Each year in the United States, approximately half a million runners complete a marathon…
…and it has been reported that during marathon training or racing up to 80-90% of those runners sustain a running related injury.
Often, for many runners, completing a marathon is the culmination of months of hard training and the completion of a lifelong goal. Runners sign up for a marathon for many reasons including weight loss, improved health, to overcome mental demons and “past-selves”, and to challenge their bodies to their physical limits.
No matter the reason you’ve signed up for a marathon, one factor is common across nearly all runners: you need to stay injury free if you’re going to complete the training and make it 26.2 miles to the finish line.
Running a marathon should be fun, exhilarating, uplifting, and the experience of a lifetime. But, to cross the finish line with arms open wide, a smile on your face, and the adrenaline pumping through your veins in victory and elation you will need to make it safely through marathon training.
This guide is designed to help you avoid the most common causes of running related injuries so that you can safely complete a marathon training plan, and have the BEST marathon race experience.
Are You Physically Ready to Train for a Marathon?
This is probably the most overlooked and undervalued aspect of a safe marathon training experience. It’s so easy to just grab some shoes and start working towards a finish line with little to no training, but the stress of a marathon is often underestimated by novice runners.
A vast number of free plans are available for the novice and seasoned marathon runner. All it takes is a quick online search, and you have pages of plans to pick from, right at your fingertips.
However, just because a training plan exists doesn’t mean every runner is ready to start at week 1. Even when a training plan starts “slow” it will not take into account your current fitness and health. Even a 1-mile run feels different for every runner and will have different effects on the body based on previous training and overall health.
There is no uniform test of marathon training readiness. Science doesn’t have definitive variables on what fitness levels are needed as a baseline to begin a training program. However, although no concrete data exists, there are relative benchmarks with sound injury avoidance theory.
To safely begin a marathon training plan, you should:
- Run consistently for 6 months (although 1 year is better) before beginning
- Have completed a 5k and 10k race without injury
- Be able to comfortably run 12-15 miles per week
- Have a clean bill of health from your primary care doctor
- Have no current injury that affects your ability to run
Most marathon training plans begin with a weekly mileage of 10-15 miles. Your body needs to already be adapted to at least that mileage before starting a training plan. Since most training plans progress weekly or every other week, a base is critical to avoid ramping weekly volume too quickly.
Novice runners sustain injuries at a higher rate than more experienced runners. Like all sports, you need to practice running so that your body can adapt to the physical demands of the movement. Especially if you’re starting a walk-to-run program, don’t ramp the mileage too fast. Take your time to build up to the 10-15 miles per week needed to start a marathon training program. This is the literal application of phrase “it’s a marathon, not a sprint”!
Although there is no “gold standard” safe mileage increase per week, the general rule of a 10% increase per week has stood the test of time. Sharp spikes in weekly mileage volume or running intensity are strongly linked to running related injuries, so it’s essential to stick to a steady and predictable increase.
Running is a high volume, high impact, repetitive sport that requires significant cardiovascular endurance, strength, dynamic stability, and mental toughness. Often, it’s not the marathon race itself that produces the abnormally high injury rate, but rather the 16-24 weeks of marathon training leading up to the race.
A common concept in avoiding running related injuries is awareness of your injury threshold or injury risk. In the graph above, the vertical variable is “intensity” and the horizontal variable is “frequency”. The area above and to the right of the sloping line indicates a higher risk of injury and the area below or to the left of the line indicates a safe training zone.
Runners tend to get into trouble from two specific scenarios.
- High frequency (too many training days per week) with moderate intensity
- Running at too high an intensity a moderate amount per week
“Junk miles” place you in either of these two injury risk categories. Junk miles occur when you run too slow on your speed/interval runs and too fast on your long slow distance days. In the first scenario, you aren’t running fast enough to produce an effective training benefit and in the second scenario you aren’t running slow enough to build an aerobic base and you end up over-straining your body.
To keep things basic, if you’re going to run long slow distance, you actually need to run SLOW. If you’re going to do speed/interval work you should run fast and limit the frequency of sessions or duration.
Here, like in all aspects of life, the 80/20 rule applies where 80% of your runs should be long slow distance and 20% of your runs should be speed/interval. This is surprisingly difficult to achieve for most runners.
Key Components to Avoiding Injury During Marathon Training
If you have met the starting criteria listed above and you’re ready to start full-on marathon training, here are the essential elements to avoid a running related injury during training.
- Weekly Volume
- Run Frequency
- Training Intensity
- Strength Training
- Proper Running Form
- Functional Warm Ups
- Stick to the Plan!
Each of these factors needs to be balanced with the rest of your training plan and mental game. There are unique training problems that arise when you start to change the plan or start to rely more heavily on one of these items than others.
There have been many studies conducted to try and pin down a concrete correlation between the number of miles run per week and injury risk. So far, there are no direct ratios; however, there are plenty of studies that show a plausible link between weekly running miles and injuries.
In multiple studies, running over 40 miles per week seems to increase the risk of sustaining a running related injury. This is especially true if you run more than 40 miles per week for a period greater than 3 months.
On the other hand, running less than 15 miles per week is also associated with a higher risk of injury. Since lower weekly running volume is associated with more novice marathon runners, these studies show that runners with greater overall running experience (more years of running training) have a lower risk of injury.
Although no consensus exists on running volume per week, it would appear that running between 20-40 miles per week for marathon training is associated with less injury risk. Elite runners who have years or decades of running training under their belt can likely run more miles per week with less injury risk.
Running frequency refers to how many days per week you run or how many running sessions total you perform per week.
An increased risk of injury was found with runners who ran only one time per week and with runners who trained 6-7 days per week. It seems running 2-5 times per week is ideal for safe marathon training.
When accounting for frequency with weekly running volume it appears that total miles run per week is a better predictor of injury risk than running sessions per week. For instance, running a low number of miles many times per week versus a large number of miles a few times per week ends up with the same total of miles run.
By keeping track of your weekly running volume via a journal or app you can monitor the 10% rule and reduce your risk of running related injury.
Surprisingly, there have been few objective studies on how training intensity affects injury risk. Part of the limitation comes from how runners track intensity.
One way to track intensity is via an “average pace” per run. This can be calculated by dividing total time by total miles. This gives an overview of intensity but fails to take into account the minimum and maximum of running speed in a given workout.
Another common way of assessing training intensity is using a “rate of perceived exertion” scale. By rating how hard each running session was on a scale of 1-10, you can track your exertion and effort over time.
Despite having no objective metric for running intensity, common sense would suggest that a higher volume of high intensity running sessions per week with little rest would increase risk of injury.
This has yet to be proven or disproven in research, so the best advice would be to track your weekly volume, frequency, AND intensity and listen to your body. (Pick one means of denoting intensity and stick to it for consistency in your records.) If you feel run down, fatigued when waking in the morning, or unmotivated to run again, these are signs you might be pushing your body beyond a safe progression.
In a given week, it’s advised to vary the type of running workout to achieve more optimal results. Most training plans will alternate long slow distance, track speed work, fartlek, tempo, and interval runs. Each of these workouts addresses a different energy system and uses different paces per workout. Variability in weekly running workouts has been shown to decrease injury risk versus uniform same pace running.
Marathon training demands a great deal of energy, strength, and endurance. Running just one mile requires, on average, 1500 steps with a loading rate of 2-3x your body weight every step! That is a great deal of force for your muscles, tendons, and joints to sustain for 26.2 miles, let alone the hundreds of miles leading up to the race itself.
As your weekly running miles increase, you need to build a “recovery phase” in to your running plan. There are many forms of recovery and each runner needs to find what medium works best. Recovery could be a weekly yoga class, Pilates for core training, nightly foam rolling for tissue lengthening, or a professional sports massage. These are all ways to keep your muscles firing in top form and to avoid the aches and pains from overuse.
Especially after long runs on the weekends, your body will benefit from “active recovery” to improve blood flow and speed muscle healing. Active recovery could involve cross-training such as cycling or swimming or just a fast walk around your neighborhood. The goal here is to do something different than running that is low impact, easy on your body, but still active enough to get your heart rate up to mobilize needed recovery elements to your tired muscles.
To have a successful marathon training cycle and race, strength training should be incorporated into your weekly workouts. Although not often performed by marathon runners, strength training has been shown to limit injuries and improve running economy.
Strength training, which you only need to perform twice per week for 20 minutes to have a positive effect, has been shown to improve tendon stiffness, muscle loading capacity, and improves neuromuscular coordination and control which improves movement quality.
Exercises like squats, deadlifts, step ups, are examples of strength training drills that have proven beneficial for improving running performance and decreasing injury risk. Believe it or not, the real benefit of these drills comes from performing high weight- low repetition lifts. This is likely a foreign idea for most marathon runners and might even cause some fear just thinking about the weight room at the gym!
Start small with kettle bells and free weights and work your way up to barbell squats and deadlifts. Consult with your local running specific physical therapist or personal trainer to help design a running specific strength program.
Strength training for marathon runners is a true win-win. Strength training will decrease your injury risk AND help improve your marathon performance! (You just have to talk yourself into the weight room first.)
Proper Running Form
Poor running mechanics are strongly linked to the high injury risk in marathon runners. During a weekend long run it’s not uncommon to take 15,000 steps or more! If you’re not using your joints and muscles optimally, you’re accumulating unnecessary wear and tear over each of those steps.
Even small changes in running form can cause issues. Proper running biomechanics involves coordination and alignment of the spine, pelvis, hips, knees, and feet. When any of these structures are out of alignment it will cause wear and tear on muscles, tendons, cartilage, or your joints.
Running is a single leg sport, meaning there is never a time in running when two legs are on the ground at the same time. It’s therefore essential for marathon runners to have optimal single leg alignment control and balance.
More often than not, marathon runners don’t practice single leg running form drills or any running form drills at all! Just like when your car is out of alignment it will cause your tires to wear faster, running out of alignment will cause faster wear on your body.
Drills such as Bulgarian split squats will help to train proper balance and symmetry. Working with a running specialist will help to design a specific program for running form drills. It is also very helpful for a running coach or physical therapist to provide training on your running form itself. This could be working on your cadence, trunk lean, or correcting an over-stride. All runners can improve on their form, and in doing so, will substantially decrease injury risk while improving efficiency.
Functional Warm Ups
Most runners wake up in the morning, lace up their shoes, and start running. Often, there is little to no warm up besides running slow for the first 5 minutes of the run. Although slow running or even walking is better than nothing for a warm up, there is a better, more functional and beneficial way to get your body ready for a run.
Ideally, you want to be sweating a bit before you start running. This will ensure your leg muscles have the blood flow and your joints have the lubrication needed for efficient comfortable running. If you feel “clunky” and stiff in your first mile of running it means you haven’t given your body enough time to prepare for running.
Using a loop band around your knees for bridges, gluteal activation drills such as clam shells and leg raises, and monster walks are all great warm up drills. Using your glutes, quads, hamstrings, and calves will help stimulate blood flow and get you sweaty before your run.
The added benefit of working your gluteal muscles is that your brain will be “primed” to use these muscles during your run. This is key since your glutes are key stabilizing muscles for your hips and knees.
Stick to the Plan!
Most marathon training plans are designed in a specific way to avoid spikes in running mileage, avoid over-training, and to peak at the optimal time for your marathon. Each run has a purpose and a plan that will provide the best marathon training experience (when followed).
Here’s the problem…runners can be stubborn and often don’t follow the training plan completely! This is especially true with long slow distance runs and speed runs.
It has been noted that runners tend to run too fast on recovery and long slow distance runs and too slow on speed and interval runs. Observational studies have compared training programs designed by coaches to data from individual workouts and found the inconsistencies noted above.
This reflects back to the comment earlier to avoid “junk miles.” If you’re going to run slow for distance or recovery you actually need to run slow to receive the benefit. If you’re going to run fast for speed or interval work, you actually need to run fast to receive the benefit. When you end up in the middle, you miss out on the full benefit. Plus, recovery runs are designed to be slow on purpose for tissue healing. When you run too fast for these drills your body never gets the needed healing it needs for additional training and you sabotage future workouts.
Listen to your coach and follow your training plan. You will decrease your risk of injury and increase the chances of making to your marathon in top shape!
What to Do If You Get Injured
Using the specific tips in this article will help you to avoid injury and run strong at your marathon. If the injury bug happens to bite (and sometimes it does no matter how diligent you are), here are a few keys to avoid being down for too long:
Seek Professional Help
If you have an injury that keeps you from running or makes you alter your running form with a limp, seeing a running specific physical therapist should be your first step. Physical therapists who specialize in running biomechanics can quickly diagnose the CAUSE of the problem and design a running specific plan to keep you running as much as possible while fixing the issue.
Solve the Root Problem
It’s imperative to address the root of the problem and not just manage the symptoms. Tight muscles and strains are common with marathon running, and while foam rolling and stretching can help, a physical therapist will help you figure out WHY certain muscles are strained or overused and will develop a focused plan for correction, rather than relying on temporary fixes.
Running re-training, the process of using real-time feedback to optimize running form, has been shown in research to have an immediate benefit in decreasing issues such as knee pain, back pain, and ITB syndrome. A running specific physical therapist will use running re-training to get you back to your training fast.
Consult Your Coach
If your injury is causing you to decrease your running volume, talk to your running coach. Your coach will be able to adjust your mileage to get the most benefit without worsening your injury. If you don’t have a coach, consider decreasing your training by a uniform percent, say 10-20%, so that when you ready you can build back up in set percentage intervals and not rush back into training.
Focus on the Long Haul
When injured, be sure to do your recovery work each day. This could be banded glute activation and strength work, stretching, core work, or foam rolling. When you’re injured, your main goal should be getting back to running ASAP which means daily work.
Remember that this daily work, even though it’s not running, is setting you up for running success. If your training has to be temporarily scaled back, it can feel like your season is over before you even started. Keep your mental game strong, focus on recovering into a more powerful runner (who’s less likely to be injured in the future), and get back to your training even stronger and ready to go.
Time to Work!
This article covered a lot of ground. There’s no shortage of planning, hard work, and adaptability that goes into making it to the starting line of a marathon.
If you find yourself overwhelmed trying to address all the aspects of training, build yourself a support system. Find a running coach, work with a physical therapist, and make sure you have supportive friends and family around you for the hard days. The online running community can be a treasure trove of connection, commiseration, and encouragement. You’re not alone!
If you follow the advice outlined here, you have a much better chance of making it to not only the start, but the finish, injury free and with a sense of pride and accomplishment.
Kevin Vandi, DPT, OCS, CSCS
Dr. Vandi is the founder of Competitive EDGE Physical Therapy — with his background in physical therapy, orthopedics, and biomechanics, he is a highly educated, compassionate specialist. Using state-of-the-art motion analysis technology and data-driven methodologies, Kevin has assisted a wide range of clients, from post-surgery patients to youth and professional athletes. When he isn’t busy working or reading research, he spends his time with his wife Chrissy and their five wonderful children, often enjoying the outdoors and staying committed to an active lifestyle.