How to Avoid Common Marathon Injuries with Physiotherapy

Running a marathon is a monumental achievement. But it’s also a huge physical challenge. Without proper care and guidance, marathon training can lead to a wide range of injuries that may not only ruin your race day but also potentially cause long-term health issues.

The good news is that many common marathon injuries are preventable. With the right physiotherapy approach, tailored strength work, and sensible training habits, you can stay on track and injury-free.

So, whether you’re an experienced runner or warming up for your first marathon, this guide will walk you through the most common marathon injuries and how sports physiotherapy can help prevent them.

Key Takeaways

• Most marathon injuries are preventable with early intervention and proper biomechanics.

• Physiotherapy helps identify weaknesses, improve technique, and optimise recovery.

• Regular check-ins with a sports physio can provide personalised training support.

• Seek physiotherapy before pain becomes a major issue.

• Focus on mobility, strength, gradual load increases, and recovery strategies.

A Practical Guide to Injury Prevention, Recovery, and Peak Performance Physiotherapy for Runners

Common marathon injuries – and why they happen

Runner’s knee (patellofemoral pain syndrome)

Runner’s knee is often caused by overuse or poor biomechanics, runner’s knee involves pain around or behind the kneecap. It’s exacerbated by hills, stairs, or long-distance runs.

Contributing factors:

• Weak quads or hips

• Poor foot alignment

• Overtraining or rapid mileage increases

How physio helps: A sports physio will assess your gait, leg alignment, and muscle balance. Targeted strengthening of the quads, glutes, and hips often helps resolve the issue.

IT band syndrome

IT band syndrome involves pain on the outside of the knee, where the iliotibial (IT) band rubs against the femur. It's particularly common in runners with weak glutes or poor lateral hip control.

Symptoms:

• Sharp pain on the outer knee

• Pain worsens with downhill running

• Tenderness or tightness in the thigh

Prevention: A physiotherapist will assess your running form and prescribe glute and core activation exercises to support hip stability.

Shin splints (Medial Tibial Stress Syndrome)

Shin splints is a common injury, which causes aching or sharp pain in the lower leg and usually stems from sudden changes in mileage or terrain.

Triggers include:

• Poor footwear

• Tight calves

• Flat feet or overpronation

Physio approach: Taping, manual therapy, and strengthening the foot and ankle muscles are key. Addressing load progression is vital to prevent recurrence.

Achilles tendinopathy

Overuse and tight calf muscles often lead to Achilles tendinopathy. Especially in runners who don’t stretch or warm up adequately.

Symptoms:

• Stiffness or pain in the back of the heel

• Discomfort when walking after rest

• Thickening of the tendon in chronic cases

Treatment with physiotherapy: Eccentric loading programs and calf strength/stretch routines are the gold standard, alongside gait analysis.

Plantar fasciitis

Plantar fasciitis involves inflammation of the fascia under the foot. It is particularly common in runners with poor foot mechanics or tight calves.

Signs:

• Heel pain, especially in the morning

• Pain when standing after sitting

• Stabbing discomfort during the first few strides of a run

Physio can help by: Providing soft tissue release, strengthening the foot arch, and recommending proper footwear or orthotics.

Why physiotherapy is critical for marathon runners

Physiotherapy is not just about treating injuries. It’s about preventing them before they occur. Which is why, before you start training for a marathon, it’s worth popping online and searching for ‘sports physio near me’. The expert guidance they can provide can be a game-changer.

The key benefits of sports physiotherapy:

Biomechanical assessment

This will help to identify any faulty movement patterns that can lead to injury. These might include overstriding, pelvic drop, and over-pronation, among other things.

Strength and conditioning plans

If you want to perform well in a marathon—and come out of the other side without ill effects—you need to build muscle balance and support. A sports physio can help you with this.

Gait and posture correction

Small tweaks to running form can make a huge difference in performance and injury risk. This usually takes place through a combination of manual therapy, exercise prescription, and postural education.

Manual therapy

There are various forms of manual therapy that can support physical health during marathon training. These include massage, dry needling, and joint mobilisations to enhance recovery and mobility.

Recovery optimisation

Marathons and marathon training are incredibly hard on the body. By learning proper cooldown, stretching, and recovery protocols, you can help to keep your body resilient.

What a marathon injury prevention plan looks like

A good sports injury prevention plan is not one-size-fits-all. Your plan should reflect your current fitness, injury history, training goals, and running experience.

A typical plan from a sports physiotherapist might include:

• Initial movement screening and running analysis

• Targeted mobility drills (hips, ankles, thoracic spine)

• Custom strength programme (glutes, hamstrings, calves, core)

• Progressive training loads with regular reassessment

• Manual therapy as needed during training peaks

• Post-race recovery sessions

How to find the right sports physio near you

So, if you’re seeking sports physiotherapy in London, what should you be looking for?

• A multidisciplinary centre that can provide physio, sports massage, and osteopathy.

• A physio that offers biomechanical assessments, such as ForceDeck testing.

• A specialist that can help you with clinical recovery, should any serious injuries occur.

• And access to experts with a background in sports performance or athletics.

It’s also always a good idea to check reviews, and qualifications, such as HCPC and CSP registration.

When to see a physiotherapist

You don’t have to be injured to visit a physiotherapist. In fact, the best time to seek out care is before pain becomes a problem. So, consider booking a consultation if:

• You’re starting marathon training for the first time

• You’re increasing mileage or intensity

• You’ve had previous injuries

• You experience tightness or discomfort that doesn’t go away after a rest day 

Extra tips for avoiding marathon injuries

Stick to the 10% rule

Never increase your weekly mileage by more than 10%. Rapid increases are a recipe for overuse injuries.

Warm-up and cool down

Include dynamic warm-ups, such as leg swings and lunges before runs. And make sure you have a proper cooldown with light jogging and stretching.

Invest in good shoes

Visit a running shop for a gait analysis and shoe fitting before you start training. Replace your running shoes every 300–500 miles.

Sleep and nutrition matter

Marathon training places stress on every system in your body. Adequate sleep and fuelling are key to staying injury-free.

Marathon training is a long game. And staying healthy through it is a sign of both discipline and smart planning. Physiotherapy offers personalised support to strengthen weaknesses, improve technique, and reduce the risk of injuries before they interrupt your training journey.

Whether you’re looking for physiotherapy in London or trying to find a sports physio near you, take the time to invest in injury prevention. Your body will thank you on race day. And for every mile after.

Based in London and looking for a sports physio near you? Get in touch with Ultra Sports Clinic. We can help you build strength, recover faster, and cross that finish line with confidence.