Marathon Training And Knee Pain

October 10, 2023

Is it possible to prevent knee pain when training for a marathon?

Why do I get knee pain when running?

When training for a half or full marathon, knee pain is incredibly common. In our experience it normally goes a little bit like this: You feel unfit and want to do something to make you feel fit and healthy again. You want a physical challenge, something to train for, and a sense of achievement when you complete it.

So you sign up for a half or a full marathon. You’ve got 6 months to get yourself in the best shape of your life. Plenty of time right?

Day one after your first run – your first thought is, “This is going to be impossible,” you lasted 20 minutes and then started walking. Your knees started hurting so you tried to ignore it hoping the pain would go away, but it didn’t.

Day two – Your knees feel a bit better, the back of your legs feel tight and your hips are a bit sore, but you try and run it off, thinking it will probably be fine. You lasted 15 minutes before walking, your legs felt stiff and sore and the knee pain came back.

You are thinking “I may not be a teenager anymore but come on body." You used to go out for a run and not even think about aches and pains. Although thinking about it, that was 20 years ago. But mentally you feel the same. So what’s going on?

You decide to take the rest of the week off and start again the following week. Work gets busy, and it ends up being two weeks but maybe that’s a good thing to rest and recover.

Week three and run number three, here we go, feeling motivated. Back up to 20 minutes before walking but the knee pain started again, and now your hips are feeling sore. Frustration starting to creep in.

You think “How on earth am I going to complete a marathon when I can’t evening run for 30 minutes.”

You go and see a physiotherapist. You get assessed and are told you have some sort of inflammation or syndrome but have been given some exercises to do with a band so you’re feeling motivated again.

You’ve been doing the exercises daily for two weeks so you try another run.

Run number four, you started off well but the knee pain came back after 20 minutes of running, you think you’ve done the exercises so maybe it will go away, You decide to keep going. You reached 30 minutes of running but you have to stop because your knees hurt, your hips hurt and now you have this new pain in your foot.

Why is this happening?

First knee pain, then hip pain, then foot pain, why is this happening?

Simply put, your body is running out of compensation options.

If specific muscles tire your body tries to find other muscles to perform the same job. Your running gait may start to look a little different but you can still move forward.

Eventually, these compensatory muscles start to tire leaving you with fewer options to continue running.

This is where you start to feel pain.

Your body can tolerate a certain amount of exercise. This will change depending on what you do and how much you have done in the past and the current strength of the muscles, tendons, and ligaments required.

If you don’t regularly exercise your tolerance will be low, and the amount your body is happy to do may be lower than you think.

But this is ok because you have to start somewhere. In most cases, we do too much at the start because motivation is higher.

Our body tries to tell us that it’s on the limit of what it can do by sending us pain signals.

Now we have an exercise dose higher than the body can tolerate. The result is muscle or joint pain.

At this point you have two options, listen to it and stop or ignore it hoping it will go away. Unfortunately, the majority of us do the latter and we end up with an injury or in pain.

Should you stop to avoid knee pain?

Every case is individual but it would be wise to get assessed by an exercise professional to get advice on the best course of action before continuing with your programme.

In short, here’s what it’s probably down to:

1. Lack of appropriate and specific strength training.

2. Your body cannot yet tolerate the distance you are running.

3. Not enough rest for the amount of stress you are putting on the muscular system.

4. Muscles aren’t strong enough to tolerate the amount of running you are doing.

What didn’t work for me?

There are many therapies out there such as acupuncture, deep tissue massage, laser, steroid injections, and shockwave to name a few.

Or maybe you have been using a foam roller or hockey ball to numb the area and get temporary relief.

If you’ve tried these and found the pain keeps coming back there is a logical explanation why. First, we need to understand pain.

Understanding pain

When we experience muscle or joint pain, our body has done an assessment and come to the conclusion there is a potential threat to the body. However, the amount of pain does not always amount to the level of tissue damage.

The body has danger sensors all over the body. If the threshold of the sensors is met, a message is sent to the brain triggering a pain response.

This is the body’s built-in protection system letting you know that if you carry on, there is potential to cause harm to the body.

If tissue damage has happened, an inflammation response is triggered to start the healing process.

The reason you may be feeling pain when there is inflammation is that your body is trying to tell you the damaged tissues have not yet been repaired.

Inflammation in the short term promotes healing. All tissues can heal when they have a good blood supply.

So what’s the best way to increase blood flow to a specific area?

Muscle contraction.

But not just any muscle or muscles, it has to be the exact muscles that require healing or strengthening.

The muscle needs to contract through its full contractile range. The resistance needs to match the strength of the muscle in question through every degree of movement.

This might explain why exercise hasn’t worked in the past. If the strength curve doesn’t match the resistance curve the exercise might be counterproductive.

So if you have been told to do lunges, squats, and deadlifts and it isn’t working, you now know why.

How to treat and cure:

So why does the pain keep coming back?

All of the above diagnoses have one common factor, the muscles are not strong enough to meet the demand placed on them.

The long-term fix is to appropriately strengthen the muscles that cross the joint of the painful area.

To do this you will need advice from an exercise professional that has an understanding of the anatomy and biomechanics.

They need to understand which muscles cross the joint but most importantly how to appropriately strengthen the specific muscles.

To do this they must have an understanding of force when it’s applied to the body.

Greg Cornthwaite | Strength House Co-Founder