What are the most common marathon training injuries?

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Runners getting ready for the Chicago Marathon in October are about halfway through their training programs—and may be feeling some aches and pains from logging all those miles. We spoke to sports medicine specialist Ryan Hudson, MD, about the most common injuries facing runners preparing for a marathon, how to prevent them, and how to tell if it’s something serious, or something you can push through for the big race.

What are some of the common injuries runners might be facing at this point in their training?

80 percent of running injuries are below the knee, and what’s called patellofemoral syndrome, or “runner’s knee,” is the most common. It affects about 33 percent of runners with an injury. Patellofemoral syndrome is an overuse condition causing anterior knee pain located underneath the patella, or kneecap. It’s irritation to the surrounding structures where the knee cap sits within the trochlear groove of the femur. By definition, it doesn’t involve any structural abnormalities— so, diagnostic testing such as X-rays or MRI are normal. But, despite “normal” structures, patellofemoral syndrome pain can still greatly impact a runner’s ability to train.

Does it come from the constant pounding from all of that running?

It can be caused by a large number of factors, but it’s thought to be primarily from overuse and under-conditioning.

Ryan Hudson, MD

How do you treat it?

Patellofemoral syndrome typically resolves with rest and conditioning. You can prevent it by strengthening muscles that help the kneecap track properly. Having strong core, quadriceps, and hip muscles will accomplish that. Also, if the foot is rolling in or pronating, this can contribute to the patella tracking issue. If this is the case, over the counter orthotics may also be helpful. Lastly, you can also get a brace that may assist with proper kneecap tracking.

After you rest, does it come back when you start running again?

You can run through it, it’s not going to cause permanent harm. Certainly if your pain is escalating I wouldn’t recommend running through it, but if it’s a low level pain that gets better after warming up, then this is something that you can run through. Patellofemoral syndrome may be a recurrent problem for some runners. An evaluation for other causes and physical therapy are recommended if it persists.

You mentioned core strength. How does that help prevent injuries?

Core strength, which refers to abdominal and hip musculature, is pivotal in maintaining a healthy running gait in endurance activities. It’s a chain: the hip impacts the knee significantly, and alterations in foot mechanics will also impact the knee. The knee is caught in the middle, so if there are alignment issues or strength deficits in the hip, or in the foot, the knee often suffers.

So many exercise programs focus on core strength to improve balance and agility, but it sounds like it keeps you from compensating for other weakness and making mistakes that can cause injuries.

Yeah, I’m a big believer in core strength and resistance training. I think that most research supports that resistance training helps with injury prevention, as well as performance, even in endurance events. I recommend one or two times a week strengthening all major muscle groups while training for a marathon. Specific to patellofemoral syndrome, you want to strengthen your core, hips, and quads.

What are the other common injuries besides runner’s knee?

Another common cause of pain is shin splints, or its more specific name, medial tibial stress syndrome. This painful condition is due to inflammation of the tibia’s outer layer, the periosteum, caused by traction forces of the stabilizing foot muscles that attach there. Basically, if the muscles that stabilize the foot are weak, this may lead to too much foot motion, and those muscles’ tendons then tug on the tibia causing pain.  Treatment of shin splints includes orthotics, conditioning and training modifications. If you run too fast and too far prior to conditioning, you are at a much greater risk for shin splints. Also, it’s important to keep in mind that stress fractures can mimic shin splints.

Do more experienced runners know how to avoid shin splints then?

Experience is a huge factor in running associated injury prevention because you typically learn from your mistakes and know how to condition and train.

Is some of the risk from running too much related to fatigue? Your muscles aren’t able to stabilize as well, so you’re putting more pressure on the joints. 

It’s probably both. In general, athletes who are fatigued are going to be at higher risk for injury because they lose their stabilization. But, most running injuries are due to overuse. That’s why it’s important to space out runs so you don’t run more than two days consecutively. If you run three days in a row during your training, you set yourself up for overuse problems of tendinitis and inflammation of a variety of structures.

Do you have any advice for runners in the home stretch of training leading up to the race?

I do have some advice on when to push through pain and when to be cautious. For problems that cause you to limp or change your running mechanics, I’d caution against pushing through it, because you may be causing long term harm. I realize it can be hard to pause training, when you may have already put in so much time to get where you are. But, if you have something that’s causing you to change your running mechanics and you recognize that, don’t push through it. Also, if your pain is more than mild pain, like more than 3 on a scale of 1 to 10, that’s probably something more serious that you shouldn’t push through either. If this is the case, get it evaluated quickly, so you can have it addressed and get back to running.

Is running this much good for your body?

It depends on how you look at it. From a joint perspective, it’s really debatable. I think the jury is still out about how running marathon distances impacts the joints and cartilage. It continues to be studied, looking at MRIs before and after marathons and seeing if there’s anything that’s changed. I think most of the literature shows that if you have preexisting arthritis and you run marathons, then you’re probably going to accelerate the arthritis at a faster rate. But if you don’t have a preexisting condition, running likely does not increase your risk of developing arthritis, as long as you’re running in a safe fashion.

Beside the joints, endurance running is generally great for your body. It can be positive socially, psychologically, and have large cardiovascular benefits. Like with everything, it’s important to keep perspective. While training, sometimes it is better to rest until a condition recovers or have it evaluated so you don’t cause permanent harm. That way, you can keep running for the years ahead.

About Matt Wood (506 Articles)
Matt Wood is a senior science writer at the University of Chicago Medicine and nonfiction editor for Another Chicago Magazine.
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