Marathon training is the most demanding undertaking most recreational runners will attempt. A 16–20-week training block typically involves 300–500 miles of running, with weekly mileage peaking at 40–50 miles for competitive amateurs. At these loads, even minor biomechanical inefficiencies or muscle imbalances become significant injury risks. Up to 90% of marathon runners experience a training-related injury during a training block. Physiotherapy plays a critical role in preventing, managing, and recovering from these injuries — and in getting you to the start line healthy.
The Role of Physiotherapy in Marathon Training
1. Pre-Training Screening
The most valuable time to see a physiotherapist is before you start your marathon training block — not when you are already injured 10 weeks in. A pre-training physiotherapy screen identifies the biomechanical risk factors that most commonly cause marathon injuries. These typically include: hip abductor weakness (associated with IT band syndrome, patellofemoral pain, and hip stress fractures), calf tightness or weakness (Achilles tendinopathy, plantar fasciitis), gait patterns such as overstriding or hip drop, and previous injury sites with incomplete rehabilitation. A targeted prehab programme started 4–8 weeks before training begins significantly reduces injury risk.
2. Treating Training Niggles Early
The most important message in marathon training: do not run through pain. A training niggle that is ignored and trained through typically becomes a full injury that requires 2–8 weeks off — missing critical training. A niggle that is assessed within the first week and managed appropriately can often be resolved within 1–2 weeks with minimal training disruption. At Lambert Sports Clinic we see many marathon runners at short notice specifically for this reason.
3. AlterG Treadmill for Injury Management
One of the most valuable tools we offer for injured marathon runners is the AlterG anti-gravity treadmill. It allows running at reduced bodyweight — from 20% bodyweight upward — which means that many training-related injuries that would otherwise require rest can be managed by cross-training on the AlterG at reduced load while the injured structure heals. For Achilles tendinopathy, shin splints, and stress reactions, the AlterG allows cardiovascular fitness to be maintained during the injury period.
4. Race-Day Preparation and Recovery
Post-marathon recovery is often overlooked. After a marathon, the body requires 2–4 weeks of recovery before returning to structured training, and many runners experience delayed-onset injuries in the 1–2 weeks following a marathon. A post-race physiotherapy assessment identifies any lingering structural issues before the next training block begins.
Most Common Marathon Training Injuries
IT Band Syndrome (Lateral Knee Pain)
The most common marathon injury, typically appearing at 15–18 miles in long runs. Caused by hip abductor weakness, hip drop, and high mileage. Treatment: hip abductor strengthening (not stretching the IT band, which does not stretch), gait retraining, and training load management.
Patellofemoral Pain (Runner's Knee)
Pain behind the kneecap, typically worsening with downhill running and stairs. Associated with hip weakness and valgus knee mechanics. Treatment: hip and knee strengthening, gait analysis.
Achilles Tendinopathy
Thickening and pain at the Achilles tendon, typically worst first thing in the morning and after long runs. Requires load management and an eccentric and heavy slow resistance (HSR) exercise programme. Shockwave therapy — available at Lambert Sports Clinic — is highly effective when combined with exercise.
Plantar Fasciitis
Heel pain worst with first steps in the morning. Load management, plantar fascia stretching, calf strengthening, and sometimes shockwave therapy. Footwear and orthotic advice may be relevant.
Medial Tibial Stress Syndrome (Shin Splints)
Pain along the inner shin, common in those increasing mileage too rapidly. Treatment: load reduction, calf and hip strengthening, and gradual return to full training. AlterG treadmill is very useful for maintaining fitness during recovery.
Hamstring Strain
More common in faster running (tempo, intervals). Requires a graded return-to-run programme and progressive eccentric hamstring loading before return to speed work.
Sports Massage for Marathon Runners
Regular sports massage is valuable throughout a marathon training block. It addresses the cumulative muscle tension that builds over high-mileage weeks, identifies tightening areas before they cause injury, and aids recovery between sessions. At Lambert Sports Clinic our Level 4 and 5 sports massage therapists work with marathon runners on a weekly or fortnightly basis throughout their training block. We recommend scheduling sports massage in the week following long runs (not immediately before).
Gait Analysis for Marathon Preparation
If you have had recurrent marathon training injuries, or if this is your first significant marathon training block, a gait analysis is valuable. AI gait analysis at Lambert Sports Clinic identifies the biomechanical patterns that most commonly lead to IT band syndrome (hip drop), patellofemoral pain (valgus collapse), and shin splints (overstriding). Correcting these patterns before high mileage begins is significantly more effective than trying to change gait under fatigue.
Lambert Sports Clinic serves the running community in Surbiton, Kingston, New Malden, and across Surrey. We offer physiotherapy, sports massage, gait analysis, and AlterG treadmill rehabilitation for marathon runners at all levels. Same-week appointments. All insurers accepted.
Frequently Asked Questions
Marathon Training Support in Surbiton
Physio · Sports massage · Gait analysis · AlterG · 380 Ewell Road, KT6 7BE
Book Online 020 8133 5694