Training for a spring marathon without picking up an overuse injury

Every January the clinic fills with runners training for London, Paris or Brighton. They are three months from the race, doing the heaviest weeks of the whole plan, in cold weather and short days, and something has started to hurt.

It is a predictable season because the ingredients are predictable. The body is being asked to do more than it has done before, repeatedly, without quite enough time to adapt to each increase.

What an overuse injury really is

It helps to think of it simply. An overuse injury is a failure of the injured part to cope with what it is being asked to do. Not a fault, not a weakness, just a mismatch between demand and the ability to adapt to it.

Tissue adapts to load. Bone, tendon and muscle all get stronger in response to being used, but they do it on their own timescale, and that timescale is slower than your cardiovascular fitness improves. This is why runners so often get injured at exactly the point they are feeling strongest. Your lungs are ready for the mileage several weeks before your shins are.

There is almost always a trigger, and it is almost always an increase. More miles, more sessions, a new hill route, a switch to faster running. Underneath the trigger there are usually contributing factors, which might include your age, previous injuries, your running pattern, the state of your shoes or simply an ambitious training plan.

The same pattern applies well outside sport. A nurse taking extra twelve hour shifts, or a postman covering additional rounds before Christmas, are running the identical experiment on their feet.

The ones we see

The feet and lower legs take the brunt of it. Pain at the front of the knee and on the outer side of it, both often grouped under runner's knee. Aching along the inner shin, which is usually medial tibial stress syndrome. Heel pain that is at its worst for the first few steps in the morning, which is typically plantar fasciitis. Achilles pain that eases as you warm up and returns afterwards.

Most of these respond well if they are addressed while they are still a niggle. Most become a genuine problem if they are run through for a month.

Six things that make the difference

Replace tired shoes. There is no exact mileage at which a shoe expires, but if yours are old, compressed and visibly worn on one side, they are contributing.

Increase gradually. Give the tissue a chance to catch up with the fitness. If a week feels like a big jump from the last one, it probably is.

Get a coach or join a club, particularly if this is your first marathon. Most running clubs cater for every level and are full of people who have made the mistakes already.

Listen to pain rather than negotiating with it. Pain is information about load. A niggle that changes your stride is telling you to reduce something now, not in a fortnight.

Do some strength work. Two short sessions a week of calf, hip and single leg work will do more for your durability than the same time spent running.

If something is not settling within a week or two of backing off, get it assessed rather than continuing to guess.

What an assessment involves

Gareth Klepacz, our podiatrist, sees a large number of runners at this time of year. The assessment starts with the history, because the trigger is usually in it, then looks at muscle tightness, joint restriction, alignment and posture, and includes gait analysis, which for a runner means watching you run rather than walk.

Treatment might be stretching and strengthening, advice on training and recovery, or custom orthotics where there is a biomechanical factor that needs changing or an injured area that needs its workload reduced while it recovers.

Podiatry, running assessment and gait analysis and sports injury assessment and treatment all form part of that work. You do not need a referral, and coming in early in the training block is considerably more useful than coming in the week before the race.