Marathon Training Injuries: Prevention, Warning Signs, and Treatment Options
With the Royal Victoria Marathon coming up on October 11, 2026, a lot of Vancouver Island runners are deep in the toughest stretch of training — the weeks where weekly mileage climbs and the body starts to feel it. Research suggests roughly 65-80% of runners deal with some kind of injury during a training cycle, and the overwhelming majority of those are overuse injuries: the kind that build slowly, get ignored, and eventually sideline a race.
The good news is that most of these injuries are both preventable and treatable, especially when they’re caught early. Here’s what to watch for and how to stay ahead of them.
The Most Common Marathon Training Injuries
Runner’s knee (patellofemoral pain syndrome) Dull, aching pain around or behind the kneecap, often worse on stairs, hills, or after sitting for a while. It’s one of the most frequent complaints among distance runners and is usually tied to how the kneecap tracks as the knee bends.
IT band syndrome Sharp or aching pain on the outside of the knee, typically flaring up during long runs, hills, or right when mileage increases. It’s closely linked to hip and pelvic stability — when those muscles fatigue, the IT band takes on more strain than it’s built for.
Shin splints Pain along the shinbone, common in runners who’ve ramped up mileage or intensity too quickly, or who’ve changed footwear or running surfaces. Left unaddressed, this can progress toward a stress fracture.
Plantar fasciitis Stabbing heel pain, often worst with the first steps in the morning. It’s caused by repetitive strain on the band of tissue that runs along the bottom of the foot.
Achilles tendinopathy Stiffness or aching along the Achilles tendon, usually worse after rest and easing slightly once warmed up — a sign the tendon isn’t recovering fully between runs.
Why These Injuries Happen
Almost all of the above share the same root causes: mileage increasing faster than the body can adapt, muscular imbalances (especially in the hips, glutes, and core), and inadequate recovery between hard efforts. None of that means training harder is the problem — it usually means training smarter is the fix.
A few habits that meaningfully lower injury risk:
- Progress gradually — increasing weekly mileage by more than about 10% is one of the most common injury triggers
- Strength train — targeting glutes, hamstrings, calves, and core supports the joints that absorb the most repetitive impact
- Warm up and cool down — a few minutes of dynamic movement before and after runs meaningfully reduces strain
- Cross-train — swimming, cycling, or yoga on recovery days keeps you moving without repeating the same impact pattern
- Get the right shoes — footwear that doesn’t match your foot type and gait is a common, easily-fixed contributor
- Don’t run through sharp or worsening pain — general fatigue is normal; pain that changes your stride is not
When to See a Professional (and Who to See)
A little soreness after a long run is expected. What’s worth getting checked out is pain that’s sharp, one-sided, worsening week over week, or changing the way you run. Catching these early is almost always faster and cheaper than treating them after they’ve derailed a training block.
Physiotherapy is often the first stop for an active injury or nagging pain. A physiotherapist can assess your movement patterns and gait, identify the muscular imbalances driving the problem, and build a targeted rehab and strengthening plan to fix the cause, not just the symptom.
Chiropractic care focuses on alignment through the spine, hips, and pelvis — areas that directly affect stride efficiency and how evenly load is distributed through your legs with every step. Many runners incorporate regular adjustments through a training block specifically to stay ahead of the imbalances that lead to IT band or plantar fascia issues.
Massage therapy helps manage the cumulative muscle tightness that builds through high-mileage weeks, improves circulation, and can be a useful part of a taper-week recovery routine heading into race day.
For a lot of runners, the most effective approach isn’t picking just one of these — it’s combining them as part of a broader training plan.
Getting Through to Race Day
Whether you’re chasing a Boston Qualifying time in the marathon or running your first 8K, the runners who make it to the start line healthy are usually the ones who treated recovery as part of training, not an afterthought. If something’s been nagging at you these past few weeks, now — not race week — is the time to get it looked at.
Book an appointment with our physiotherapy, chiropractic, or massage team →
This article is intended for general information and isn’t a substitute for individualized medical or professional advice. If you’re experiencing pain that’s affecting your training, please book an assessment with one of our practitioners.