment.

Knee Injuries:

• Runner’s Knee (Patellofemoral Pain Syndrome): Pain around or behind the kneecap, often worse when going downstairs or running downhill – perhaps the most common running injury.
  -Recovery: Rest, ice, strengthening exercises (quadriceps, hamstrings), and potentially physical therapy.
• Iliotibial (IT) Band Syndrome: Pain on the outside of the knee, often caused by overuse.
  -Recovery: Rest, ice, stretching (IT band stretches), foam rolling, and strengthening exercises for the hips and glutes.

Thigh Injuries:

• Quadriceps Strains: Pain and weakness in the front of the thigh.
  -Recovery: The RICE protocol (Rest, Ice, Compression, Elevation) is crucial in the initial stages. Gentle stretching should be introduced gradually as pain subsides.
• Hamstring Strains: Pain and weakness in the back of the thigh.
  -Recovery: The RICE protocol is essential. Gentle stretching should be introduced gradually as pain allows. Strengthening exercises for the hamstrings are important for preventing future strains.

Adjusting Your Marathon Goals:

The severity of the running injury will significantly impact your training and race goals.

• Minor Injuries: Minor injuries, such as mild plantar fasciitis or a minor hamstring strain, may require adjustments to your training schedule. You might need to cross-train more, reduce mileage temporarily, or adjust your long run distances. You may still be able to participate in the marathon, but you may need to adjust your goal to a more realistic time or simply focus on finishing the race.
• Moderate Injuries: Moderate injuries, such as moderate strains or sprains, may require a significant reduction in training or even a temporary break from running. You may need to consider adjusting your race goal to a less ambitious time or even deferring the race to a later date.
• Severe Injuries: Severe injuries, such as stress fractures or ligament tears, may necessitate withdrawing from the marathon altogether. Prioritizing your long-term health and complete recovery is crucial in these situations.

Seeking Professional Help:

Consulting with a qualified healthcare professional is crucial when dealing with running injuries. Osteopaths and Physiotherapists specialize in musculoskeletal conditions and can accurately diagnose your injury, develop a personalized treatment plan, and provide guidance on returning to running safely. They can also offer valuable advice on injury prevention strategies.
By prioritizing injury prevention and seeking professional guidance when needed, you can increase your chances of a safe and successful marathon experience. Ben Posen, the author of this article is an osteopath who specialises in running injuries. He is also a qualified UK athletics running coach. To make an appointment with Ben go to www.hampsteadosteopathy.com and click book online.

Disclaimer: This information is for general knowledge and informational purposes only and does not constitute medical advice. Consult with a qualified healthcare professional for diagnosis and treatment of any medical conditions