Sports Physiotherapy · Running Injuries
Quick answer
The most common marathon running injuries are overuse injuries of the knee, lower leg and foot — led by runner's knee (patellofemoral pain), IT band syndrome, shin splints, Achilles tendinopathy and plantar fasciitis. About 80% of running injuries are caused by overuse, and roughly half of marathon trainees pick up an injury during a training block. Most recover fully with progressive load management and structured physiotherapy — you rarely need to stop running completely.
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.
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.
| Injury | Where it hurts | Approx. share of running injuries |
|---|---|---|
| Runner's knee (patellofemoral pain) | Around or behind the kneecap | Most common overall |
| Patellar tendinopathy | Just below the kneecap | ~12% |
| IT band syndrome | Outside of the knee | ~10% |
| Shin splints (medial tibial stress syndrome) | Inner shinbone | ~10% |
| Achilles tendinopathy | Back of the ankle or heel | ~6–9% |
| Plantar fasciitis | Underside of the heel | ~5–18% |
| Hamstring injury | Back of the thigh | ~19% (all combined) |
| Tibial stress fracture | Shinbone (localised) | ~4% |
Source: Arnold & Moody, American Family Physician 2018;97(8):510, Table 1.
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.
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:
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.”
The practical takeaway
Single-session spikes raised overuse-injury risk by roughly 64% (a 10–30% spike), 52% (30–100%) and 128% for large spikes over 100%. Week-to-week mileage change showed no clear association. Plan each long run relative to your longest run in the past month, not just your weekly total.
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.
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.
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.
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:
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.
Not sure if it's serious?
Book a running injury assessment at our Hanwell & Ealing clinic. We'll triage the pain, explain what's driving it, and build you a plan back to full training.
Book an assessment → or call 020 8566 4113
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.
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:
Recovery time depends on the injury and how early it is managed. As a general guide only:
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.
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:
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).
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.
It is not advisable without an assessment. Running 26.2 miles can turn a minor niggle into a longer-term problem. Have any pain checked by a chartered physiotherapist first so you can make an informed decision about the start line.
Ideally 6–8 weeks before race day. This allows time for assessment, treatment and a staged return, rather than a rushed fix in race week when your options narrow.
It depends on the injury. Some respond well to loading and gentle movement, others don't — and a few are worsened by aggressive stretching. Ask a physiotherapist for a personalised plan rather than stretching blindly.
There is good evidence for shockwave therapy in plantar fasciitis, and it is used as an adjunct to exercise rehabilitation for some chronic tendon problems. It is not a stand-alone cure, and suitability should be assessed individually.
Normal soreness (DOMS) appears 24–48 hours after a run, affects both sides fairly evenly and eases with gentle movement. Injury pain usually appears during or right after running, tends to be one-sided, and doesn't improve with movement. If unsure, get it assessed.
No. You can book privately with a chartered physiotherapist in the UK without a GP referral, and many NHS physiotherapy services also accept self-referrals for musculoskeletal problems.
Training for London 2026?
Whether it's a first niggle or a stubborn problem you've been carrying for months, book an assessment with our chartered physiotherapy team in Hanwell & Ealing.
Book a running injury assessment
CK Physiotherapy · 57 Elthorne Avenue, Hanwell, London W7 2JY · 020 8566 4113
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.