Common Marathon Injuries & How Physio Helps

Sports Physiotherapy · Running Injuries

Marathon Running Injuries: A West London Physiotherapist's Evidence-Based Guide to Prevention & Recovery

The 2026 TCS London Marathon ballot received a record 1,133,813 applications — 869,803 from the UK and 264,011 international — making it the first marathon ballot in history to pass one million. With thousands of West London runners now training through Gunnersbury Park, Walpole Park and the Grand Union Canal towpaths for the race on Sunday 26 April 2026, injury prevention has rarely been more relevant locally.

This guide explains the most common marathon injuries, what the latest 2024–2026 research says about preventing them, and exactly when to see a physiotherapist. It is written for the first-time charity runner, the club runner chasing a personal best and the runner Googling their symptoms at 11pm the night before a long run.

What are the most common marathon running injuries?

Most marathon injuries are overuse injuries concentrated at the knee, lower leg and foot. According to the American Academy of Family Physicians' clinical review Common Running Injuries: Evaluation and Management (American Family Physician, 2018), the knee accounts for around 28% of running injuries, and about 80% of running injuries are caused by overuse rather than a single traumatic event.

Source: Arnold & Moody, American Family Physician 2018;97(8):510, Table 1.

How common are marathon injuries, really?

Marathon injuries are very common but rarely serious. A systematic review cited in the AAFP review found a one-year injury rate of 27% in novice runners, 32% in long-distance runners and 52% in marathon runners. In first-time marathon runners specifically, roughly half report a minor injury that interferes with training, while under 10% sustain a major one.

That is genuinely reassuring: the overwhelming majority of running injuries are manageable overuse problems, not season-enders. Early, structured management is usually what separates a two-week interruption from a lost training block.

Why do marathon injuries happen?

Most marathon injuries happen because training load outpaces tissue capacity — a spike in distance, pace or hills that asks more of your tendons, bones and muscles than they have adapted to handle. Around 80% of running injuries are overuse-related rather than caused by a single traumatic event.

Common contributing factors include:

• Sudden load spikes — the biggest single driver (see the updated evidence below).
• Low strength and capacity — weak hips, calves and glutes.
• Rapid changes in surface, footwear or terrain.
• Under-recovery — poor sleep and inadequate fuelling (a particular risk for bone stress injuries).
• Previous injury — consistently the strongest predictor of a future one.

Is the “10% rule” still the best way to increase mileage?

Not on its own. The classic “10% rule” (never increase weekly mileage by more than 10%) has never been validated in a landmark trial. New evidence from 2025 has meaningfully shifted the picture.

Frandsen and colleagues, publishing in the British Journal of Sports Medicine (2025), followed 5,205 runners across 588,071 sessions over 18 months. Their conclusion: “A significant increase in the rate of running-related overuse injury was found when the distance of a single running session exceeded 10% of the longest run undertaken in the last 30 days.”

This does not make the 10% rule wrong so much as incomplete. It is the single big run that most often breaks a runner, not the weekly total. When our physiotherapists build a return-to-training plan at our Hanwell clinic, this is one of the first things we look at in a runner's Strava or Garmin history.

How do I prevent runner's knee and other marathon injuries?

The best-evidenced ways to reduce running injury risk are progressive load management, strength training and — for knee pain specifically — a small increase in running cadence. There is no single magic exercise; consistency across these areas is what protects you.

• Manage load session by session. Avoid big jumps in any single long run; build gradually and schedule recovery weeks.
• Strength train twice a week. Lauersen, Andersen & Andersen (BJSM 2018), a meta-analysis of 7,738 participants, found strength training reduced injury risk to roughly one-third of controls (RR 0.34) — nearly halving overuse injuries. Compliance matters, so a supervised, progressive programme tends to work best. Our team's strengthening exercise guide is a useful starting point.
• Consider a cadence tweak for knee pain. Increasing your step rate by 5–10% can meaningfully reduce peak forces through the knee — a simple change a physiotherapist can coach in a running assessment.
• Prioritise sleep and fuelling. Under-fuelling raises the risk of bone stress injuries, especially in female runners.
• Get a gait or movement assessment if you are injury-prone or building for a first marathon.

A note on carbon-plated “super shoes”

Carbon-plated racing shoes reliably improve running economy, but their long-term injury profile is still emerging. Early biomechanical studies and case reports suggest they can alter foot mechanics and lower step rate; no study has yet proven they cause injuries, but the sensible position is to introduce them gradually rather than racing 26.2 miles in a brand-new pair.

When should I see a physiotherapist for a running injury?

See a physiotherapist if pain lasts more than a few days, changes how you run, is sharp or localised, or keeps returning. In the UK you can book privately with a chartered physiotherapist without a GP referral, and many NHS musculoskeletal services also accept self-referrals.

Book an assessment if you notice any of the following:

• Pain that alters your running form or gait.
• Pain that persists beyond the first mile or worsens during a run.
• Swelling, or pain that is worse on one side only.
• Sharp, localised bone pain (a possible stress fracture — needs prompt assessment).
• The same niggle returning every time you build mileage.

If you are training for London 2026, aim to have persistent pain assessed 6–8 weeks before race day so there is time for treatment and a staged return.

Is it shin splints or a stress fracture?

Shin splints (medial tibial stress syndrome) usually cause diffuse pain along the inner shinbone that eases as you warm up. A stress fracture tends to cause sharp, pinpoint pain on the bone that worsens with impact and can hurt at rest. Any localised, worsening bone pain should be assessed promptly, because running through a stress fracture can turn a 4-week problem into a 12-week one.

How are marathon injuries treated?

Modern physiotherapy for running injuries centres on progressive loading and exercise rehabilitation, supported by hands-on therapy and education — not rest alone. For acute soft-tissue injuries, the current international framework is PEACE & LOVE (Protection, Elevation, Avoid anti-inflammatories, Compression, Education — then Load, Optimism, Vascularisation, Exercise), introduced by Dubois & Esculier in the BJSM, which has replaced RICE in current sports medicine practice.

Evidence-based options a physiotherapist may use:

• Progressive strength & loading programmes — the core of tendon and overuse rehabilitation (for example, heavy slow resistance for Achilles tendinopathy). See our guide to healing Achilles tendonitis.
• Running retraining — cadence and technique cues informed by gait analysis.
• Manual therapy — to ease symptoms and support movement while active rehab progresses.
• Shockwave therapy — the evidence is strongest for plantar fasciitis; for Achilles and patellar tendinopathy it is more mixed, so we use it as an adjunct to exercise rather than a stand-alone fix.
• Electrotherapy — for symptom management alongside active rehabilitation.
• Patient education — realistic timelines, load rules, and what to do (and not do) on rest days.

How long do marathon injuries take to recover?

Recovery time depends on the injury and how early it is managed. As a general guide only:

• Mild strains and early tendinopathy: often 2–3 weeks.
• Runner's knee, IT band syndrome, plantar fasciitis: often 4–8 weeks.
• Stress fractures or severe tendinopathy: commonly 8–12+ weeks.

These are estimates only. Individual recovery varies with age, training history, sleep, nutrition and how quickly you get expert input — follow a personalised plan from a qualified professional rather than a generic timeline from Google.

How do I safely return to running after injury?

Return to running gradually using a walk–run progression, guided by symptoms rather than the calendar. Pain should stay low (generally 3/10 or below) and settle quickly afterwards. A typical staged return:

• Phase 1 (weeks 1–2): short walk/run intervals on flat, forgiving surfaces, every other day.
• Phase 2 (weeks 3–4): lengthen the running intervals; 3–4 sessions per week.
• Phase 3 (weeks 5–8): continuous running, gradually increasing distance and reintroducing varied terrain.

Our team builds individualised return-to-run plans that account for your race target, training history and life outside running. For a broader view of what physiotherapy for running looks like at our clinic, see our complete UK running injuries guide and our guide to patellofemoral pain (runner's knee).

Running in Ealing & West London

West London is one of the best places in the capital to train. The Ealing Eagles Running Club — one of the UK's largest, with more than 700 members — welcomes runners of all abilities; Gunnersbury parkrun holds a free, timed 5K every Saturday at 9am in Gunnersbury Park; and the Ealing Half Marathon returns to Walpole Park in late September.

Many local runners use these events as stepping stones to the London Marathon. Our clinic on Elthorne Avenue in Hanwell is minutes from these routes, so we see the full spectrum of local running injuries — from first-timers finding their long-run legs to sub-3 club runners fine-tuning form. If you'd like to see the wider range of sport-specific work we do, our sports physiotherapy service page is a good starting point, and our overview of how we help injured runners covers what a first appointment looks like.

Frequently asked questions

This article is for general information and is not a substitute for individual clinical assessment. If you have a running injury, consult a qualified healthcare professional. Content reviewed by CK Physiotherapy's HCPC-registered chartered physiotherapy team.

References

1. Arnold MJ, Moody AL. Common Running Injuries: Evaluation and Management. American Family Physician. 2018;97(8):510–516. www.aafp.org/pubs/afp/issues/2018/0415/p510.html
2. Schuster Brandt Frandsen J, Hulme A, Parner ET, et al. How much running is too much? Identifying high-risk running sessions in a 5200-person cohort study. British Journal of Sports Medicine. 2025;59(17):1203–1210. doi:10.1136/bjsports-2024-109380. pmc.ncbi.nlm.nih.gov/articles/PMC12421110
3. Lauersen JB, Andersen TE, Andersen LB. Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries: a systematic review, qualitative analysis and meta-analysis. British Journal of Sports Medicine. 2018;52(24):1557–1563. doi.org/10.1136/bjsports-2018-099078
4. Dubois B, Esculier J-F. Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine. 2020;54(2):72–73. doi.org/10.1136/bjsports-2019-101253
5. NHS. Get NHS help for back or joint problems from community musculoskeletal (MSK) services. www.nhs.uk/nhs-services/get-nhs-help-for-back-joint-problems
6. Athletics Weekly. Over one million people apply for 2026 London Marathon. 3 May 2025. athleticsweekly.com/news/over-one-million-people-apply-for-2026-london-marathon-1040001434