Marathon Training: Prevention Is Better Than Cure [Part 2]


I’ve been a runner for over thirty years, and I’ve run many, many marathons including running London several times (and it’s by far and away my favourite marathon - if you’re running it for the first time, you’re going to love it!)

As a sports doctor, I see injured runners daily, and in the run up the marathon (forgive the pun), the volume of injuries increases. 

So, here’s a few words of advice about how to get to the start of the race in one piece. 

Firstly, whilst all runners will experience some aches and pains, there are some that you shouldn’t ignore, and definitely some that you should see a physio (or a sports doc) about sooner, rather than later, so that you can nip it in the bud, and get to race day.

If you’re getting a pain in your groin, buttock, thigh, shin, calf, or foot that keeps showing up when you run, and if you feel discomfort in said body part each time your foot hits the ground, or, if you can sense it when hopping, you need to STOP running and get it checked out. It could be a stress fracture, and it’s not the time to keep pushing on, hoping it may go away. 

Some stress fractures are serious (such as a femoral neck stress fracture), and you may need an urgent MRI to rule it out – an X-ray won’t be sufficient. Rather than go to your G.P., see a physio or sports doctor, as they will be more likely to be able to help. 

If you’re getting pain in your IT band (at the side of your knee), or an Achilles irritation, or shin splint pain, again, don’t push on; see a clinician, as we can probably get it under sufficient control for you to be able to run the marathon. It’s so much easier to do this, whilst it’s mild. 

If you’ve had to take time out from your training (e.g. because you’ve had Covid, big work commitments, or an injury), don’t make the mistake of simply picking up again where you left off in your training. That’s a recipe for quickly inducing an overuse injury (including a stress fracture). 

You need to go back a few steps in your training, and you may need to lower your expectations around your longest run and pacing.  If you’re not sure what to do, get in touch with a running physio or coach.

Many runners who combine long, stressful working hours, with marathon training, become overtrained during marathon season.  The tell-tale signs are a reduction in your performance (e.g. you feel like you’re getting slower and slower), your sleep is disturbed (e.g. you go to bed shattered, but you’re waking up early and tired), and if you’re feeling really grumpy or short-tempered. An increase in your resting heart rate on waking is another clue. Stop. Take a few days off, and rest completely.  You’re far better of going into a marathon slightly underprepared, than overtrained.

I can’t emphasise enough the importance of fuelling sufficiently and getting enough sleep. Many people ‘under calorie’ by eating a super clean diet, and then accidently find themselves with a case of RED-S (relative energy deficiency in sport). 

This can lead to all kinds of upset with your body’s physiology and is a big contributor to stress fractures. Be warned.  Maintaining your weight is NOT a reassurance that you’re in good energy balance. If you’re skipping periods, this is a classic sign, and if you’ve had a history of stress fractures, I recommend seeing a sports doctor to get a proper assessment.

Most runners I meet in clinic don’t prioritise sleep; I totally understand the pressures that work and family can bring. However, sleeping less than eight hours per night has been shown to significantly increase your risk of injury. Switch off ‘Stranger Things’ and get to bed.

Remember to actually prepare for Marathon Day.  Get a really good night’s sleep the-night-before-the-night-before (i.e., on Friday night), and don’t spend hours (and energy) wondering around Excel. Get home (maybe now’s the time to put your feet up and watch ‘Stranger Things’), and eat a regular dinner, rather than triple servings of carbs that may lead to heavy ‘pasta’ legs the next day.

And finally, remember to really enjoy the marathon. Less than half of UK adults can run a mile, let alone 26.2. You’ll be doing something really special, so soak up the atmosphere, and let the crowds cheer you through those last few miles.

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