Injury Prevention in Marathon Runners
Training for a marathon can be an extremely grueling process. Staying injury free can be just as challenging. Whether you are a novice runner or have several marathons under your belt, injuries can pop up at any time due to repetitive overuse, training errors, footwear choices, terrain, muscle weakness, and lack of flexibility. If you are currently training for a marathon or planning to do so in the future, below are a few tips to keep you healthy, injury free, and on the road to accomplishing your goal.
- Find a training plan and stick to it – Research a training plan that is right for you and give yourself enough time to complete it. You will find more aggressive training programs for advanced runners in as little as 12 weeks, longer 6 month programs for beginners with no running experience, and everything in between. Most marathon training programs have a gradual increase in mileage weekly until race day with an average of 3-5 runs per week, 1-2 days of cross training, and a rest day. It is important to avoid a sharp increase in running mileage and running intensity as this has been shown to increase rates of injury. Running experts advise to increase mileage no more than 10% each week to reduce your risk of injury. It is also important to pay attention to the type of run you should be doing. If you run too fast on a distance/recovery run or if you run too slowly on a speed/interval run, you are missing out on the full benefit or the intention of the run.
- Warm-up – While a 5 minute slow jog or a walk before your run is better than no warm-up, a more efficient and beneficial way to increase blood flow to your muscles, lubricate your joints, and improve your flexibility is to do a functional, dynamic warm up. Focusing on key stabilizing muscles such as your gluteals prior to your run can helps you to activate them during your run and decrease injury risk. Some examples include squats, a lunge matrix, bridges, monster walks, and mountain climbers.
- Vary your workouts – Ideally, workouts should encompass running, cross training, strengthening, and stretching. Variability in your weekly workouts has been shown to decrease injury risk and help you achieve more optimal results. Instead of running at the same pace for every run make sure you are including long slow distance, track speed work, fartlek, tempo, and interval runs as suggested by your training plan. Also include non-running, aerobic, low intensity workouts such as swimming, biking, yoga, and Pilates weekly. Runners should be strong AND powerful. While running does help to increase your overall muscular strength and endurance, specific strengthening exercises can help to improve your stability to maintain proper postural and dynamic alignment and power to generate lift against gravity to minimize fatigue and achieve good stride length. Strength training can help to reduce injury and improve running economy. To maximize your benefit, emphasize incorporation of gluteal and core strengthening into your weekly routine. After each run, performing active stretching or foam rolling can be beneficial to decrease post run soreness and improve blood flow. This also helps to decrease tissue tightness and inflexibility which can affect your running form.
- Check in on your form – As your training distances increase, your body gets tired and it’s only natural for your running form and stride to start to deteriorate. This added stress on the body places more strain on your tissues, leading to potential injury. For most people there is no need to drastically change your entire running form – just check in with yourself frequently (every 3-4 songs if you’re listening to music) to see where you are and make adjustments. Specifically, are your shoulders elevated with tension? If so, take a deep breath and allow the shoulders to lower to reduce tension. Relaxed muscles respond with an easier turn over and less wasted energy. Improve your posture by keeping your chin parallel to the ground, keeping chest lifted, engaging your core and leaning slightly forward. Keep your arms moving, but don’t allow them to cross in front of the body. Elbows should be bent 90 degrees, thumb tip facing forward, and palms facing body. As far as running stride, it is not about lengthening your stride, rather quickening your turn over so your feet are landing right under you. Minimizing vertical bounce will also make you a more efficient runner.
- Rest and recovery – Rest days are essential to avoiding injury while training. Our bodies need this time to recover effectively and heal any damage that may have occurred. This in turn helps our bodies get stronger and adapt to the demands being placed on it, reducing risk of injury. Pay attention to what your body is telling you. If you need more recovery time, take it. Supplement in low impact activities on these days such as walking, yoga, or gentle stretching and make sure you are getting enough sleep at night.
- Proper nutrition and hydration – What you put in your body for proper fuel is extremely important as it can help you sustain energy, heal from injury, and recover more quickly between running sessions. Aim for nutrient dense foods with avoidance of sugar and processed foods which can cause inflammatory responses in the body. You will also need about 100-150 calories after every hour 1 hour of running. Pack a quick snack, energy gels or chews that are a mix of fast and slow burning carbs. It’s also a good idea to eat food higher in protein and carbs within 1 hour of finishing a long run to replace nutrients and energy needed to recover and rebuild muscles. It is also important to make sure you are staying hydrated. Carry water with you on your run or plan your runs around where you can stop to take a drink. Signs of dehydration may include headaches, increased irritability, sleep issues, chapped lips, dizziness, lightheadedness, and dark colored urine.
- Footwear – Take the time to get fitted for a proper pair of running shoes based on your foot type and make sure they fit right. Running shoes should be replaced every 300-500 miles or 3-6 months, whatever comes first. Running in worn shoes can change your running pattern as the shoes cushioning decreases, putting you at greater risk of injury or tissue strain. When training for a marathon, consider buying 2 pairs of shoes. As you are wearing out the first pair, you can start to wear in and acclimate to the new pair before race day. Furthermore, race day is not the day to try a new shoe style.
In addition to these tips, it’s also important to listen to your body and learn the difference between running soreness and pain. It can be normal to experience some degree of muscle soreness when you start a new program and work through it; however, you should not ignore pain. Is the discomfort a result of muscle soreness from pushing your mileage or tempo, or is that twinge of pain becoming more constant with every stride and showing up on every run you take. Is the pain persisting during non-running activities? Any pain that changes your gait needs to be addressed as well as sharp, shooting pains, and joint pains that happen repeatedly. Swelling and numbness are also red flags that shouldn’t be ignored. Taking anti-inflammatory or pain medication after each run is also a sign that you have pain that needs to be addressed. If your stride feels off or uncomfortable the first few miles and then feels alright, it may be a sign that you need to include a longer, more dynamic warmup with active stretches before running. The body needs stress to improve, however, too much and the body becomes susceptible to injury.
If you have a persistent pain while running, can’t seem to recover from an injury without it returning every time you run, or have concerns about your running form, seeing a physical therapist is a good idea. They can fully assess your running form, posture and alignment, mobility and strength to determine the cause and set up on a treatment plan to get you back running more efficiently and decrease your risk of reinjury.
Kristen DePrey, PT,MS