Common Marathon Injuries

We are now 3 months out from the London marathon and while some people are already training for it there are some people who are yet to start their program. 

Completing a full marathon (42km or 26.2 miles) is an exceptionally challenging test and unfortunately many people get injured and don’t make the start line. Marathon injuries are not often attributable to one cause, they are usually multifactorial. 

Common injury sites: 

1. Knee pain
2. Stress fractures 
3. Foot and ankle pain 
4. Shin pain 
5. Achilles pain 
6. Low back pain 

Knee pain

1. ITB syndrome – pain on the outside of the knee
2. Patellofemoral pain syndrome “Runner’s Knee”- pain generally at the front of the knee and either underneath or behind the kneecap (patella), but it can be felt throughout the knee. 

ITB Syndrome affects about 7-14% of runners ^2,3

Foot and ankle pain

1. Plantar Fascia pain / plantar fasciopathy – Pain in the heel or arch of the foot 
2. Sprained ankles – most commonly the outside of the ankle (roughly 90%).

Bone Stress Injuries

Our next blog will be looking at bone stress injuries in more detail. Bone stress injuries can be a stress reaction in the bone which if not dealt with can develop into a stress fracture and further down the line a fracture. 

Common sites in runners: 

1. Feet: Base 2nd / 5th metatarsal, Navicular, Talus, Calcaneus, Cuboid, Big toe
2. Leg: Femoral shaft, Femoral neck

• Annual BSI incidence of 4.9 – 21% in elite track and field athletes (Bennell et al 1997) 
• High school runners 20% annually (Tenforde et al 2015) 
• Division 1 track and field athletes 32% reported having at least one or more bone stress fractures (Day et al., 2014)

Achilles pain

Achilles tendinopathy / Paratenonitis – pain in the achilles tendon. Pain can occur where the achilles attaches into the heel bone, in the middle of the achilles or high up where the calf meets the achilles

Shin pain or ‘Shin Splints’

Shin splints is a generic term given to pain in the front of the shin. There is generally two main types;

1. Medial Tibial Stress Syndrome – pain on the inside of the shin 
2. Anterior shin pain – pain in the muscles in the front of the shin

Is running bad for my knees??

A study by Alentorn-Geli et al in 2017 looked at the rate of hip and knee osteoarthritis in professional/elite athletes, recreational runners and sedentary people. They analysed over 25 studies with over 125,000 individuals. ⁴

The results were: 

• 13.3% in elite runners
• 3.5% in recreational runners 
• 10.2% in sedentary people 

So the above would suggest that recreational running is better than no running for your hips and knees! 

My MRI has shown something – does this mean I should stop running?

Horga et al (202, 2021, 2022) found in Asymptomatic runners (runners with no pain): 

• 36% had a cartilage tear in the knee
• 61% had a disc degeneration in the spine
• 90% had MRI abnormalities of the hip 

The study found that these presentations did not worsen despite training for and completing a marathon.

This doesn’t mean that it is always appropriate to continue training, if MRI findings correlate with a persons symptoms they may need to rest or reduce their load. It’s important to make an educated decision between you and your health care professional.

What can I do to prevent injury? 

• Gradually increase your load over the next 12 weeks
• Follow a program or get advice from a coach or physiotherapist 
• Keep on top of your strength training 
• Get on top of niggles early 
• If you know you have areas you need to improve on such as strength – start early and incorporate it into your program 
• Good footwear 
• Don’t overdo the stretching 
• Gait analysis
• Ensure you recover well – injuries often come from not overtraining but under recovering – Healthy diet, stay hydrated, consume enough calories and get enough sleep. 

Read our previous blog posts on the importance of sleep and how to manage niggles while training.

References:

1. Edouard P, Navarro L, Branco P, et alInjury frequency and characteristics (location, type, cause and severity) differed significantly among athletics (‘track and field’) disciplines during 14 international championships (2007–2018): implications for medical service planningBritish Journal of Sports Medicine 2020;54:159-167.
2. Taunton  JE, Ryan  MB, Clement  DB, McKenzie  DC, Lloyd-Smith  DR, Zumbo  BD. A retrospective case-control analysis of 2002 running injuries. Br J Sports Med2002;36:95-101. doi:10.1136/bjsm.36.2.95 pmid:11916889
3. van Gent  RN, Siem  D, van Middelkoop  M, van Os  AG, Bierma-Zeinstra  SM, Koes  BW. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med 2007;41:469-80, discussion 480.doi:10.1136/bjsm.2006.033548 pmid:17473005
4. Alentorn-Geli E, Samuelsson K, Musahl V, Green CL, Bhandari M, Karlsson J. The Association of Recreational and Competitive Running With Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther. 2017 Jun;47(6):373-390. doi: 10.2519/jospt.2017.7137. Epub 2017 May 13. PMID: 28504066.