Training for a marathon asks a lot of your body. As the kilometres build and long runs start to dominate the week, muscles, tendons and joints are placed under more and more load. While stiffness and fatigue are part of the process, any pain that lingers or worsens is usually a sign that your body needs a change in approach.
At Hein Viljoen Physiotherapy, we regularly see runner’s knee, Achilles tendinopathy, plantar fasciitis, iliotibial band (ITB) syndrome, and calf muscle strains in marathon runners. These injuries usually develop gradually during marathon training, often when training load and recovery are out of balance.
1. Runner’s knee
Runner’s knee is one of the most common issues runners experience during marathon preparation.
- You might notice:
A dull ache around or behind the kneecap, often after long runs, downhill sections, or when sitting for a while. - What’s usually behind it:
An increase in training load combined with reduced hip and glute support places extra stress on the knee. - How to avoid it:
Gradual mileage progression, regular strength work for the hips and thighs, and paying attention to early niggles before they become persistent.
2. Achilles tendinopathy
The Achilles tendon plays a major role in every step you take, especially as training intensity increases.
- You might notice:
Stiffness or soreness in the tendon is often the first thing in the morning or at the start of a run. - What’s usually behind it:
Sudden changes in speed work, hill sessions, or overall mileage without enough time for the tendon to adapt. - How to avoid it:
Introducing training changes gradually, prioritising calf strengthening, and responding early to ongoing stiffness rather than pushing through pain.
3. Plantar fasciitis
Foot pain can be particularly frustrating, especially when it starts affecting everyday movement.
- You might notice:
Sharp or aching pain under the heel or along the arch, often worse with the first steps out of bed. - What’s usually behind it:
Repeated loading during long runs, combined with limited foot strength or recovery time. - How to avoid it:
Building long-run distance carefully, strengthening the feet and calves, and addressing symptoms early before they become long-standing.
4. Iliotibial band syndrome
ITB syndrome often shows up just as training volume peaks.
- You might notice:
A sharp or burning pain on the outside of the knee that worsens the longer you run. - What’s usually behind it:
Repetitive load, reduced hip control, sudden increases in mileage, or consistently running on cambered roads. - How to avoid it:
Strengthening the hips and glutes, managing training load during busy training weeks, and varying running surfaces where possible.
5. Calf muscle strains and tightness
Calf issues are common in marathon runners, particularly towards the end of long runs.
- You might notice:
Tightness, cramping, or a sharp twinge in the calf as fatigue sets in. - What’s usually behind it:
Calves that haven’t yet adapted to the demands of higher mileage, often combined with limited recovery. - How to avoid it:
Progressive calf strengthening, scheduling rest days between hard sessions, and listening to early signs of tightness.
A gentle reminder
If pain sticks around for more than a few runs or gradually worsens as training ramps up, it’s usually worth paying attention. Marathon training places real demands on your body, but ongoing pain isn’t something you need to push through.
Don’t let a marathon injury make you fall behind. Click here to book an appointment with one of our Cape Town physiotherapists.
