Muscling in on the marathon


Some things really are better left to the professionals. For the latest in our series on preparing for the marathon, we asked chartered physiotherapist Catherine Cradockto look at the more commonly encountered injuries and their treatment

Good trunk muscle strength will help to improve your posture and maintain good alignment of your legs while running. Therefore, doing regular exercises to improve your trunk's core stability could reduce your risk of injury.

Before you run, your tissues need to be warmed up, for example, by doing a light jog/brisk walk, anything that gets the blood flowing.

A common misconception is that people need to spend a lot of time stretching before they run. In fact, static stretching is more important as part of your cool-down and recovery. Adequate time needs to be allowed for both the warm-up and cool-down, this can vary from five to 15 minutes but ensure you feel the benefit before you stop.

Common overuse injuries

Iliotibial band (ITB) friction syndrome:

The iliotibial band is a large fibrous band that runs from the side of the hip, down the side of the thigh and into the outer part of the shin bone. It bends your hip and your knee. If it gets overly fatigued, it can rub (or friction) on the bone underneath.

Some of the common causes of ITB friction syndrome include building mileage too quickly, excessive downhill running, running on an uneven surface (for example a cambered surface on a road), weakness in the hip and trunk muscles and abnormal biomechanics.

Pain usually builds up gradually, starting as a nagging pain or dull ache at the outer part of the knee. You might be okay on the shorter runs, and convince yourself it has gone away, until it rears its ugly head on the longer runs. If the cause of the pain is not addressed, it tends to build to the point where you may have to stop running for some time.

Treatment can involve reducing inflammation (with ice or anti-inflammatories), stretching, massage therapy, strengthening of the hip muscles to help control the alignment of the leg, correction of any flaws in training, and addressing biomechanical abnormalities such as over-pronation (to be dealt with in more detail in next week's piece), or asymmetry around the pelvis.

Patellofemoral pain syndrome (runner's knee):

This term describes pain around the kneecap (patella). The position of the kneecap is controlled by the quadriceps muscle group (front of thigh). If these muscles are weak, the kneecap moves abnormally, causing friction on the smooth cartilage that lines the kneecap. This in turn causes inflammation.

Training/running related causes include increasing mileage too quickly and excessive downhill running. Anything that affects the alignment of the hips and knee can also contribute to it, such as "knock knees", tight hip muscles (caused by excessive crossing of legs for example), weak hip muscles, excessive high-heel wearing, or over-pronation of the foot.

Treatment involves reducing pain and inflammation, possibly taping the knee to control the position of the kneecap, strengthening of the thigh and hip muscles, stretching tight hips, massage therapy and correction of any abnormal foot biomechanics. Obviously if there is a flaw in your running technique or training schedule then this should also be addressed.

Shin pain:

There are several causes of shin pain, the most common being inflammatory shin pain (what people call shin splints). This is an inflammation of the muscles on the shin where they attach to the shin bone. People usually feel this as an ache in the lower inner part of the shin bone, which can be present at the start of a run, and can ease out as you warm up. However, the pain can then return after exercise and the next morning. It is often very tender to touch this part of the shin bone.

This is a very common injury in novice runners. Causes include excessive running on hard surfaces, tight calf muscles, poor choice of footwear and a poor or non-existent warm-up routine. Shin pain can occur in people with both over-supinated and over-pronated feet.

Treatment includes deep massage therapy, calf stretching, correction of footwear and sometimes orthotics. It is important that this condition is managed as it can potentially lead to a stress fracture.

Plantar fasciitis:

The plantar fascia is a band of tissue that runs underneath the foot from the heel to the ball of the foot, and helps to support your arch. Tightness and/or inflammation of this can give pain both on the sole of the foot and in the heel. It is often painful first thing in the morning, can improve over the course of the day, but can be aggravated by long periods of standing or walking.

Running in old, worn-out footwear or footwear that is either too flexible or too rigid for your individual foot type can cause this. Building up the mileage too quickly can also be a problem as the foot needs time to develop the strength to remain stable during running.

Treatment may involve advice on more appropriate footwear, supportive taping of the foot and stretching the plantar fascia. Ice and anti-inflammatories may help to reduce the inflammation.

Achilles tendon pain:

The Achilles tendon is the thickest, strongest tendon in the body. It is the combined tendon of the two main calf muscles and inserts into the heel area. Common causes of pain in the Achilles region include tight or weak calf muscles, poor hip strength, poor footwear, excessive foot pronation, excessive uphill running and, like many of the aforementioned problems, increasing your mileage too quickly.

Catherine Cradock is a chartered physiotherapist based at the Portobello Clinic ( or tel: 01-4763330). She is a member of the Irish Society of Chartered Physiotherapists and of its Sports Medicine Committee. Details on how to find other chartered physiotherapists are available at or at 01-4022148. A programme with suitable warm-up, cool-down and core strengthening exercises has been designed for runners by the society and can be found by visiting its website and clicking on the marathon icon.

Comments or queries on this series can be sent to