Marathon running is a grueling test of physical and mental endurance, and with such a demanding sport comes the risk of sustaining injuries. It’s crucial for distance runners to understand the intricacies of common running injuries and how to navigate the fine line between pushing through the pain and knowing when to stop, rest, and allow the body to heal.

In a recent interview with Dr. Chris McKenzie, owner and physical therapist of McKenzie Sports Physical Therapy, I delved into the nuanced world of running injuries and the considerations involved in deciding whether to continue training or take a break. 

One of the biggest challenges for runners is the amount of time spent preparing for the race. It’s been said that a marathon is really hundreds of miles. The actual race is just the last 26 or so. Getting an injury at any point while training can be a major setback, but stopping to rest is even less ideal as you near race day, as we are with the upcoming Philadelphia Marathon. 

“Some of the most prevalent nagging injuries we see in distance running include shin splints, Achilles tendonitis, and IT band friction syndrome,” said Dr. McKenzie. 

Shin splints

Shin splints are a common affliction among runners and can stem from various causes such as overpronation, a collapsing arch, or overly rapid increases in training distance. However, the location of the pain can serve as an indicator of the severity of the condition. Dr. McKenzie noted that pain in the muscle on the front outside of the lower leg is generally easier to treat. In contrast, pain on the inside of the shin bone can signify more serious stress that may necessitate a temporary break from running to facilitate proper healing.

Achilles tendonitis

Achilles tendonitis is a common condition known for intense pain at the heel. Most often felt in the morning upon waking or after sitting for extended periods, Achilles tendinitis can be the bane of a marathon runner’s existence. Whether or not you push through or stop depends on the characteristics of the Achilles’ pain. Does the pain just hurt at the beginning and then go away? Are you fine until mile 18 and then can’t run anymore? 

“If it just hurts at the beginning of a training run but can get through the run, you likely can get through the actual race with some calf stretching and strengthening exercises and by addressing any pronation or high arch issues,” said Dr. McKenzie. 

Achilles tendonitis often occurs when a person lacks ankle mobility, which places more stress or tension on the Achilles tendon. Dr. McKenzie stresses the importance of addressing any areas of tightness and weakness through stretching and strengthening exercises for recovery. As a temporary fix, he also said placing a heel lift in the shoe with the Achilles problem can help reduce pain and allow a runner to get through a race. Dr. McKenzie emphasizes that this is not a long-term solution. 

“A heel lift prevents the Achilles from maximally lengthening, which can reduce pain but places more stress on the ball of the foot,” he said.

IT band syndrome

IT band friction syndrome occurs when the iliotibial band, a thick band of fascia running along the outside of the thigh, becomes tight or inflamed. This condition often leads to pain and discomfort on the outside of the knee, which can be exacerbated during running or other repetitive activities. IT band syndrome can occur due to hip weakness, foot pronation, and poor or worn shoes. It can also happen due to a recent increase in quadricep muscle size (hypertrophy). 

Whether or not to push through depends on the pain.

“If you experience IT band pain at the beginning of the run, but it goes away, it is likely safe to keep running,” said Dr. McKenzie. “However, if the IT band pain becomes debilitating, you must stop.”

Some of the best ways to address IT band pain are scraping, foam rolling, and stretching. Dr. McKenzie emphasizes that these treatments don’t address the underlying cause of the pain and should only be used for the short term. 

Running injuries can be prevented with the right shoes.

Shoes are another great way to mitigate the risk of running injuries during marathon training and on race day. Having a repertoire of different shoe types tailored to various stages of the running season can significantly reduce the likelihood of overuse injuries and enhance overall performance and comfort. Dr. McKenzie recommends visiting the experts at Philadelphia Runner for shoe recommendations and proper fit and highlights the importance of breaking in shoes well ahead of race day. 

Getting help with running injuries.

McKenzie Sports Physical Therapy began offering a specialized cash-based Running Peace of Mind examination several years ago to assist runners in assessing their ability to continue training despite pain. This half-hour exam was designed to provide runners with a clear understanding of whether they can safely persist with their training or need to take a hiatus from running to address underlying issues. They also offer full-hour-long appointments and mentioned that a referral isn’t necessary for an initial assessment and that they accept most major insurances. In addition, Dr. McKenzie and his team are joining eatery Winnies Manayunk in the VIP tent at the Philadelphia Marathon. The McKenzie PT team will work firsthand with runners experiencing pre-, during, and post-race issues.

Understanding when to persevere through discomfort and when to take a break can profoundly impact long-term running performance and overall well-being. If you’re a runner, consider a Running Peace of Mind examination, which can provide a comprehensive assessment of your readiness and set the stage for a safe, successful, and enduring running experience. Best of luck to all runners in this year’s Philadelphia Marathon!