The Real Reason Marathon Injuries Keep Coming Back (and How to Stop It)

Any of these sound like you?

Constantly fighting with repeat shin splints (tibial bone injuries), runner's knee (knee tendinopathies) , plantar fascia, ITB pain, or achilles tendinopathies...

Being diligent about ramping up slow and steady with a written plan to ease back into things only to end up with ANOTHER injury after a 3 month build ...

This time returning to running gradually with cross training religiously mixed it.

Beginning to begrudgingly accepting that maybe your mileage will never be what you want it to be...

Then finding that once your right knee pain settles down, you start running again just for your left achilles to act up!

Leaving you feeling like you're playing whack-a-mole with running injuries-one goes down and another pops up...

No, I'm not sneaking in and reading your training journal or scouring your Garmin data at night.

(That would be weird).

But I wonder if you notice a pattern with your own repeat injuries?

Think back to your own list of injuries: what got hurt?

There's probably a tendon issue lurking in there somewhere.

Maybe a muscle strain?

There are a billion and one different factors as to why someone get's injured. (running experience, genetics, muscle mass, bone density, work-life stress, energy levels, etc.)

But there are a few hard facts we know.

So let's break down the 3 reasons why marathon injuries keep coming back and how you can actually stop them.

3 Reasons Why Your Marathon Injuries Keep Coming Back

1. Your Training Load is Signing Checks Your Body Can't Cash

Crash course:

Running Injuries happen when your training load is greater than your body's capacity to handle all that hard work.

What determines that?

Tissue quality (muscle strength, tendon stiffness) combined with your own personal biomechanics (how your body moves).

Running injuries keep rearing their ugly head when your tissue quality never fully reaches the strength-level you need it to. You end up experiencing "relative tissue overload", a continued increase in load/work/training that continues to exceed your injured tissue's ability to adapt.

This ends up looking like bone stress injuries (BSIs), otherwise known as shin splints, stubborn hamstring tendinopathy, and repeat hip flexor muscle strains.

What keeps perpetuating the cycle? Psychosocial influences (think unrelenting stress at work or at home), continued training load errors, running hard, running downhills, and/or continued funky biomechanics.

In other words, you're training load is signing checks that your body can't keep cashing repeatedly because you keep exceeding your "tissue capacity bank account"

2. Age Matters as to Where We Get Injured

Hey, I don't make the rules here.

But we know for repeated research, newer and younger runners are more likely to end up with shin splints/bone stress injuries and runner's knee while older (think Master's age) runners are more likely to struggle with soft tissue injuries/strains like calf and hamstring strains, achilles tendinopathy, and plantar fasciopathy.

Why?

It comes down to tissue tolerance (tendon and muscle strength) and age.

Tendon strength, which is called stiffness, naturally deteriorates with age. Younger runners naturally have stronger, stiffer tendons, and despite potentially placing higher load on their tendons, their tendons can remain uninjured due to having a higher load tolerance.

However, not always.

Remember: younger runners struggle a lot with runner's knee. So despite having the the tendon strength of youth, funky biomechanics can still catch up.

That doesn't mean the Master's level runners are beyond help. It demonstrates the important of strength training and plyometrics that help older runners reverse time, keeping both joints and muscles happy and ready to run.

3. Biggest Injury Predictor: You’ve Had This Injury Before.

I'm always amazing how the majority of runners want to immediately blame a running injury on running form.

Because from research, we know this actually has LEAST IMPACT and at best, plays the smallest role in preventing repeat injuries.

Yes, overstriding is bad. Yes, increasing your cadence can frequently help, but you need to realize...

Most of your running form is driven by your anatomy. We can't change your skeleton (sorry).

But what we can change is your tissue quality, training loads, etc. These are the driving factors, the needle movers you need to work on to prevent a repeat episode. Because like the header said: your biggest injury predictor is you've had this problem before.

Focusing on single leg strength, tendon stiffness, and general tissue capacity help you mitigate and potential prevent the greatest impact, which is that prior history of the same running injury.

3 Ways to Stop the Marathon Repeat Running Injury Cycle for Good

1. Be able to spot training errors

How do you know you've made one?

If you have NO injuries, this means you're in a place called tissue homeostasis where your applied training load (how much you're running per week, the intensity, etc) is equal to your current capacity (your body's /tissue's ability to adapt and tolerate this load).

(yeah, we like tissue homeostasis!)

Injuries happen when a greater applied training load exceeds your current capacity (ex: you upped your speed workouts too many, too soon). This places you in a capacity deficit, resulting in an injury (because you're body could adapt and tolerate your new found speed.)

What becomes tricky, is that this training error may not be obvious immediately. It most likely comes on gradually.

What does this matter?

It means that injuries tend to peak 3-6 weeks AFTER a training error!

What exactly is a training error and what does it look it? It depends. Often we can trace a

a training error back to too much load applied or accumulated too quickly in the form of upping mileage, increasing intensity of speed work, too many hills, etc.

But it's not all about "running errors". These errors can also be long termed poor recovery, under fueling, poor sleep for 3 weeks, long-term stress from work etc.

YOU ACTION ITEMS:

What's important is when you start to feel a niggle or realize you're in a full-blown injury, is to go back in your training log 3-6 weeks. Read your running data, your notes to yourself.

And remember in the future that progressing training week to week looks like a solid build for 2-3 weeks followed by 1 week of recovery. During this recovery week, you reduce total running volume by 20-30%, maintaining that 80:20 split (easy: hard).

2. Strength Training, but make it Slow Heavy Lifting

What happens immediately after an injury? You typically take rest days, protect the injured area from any further load. Nothing wrong with that.

But the natural consequence of that is, mileage get cuts, and the your capacity, or "fitness". drops.

Our goal with slow heavy lifting, specifically using progressive overload (lifting heavier and heavier), is to increase your load capacity, meaning how much hard work or "training" you can handle and NOT break.

Strength training becomes your cheat code.

We use it strengthen your body, helping it do hard things safely, increase the training load just enough to help your current capacity to catch up and improve!

What's cool is that now BOTH your training load AND your capacity have increased! (how much a runner is able to safely run per week and their ability to adapt and tolerate this load)

Because remember, when need both training load and capacity to be even sides of this running equation. When this equation is lopsided and the you run too much or too hard per week for an extended period of time, that's how injuries happen.

Strength training continues to increase your ability to tolerate load so you can handle whatever your training throws at you, because your capacity is now GREATER and you're never stuck playing catch up.

YOU ACTION ITEMS:

Strength train 2x a week with reps ranging 5-10 with the last few reps feeling like a struggle.

Want some workouts to get started with?

Check out my YouTube videos here:

3. You Need Plyos, But Not the Death Drop Kind.

Remember that knee-achilles example at the beginning of the blog?

A runner has a knee injury, so they rest, their knee gets better, they return to run, just for the opposite Achilles to act up.

BUT WHY DOES THIS HAPPEN?

As a result of total body rest, the runner loses stiffness (tendon strength) in their Achilles, plantarfascia, or have a marked decrease in calf strength so when they come back to running, the injury "shifts" to the OTHER foot or ankle.

Because, like above, their body's overall physical capacity to do hard things has dropped because they haven't been running.

I know, it's a cruel, cruel cycle.

But that's why plyos are so cool.

Tendons do get stronger from the heavy slow lifting we talked about above.

But they also NEED quick, powerful, explosive movements to continue building stiffness because these movements "remind" them how to store and release energy.

Your tendons are giant springs that absorb the impact of gravity slamming you back into the ground and then release that energy to help propel you forward into your next stride.

The cool part? You don't need to do a whole lot.

30 reps, which is relatively low load, is a great starting point especially if you think about those as 30 foot strikes or strides compared to how many steps you might take running 6 or 8 miles.

Starting to see how plyos are more bang for your energy buck?

YOUR ACTION ITEMS:

The best time to add plyos: use them as a warm up before a run or before a strength workout.

Often runners will find that if they've hit a progress plateau in rehabbing their running injury, plyos help them gain those final inches of progress.

want some plyos you can do ? Check out my YT videos here:

WRAPPING UP

I never want you to feel powerless, like your body has just given up on you and you'll never run again.

Because when we're honest with ourselves, we don't feel like us unless we're running.

And now, you have REAL answers.

Real reasons as to WHY your body is doing what it's doing.

It's not always about your running form.

Or that you "didn't try hard enough."

You may not have had the right tools.

And now you do.

You got this, running fit fam.

Dare to Train Differently,

Marie Whitt, PT, DPT // @dr.whitt.fit