After the marathon, recovery matters most

That a world-record 1.1 million people applied to take part in the 2026 London Marathon tells you everything you need to know about the popularity of this great race.

The 2025 event set a world record of its own when 56,640 runners crossed the finish line, the most ever for a single marathon.

To say there is a bit of hype around the April 26 showpiece is something of an understatement.

While excitement for the marathon is understandably at fever-pitch, it is important for runners to pay close attention to their conditioning.

It often happens that injuries only become apparent once the 42.1km have been run. 

“After intense events such as a marathon, the body has undergone muscle damage, fatigue, and inflammation. This leads to delayed onset muscle soreness,” explains Ultra Sports Clinic senior physiotherapist Tim Ling.

“Muscle glycogen stores become depleted, making contractile tissue less capable of producing force over longer periods of time. The neuromuscular system is also affected after marathons, affecting proprioception [the body's ability to sense its own position and movements] and the ability for the body to coordinate movements.”

Post-marathon injuries include many that occur in the lead-up and during a race. 

Tendinopathies (when tendons become irritated) of the Achilles, knee, and hip commonly occur due to excessive repetitive activity, too quickly, or not having the foundational strength to support activity.

Runners can also experience a variety of knee-related conditions, including patella femoral pain and iliotibial band pain, as well as muscle strains in the calves, hamstrings and quadriceps. 

In more serious cases, bony stress reactions occur in different areas of the lower limb. This is usually caused by a combination of excessive activity load, biomechanics, inappropriate diet and lack of sleep.

Physiotherapy can be helpful post-marathon to address any musculoskeletal injuries through a combination of manual therapy techniques like soft tissue therapy, acupuncture/dry-needling and shockwave therapy.

After a body assessment, different weaknesses can be addressed through targeted strength training and exercise rehabilitation.

“Runners should look to seek the advice of a physiotherapist if an injury is present. They should then address the acute recovery phase within days of the race,” Tim says.

“This can include following a balanced diet, sleeping well, and introducing gentle activity like walking. After the initial recovery phase, look to begin training the muscle groups which are emphasised during running, such as the quads, glutes, hamstrings and calves.”

Resuming regular training really depends on how the body is feeling, the extent of muscle soreness, joint pain, as well as the runner’s psychological readiness.

“You should look to be able to complete light running for this initial period with minimal symptoms,” Tim says.