Training for a marathon, or any distance race, is a journey of dedication and commitment. Distance running is about following a schedule, mindfully increasing your mileage, and not forgetting to take crucial rest days. But what happens when a nagging ache turns into an injury that threatens to derail all your hard work? Do you push on and risk a more serious injury or cancel the race altogether? At McKenzie Sports Physical Therapy, we see it all too often: runners who have done everything right yet still find themselves in pain as race day approaches.

The reality of endurance training is that with every mile you add, the risk of a running overuse injury increases. This is why it’s essential for any runner—whether you’re training for your first 5K or your tenth marathon—to be proactive about your body mechanics. An assessment can identify potential dysfunctions and malalignments before they become a problem.

Take Michelle, for example. As she ramped up her mileage ahead of her first half-marathon, she began experiencing persistent shin splint pain. While her pain was linked to the rapid increase in her training volume and not wearing shoes that provided more stability, our physical therapy assessment also identified that her feet were overpronating. While this wasn’t the direct cause of her shin splints, it was a key biomechanical factor that had a role in her pain and, if left unaddressed, could contribute to future issues like patellafemoral knee pain. By identifying this early, we were able to address her current pain while also providing a proactive plan to prevent other injuries.

The Culprits: Common Running Overuse Injuries

Long-distance running often brings with it a few common adversaries:

  • Shin splints: The classic runner’s pain, often a result of increasing mileage too quickly or wearing the wrong shoes.
  • Patellafemoral knee pain: A persistent ache around or behind the kneecap, often linked to imbalances or weak supporting muscles.
  • High hamstring tendinopathy: A deep, nagging pain at the top of the hamstring, caused by the repetitive stress of running.

These issues are often a sign that your body isn’t able to handle the stress you’re putting it under. Sometimes, it’s not about doing something wrong, but rather not doing enough of the right things. For example, you’ve been strength training, but you haven’t been progressively increasing your loads, like squatting with the same weight for months. Or your running shoes are no longer providing the support you need, altering your foot position and leading to pain.

Your Gear and Your Gait

The right pair of running shoes is a runner’s best friend, but even the best shoes have a limited lifespan. On average, a pair of running shoes is good for approximately 300-500 miles. Neglecting to rotate your shoes can lead to a breakdown of cushioning and support, potentially contributing to injury. Many runners rotate their shoes for training and what they wear on race day. And one rule to not forget – don’t wear new shoes to a race. They must be properly broken in to minimize issues on race day. To find the perfect fit and style for your needs, we always recommend visiting a specialized running store like Philadelphia Runner for a professional shoe fitting and gait analysis.

The Proactive Approach to Preventing Running Overuse Injuries

The key to preventing running overuse injuries is to get seen early. Many runners wait until the pain is unbearable, often just a week or two before their race, which leaves little time for effective treatment. By scheduling a physical therapy appointment as soon as you feel a nagging issue, we can look at your body holistically, rather than just focusing on where the pain lives. This allows us to uncover the underlying source of your discomfort—be it a strength deficit, a flexibility issue, or a biomechanical problem—and address it so you don’t miss your chance to cross the finish line. Peace of mind is a beautiful thing!

As you follow your training plan, listen to your body. Take your rest days, incorporate cross-training, and don’t increase your mileage too fast. But if you’re doing all the right things and still experiencing pain, come in for an appointment. We are here to help you get to the starting line strong and injury-free.

Stay tuned for our November blog post, where we will discuss what happens after the race and how to take care of your body, including recovery tools and therapies like Normatec boots!