Common Distance Running Injuries You Should Know Before Running a Marathon

Here at Body Gears, we treat every patient with a unique approach to identify the source of your issue. With the Chicago Marathon around the corner, our physical therapists are ready for any injury, especially lower extremity pain. Annually, 19.4%-79.3% of long distance runners will have a lower extremity injury, but don’t worry, we are here to help! 



  1. Patellofemoral Pain Syndrome – AKA Runner’s Knee


Runner Knee 300x300 Common Distance Running Injuries You Should Know Before Running a Marathon

Patellofemoral Pain Syndrome (PFPS) is a pain right at the front of the knee and sometimes wrapping around the kneecap – the patella.  Often times, this pain is from the patella rubbing on the femur, the thigh bone, in a dysfunctional way. Think about driving through the snow, you want to stay on the tracks created by the car in front of you. If you veer off those tracks, your tires have to go through the snow and your ride might not be as smooth or safe. The same thing may be happening to your patella! Preventing poor patellar tracking is key to successful marathon training and completion – so make sure ALL of your leg muscles strong and flexible, helping the patella stay on track!


Try This!

  • Clams (could also be substituted with side-lying or standing hip abduction or exercises like a hip hike while standing with one leg on a step)  This exercise is good for activation and strengthening of the gluteus medius and gluteus minimus muscles of the hip. These muscles act to abduct the hip and are often weak in patients presenting with running injuries, including PFPS. The weakness of these hip abductors and the strength of the quadriceps in runners could lead to compression and poor patellar tracking further leading to pain.


  1. Shin Splints / medial tibial stress syndrome

anterior tibialis tendonitis 284x300 284x300 Common Distance Running Injuries You Should Know Before Running a MarathonShin splints are likely the most common runner’s injury but it is very underreported. This manifests as pain along the inside of your shin bone, your tibia. This injury is usually related to overuse – for example, training for a marathon! But don’t fret, your physical therapists at Body Gears can help you figure out why your lower leg is in pain, and don’t be surprised if we discover that the culprit is elsewhere in your body!


Predictors of this injury:

Higher BMI >25


Try this!

  • Ice Cupping: Put 1-4 small paper cups in your freezer filled with water – let them freeze overnight. Once frozen, tear off the top of the paper cup to expose the ice. Apply the ice with decent pressure in small circles along the inside of our shin bone after a run to reduce pain and inflammation


  1. Stress Fracture – usually at the tibia

Runner Knee 1 300x300 Common Distance Running Injuries You Should Know Before Running a MarathonShin splints gone wrong – a tibial stress fracture from long distance running is not an easy feat. This injury is painful. More severe cases require orthopedic boot wear and minimal weight bearing for up to 12 weeks to allow proper healing of the tibia – the shin bone.


It is important to note that stress fractures of other parts of the leg could result from long distance running including metatarsal fractures, talus fractures, or calcaneal fractures. These injuries are serious and need to be investigated. The “no pain no gain” mentality is NOT appropriate of these injuries to exist.


Try this!

  • Planks (can be progressed to a number of plank variation or exercises like bird-dog in plank position where you are lifting one arm/leg off the ground while maintaining the stable plank position) This exercise is great for trunk stability which is necessary during running. The legs need a stable base to work from when running in order to have optimal gait/biomechanics. When core stability is not present the leg can be predisposed to injury and your body has poor force attenuation – poor ability to absorb the shock from the ground. If you are poorly striking the ground and not taking on the force due to lack of core engagement, it is possible for your bones to be overstressed


  1. IT Band Syndrome

13272256300x300 300x281 Common Distance Running Injuries You Should Know Before Running a MarathonYour Iliotibial Band is a fibrous chain of connective tissue that travels from the outside of your hip to the outside of our knee. This band can become tight, can become adhered down to other tissues, or can roll over the outside of your hip (your greater trochanter) and lead to pain and dysfunction. This pain may even be felt at your knee because the band itself crosses both the hip and knee joint. Sometimes, the IT Band is a contributing factor to low back pain, as well. This is definitely a band worth listening to – don’t push past your pain here, have it checked out!


Helpful hint:

Sometimes over-rolling your ITB on a foam roller actually INCREASES your ITB discomfort!


A simple test for IT Band syndrome:

Thank you Physiopedia for this break down of Noble’s Test for IT Band Syndrome!

Try this!

  • Dynamic warm up exercises can be used prior to running, or prior to completing an interval session after warming up. Ideas for this include exercises such as high knees, high kicks, butt kicks, swinging leg front to back or side-to-side while holding onto a fence, etc. See our Warm Up article here!
  1. Plantar Fasciitis

Runner Knee 3 201x300 Common Distance Running Injuries You Should Know Before Running a MarathonPlantar fasciitis is inflammation of the thick band like tissue on the bottom of your foot. This inflammation can lead to the limited play of the fascia creating pain and poor mobility of the small foot joints.


A tell-tale sign of plantar fasciitis:

Pain in the morning in the bottom of your foot with your first few steps


Are you getting the right care you need to manage your plantar fasciitis?

Check out this Body Gears Post for more information about Plantar Fasciitis


  1. Achilles tendinopathy

Runner Knee 5 300x300 Common Distance Running Injuries You Should Know Before Running a Marathon

The achilles tendon connects your calf muscles to your heel bone. This tendon can get inflamed or even partially torn if it is overworked the wrong way. Having an appropriate balance of ankle plantar and dorsiflexion (lifting and pointing your toes), knee flexion and extension, and hip flexion and extension during running is essential for preventing achilles tendinopathy. For example, if you have excessive ankle plantar flexion range and strength, but limited hip flexion during running, you’re spending a lot of time pushing the ground behind you with your foot instead of pulling your leg up and forward from your hip. This extra strain at your ankle joint can lead to achilles pathology.


Predictor for this injury:

History of ankle sprains

History of past achilles injury


  1. Hamstring Strain

Runner Knee 6 300x300 Common Distance Running Injuries You Should Know Before Running a MarathonA major predictor of a future hamstring strain is muscular strength and weakness. Individuals who have too strong of quads and too weak of hamstrings are more likely to injure the hamstrings. When we run, we tend to think of only the muscles in the front of our body pulling us forward. To prevent hamstring strains, we must think about the muscles in the back of our body that push us forward during running.


Try this to help!

  • Squats (progression of partial squat not going fully to 90 degrees of knee flexion full squat single leg squat/other squat alternatives like deadlifts) Squatting is a great exercise for strengthening the “posterior chain” muscles of the legs especially the hamstrings and gluteus maximus. These muscles are critical to running as they function to propel the body forward in the push-off phase of running. Weakness and improper motor control is commonly observed in these muscles in runners presenting to physical therapy. Deficits in gluteus maximus strength and activation can lead to common gait deviations such as femoral internal rotation which has been correlated to injuries such as patellofemoral pain syndrome.
  • Bridging (can be progressed to single leg, if a swiss-ball is available this can be used to further advance the exercise and hamstring curls can be incorporated if desired)

Similar to squats, this exercise mostly strengthens the hip extensors. It is good for isolating and strengthening glute max as it places the hamstrings in a shortened position since the knee is flexed throughout the movement. If desired the hamstrings can be targeted by using a swiss-ball to bridge up in a knee extended position or by adding a hamstring curl onto the movement. This exercise also incorporates trunk stability, especially when progressed to using something like a swiss-ball.


And there you have it! 7 common running injuries. Your Body Gears physical therapy team is ready to take them on, and so much more! Listen to your body as you train and prevent these injuries from getting worse or throwing off your big day. Best of luck and happy running!



Van Gent RN, Siem D, van Middelkoop M, et al. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med 2007;41:469–80

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