Marathon Training Injuries: Protecting Your Knees and Hips

Marathon Training Injuries: Protecting Your Knees and Hips

Common knee and hip injuries during marathon and half-marathon training, why they happen, practical ways to reduce risk during your build-up, race-week tips and the warning signs that mean you should stop.

Most knee and hip injuries during marathon and half-marathon training are overuse injuries, and they usually come from increasing training load too quickly. The most common problems are pain around the kneecap (patellofemoral pain), iliotibial band syndrome on the outer knee, patellar tendon pain, tendon pain on the outer hip, strains at the front of the hip and groin, and bone stress injuries. Building up gradually, doing regular strength work, getting enough recovery and taking early warning signs seriously all help lower the risk.

This article is for runners preparing for autumn and spring races. It explains why marathon injuries happen, the common knee and hip problems, practical ways to reduce risk during your build-up, what to watch for in race week, and which symptoms mean you should stop training and see an orthopedic surgeon.

Why do injuries increase during marathon training?

A marathon build-up usually means a substantial rise in weekly distance over 12–20 weeks. Muscles and the cardiovascular system adapt relatively quickly, but tendons, cartilage and bone adapt more slowly. When training load outpaces these tissues, overuse injuries can develop, often starting as mild aches.

The main contributing factors are:

• Rapid increases in distance: raising weekly mileage or long-run distance sharply in a short time.
• Stacked intensity: tempo, interval and hill sessions crammed into the same week.
• Poor recovery: skipped rest days, short or poor sleep, inadequate fuelling.
• Lack of strength: hip, thigh and calf muscles that are not strong enough for the running load.
• Previous injuries: returning to running before an old injury has fully healed.
• Equipment and terrain: worn-out shoes, switching shoe models close to race day, always running on a cambered road.

Common knee injuries in runners

Patellofemoral pain

Pain around or behind the kneecap, worse downhill, on stairs and after sitting with bent knees. It is one of the most frequent knee problems in runners, often linked to weak hip and thigh muscles and sudden jumps in mileage.

Iliotibial band syndrome

A burning pain on the outside of the knee that starts after a predictable distance and gets worse running downhill. Long runs and cambered routes can trigger it.

Patellar tendinopathy

Pain in the tendon just below the kneecap that is felt at the start of a run, eases as you warm up and returns afterwards. Hill work and jumping drills increase the load.

Meniscus and cartilage problems

Especially after 35–40, swelling, catching or pain on the joint line may point to a degenerative meniscus tear or cartilage problem. These symptoms differ from simple overuse aches and should be assessed.

Common hip injuries in runners

• Outer hip tendon pain (greater trochanteric pain syndrome): pain on the side of the hip, worse lying on that side and after runs.
• Hip flexor and groin strains: pain at the front of the hip and groin with tempo and hill running.
• Proximal hamstring tendinopathy: deep pain just below the sitting bone, worse with long sitting and faster running.
• Femoral neck and pelvic stress injuries: groin pain that increases with weight-bearing, eases with rest and gets steadily worse. This needs to be taken seriously and caught early.
• Hip impingement and labral problems: deep groin pain, catching or locking, which can also occur in distance runners.

Practical ways to reduce risk during your build-up

1. Increase load gradually: raise weekly distance in small steps and plan a lighter recovery week every 3–4 weeks.
2. Keep easy runs easy: most of your running should be at a conversational pace, with hard sessions spread across the week.
3. Strength train twice a week: bridges, side-lying leg raises, single-leg squats, step-ups, calf raises and core work make your body more resilient. See injury prevention through strength training.
4. Prioritise recovery: enough sleep, at least one full rest day a week and energy intake that matches your training all affect injury risk. We cover nutrition in nutrition and exercise balance for athletes.
5. Manage shoes and surfaces: replace worn shoes in good time, break in new ones weeks before the race, and avoid always running the same way on a cambered road.
6. Keep a pain log: score pain from 0 to 10 during runs and the next morning. Pain that lasts into the next day, keeps rising or makes you limp means you should cut back.

Race week and race day

• Distance is reduced in the last 2–3 weeks (the taper); trying to make up for missed training at this stage raises injury risk.
• Do not use new shoes, new socks or an untested fuelling plan on race day.
• If you have ongoing pain before the race, have it assessed rather than running on painkillers.
• If sudden severe pain, limping or an inability to bear weight starts during the race, stopping is the safest choice.

Our article is pain during exercise normal? explains which aches are expected and which are warning signs.

When should you stop training and see an orthopedic surgeon?

• Pain that builds during a run and makes you limp
• Pain at rest or at night
• Pinpoint tenderness over bone, or groin pain that worsens with weight-bearing (possible stress fracture)
• Swelling, catching, locking or the knee giving way
• Pain that has not eased within 1–2 weeks of reduced training
• Pain that started after a fall or twist

Groin pain that worsens with weight-bearing deserves particular attention, because femoral neck stress fractures can progress if they are missed. Stop running and get assessed promptly.

At Prof. Dr. Gökhan Polat's clinic, running injuries are evaluated by combining your training history, the examination and imaging where needed, and treatment is planned with your race goals in mind. Recovery time varies from person to person. Learn more on our sports injuries page.

Summary

• Most knee and hip injuries during marathon training are overuse problems caused by load outpacing tissue adaptation.
• Gradual progression, twice-weekly strength work, good recovery and suitable equipment help reduce risk.
• In race week, avoid trying anything new and do not mask ongoing pain with painkillers.
• Pain that makes you limp, persists at night or worsens in the groin with weight-bearing may signal a serious problem such as a stress fracture.

This article is for general information only; diagnosis and treatment decisions are made individually after examination and the necessary tests.