How can I stay injury-free while training for a marathon?

Christopher C. Bell, MD
Sports Medicine

The key is to take it slow and gradually increase! A lot of people tend to overreach and wind up getting injured. A popular rule of thumb is to increase your weekly mileage about 10% per week, and most training plans follow this. It's also important to take an "easy" week every 3 or 4 weeks to allow your body to rest and adapt.

Another important element to include in your training is resistance or weight training, including balance (or what's called "proprioceptive") training. A lot of people get into running with weakened core, including the pelvis/hip muscles that contribute very much to your lower extremity kinetics. Things like planks, bridges, single leg stance and eventually single leg squats can all help strengthen your core and prevent injury down the road.

A lot of injuries depend on how long you have been a runner. If you are new to running, then relax, take your time and enjoy running. Start at a slow pace and gradually work up to a faster pace; but putting the distance in is more important that being fast. I agree with the slow increase in mileage per week no more than 10% each week. I also think that if you are an experienced runner, but have not run a marathon before, then listening to your body helps too. Experienced or not you need to take time to rest - set a schedule and be consistent. Many times injuries occur due to inconsistent training. Missing a week and then running 7 days in a row is not teaching your body to work for you. I am a huge advocate for yoga it really helps to release some of the tension in the muscles during the journey of marathon training.

“In the months leading up to a marathon, we often see people coming in with overuse injuries because they are ramping up their mileage too quickly,” says David R. McAllister, MD, chief of the Sports Medicine Service in the UCLA Department of Orthopaedic Surgery. But most injuries can be avoided with an appropriate training regimen.

“Running is a high-impact activity,” says UCLA family and sports medicine specialist Heather Gillespie, MD. “If you do too much too soon, your joints and muscles will start to break down because of the impact and stress on your body.” Previous injuries with inadequate physical rehabilitation, muscle weakness or imbalance and, in women, low bone-mineral density may also increase risk for injuries, experts say.

Dr. Gillespie recommends that beginners should start running a mile a few times per week and refrain from increasing activity more than 10% per week. Runners can also cross-train with activities such as cycling, swimming and other low-impact activities at the gym to build up cardiovascular fitness without increasing stress to the joints. Runners should get adequate nutrition and hydration -- approximately 6 to 12 ounces of water every 20 minutes -- before and during each run. Finally, aspiring runners with a history of heart disease, diabetes, arthritis or asthma, or who experience shortness of breath or chest pain with exercise, should check with a doctor before pursuing any type of physical activity or task.
Undertaking a marathon can cause a significant stress on a person. Preparing the body to endure the metabolic demands, the risk of chafing and skin breakdown, as well as the repetitive strain injury or stress fractures, can best be accomplished by starting at a lower mileage and working up over time. Cross training, appropriate stretching, good nutrition, finding a good fit of shoes and clothing and learning how to pay attention to minor injuries and treat them early to avoid larger injuries are part of the training program. If you are considering training for a marathon, there are many running groups and online resources that will help you choose an appropriate training schedule over a time frame suitable for your preexisting level of expertise.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.