Marathon Running: Don't Let Knee PainDerail Your Training

Written By Chloe Wanless (Chartered Physiotherapist)

More people than ever are lacing up their running shoes and signing up for endurance events. In fact, the demand for places in the London Marathon has never been higher, with record numbers of applicants hoping to secure a spot in future races. As someone who hasentered myself, I can certainly understand the appeal.

Whether you're training for a marathon, a half marathon, or simply trying to improve your fitness through running, it's important to remember that increased training volume also increases the risk of injury. Research suggests that around 20% of runners training for an event will experience an injury during their preparation. One of the most common complaints? Knee pain.

I learnt this the hard way myself when my training for a half marathon was disrupted by patellar tendinopathy. What initially seemed like a minor ache quickly became a limitation on my training, forcing me to reassess my running schedule and recovery strategies. It highlighted the importance of balancing training load, strength work, and recovery to keep progressing without overloading the body.

Think about your local parkrun or running club. How many runners do you see wearing knee supports or colourful strips of tape? While these can sometimes help manage symptoms, they don't always address the underlying cause of the problem.

Why Do Runners Develop Knee Pain?

Knee pain is rarely caused by a single factor. More commonly, it develops as a result of

several contributing issues, including:

● Running biomechanics and technique

● Muscle weakness or imbalances, particularly around the hips and thighs

● Sudden increases in training distance, intensity, or frequency

● Inappropriate or worn-out footwear

● Reduced recovery between training sessions

Identifying the root cause is often the key to long-term recovery.

How Can Physiotherapy Help?

Physiotherapy aims to understand why your knee pain has developed rather than simply

treating the symptoms.

A thorough assessment may include:

● Analysis of your running gait and movement patterns

● Assessment of foot posture and lower limb alignment

● Strength testing of key muscle groups

● Review of your training schedule and recovery strategies

Using this information, a personalised treatment plan can be developed to help reduce pain, improve performance, and allow you to continue progressing towards your running goals. This may include targeted strengthening exercises, mobility work, training modifications, and advice regarding footwear and recovery.

Prevention Is Better Than Cure

Many runners only seek help once pain has already started. However, physiotherapy can also play an important role in injury prevention.

A proactive approach may include:

● Individualised strength and conditioning programmes

● Guidance on gradual training progression

● Recovery strategies to support increasing mileage

● Sports massage and other therapies where appropriate

● Advice tailored to your experience level and goals

By addressing potential weaknesses before they become problematic, runners can often

reduce their risk of injury and train more consistently.

Ready to Start Running?

Whether you're preparing for your first marathon, chasing a personal best, or simply looking

to get into running safely, physiotherapy can help you build confidence in your training.

By understanding your body's strengths, identifying areas for improvement, and creating a

structured plan, you can reduce your risk of injury and focus on what matters most—enjoying

your running and achieving your goals.