Tips to Prevent Injuries While Training For a Marathon

Completing a marathon is a huge feat, and the preparations involved to get your body in shape for the 26.2-mile run aren’t easy. Many runners, especially those who are less experienced, risk injuring their joints and muscles during periods of rigorous training. So what’s the best way to stay injury-free and get to the starting line healthy?

Health Matters spoke to Dr. Morgan Busko, a sports medicine physician with NewYork-Presbyterian Westchester who is training for the New York City marathon, for tips on how runners of all levels can best prepare for a marathon. She explains how to reduce the chance of injury and ways to recover after putting your body through this tremendous challenge.

Start with Strength Training

If you are a casual runner who has never run a marathon, you should give yourself about six months to get into marathon shape. If you are a year-round runner, you may need only three months to get into shape, but if you are going from “couch to 5K to marathon” you might need more than a year.

To be strong enough to run 26.2 miles and do the training runs that prepare you for that distance, casual and beginner runners should lay a foundation of strengthening specific muscle groups of the core, the pelvis, and the legs. This can include weightlifting, resistance band exercises, and isometric exercises, such as planks, single-leg bridges, or wall-sits. That underlying strength is critical for promoting efficient and low-impact running strides and for reducing wear and tear in the hip and knee joints.

It’s also important to establish a short, pre-run routine which can include exercises to strengthen the deep core and gluteal muscles, followed by dynamic stretching, where you stretch your muscles to their full range of motion. After a run, foam rolling, stretching, and deep tissue massage can help your muscles recover faster and be better prepared to tackle the next run.

Build Up to Marathon Distance

Be patient in your training. It’s important to allow your muscles and aerobic endurance adequate time to both adapt to the training load and build up to new distances and paces. Anyone pushing themselves in training will undergo muscle breakdown during the harder efforts. This may sound bad, but it is an imperative part of muscle growth and gaining fitness because the muscles build back stronger during the repair process. Proper hydration, nutrition, and sleep after difficult workouts will optimize muscle repair and allow a runner to get the most gains from their hard efforts.

Ideally, runners will increase their training mileage by no more than 10% per week to avoid overuse injuries like stress fractures or tendinopathies — repetitive stress injuries to the bones and tendons, respectively. Many runners will respond to a few weeks of building mileage and intensity and then a week of backing down to a lower mileage and intensity. Going too fast or running too many miles can lead to setbacks, including overtraining syndrome, which can include fatigue and declining performance. Unless you are a professional marathon runner, you don’t need to run a full marathon distance before the race. I recommend trying to peak your long run at 18 to 22 miles about 4 weeks out from the race.

The most important job you have while training is listening to your body. Take a rest day if you need to, run easy if that’s what your body is telling you, take extra rest days if you’re ill. It’s important to challenge yourself, but if you find that your muscles are repeatedly sore and not recovering in time for the next run, then consider changing your effort levels.

Simulate the Race Experience

Your race will likely be outside, so if possible, it’s best to do most of your training outside. Running outdoors lets your body to naturally fall into a pace and rhythm that is appropriate for you.

You will also be exposed to outdoor elements like wind, rain, and the ground’s natural inclines and declines. Running on a variety of terrains, such as dirt roads, trails, and asphalt, is beneficial as it will give you a feel for what it’s going to be like in an uncontrolled environment. And running on a trail or soft surface can decrease the impact force on your joints. Asphalt is more forgiving than concrete, so running on roads instead of sidewalks — if it’s safe to do so — can be better for your joints.

Fuel During the Race

Proper hydration and fueling is critical. It’s important to understand your individual fluid and nutritional needs during the race, and that’s something you should work out either naturally as you train, or with the help of a doctor or nutritionist. There is no exact guideline because the amount of fluid, electrolytes, and calories needed during a marathon is highly individualized, even if two runners have similar body types and are running in the exact same conditions. And you should never drink just to drink. If you truly don’t feel thirsty in a race, you don’t need to consume two full bottles of fluid just because someone said you should.

Along with hydration is replenishing your electrolytes and calories. When you sweat, you lose electrolytes, which help regulate nerve and muscle function. Water doesn’t have electrolytes, so if you drink just water you can overdilute yourself and run the risk of hyponatremia, which is when the sodium level in your body is too low. Certain sports drinks and gel packs are formulated to have higher concentrations of electrolytes, meaning they primarily have a higher sodium content, in addition to simple, easily digested carbohydrates, which provides calories. Consuming carbohydrates is critical as your body will quickly burn through all of your accessible carbohydrates early in the race. Failure to replenish these calories can lead to “hitting the wall,” a term that refers to sudden fatigue and loss of energy caused by depletion of glycogen in the muscles and liver. Work on fueling during your training runs to avoid any surprises on race day.

Focus on Recovery

Recovery starts during the race. The better fueled you are during a marathon, the faster you’ll recover afterwards. If you’re not taking in enough fluids, electrolytes, and calories during the race, your muscles are going to break down much earlier in the race, making recovery harder.

A lot of athletes need extra warmth at the finish line because their muscles are depleted of glycogen, the carbohydrate that your body burns for fuel while running. Without that energy source, a person may start shivering, which is why a lot of marathon runners wear blankets immediately after a race.

In the hours after a marathon, massages, foam rolling, stretching, adequate nutrition and quality sleep are all important to optimize our chances at recovering quickly. Some people may take an ice bath after a race to reduce inflammation around the muscles, while others will take a warm bath to promote blood flow to the muscles, delivering nutrients. Both methods can be helpful, but there’s no great evidence to say one is better than the other. It’s more of a personal preference.

In the following days, gentle active recovery, like swimming or light cycling, can help your muscles recover.