Marathon Training and Injury Prevention: A PT’s Guide for Runners
Training for a marathon is a major physical commitment. Whether you're a first-time participant or a seasoned racer, the months leading up to race day place significant stress on your musculoskeletal system. Running long distances repeatedly, often on pavement or hard surfaces, challenges every part of your body — from your feet and ankles to your hips and spine.
As weekly mileage builds, so does the accumulated impact on your joints and soft tissues. Each step sends a force through the legs that’s several times your body weight. Over time, without proper preparation and recovery, these forces can lead to overuse injuries that derail your training.
READ: Overuse Injuries in Runners: Signs, Symptoms, and How PT Can Help
In addition to physical wear, marathon prep often exposes movement inefficiencies that may not surface during shorter runs. Subtle biomechanical issues — like slight hip instability, poor ankle mobility, or low core engagement — can compound over the course of 26.2 miles, increasing your risk of injury.
That’s why marathon training isn’t just about running more — it’s about running smarter, with attention to strength, form, and recovery built into every phase of your plan.
Common Injuries During Marathon Prep
The road to marathon day is often paved with good intentions — and unexpected injuries. As training intensity increases, so does the likelihood of developing overuse conditions that can stall progress or force runners to scale back. Many of these injuries are preventable with proper form, footwear, and load management, but they often go unnoticed until pain sets in.
Some of the most common marathon training injuries include:
Runner’s Knee (Patellofemoral Pain Syndrome): Often caused by poor tracking of the kneecap due to weak hips or imbalanced muscle activation.
Shin Splints (Medial Tibial Stress Syndrome): A frequent result of rapid mileage increases, hard surfaces, or improper footwear.
Achilles Tendonitis: Irritation of the Achilles tendon due to tight calves, poor ankle mobility, or excessive uphill running.
Stress Fractures: Tiny cracks in bone from repetitive impact and inadequate recovery, typically in the foot, tibia, or pelvis.
READ: When to Rest vs. When to Train: How PT Helps Runners Find the Balance
These injuries don’t usually happen all at once — they develop gradually. That’s why recognizing early warning signs like persistent soreness, stiffness, or changes in gait is essential for intervention. Working with a physical therapist early in your training cycle can help identify and correct the movement patterns that often lead to these breakdowns.
Key PT Strategies for Injury Prevention
Preventing injury during marathon training isn’t just about running less — it’s about training smarter and giving your body the tools it needs to withstand the demands of high mileage. Physical therapists use a combination of strategies to help runners stay strong, resilient, and race-ready.
Here are a few core approaches we emphasize at Dang PT:
Movement Screening: A full-body assessment helps identify biomechanical weaknesses or asymmetries before they become problems. We look at how your joints move, how your muscles activate, and where compensation patterns may exist.
Strength Training: Endurance runners often neglect strength work, but it’s one of the most effective ways to prevent injury. Targeting the glutes, hips, core, and calves builds stability and power — both essential for efficient running.
Mobility and Flexibility Work: Tight hips, stiff ankles, and limited thoracic rotation can all restrict your stride and place extra stress on surrounding tissues. Incorporating dynamic mobility and stretching into your routine keeps your body moving well.
Recovery Planning: Recovery isn’t passive — it’s part of the training plan. Foam rolling, cross-training, sleep, and rest days all help your body absorb the benefits of training without tipping into overload.
By blending these strategies into your marathon prep, you reduce the risk of setbacks and build a foundation for sustainable performance.
The Importance of Gait Analysis and Load Management
When it comes to preventing injury and optimizing performance, understanding how you run is just as important as how much you run. Gait analysis and load management are two essential tools physical therapists use to keep marathoners moving efficiently and safely.
READ: The Role of Flexibility and Mobility in Running Injury Prevention
Gait analysis involves evaluating your running mechanics — including foot strike pattern, cadence, stride length, and joint alignment — to identify inefficiencies or asymmetries. Small issues, like overstriding or excessive hip drop, can place added stress on the knees, shins, and lower back over time. A trained PT can pinpoint these patterns and recommend movement cues, drills, or footwear changes to correct them.
Equally important is load management, which refers to how your training volume is progressed over time. Increasing mileage too quickly is one of the most common causes of injury. At Dang PT, we help runners find the right balance between training stress and recovery, ensuring that their weekly mileage, long runs, and intensity are scaled appropriately to meet their current capacity.
Together, gait analysis and load management provide a data-informed approach to marathon training — reducing guesswork and minimizing risk, so you can train with confidence.
How Dang PT Supports Runners in Los Angeles
At Dang PT, we understand the unique demands of long-distance running. Whether you're training for your first marathon or aiming for a personal best, our team is here to help you prepare with confidence and prevent injury along the way.
Our approach is rooted in evidence-based physical therapy combined with real-world running expertise. We begin with a comprehensive evaluation that includes movement screening, gait analysis, and a discussion of your training goals. From there, we build a personalized plan that may include strength training, mobility work, manual therapy, and running-specific drills.
We’ve worked with marathoners of all levels — from beginners working up to their first 10-mile run, to seasoned runners looking to correct chronic issues that resurface mid-training. Our focus is on helping you train smarter, move more efficiently, and recover faster, all while staying aligned with your race timeline.
READ: The Top 5 Running Injuries and How PT Can Help You Avoid Them
To learn more about our approach to running physical therapy, visit our About Us page, or explore the full range of services we offer on our Our Services page.
Train Smarter, Not Harder — Start with a PT Evaluation
If you're preparing for a marathon, now is the time to think beyond mileage. A physical therapy evaluation can uncover movement limitations, imbalances, or gait inefficiencies that may otherwise lead to injury — especially when training volume ramps up.
At Dang PT, our team offers personalized assessments that go beyond the surface. We help you understand how your body moves, what areas need attention, and how to adjust your training plan to meet your goals without sacrificing your health.
Whether you're dealing with nagging pain, hoping to avoid overuse injuries, or simply looking to run more efficiently, we’re here to support your journey — from base training to race day.
Let’s make this your strongest marathon yet. Book your running assessment today through our Contact Us page.