Physiotherapy Insights: Key Considerations for Marathon Training by Megan Schneider Senior APA Physiotherapist
Have you just completed the Sydney half marathon and decided to keep those legs going for a full marathon? Then you need to make sure your body is fully prepared! Continue reading to ensure you’ve got all the boxes covered to give yourself the best chance of success without injury!
Running a marathon is a major physical and mental feat, but successful training goes beyond just racking up kilometres. As physiotherapists, we see first-hand how injuries and inefficiencies can derail even the most motivated runners. Integrating physiotherapy principles into your marathon training can help you reduce injury risk, improve performance, and build long-term resilience.
Here are eight key considerations for marathon training—grounded in evidence-based physiotherapy practice.
1. Progressive Load Management
Tissues such as muscles, tendons, and bones adapt best when training loads are increased gradually. Sudden spikes in load are strongly linked to overuse injuries like stress fractures and tendinopathies. To avoid this occurring for you, make sure to increase your load appropriately. Evidence shows that if you follow the 10% rule -don’t increase your weekly distance by more than 10% (Hreljac, 2004)- you will reduce you risk of an overload injury. In addition to this you should build in recovery weeks every 3–4 weeks.
2. Biomechanical Assessment
Subtle gait abnormalities or imbalances can lead to compensatory movement patterns and injuries. A physiotherapy-led biomechanics and running assessment can highlight these issues before they become problems. Looking at how your body moves, absorbs load and transfers weight can all be assessed and managed to give you the best chance of reducing risk of injury.
3. Strength and Stability Training
Strength training is one of the most under-utilised yet powerful tools in marathon training. Far from being a distraction from running, well-structured strength work can improve performance, reduce injury risk, and enhance running economy.
Strengthening the kinetic chain helps support efficient running and offloads stress from joints. Incorporating resistance training 1-2 times per week during marathon training will help to strengthen the muscles required to keep you running.
Key Focus Areas:
• Glutes and hips (for stride power and pelvic stability)
• Hamstrings and calves (for propulsion and injury prevention)
• Core muscles (for trunk stability and control)
• Single-leg balance and strength (to mirror running demands)
Why Strength Training Matters for Marathon Runners
A. Injury Prevention
Strength training improves tissue resilience and corrects muscle imbalances that contribute to common running injuries like:
• Patellofemoral pain syndrome
• Iliotibial band syndrome
• Achilles tendinopathy
• Shin splints
Evidence shows that strength training can reduce overuse sports injuries by up to 50%. (Lauersen et al. 2014).
B. Improved Running Economy
Running economy refers to the amount of oxygen used at a given pace. Strength training—particularly heavy, low-rep training—can improve neuromuscular efficiency, meaning you run faster using less energy.
Evidence: Aagaard & Andersen (2010) and Balsalobre-Fernández et al. (2016) found significant improvements in running economy and time trial performance in runners following strength programs.
C. Fatigue Resistance
Marathons test your ability to maintain form and power under fatigue. Strength training builds muscular endurance and helps delay the breakdown in mechanics that often occurs in the final third of a race.
4. Flexibility and Mobility Work
Limited flexibility can alter movement mechanics and increase strain on key structures. You might notice after a long run that you feel particularly tight through the hips and legs. If this is not addressed it can cause pain in areas including your lower back and knees. It is important to address this tightness early on, without letting it build up, to keep those legs moving.
Tip: Use dynamic stretches pre-run and static stretches post-run. Foam rolling may also aid in muscle recovery and tissue mobility.
5. Recovery and Rest
Recovery is when adaptation occurs. Neglecting rest increases the risk of overtraining syndrome and overuse injuries. You should incorporate at least one full rest day per week and consider active recovery methods like walking, mobility drills, or gentle yoga. Other recovery methods include ice baths and saunas, both have evidence for recovery, yet have different benefits:
Ice Baths (Cold Water Immersion)
Evidence-based benefits:
- Reduces muscle soreness (DOMS): Ice baths can reduce delayed-onset muscle soreness 24–72 hours post-exercise (Leeder et al., 2012).
- Decreases inflammation and swelling: Cold exposure causes vasoconstriction, which may limit excessive inflammation after intense runs.
- Useful for recovery between back-to-back sessions or races.
Considerations:
- May blunt some muscle adaptation and strength gains if used immediately after resistance training (Roberts et al., 2015).
- Best reserved for high-volume or back-to-back running sessions where performance is prioritised over adaptation.
Typical protocol:
10–15°C for 10–15 minutes after intense or long runs.
Sauna (Heat Therapy)
Evidence-based benefits:
- Improves endurance: Regular sauna use post-exercise has been shown to increase plasma volume and promote cardiovascular adaptations (Scoon et al., 2007).
- Reduces muscle soreness: Heat may help relax muscles and reduce perceived soreness.
- May promote mitochondrial function and metabolic recovery (Zurawlew et al., 2016).
Considerations:
- Not ideal immediately after a race when inflammation is high—better used during recovery phases.
- Hydration is crucial before and after use.
Typical protocol:
15–30 minutes at 80–100°C after training, 2–3 times/week.
6. Injury Prevention and Early Management
Many running injuries start small. Early intervention from a physiotherapist can prevent a short-term issue from becoming a chronic one. Don’t run through pain that alters your gait or persists longer than 48 hours. Seek assessment early.
7. Cross-Training Benefits
Cross-training provides cardiovascular benefits while reducing impact stress. This can be especially useful during recovery or high-volume weeks. Replace one weekly run with a low-impact activity like swimming, cycling, or rowing.
8. Footwear and Orthotics
Footwear plays a crucial role in shock absorption and alignment. Running in worn-out or inappropriate shoes increases injury risk. Replace shoes every 500–800 km, or sooner if you notice wear patterns or discomfort. A physiotherapist can assess whether custom orthotics may be helpful.
Final Thoughts: Train Smart, Run Strong
Preparing for a marathon is about more than endurance—it’s about building a resilient, well-balanced body. By applying physiotherapy principles, you can train smarter, recover faster, and reduce the risk of injury on your road to race day.
Need help planning your training or recovering from a niggle? Book a physiotherapy consultation with us to set up a tailored plan.
References:
Aagaard, P., & Andersen, J. L. (2010). Effects of strength training on endurance capacity in top-level endurance athletes. Scandinavian Journal of Medicine & Science in Sports, 20(Suppl 2), 39–47. https://doi.org/10.1111/j.1600-0838.2010.01197.x
Balsalobre-Fernández, C., Santos-Concejero, J., & Grivas, G. V. (2016). The effects of strength training on running economy in highly trained runners: A systematic review with meta-analysis. Journal of Strength and Conditioning Research, 30(8), 2361–2368. https://doi.org/10.1519/JSC.0000000000001316
Hreljac, A. (2004). Impact and overuse injuries in runners. Medicine & Science in Sports & Exercise, 36(5), 845–849. https://doi.org/10.1249/01.MSS.0000126803.66636.DD
Kellmann, M. (2010). Preventing overtraining in athletes in high-intensity sports and stress/recovery monitoring. Scandinavian Journal of Medicine & Science in Sports, 20(Suppl 2), 95–102. https://doi.org/10.1111/j.1600-0838.2010.01192.x
Lauersen, J. B., Bertelsen, D. M., & Andersen, L. B. (2014). The effectiveness of exercise interventions to prevent sports injuries: A systematic review and meta-analysis. British Journal of Sports Medicine, 48(11), 871–877. https://doi.org/10.1136/bjsports-2013-092538
Leeder, J., Gissane, C., van Someren, K., Gregson, W., & Howatson, G. (2012). Cold water immersion and recovery from strenuous exercise: A meta-analysis. British Journal of Sports Medicine, 46(4), 233–240. https://doi.org/10.1136/bjsports-2011-090061
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