Marathon Injury Prevention

Marathon Injury Prevention

Running is accessible, convenient, affordable perhaps even, primal. Thus, running endures as the principal source of exercise for many. The health benefits from running are numerous. But running can lead to injuries, and every year plenty of people are forced to withdraw from the London Marathon because of injury. Here’s how you can find out what injuries are most likely and what can be done to steer clear of them.

Typically, risk factors for injuries are split into two types by doctors. The first are “intrinsic factors.” These are risk factors that are personal to the runner and might protect or predispose them to injury. “Extrinsic factors” are any outside forces that could affect the runner.

However, I think it is more helpful for recreational runners to split injury risk factors into “training related” and “general health and lifestyle.”

What are the common injuries? – Hips, Knees & Feet

“Runner’s knee” or “patellofemoral pain” is the most commonly diagnosed injury and several studies note the knee is the most common site of running injury. Weak hip muscles have been shown to be associated with runner’s knee as well as iliotibial band syndrome, another common running injury. It’s a bit of a chicken and egg problem though as to what comes first, the knee pain or hip weakness. We do know hip strengthening can help knee pain in runners, but it has yet to be proven that hip strengthening can prevent these injuries.

Foot injuries affect between 5 and 39% of long distance runners. They are the most common site of injury in female recreational runners and commonly effect marathon runners.

Training Related Injury Avoidance

Make sure you have a good training base from which to undertake your big event. Training errors are a frequently cited cause for injuries in runners, though some of the evidence is conflicting. Nevertheless, training errors are of paramount importance to address because while you cannot change your injury history you can change your training programme. Avoid sudden increases in training distance or intensity. Increasing training hours incrementally each week has been found to protect recreational marathon runners against foot injuries. In a study of people training for a 10k event, it was found those who attended a group session of steadily increasing distance each week but did not also do the suggested solo runs in between were more likely to suffer injuries than those who trained steadily including the solo runs. So don’t miss out on your midweek training!

Studies into different “training errors” are hampered by the fact that it is extremely difficult to isolate one particular factor. For example, intensity and volume of training are inextricably linked so it can be difficult to say which of these factors cause more running injuries. Some training errors do stand out in the scientific literature though. Large training distances of more than 64km per week have been strongly associated with injuries.

Experience over Talent

Studies suggest that experienced runners are less likely to suffer injury. Seasoned runners may reduce the risk of injury by being more “in tune” with their bodies than novice runners. On the other hand, it might be that more experienced runners have been toughened up by their hours pounding the tarmac and report fewer injuries. So, it’s difficult to determine which training errors are most significant, aside from running greater than 64km per week. A bespoke graduated training programme that recognises past experience, risk factors and goals tailored to the individual is likely to result in the least number of injuries.

Running Old Gracefully

Studies in military personnel have linked increasing age with running injuries. This is not the case in studies of civilians where older age has been found to have a protective effect. It is thought that with experience comes a better understanding of one’s body and a wherewithal that allows the more mature athlete to develop sensible training habits.

It’s Not About The Shoe

Who doesn’t love new shiny trainers? But can they make you run any better? Well, now there is scientific proof that new shoes do help – but only for women! A study in runners preparing for a 10k showed that wearing new running shoes helped women avoid injury, whilst men were better off in well-worn running shoes. But before you ladies go out and buy a fancy new pair of trainers and you blokes assess whether yours are of a sufficient vintage, it is important to note that despite numerous ‘innovations’ in running shoe design over the past four decades, injury rates in runners have not changed much over this time. There is now emerging evidence that runners can intuitively select running shoes that are most comfortable for them and that this inherently reduces injury risk. There have even been some studies suggesting that shoes designed to increase foot stability can actually be injurious. Furthermore, different running shoes have surprisingly little effect on the path of leg movement. This suggests that runners naturally adapt to different running shoes without compromising their stride too much.

Do give some consideration to your work shoes too. Tight fitting shoes may increase the risk of bunions, corns and callouses which will not help you run.

Rough Terrain

Road-runner or park running grass-lover? Interestingly, there has been no compelling research to suggest that running on any particular surface or terrain has a significant impact on rates of injury. However, running on rough or slippery terrain will certainly increase the chance of an ankle injury.

Carrying An Old Injury Niggle?

Previous injury has, perhaps unsurprisingly, been found to be a risk factor for injury. From the scientific studies, it is not certain whether this is because of incomplete recovery, an individual predisposition to that injury or an abnormality in running action. However, it would seem sensible to ensure that any injury has been completely rehabilitated before starting a training programme or competing in the London Marathon. A good doctor or physio should be able to check you’re ready to run again and make sure any predisposing factors are addressed too.

Swim Or Cycle Your Way To A Better Race Time

General lack of physical fitness has been associated with increased risk of injury in runners, although the majority of studies that demonstrated this were in the military. It does highlight the importance of having a good basic level of fitness to prevent injury. Given that a strong predictor of injury is miles on the clock, a useful way to increase fitness and avoid overuse injuries could be to ‘cross-train’ in other activities that build aerobic fitness such as swimming and cycling. Although this was not confirmed to reduce injury rates in runners training for a marathon there is good reason to believe it may help. Other sports may strengthen some of the muscles not activated as much by running and avoid the forces transmitted through the legs pounding the pavement.

Injury Free Diet

The main dietary consideration in preventing running injuries (as opposed to fuelling) is the prevention of stress fractures. Female runners with a high dairy intake have been found to be at significantly lower risk of stress fractures, but there has been some dissenting evidence of the impact of low calcium diets in case control studies of stress fractures. However, a prospective study has shown that higher intake of dietary calcium is associated with higher bone mineral density and more importantly lower rates of stress fracture. Medication use may also be significant. For example, pain-killers or anti-inflammatories may mask symptoms of an injury which can lead to it inadvertently getting worse by continued training.

Foods that help reduce inflammation may help reduce the risk of tendinitis. These include Turmeric (perhaps in a Turmeric Latté), Green tea extract (best found in Matcha green tea or EGCG capsules) and Omega Fish Oils.

Getting To The Start Line

So, to get to the start line of the London Marathon injury free start by listening to what your body is telling you. Wear whatever running shoes are most comfortable for you. Ensure you are completely rehabilitated from previous injury. And then enjoy.


Dr Hugh Coyne