How to survive a marathon without getting injured


Dr Jo Larkin, consultant in sport and exercise medicine at Fortius Clinic and a former marathon runner, offers her tips for an injury-free endurance event

As a former recreational marathon runner, I have always enjoyed the benefits of running and appreciated the convenience this form of exercise offers. During the restrictions of the COVID lockdowns, getting outside and being physically active has been even more crucial than usual for many people’s wellbeing and should always be encouraged: the benefits far outweigh any risk of injury.

However, that injury risk is always there. This year, as a consultant in sport and exercise medicine at Fortius Clinic, I have found myself treating lots of injuries caused by running – usually the result of people going from very little exercise to running every day. This has led to a spike in their running loads, which pre-disposes them to injuries.

In more normal times, the London Marathon would be taking place this month. With that in mind, here’s some advice to help you stay injury free if you’re training for a marathon or any other endurance event.

Dr Jo Larkin

Dr Jo Larkin

Build up over time
Ideally, you should gradually increase any form of activity, allowing your body to adapt. In the long term, this means you can train for longer, as you’ve invested more in the foundation work. One of the most important things is to ensure you have a plan: take time to create a schedule that builds up slowly and steadily. There are lots of training programmes out there for running, but essentially you should build up over time until you’re running three to five times per week, depending on the length and intensity of the runs.

Make sure you have recovery days
Taking time for your body to recover and adapt from the training is crucial. Recovery is an essential component of any training plan, as are exercises that work on your strength, flexibility and mobility.

Select the right footwear
Having the right footwear is crucial. One of the issues with lockdown is that people have had to buy trainers online, which means they don’t know whether they’re entirely suitable or supportive enough for them.

Prepare for the course
Take part in an event which is on similar terrain to the one you have trained on. If you’ve been training on flat roads, it is not advisable to sign up to a hilly marathon.

Manage your energy balance
It’s key that you keep hydrated and refuel as you go along, as an imbalance predisposes the bone to injury. When I first started training for a marathon, I initially found it hard to run and drink at the same time, so I practiced it. Also, make sure you refuel post exercise for optimum recovery.

Seek advice if you pick up an injury
If you’re unfortunate enough to develop an injury while you’re training, seek medical advice. This is particularly crucial closer to the event, as you need to maximise your recovery and minimise any future injury risks.

The most common problems are overload injuries – whether that’s the bone, tendon or other soft tissue structures – many of which are linked to a mechanical movement pattern repetitively causing the same issue. In the case of bone injuries, this can be compounded by the energy imbalance mentioned above.

I’m a firm believer that any injury can be modified to maintain your fitness. For example, if you have a foot injury, you may not need to stop all forms of exercise; many can be adapted to partial weight bearing, seated exercises or pool work. In preparation for one of my marathons, I had to do weeks of aqua jogging, and at times this was significantly harder than ground-based running.

On the day of the marathon
Don’t suddenly believe you can shave an hour from your best time. Don’t go too hard or too fast, as this can lead to medical complications such as hyperthermia and injuries. Replicate the pace you’ve been training at.

If you do get an injury during the event, there will be medics positioned along the course who can help with minor issues such as blisters, black toenails, cuts and grazes. If your injury is more significant, such as a bone injury, you should stop. However, significant injuries are less likely if you’ve trained properly and haven’t ignored any niggles.

After the event
People like to recover in a variety of ways. Some swear by a light form of massage, others prefer ice baths. I have always been a fan of active recovery: ‘flushing’ the lactic acid from the legs by getting on a static bike. If you have access to a pool either on the same day or the next day, swimming is a great way to recover, as hydrostatic pressure enables the body to flush out oedema.

I remember feeling both nervous and excited in the lead up to the marathons, particularly when I collected my number from the ExCel centre. The best advice I can give is to remain calm, focus on the day and enjoy it!

Fortius Clinic is the largest single group of orthopaedic and MSK consultants in Europe, with more than 100 leading specialists, and ranks among the top 20 orthopaedic groups in the world. It operates three outpatient and diagnostic clinics in central London, as well as Fortius Surgical Centre and an orthopaedic partnership with Cromwell Hospital. To book an appointment with Jo, or another one of our specialists, call 0203 195 2442 or visit