It's reassuring to know, when training for a marathon, that the risk of injury can be mitigated and, with the right approach, you can increase your chances of crossing the finish line injury-free.
Listen to your body
This point cannot be stressed enough; your inner voice and bodily sensations are an inbuilt tool for injury prevention. For example, if you feel a little irritation or pain in your achilles when running, acknowledge it. This could be a warning sign for a much bigger problem. This could be your body telling you you’re increasing your speed too quickly or maybe you have weakness in your calf and it's causing excessive load on your achilles. Research has also found that running through pain can produce compensatory biomechanics and increased stress on other joints, possibly increasing your risk of a secondary injury due to this change in running gait (1). If this happens, reduce back the speed and try some calf-strengthening exercises. If the pain does not reduce in intensity and it’s hindering your marathon training, get checked by a physiotherapist.
Stick to the plan
The golden rule of marathon training is to stick to a marathon training plan. Firstly, this takes away the stress and pressure of planning your runs. A typical marathon training plan is 16-20 weeks long and will involve 3-5 runs per week. The plan should guide you to gradually progress your miles which will allow your body and tissues to adapt gently as your miles increase. Sticking to the plan will help reduce the risk of an overuse injury which is common in runners who increase their distance, speed, or intensity beyond their tissue's capacity to handle this increase. You can find running coaches to write you bespoke plans or use apps (we like Runna!)
Warmup
Many people skip this important part of marathon training due to tight schedules, juggling work, and finding time for family and social life as well as a rigid marathon training programme. However, warming up before your run may help to reduce your risk of injury. The best type of warmup is often debated with research showing that static stretching may not be as useful as it doesn’t really translate to the biomechanics of running. A more effective running warmup should be more dynamic and focus on preparing your muscles, tendons, and joints with the task of running. This might involve A-skips, walking lunges, vertical jumps, standing hip-in-out circles, quick running forward and backwards, hip swings, and inchworm walk-outs (1,2).
Running Shoes
It is important when training for a marathon that you invest in a good pair of running shoes as this may reduce your risk of running-related injuries and improve your running efficiency (3). Studies have shown that excessive foot pronation [foot collapsing inwards] is a risk factor for achilles tendinopathy, medial tibial stress syndrome [shin splints - more on that here], patellofemoral pain [pain at the front of the knee] and plantar fasciopathy (pain at the heel) (4). It is important to note a small amount of pronation is normal but if it is excessive, this can increase stress on the foot, lower leg, and knee. Therefore, it is thought that a shoe that counteracts this overpronation may reduce the risk of running-related injury. Motion control shoes have features that aim to reduce excessive foot motion, limit pronation, and increase the efficiency of the foot during the push-off phase of running. A research study in 2021 recruited three 372 runners. One group received a standard neutral shoe, and one group received a motion-control shoe. The study found that the runners wearing the motion-control shoes had a lower risk of pronation-related running injuries when compared with runners who wore standard neutral shoes (4).
When running our body is subjected to ground reaction forces of up to 2-4 x our body weight (5). It is thought that by having a shoe that offers a high amount of cushioning it may reduce ground reaction force and modify foot motion. Research confirmed this in a large study that took 848 participants and randomised them into two groups. Group one received a highly cushioned shoe, and group two received a stiffer and harder shoe. The group that received the stiffer shoe had an increased risk of injury over a 6-month period (6).
There are many different brands and shoes on the market and comfort is also key. I would suggest buying shoes from a specialist shop, where the staff are trained to help you buy a shoe that is suited to your foot posture, running style, and biomechanics. Once you find your perfect running shoes, it can be hard to think about replacing them, but over time your shoes will begin to break down and offer less support. You should be thinking about replacing your shoes every 300-500 miles depending on the brand and durability.
Strength training
Strength training is a must for any runner whether you are training for a 5k or a marathon as the benefits are huge on running economy, performance, and injury prevention. A recent study took 433 runners and split them into two groups. One group was given an 18-week strength programme that included single-leg squats, lunges, side planks, hip abduction, bird dog, and resisted foot supination. Group one was also asked to foam roll their plantar fascia, their quads, hamstrings, calves, and shins. The programme took 30 minutes to complete, 2 x per week. Group two were asked to continue their normal running training. The study found that those who were highly compliant with the strength and foam rolling intervention had a huge 85% reduced risk of injury (7). This study is a great example to show that strength exercises do not need to take a huge amount of time and can be completed at home to get the benefits of injury prevention.
Hamstring injuries are common in runners and are known to occur in high-speed running or when there is excessive hamstring lengthening whilst running. A systematic review [a study of all the available evidence] found that the risk of hamstring injuries can be mitigated by adding a Nordic hamstring exercise into your strength training programme 2 x per week. The study found this would reduce the risk of hamstring-related injuries by a huge 51% (8).
Plyometric exercises have also been shown to improve efficiency, neuromuscular control, tendon stiffness, joint position sense, and postural control and therefore improve performance. A plyometric programme will commonly include variations of drop jumps, tuck and scissor jumps, squat jumps, countermovement jumps, and hopping. Research has also found that plyometric exercises when combined with strength training may reduce injury risk by correcting any neuromuscular imbalances that may pre-dispose injury (1,9).
Not sure where to start with incorporating strength programming into your running? Check out our running webinar ‘Eat, Run, Lift’.
Running form
Optimising a runner’s form can be highly valuable in the case of an injury, to improve running performance or to avoid flaring up a persistent injury. However, I would not stress about having a “perfect” form to avoid injury, if you are managing well with no injuries or issues then your form is most likely right for you. It is important to understand that there is a “textbook” running form but most runners one way or another will deviate from this. If you’re not sure, take a look at professional marathon runner Priscah Jeptoo’s running style, she has a notable valgus knee and her hips adduct to the midline, yet she has won multiple Marathons.
However, I do advocate maintaining a tall and upright posture and relaxing your shoulders. Think about bringing your shoulders back and down; this will open your chest and allow for nice deep breaths. A hunched-over posture will constrict the ability of the lungs to fully inflate and prevent the respiratory muscles from shortening and lengthening optimally. This will potentially reduce your efficiency as you will fatigue at a quicker rate.
Nutrition
Finally, don't forget about nutrition. Amping up your mileage means you’re increasing your energy output which needs to be replaced with sufficient calories to keep your body healthy and primed for training. The most important factor here is to make sure you’re eating enough. This doesn’t mean obsessing over calories but ensuring before and after your runs you’re fueling appropriately (and intra-workout on longer runs!) but also fuelling across the day and on non-training days. Make sure you’re including sufficient carbohydrates to replenish your glycogen stores, protein to help repair and build muscle - and healthy fats too, including omega-3 fatty acids, which can support regulating inflammation. Find out more about fuelling any length of run in our running webinar ‘Eat, Run, Lift’.
Conclusion
Unfortunately, injuries are common in runners training for a marathon and increasing their distance. Ultimately you will never be able to completely escape the risks of injury as injuries are a fact of living a healthy and active lifestyle. However, you can protect your joints and muscles by following the tips above. If you do struggle with an injury during your training, please speak to a physiotherapist for an assessment and plan to get you safely back to your marathon training.
