Common overuse injuries in marathon runners

Athletes in training for a marathon frequently experience injuries classified as “overuse” injuries.  These are not caused any external force or accident, but typically develop from the result of continuous miles and hours of running and training.

These injuries are often minor and and brought on through biomechanical faults within our running style and when combined with running, place additional stresses on joints, muscles and other tissues.


Listening to and recognising the early warning signs of these conditions are key to ensure that a minor problem, does not lead a more serious condition that could enforce withdrawal from training or competition.  Some of the main overuse injuries which affect runners.


  1. Runner’s knee

This is a descriptive term for pain just below the kneecap.  The pain first starts during running, and gradually gets worse when even more sedate activities including walking up or down stairs, squatting and even prolonged sitting with the knees bent can cause pain. These symptoms are the result of bruising and inflammation near the bottom of the kneecap.


The problem is often be caused by incorrect tracking of the kneecap as you run or over-pronation in the feet, which is often combined with inappropriate running shoes or the sudden increase in training load brought on by your upstart in training.


Once correctly diagnosed, runner’s knee can be corrected by fixing the causes of the biomechanical problems that caused it.  Studies have shown that up to 80% of runners with this condition can have symptoms relieved by the use of orthotics in combination with sports injury treatment.


  1. Iliotibial band (ITB) friction syndrome

It is not uncommon for runners to experience severe pain on the outside of the knee joint that worsens with the increases in training load and intensity. The iliotibial band is a band of tissue that runs from the hip, down the outside of the thigh, past the knee, and connects to the lower leg helping to keep the knee joint stable.


ITB friction syndrome occurs when this band becomes irritated as it rubs over a bony prominence near the knee (technically called the lateral epicondyle of the femur) which it passes over as you bend your leg at the knee.


Causes of ITB syndrome include excessive ankle pronation, but there are other possible causes, including tightness of the Tensor Fasciae Latae (TFL) muscle, or leg length discrepancies that result in tilting of the pelvis.  This condition can be exacerbated by sudden increases training, downhill running or on heavily cambered roads.


ITB syndrome may be managed or alleviated via stretching techniques for the ITB, icing after runs or deep friction massage / myofascial release.  Treatment may require a reduction or management of the training mileage and intensity, or complete rest while the underlying causes are addressed.


  1. Achilles tendonitis

achilles tendonitisThe Achilles tendon runs down the back of your heel, connecting the calf muscles to the heel.  Achilles tendonitis begins as an inflammation of this tendon; but if left untreated it can develop into a rupture of the tendon especially in athletes 35 and over.  Its early indicators are stiffness behind the ankle when you first rise from bed in the morning that diminish while you are running.


Factors associated with the onset of Achilles tendonitis are excessively tight calf muscles, over-pronation, wearing of high heels, worn out shoes and overtraining.   The condition can be managed and relieved with post run ice treatments, ensuring suitable footwear is worn; however reduction in training or complete rest may be needed required if severe enough.  It is recommended that incline running and speed work be avoided whilst symptoms are painful.


  1. Shin splints

shin splintsFrequently pains described in the lower leg is passed off as “shin splints”.  A term that is used to describe an injury referred to as medial tibial stress syndrome – or irritation of the muscles and tendons as they attach to the tibia.


Pain develops along the inner border of the shin, about 5-10 cm above the ankle. Initially, the pain may be felt at the beginning of a run; that  recedes as the session continues, but recurs on finishing the session.  When more severe the pain becomes, sharper, and more persistent, until eventually it becomes difficult to walk normally.


This common in new runners (often within their first three months of running) who have increased their training load too rapidly, or who are using inappropriate running shoes.


Treatment at first includes regular ice, together with reduced mileage or rest.  Addressing the causes is likely to include ensuring that shoes have adequate cushioning and stability, and building up training mileage slowly.


Brendon Skinner

Award Leader Sport Strength and Conditioning
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