Injured Before Your Marathon? Here’s How to Respond

It is every marathoner’s worst nightmare: you put in all the hard work and sacrifice to train for your race and then become injured before your marathon. 

Then the questions swirl and the bargaining begins. Can you still run your marathon? Maybe you can run if you ditch your A goal? Maybe you can pick a race that is a month later? 

Unfortunately, many runners ignore the red flags that they need to stop training for a marathon and focus on recovery—and become worse for wear. 

This happened to me personally when I was diagnosed with a partial hamstring tear ahead of my 2019 marathon. I continued to rigorously train while getting physical therapy, only to not be able to run for an entire year after my race.

Then, less than six months after finally returning to running, I was diagnosed with a plantar fascia tear. Not wanting history to repeat itself, I immediately canceled my 2021 marathon entry and focused on recovery. 

However, it is not black or white, and sometimes it is possible to still run a marathon if you’ve suffered an injury. It depends on what type of injury you have and how much time remains before your marathon. 

To fully understand the dos and don’ts, we’ve spoken with experts Todd Buckingham, an exercise physiologist at Mary Free Bed Rehabilitation Hospital, and Joe Norton, a doctor of physical therapy, to make the decision as clear as possible for you, should you become injured before your marathon. 

What Should You Do If You Become Injured Before Your Marathon?

Nearly every runner has at some point woken up with an odd ache, soreness, or had a sudden pain while running. 

If you become injured before your marathon, Norton says you should:

• Go see a sports physician, orthopedic doctor, or physical therapist who is familiar with runners to find out what is going on.

• Develop a treatment plan that includes whether you need to stop running.

• If you are resting your injury, continue to do non-aggravating cross-training activities such as yoga, cycling, swimming, aqua jogging, or the elliptical.

Related Article: The Ultimate Guide for Cross Training for Runners

It is advised to seek medical help when confronted with a running injury. However, if you can’t see a health professional or physiotherapist, you should:

• Stop running, and ice and heat for 20 minutes at least 3 times throughout the day.

• If the injury is feeling better after several days of rest, attempt a very easy run. 

• If the pain does not get worse or goes away, you can resume running at 50 percent volume of easy running for several days before resuming training.

• If the pain gets worse on the run or within 48 hours, you need to stop running for at least a week and reevaluate. 

• You can continue to train with activities such as cycling, swimming, aqua jogging, or the elliptical.

What Type of Injuries Can You Still Run With?

Generally speaking, runners can continue to run if they suffer from a mild strain or inflammation such as plantar fasciitis, runner’s knee, or IT band syndrome. 

What Types of Injuries Require You to Cancel Your Marathon?

If a runner has an acute injury such as a tear, grade II or III strain, stress fracture, or broken bone, then they cannot continue to run and should cancel their marathon. 

According to Buckingham, here are the injuries you can and cannot run with:

Bone fractures: 

Most fractures heal in 6-8 weeks, but it varies from person to person and bone to bone. 

“Depending on the fracture and if it occurs early in the training cycle, it could be very possible for a runner to complete their marathon training,” Buckingham suggests, saying runners should shift their goals to finishing rather than hitting a personal best since that can set the athlete back even further.

Muscle strains: 

A mild Grade I strain can heal in 3-6 weeks, and training can continue if it does not worsen the pain. 

For more severe strains like a Grade II or Grade III or a muscle tear, the recovery process can take several months and sometimes requires surgery to repair the injury. Therefore, runners should cancel their marathon if suffering from an injury of this degree.

Tendonitis:

Tendonitis can heal in 2-4 weeks, depending on the amount of inflammation. However, chronic inflammation could take 6 weeks or longer to heal. 

“Based on the severity and location of the tendonitis, training could continue unless pain is made worse through training,” advises Buckingham. 

He advises that for all these injuries, it is important to consult with a health professional prior to continuing training or racing.

Can You Run a Marathon if You are Injured Four Weeks Before? 

There is hope for runners if they are mildly injured early on in the training cycle, but what if it is just one month before? It is still possible, says Buckingham.

“Depending on the type, severity, and location of the injury, it is possible to run a marathon if injured 4 weeks before the race.’ 

Here are the injuries you CAN possibly run your marathon with:

• A Grade I muscle strain could heal on its own before race day. 

• Tendonitis (if not painful to run and the goal is to finish, not run a personal best).

• Stress fracture depending on the severity and location of the fracture (but this is not advisable).

Here are the injuries you CANNOT run your marathon with:

• A Grade II or Grade III strain 

• Muscle tear

• Stress fracture 

• Broken bone

How Can I Tell If I Need to Stop Running Because of an Injury?

You need to stop running due to pain if:

• The pain does not go away after traditional at-home treatments like ice and heat, and rest. If you treat at home with no improvement for 2 weeks, stop running!

• The pain causes you to change your gait, putting you at risk for compensatory injuries.

• The pain gets worse as you run or intensifies within 48 hours of your run.

Buckingham adds that if you continue to run and the pain doesn’t intensify, then running is not making it worse and you can continue to train. 

How Can I Tell What Injury I May Have?

The location of the pain will be the first indicator, according to Norton. If the pain is acute, it could be a joint or tendon. If it is diffused, it could be a joint. 

The second indicator is how the pain behaves, meaning what makes it worse and what makes it go away. 

Here are a few indicators that may be able to help you identify your injury:

• Tendons and muscles warm-up and improve with activity unless they are torn.

• Bones get worse with activity.

• Joints like some mobility but may have a threshold of how much.

• Hamstrings and calves will be more stimulated with speed activities as they are associated with faster running velocity.

Related Article: Ibuprofen and Running: Negative Effects and Substitutes Of This Anti-Inflammatory Drug

The 1 to 10 Pain Scale

Norton likes to use a pain scale of 1 to 10 to ascertain if a patient should stop running:

• If the pain hurts more than a 6, stop running. If you can’t walk – see a professional.

• If the pain hurts at a level 5, proceed with caution. If the pain does not improve within 2 weeks of taking it easy but doesn’t hurt outside of running, take 3 days rest. After this, try running at 50 percent of your volume at an easy pace. If it still hurts, see a professional. 

• If the pain is at a level 2, tread lightly for a couple of days until it is gone. Focus on eating a balanced diet, sleeping, and using heat, ice, massage, and compression to spur healing.

Related Article: How to Start Running Again After a Break

How Can I Decide If I Need to Cancel My Marathon?

Many runners push through the pain of an injury all because they don’t want to think their hard work is wasted. However, training with an injury is risky and it could lead to more time off in the future. 

Remember, there will always be other marathons and the most important thing in running is longevity in the sport.

If you are planning to train for a marathon, we would love to help you. Check out our marathon training resources including training programs and training guides.

FAQs

How Can I Prevent a Running Injury From Happening Again?

One of the most crucial aspects of injury prevention for long distance runners is strength training.

Strength training improves your stability and keeps your joints, muscles, and connective tissues strong so you can stay pain free throughout your training, and make it without injury from the start line to the finish line of any race.

It is also critically important that you stick to your physio and let any injury recovery fully before jumping back into your training runs at a high intensity.

Finally, to avoid overuse injuries, make sure to follow a marathon training plan (or whatever other distance you may be training for) and gradually build up your mileage to avoid overtraining. Feeling like it’s too much on your joints? Take an extra rest day. It’s better to listen to your body that to blindly stick to a training plan an injure yourself.