Preparing for the London Marathon: A Physiotherapy Guide for Runners

By Physiotherapist Jake Peters

With the London Marathon fast approaching, runners across the UK are entering the final phase of training. Whether you’re preparing for your first marathon or aiming for a personal best, this period is where load management, recovery, and injury prevention become critical to performance on race day.

As an HCPC-registered musculoskeletal (MSK) physiotherapist with over 8 years of experience working with runners, I’ve supported both recreational and competitive athletes through marathon preparation. In line with evidence-based physiotherapy practice, the difference between arriving at the start line feeling strong versus managing pain or injury often comes down to how effectively you manage training stress in these final weeks.

This guide outlines common marathon-related injuries, alongside clinically supported strategies and physiotherapy treatments to help you stay consistent, reduce injury risk, and optimise performance.

Common Marathon Training Injuries

Shin Splints (Medial Tibial Stress Syndrome)

Shin splints, clinically known as Medial Tibial Stress Syndrome are one of the most common overuse injuries during marathon training.

Symptoms:

• Diffuse aching pain along the inner (medial) border of the tibia

• Pain that worsens during or after running

• Tenderness on palpation of the shin

Common contributing factors (multifactorial):

• Rapid increases in training volume or intensity (training load errors)

• Reduced calf strength and endurance

• Limited ankle mobility

• Suboptimal running mechanics

• Inadequate or worn footwear

Clinical insight (evidence-informed):
MTSS is associated with bone stress reaction and repetitive loading exceeding tissue capacity. Early management is essential to prevent progression toward tibial stress fractures.

Physiotherapy management may include:

• Load modification (not complete rest unless clinically indicated)

• Progressive calf strengthening (eccentric + isometric loading)

• Running gait assessment and retraining

• Manual therapy to improve ankle mobility

• Graduated return-to-running programmes

Runner’s Knee (Patellofemoral Pain Syndrome)

Patellofemoral Pain Syndrome, commonly known as runner’s knee, presents as pain around or behind the kneecap.

Symptoms:

• Pain during running (especially downhill)

• Discomfort when climbing or descending stairs

• Pain after prolonged sitting (“theatre sign”)

Key contributing factors:

• Reduced strength in the gluteal muscles (hip stabilisers)

• Poor control of knee alignment (dynamic valgus)

• Overtraining or insufficient recovery

• Reduced flexibility in quadriceps, hamstrings, or calves

Clinical insight:
Patellofemoral pain is strongly linked to biomechanical loading patterns and hip/knee control deficits, rather than structural damage alone.

Physiotherapy management may include:

• Targeted strengthening (glutes, quadriceps, lateral hip stabilisers)

• Movement retraining (running and functional tasks)

• Load management strategies

• Taping techniques (short-term symptom relief)

• Education on pacing and training progression

Other Conditions We Commonly See in Marathon Runners

To keep this practical and relevant to London Marathon prep, here are additional issues worth recognising early:

Achilles Tendinopathy

• Stiffness and pain in the tendon, especially in the morning

• Often linked to increased mileage or hill work

• Managed with progressive loading programmes

Iliotibial Band (ITB) Syndrome

• Sharp pain on the outside of the knee

• Common in runners increasing distance too quickly

• Treated through load management + hip strengthening

Plantar Fasciitis

• Heel pain, worse with first steps in the morning

• Linked to calf tightness and foot load capacity

• Managed with strength work + load modificationKey Strategies to Stay Injury-Free Before Race Day

1. Manage Training Load Intelligently

Avoid sudden spikes in mileage or intensity. A general principle supported in sports medicine is gradual progression, allowing tissues time to adapt.

2. Prioritise Recovery

Recovery is where adaptation occurs. Ensure:

• Adequate sleep (7–9 hours)

• Structured rest or low-load days

• Appropriate nutrition and hydration

3. Strength and Conditioning

Incorporating 2–3 strength sessions per week can improve running efficiency and reduce injury risk. Focus on:

• Calf complex (for load tolerance)

• Glutes and hips (for stability)

• Core (for overall control)

4. Don’t Ignore Early Warning Signs

Pain that persists beyond a few runs or worsens with activity should be assessed early. Early physiotherapy input can:

• Reduce time lost from training

• Prevent progression to more serious injury

Performance-Focused Treatment Options

Our approach is always individualised and evidence-informed, combining hands-on therapy with active rehabilitation.

Physiotherapy & Rehabilitation

• Detailed biomechanical assessment

• Personalised strength and loading plans

• Return-to-running strategies

Sports Massage (Pre & Post Marathon Support)

Working alongside the Midtown team, we offer targeted sports massage as part of your marathon preparation:

Pre-event massage:

• Reduces muscle tension without overloading tissues

• Supports circulation and mobility

• Helps you feel physically ready without fatigue

Post-event massage:

• Aids recovery and reduces muscle soreness

• Promotes circulation and tissue repair

• Supports return to training or normal activity

Dry Needling & Acupuncture

Dry Needling and Acupuncture can be used to:

• Reduce muscle tightness and pain

• Improve neuromuscular activation

• Support recovery between training sessions

These are always used as adjuncts, not standalone treatments.

Shockwave Therapy

Extracorporeal Shockwave Therapy is particularly effective for:

• Persistent tendon pain (Achilles, plantar fascia)

• Chronic conditions not responding to standard rehab

It works by stimulating tissue healing and regeneration.

Key Strategies to Stay Injury-Free Before Race Day

• Avoid sudden training spikes in the final weeks

• Prioritise sleep and nutrition

• Address pain early; don’t “run through it”

• Incorporate strength training (2x/week minimum)

• Use recovery tools strategically (massage, mobility, deload weeks)

Final Thoughts

The goal in the final phase before the London Marathon is simple:
arrive healthy, consistent, and confident.

Most injuries we see are preventable with the right balance of load management, strength, and recovery. If something doesn’t feel right, early assessment and treatment can make the difference between standing on the start line or sitting it out.