How to Avoid Running Injuries During Marathon Training
Which runners get injured?
Running related injuries are very common, especially amongst novice runners.
So, who is most likely to get injured? Here are some of the most common risk factors, according to the literature:
Previous running related injury
Increased quadriceps angle (Q angle)
Abnormal foot posture (high pronation or high supination)
Assessed by the Foot Posture Index (FPI)
Weakness or poor movement control of the hip abductors and external rotators
Improper joint kinematics
Biomechanical errors identified through gait analysis
Training errors
Increasing volume, intensity, or frequency of training too rapidly
Increasing running mileage
Adding speed work or hill training
Failing to allow adequate rest and recovery
One or more changes in speed, distance, or frequency of running
An increase in weekly running mileage by more than 30%, compared to an increase of less than 10%, as evidence by this research study.
A significant increase in running distance between 2 training weeks
Stress fracture within the past year
What are the most common injury sites for running injuries?
The most common injury sites are as follows:
Knee (runners knee, ITB syndrome)
Lower leg (shin splints)
Foot/ankle (achilles tendinopathy, plantar fasciitis)
Strength Training for Runners
This 2018 systematic review found that strength training in middle- and long-distance runners improves running economy, running time performance, and sprint performance.
Parameters for Strength Training In-Season
Parameters for Strength Training In-Season
Frequency: 2-3x/week
Duration: 45-60 minutes
Volume: 2-4 sets per exercises; total of 4-6 exercises (excluding warm up, plyometric training, conditioning stimulus); 6 reps per set
Intensity: RPE 6-7/10 (Rate of Perceived Exertion, do not approach failure)
Rest/Recovery: superset optional, then 2-3 minutes rest. If not supersetting, then 2-3 minutes rest between each set.
*This will be different when in the pre-competition phase, or in the off-season.
Strength training for distance runners should focus on the muscle groups with the highest demands during running:
Soleus
Gastrocnemius
Quadriceps
Gluteus Medius
As running speed increases, there will be more demand on the hip extensors (gluteus maximus, hamstrings) & hip flexors (iliopsoas). This is especially important for those who are looking to increase their speed.
Plyometric Training for Runners
According to this article, short-term plyometric training in highly trained middle- and long-distance runners improves running economy.
Here is how we incorporate plyometrics with our runners to decrease injury risk.
Frequency: every 3rd day (so 2x/week, typically)
Perform plyometrics at the beginning of the training session
Duration: 15-30 minutes, depending on the experience of the runner
Volume: 3-4 sets of 5-6 reps per set
Some of the plyometric drills that are designed for short ground contact time can be performed for time (20-30 seconds, 3-4 rounds)
Rest/Recovery: (1-3 minutes rest, generally)
Rest can vary, depending on intensity of the plyometric exercise
Shoewear for Runners
Runners ask our therapists about shoewear all the time. Below is our best advice based on the most relevant evidence on shoewear.
How often should I change my running shoes?
The American College of Sports Medicine (ACSM) recommends changing your running shoes every 350 miles, which you can read about here.
Our therapists advise that you track your mileage on each pair of running shoes that you use. However, it’s also important to make changes to your shoes based on how you feel running in that shoe. If you feel like it’s time to change your shoes, but it’s only been 320 miles, go ahead and change the shoe.
Depending on the surface you are running on, your shoes could last up to 500 miles. Less miles on asphalt, and more miles on a track or boardwalk.
Do I need a specific running shoe?
The most common types of shoes are “neutral” and “stability” shoes. Those with flatter feet and lower arches may enjoy a stability shoe more. And those with neutral or high arches will likely enjoy a neutral shoe more. At the end of the day, the most important factor is how the shoes fit, and your comfort running in them. Don’t assume the shoes will get more comfortable with time- they won’t. If you don’t like them on day 1, then they aren’t right for you and your feet.
If you know that you are susceptible to foot and ankle injuries, our therapists do recommend a running shoe with a higher heel drop (10-12 millimeters). If you have a history of knee pain or knee injuries with running, then a shoe with a lower heel drop may be better for you (4-5 millimeters). If you have no known history, then a moderate drop of 5-8 millimeters should work for you.
Should I wear multiple pairs of running shoes during my training?
Our therapists do advise having a shoe rotation during your training. Different running shoes have different purposes. For example, a daily trainer may be slightly heavier and have more of a heel drop than a speed training shoe, which is usually lighter in weight and has a lower heel drop. This study demonstrated that recreational runners who wore multiple pairs of running shoes during their 22 week training period were 39% less likely to experience a running injury.
Nutrition for Runners
Proper nutrition is super important for runners. The running athlete has unique dietary needs compared to the general population.
How many carbs do runners need when training?
We are not sports nutritionists, but the general recommendation is that runners should consume 5-7 grams of carbohydrate per kilogram of body weight. On days before and days of long runs, the recommendation increases to 8-10 grams per kilogram of body weight. A lack of appropriate carbohydrate refueling can lead to energy deficits that result in bony pathology like bone stress injuries, as evidenced in the literature.
How much protein do runners need?
Runners need 1.2-1.6 grams of protein per kilogram of body weight. For example, if you weigh 150 pounds, then you are about 68 kilograms. Your daily protein demands would be at least 82-109 grams of protein.
How much sleep do runners need to avoid injury?
Runners need to sleep for at least 7-9 hours per night. The research shows that endurance sport participants who sleep for less than 7 hours per night had a significantly increased risk of developing an injury. So it seems like 7 hours is the absolute minimum requirement.
This narrative review investigated injury risk in adolescent athletes. The researchers found that sleeping for at least 8 hours a night throughout the week decreased injury risk by 61%. This was not specific to running athletes, but it appears as though adolescent athletes need even more sleep than adults to mitigate injury risk.
Closing Remarks
If you are a runner who would like to prevent injury and optimize your performance, you can reach out to speak with us below.
Disclaimer: This is not intended to be formal medical advice. Your individual needs should be met by the appropriate health care practitioner. Please consult with a trusted provider.
Dr. Paul Nasri PT, DPT, OCS, COMT
Dr. Vincent Liu PT, DPT
Doctor of Physical Therapy