Marathon Series – Common Training Injuries, Why They Happen, and What Can You Do to Fix It

Annually, up to 79% of long-distance runners will sustain a lower extremity injury, but don’t worry, we are here to help! Here at Body Gears, we treat every patient with a unique approach to identify the root of the issue. With the Chicago Marathon around the corner, our physical therapists are ready to help you with any injury with minimal to no disruption to your training schedule.


Patellofemoral Pain Syndrome
AKA “Runner’s Knee”

Patellofemoral Pain Syndrome (PFPS) is an umbrella diagnosis but is generally characterized by pain at the front of the knee and sometimes wrapping around the kneecap (patella).  Often times, this pain stems from the patella rubbing against the thigh bone (femur) where it’s not supposed to. Preventing your patella from tracking off course is key to staying on course with your marathon training. There are generally two root causes of poor patellar tracking or you could have a combination. The first is an imbalance in your quadriceps muscles. As the name suggests, there are 4 muscles that make up the quadriceps and they all attach onto the patella. If one is stronger than the others or one is sluggish to turn on, the patella will get pulled off course. The second common cause is hip muscle weakness that results in the knee caving in (knee valgus). When the femur angles in, it changes the line of pull on the patella, increasing the likelihood of it getting pulled painfully off course.


Pain in the front of your knee? Try this!

Runners Knee Marathon Series   Common Training Injuries, Why They Happen, and What Can You Do to Fix It

Stand with one foot on the edge of a step and the other foot floating next to it. Be sure to have a wall or railing nearby if you lose your balance. Keeping both knees straight and without leaning to the side, tilt your pelvis by relaxing and contracting your glute muscles so your floating foot goes below the step then above the step (try 2 sets of 10). See if you can hold your pelvis level for 30 seconds with both feet at the same height (you should feel this in the glutes of your stance leg). If you’ve mastered this, try doing a mini single leg squat, making sure to keep your pelvis level. 


Medial Tibial Stress Syndrome
AKA “Shin Splints”

Though underreported, medial tibial stress syndrome is likely the most common runner’s injury. It’s characterized by pain and often tightness along the inside of your shin bone (tibia). This injury is usually related to overuse – for example, training for a marathon! But don’t fret, our physical therapists at Body Gears can help you figure out why your lower leg is in pain. Don’t be surprised if we discover that the culprit is elsewhere in your body, there are too many potential causes to make blanket statements for this diagnosis. A thorough assessment of your running technique will also be required to get to the real root of the problem.


Pain in the front of your shin? Try this!

Shine Pain Marathon Series   Common Training Injuries, Why They Happen, and What Can You Do to Fix It

Ice Massage: Place some small paper cups filled with water in your freezer and let them sit overnight. Once frozen, apply the ice with decent pressure in small circles along the inside of our shin bone after a run to reduce pain and inflammation. As the ice melts, continue tearing the top of the cup away to expose more ice. Icing this area with continuous motion is preferable to leaving an icepack on your shin since areas with prominent bone can become too cold too quickly.


Stress Fractures

Shin splints gone wrong – a tibial stress fracture from long distance running is not an easy feat. This injury is painful and more severe cases require orthopedic boot wear and minimal weight bearing for up to 12 weeks to allow for proper healing of the tibia.  Stress fractures in different parts of the foot that can result from long distance running include metatarsal fractures, talus fractures, and calcaneal fractures. These injuries are serious and need to be investigated. The “no pain no gain” mentality is NOT appropriate when these injuries to exist. A couple tell-tale signs of a fracture are an inability to bear weight and/or exacerbated pain with vibration (eg. taping the bone away from the suspected fracture site or a bumpy car ride). 


Worried about developing a stress fracture? Try this!

Palloff Marathon Series   Common Training Injuries, Why They Happen, and What Can You Do to Fix It

The Pallof Press is great for trunk stability which is necessary during running. Be sure to keep a neutral spine and prevent twisting as you bring your hands in and out from your chest while holding tight to the stretchy band (try 2 sets of 10 facing both directions). Your legs need a stable base to move from in order to run efficiently. When there’s no core stability, the legs can be predisposed to injury from poor shock absorption. You can also try this exercise standing on just your outside leg to better mimic running.


IT Band Syndrome
Also AKA “Runners Knee”

Your iliotibial (IT) band is a fibrous sheath of connective tissue that spans from the outside of your hip down to the outside of our knee. IT band syndrome is characterized by precise pain at or just above the outward facing side of the knee. Sometimes, the IT band can contribute to lower back pain and other hip and knee conditions as well. This is definitely a band worth listening to – don’t push past your pain here, have it checked out!


Pain on the outer side of your knee? Try this!

IT Band Marathon Series   Common Training Injuries, Why They Happen, and What Can You Do to Fix It

Sometimes over-rolling your ITB on a foam roller actually INCREASES your ITB discomfort! It’s no use stretching it either because your IT band doesn’t contain contractile units so it doesn’t get tight. The tensor fasciae latae (TFL) it attaches to on the other hand is a contracting muscle that sure can become tight and can also respond well to stretching. Try crossing your leg behind the other and jutting your hip out towards a wall to stretch your TFL for 30 seconds.


Plantar Fasciitis

Plantar fasciitis is an overuse injury and the name refers to inflammation of the thick band-like tissue on the bottom of your foot. However, recent research has found collagen degeneration and disorganization rather than inflammation leads to pain and reduced mobility of the fascia that can then affect the small joints of the foot. A tell-tale sign of plantar fasciitis is a pain in the morning in the bottom of your foot with your first few steps out of bed. The plantar fascia helps to support the arch and keep it springy. If the rest of the support structures are too springy, the foot flattens out and can overstretch the plantar fascia. On the other hand, if the other support structures aren’t springy enough, the plantar fascia can be forced to absorb too much weight. Not only are there several causes of plantar fasciitis within the foot, but there can be contributing factors elsewhere in the body, even including an issue with your hip control.


Pain in the bottom of your foot? Try this! 

Plantar Faciitis Marathon Series   Common Training Injuries, Why They Happen, and What Can You Do to Fix It

Calf muscle tightness can be a significant contributing factor to plantar fasciitis but stretching often provides only short-term relief. Instead, try strengthening your muscles in their lengthened position by doing eccentric heel raises. Drop your heel off a step until you feel a stretch, then perform a heel raise. Slowly lower back down to your starting position for 3 sets of 10.


Achilles Tendinopathy

The Achilles tendon connects your calf muscles to your heel bone. This tendon can get microtears or become partially torn if it’s overworked the wrong way. You might also hear this condition referred to as Achilles Tendinitis, which indicates an inflammatory pathology, but the jury’s still out on the amount of inflammation that actually occurs within injured tendons. The safer suffix is -pathy which generally indicates a condition, disease, or disorder. Having a good balance of flexion and extension in your ankles, knees, and hips while running is essential for preventing Achilles tendinopathy. For example, if you have limited hip flexion while running, you’re spending more energy pushing off the ground behind you with your calf muscles to swing your leg forward instead of pulling your leg up and forward with your hip. This extra load at your ankle joint could lead to Achilles pathology.


Pain in the back of your ankle? Try this!

Plantar Faciitis Marathon Series   Common Training Injuries, Why They Happen, and What Can You Do to Fix It

Research has found that the best way to heal a tendon is with eccentric exercises, meaning a strengthening exercise for a muscle as it lengthens. You can generally think of these as deceleration exercises. Drop your heel off a step until you feel the start of a stretch, then perform a heel raise. The eccentric part is when you fight gravity to slowly lower your heel back down to your starting position for 3 sets of 10.


Hamstring Strain

A major predictor of a future hamstring strain (apart from having a previous hamstring strain) is having a muscular imbalance. In particular, individuals who have very strong of quads and comparatively weak hamstrings (often referred to as being quad dominant) are more likely to injure their hamstrings. When we run, we tend to think of only the muscles in the front of our bodies pulling us forward. To prevent hamstring strains, we need to focus more on the muscles in the back of our body (posterior chain) that push us forward while running. 


Pain in the back of your thigh? Try this!

Lunge Marathon Series   Common Training Injuries, Why They Happen, and What Can You Do to Fix It

Lunges are a great exercise for strengthening the posterior chain muscles of the legs, especially the hamstrings and gluteus maximus. These muscles are critical as they function to propel the body forward in the push-off phase of running. Lunges more closely mimic running than squats (though these are still a great exercise for runners!) and there are endless variations and progressions you can try, including walking lunges and jumping lunges, as well as adding sliders or a Bosu ball.

  And there you have it! 7 common running injuries. Your Body Gears physical therapy team is ready to take on whatever you come in the door with, whether it’s on this list or not! Listen to your body as you train to prevent these injuries from occurring and be sure to seek help at the first sign of trouble BEFORE you start scaling back your training regimen or throw off your big day.   



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IA Logo Marathon Series   Common Training Injuries, Why They Happen, and What Can You Do to Fix It

As always, consult with your Licensed Physical Therapist for individualized advice. For those in Illinois and California, visit your PT immediately without a prescription or referral.

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Reference: 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