You’re weeks into marathon training. Your fitness is finally coming together, your long runs are getting longer, and you can see that finish line getting closer.

 

Then something starts hurting.

 

Maybe it’s a nagging ache underneath your glute. Maybe you feel a sharp pain on the outside of your knee. Or perhaps your Achilles has suddenly become stiff and sore every morning.

 

Your first thought is probably:

“Do I need to stop running?”

 

Not necessarily.

 

 

 

 

One of the biggest misconceptions about running injuries is that pain automatically means you need to completely shut down your training.

 

Depending on the injury and severity of your symptoms, many runners can continue running with appropriate modifications while addressing the underlying problem through strength training and better load management.

 

In Episode 307 of the Healthy Runner Podcast, I’m sharing an insightful conversation I had with Carolyn Coffin from the Inspired Soles Podcast. We took a deep dive into three common injuries that can derail marathon training:

 

-Proximal hamstring tendinopathy

-Iliotibial band (IT band) syndrome

-Achilles tendinopathy

 

 

The 3 Marathon Injuries That Derail Runners (And How to Fix Them)

 

 

 

 

More importantly, we discussed what runners can actually DO about these injuries so they can get healthy, become stronger, and hopefully avoid losing months of training.

 

Let’s break them down.

 

 

Marathon Injury #1: Proximal Hamstring Tendinopathy

 

 

Have you ever experienced a deep, nagging pain right around your “sit bone” underneath your glute?

 

This could be proximal hamstring tendinopathy, or PHT.

 

The proximal hamstring tendon attaches the hamstring muscles to the pelvis near the ischial tuberosity—the bony area you feel when sitting on a hard chair.

 

Runners with proximal hamstring tendinopathy often notice discomfort while running, sitting for prolonged periods, bending forward at the hip, or after increasing their training load.

 

And there’s one common mistake I see runners make when this area starts feeling tight:

They stretch it.

 

 

Why Stretching Your Hamstring May Make It Worse

 

Your hamstring may FEEL tight, but that doesn’t necessarily mean it needs more stretching.

 

With proximal hamstring tendinopathy, bringing the hip into deeper flexion while straightening the knee can increase compression around the irritated tendon.

 

Aggressively stretching an already sensitive tendon may therefore continue to aggravate symptoms instead of addressing the problem.

 

Rather than repeatedly stretching the area, we typically want to gradually build the tendon’s ability to tolerate load.

 

 

What Should Runners Do Instead?

 

Progressive strength training is a key component of rehabilitating hamstring tendinopathy.

 

Depending on your current symptoms and strength level, exercises may progress from more basic hamstring loading to movements such as:

-Bridges and elevated bridges

-Single-leg bridge variations

-Hip-dominant strengthening

-Progressive hamstring curls

-Nordic hamstring curl variations

 

The goal isn’t to jump immediately into the hardest exercise.

 

You want to gradually increase the amount of load your hamstring can tolerate so the tendon becomes more resilient over time.

 

 

Can You Run With Proximal Hamstring Tendinopathy?

 

This depends on your individual symptoms, but having hamstring tendinopathy doesn’t automatically mean running has to disappear.

 

You may need to temporarily adjust variables such as your pace, hills, workout intensity, long-run distance, or overall training volume.

 

The key is finding an appropriate amount of running stress that your body can currently tolerate while progressively rebuilding strength.

 

Dealing with high hamstring pain?

 

👉🏼 Download my FREE Proximal Hamstring Tendinopathy Playbook here

 

 

 

Marathon Injury #2: IT Band Syndrome

 

 

IT band syndrome is another extremely frustrating injury for runners, especially during marathon training.

 

The classic symptom is sharp pain on the outside of the knee, which may become progressively worse as you continue running.

 

And when runners search online for what to do about IT band pain, two recommendations often appear:

Stretch your IT band.

Foam roll your IT band.

 

But neither addresses one of the most important pieces of the puzzle.

 

 

Your IT Band Isn’t Simply “Too Tight”

 

The iliotibial band is a thick connective tissue structure running along the outside of your thigh.

 

Rather than thinking about IT band syndrome as simply a “tight IT band,” we need to consider what is happening throughout the entire kinetic chain while you’re running.

 

One area I pay particular attention to is hip strength and control.

 

If your pelvis drops excessively while you’re running, it can alter the mechanics at your hip and knee and potentially increase stress around the outside of the knee.

 

That is why simply attacking the painful area isn’t enough.

 

 

Strengthen Your Hips Instead of Just Rolling Your IT Band

 

Rather than spending all your time aggressively foam rolling the outside of your thigh, start thinking about building a stronger running body.

 

That may include exercises targeting the glutes and other muscles responsible for controlling the pelvis and leg while you run.

 

Your strengthening program should eventually progress beyond basic activation exercises into functional movements that challenge you in positions that better represent the demands of running.

 

This is also why strength training shouldn’t only become a priority AFTER you get hurt.

 

Consistent strength training can help build the capacity your body needs to handle marathon training in the first place.

 

Struggling with pain on the outside of your knee?

 

 

👉🏼 Download my FREE Ultimate IT Band Pain Playbook here

 

 

 

Marathon Injury #3: Achilles Tendinopathy

 

 

Achilles tendinopathy is another common problem I see in runners.

 

You may notice pain or stiffness along the Achilles tendon, especially first thing in the morning or when you begin moving after sitting for a while.

 

One of the most important things runners need to understand about Achilles tendinopathy is this:

Tendons need appropriate load to become stronger.

 

Completely resting the tendon for an extended period may calm symptoms, but rest alone doesn’t necessarily rebuild its capacity to tolerate the demands of running.

 

 

Progressive Loading Is Key

 

Achilles rehabilitation typically involves progressively strengthening the calf-Achilles complex.

 

Depending on your symptoms and current strength, this may begin with more basic calf-loading exercises before progressing toward heavier and more challenging movements.

 

Eventually, runners need to develop the strength and elastic capacity required to tolerate running.

 

Why?

 

Because running is essentially a series of repeated hops from one leg to the other.

 

Your Achilles tendon stores and releases energy with every stride.

 

This is why your rehabilitation shouldn’t stop the moment you can perform a few pain-free heel raises.

 

Eventually, the tendon needs to be prepared for the faster loading demands of running.

 

 

Don’t Rush Into Plyometrics

 

Plyometric exercises can be extremely valuable for runners, but you need an adequate foundation of strength first.

 

If you can’t demonstrate sufficient calf strength and control, jumping immediately into hopping and explosive exercises may simply be more load than your Achilles is ready to tolerate.

 

Build the foundation first.

 

Then progress toward the higher-level demands of running.

 

 

Be Careful When Changing Running Shoes

 

Another factor runners often overlook is footwear.

 

If you’ve spent years running in shoes with a traditional heel-to-toe drop and suddenly switch to a zero-drop or dramatically lower-drop shoe, you may significantly change the demands placed on your calf and Achilles.

 

That doesn’t mean lower-drop shoes are inherently bad.

 

It means your body needs time to adapt.

 

The same principle applies when introducing different racing shoes or “super shoes.”

 

Don’t make dramatic changes all at once—especially when your marathon training load is already increasing.

 

Dealing with Achilles pain or stiffness?

 

👉🏼 Download my FREE Ultimate Achilles Pain Playbook here!

 

 

 

Do You Have to Stop Running When You’re Injured?

 

 

This is one of the most important messages I want runners to take away from this conversation.

 

An injury doesn’t automatically mean you need to stop running.

 

There are certainly injuries and symptoms that warrant stopping and getting evaluated by a medical professional. Significant pain, worsening symptoms, suspected bone stress injuries, or symptoms that alter your normal running mechanics shouldn’t simply be ignored.

 

But for many common running-related injuries, the solution isn’t necessarily:

“Don’t run until it doesn’t hurt anymore.”

 

Instead, we can look at the variables contributing to the total stress on your body.

 

That might mean modifying:

-Weekly mileage

-Long-run distance

-Running intensity

-Speed workouts

-Hills and elevation

-Running frequency

-Strength-training load

-Recovery between workouts

 

The question becomes less about “Can I run?” and more about:

“What amount of running can my body tolerate right now?”

 

That distinction can be incredibly important for runners trying to maintain fitness while recovering.

 

 

 

Avoid the “Hero Workout” During Marathon Training

 

 

Running injuries rarely come down to one single factor.

 

Often, runners simply accumulate more training stress than their bodies are currently prepared to handle.

 

Maybe your training plan says you have a huge workout scheduled.

 

You didn’t sleep well.

 

Work has been stressful.

 

Your legs already feel tired.

 

But you look at the workout and think:

“It’s on the plan. I HAVE to do it.”

 

You push through anyway.

 

That’s what I call the hero workout mentality.

 

One workout isn’t going to make your marathon.

 

But repeatedly pushing your body beyond what it can currently recover from can certainly derail your training.

 

Your training plan should guide you—not control you.

 

Sometimes the smartest training decision is adjusting the workout so you can come back and train consistently tomorrow, next week, and next month.

 

 

Don’t Forget Your 5-Minute Warm-Up

 

 

Another simple strategy runners often overlook is warming up before running.

 

Especially as we get older, going directly from sitting at a desk or driving in the car to immediately running isn’t the best way to prepare your body for the demands ahead.

 

A short dynamic warm-up can help increase blood flow, move your joints through the ranges of motion you’ll use while running, and activate the muscles you’re about to ask to work.

 

And you don’t need a complicated 20-minute routine.

 

Five minutes can make a difference.

 

This can be particularly valuable when you’re returning from an injury and want to appropriately prepare your muscles and tendons before loading them with running.

 

👉🏼 Watch my 5-Minute Warm-Up Before Running here

 

 

 

How to Prevent Marathon Training Injuries

 

 

If you want to stay healthy throughout marathon training, don’t wait until something hurts to start thinking about injury prevention.

 

Focus on building a body that has the capacity to handle your training.

 

That means consistently addressing the big rocks:

Strength train. Build stronger glutes, calves, hamstrings, and running-specific muscles.

Manage your training load. Avoid dramatic spikes in mileage, intensity, or elevation.

Warm up before you run. Prepare your body for the work you’re about to ask it to perform.

Recover between workouts. Your body adapts to training when it has enough time and resources to recover.

Fuel your training. Marathon training requires energy. Don’t expect your body to recover and adapt optimally if you’re consistently under-fueling.

Make gradual changes. Whether you’re increasing mileage, adding speed, introducing hills, or changing shoes, give your body time to adapt.

 

There isn’t one magical exercise or treatment that prevents every running injury.

 

It’s the consistency of these habits over weeks, months, and years that helps you become a stronger and more resilient runner.

 

 

 

The Goal Is Lifelong Running

 

 

Your marathon finish line matters.

 

But I want you to think bigger than one race.

 

The real goal is being able to continue doing this sport you love for decades.

 

That means we don’t simply chase symptoms every time something hurts.

 

We build stronger bodies.

 

We manage our training intelligently.

 

We fuel and recover appropriately.

 

And when an injury does pop up, we don’t immediately panic and assume all of our training is lost.

 

We figure out what your body can tolerate, address the underlying problem, and gradually build your capacity back up.

 

That’s how you don’t just get through your next marathon.

 

That’s how you become a Healthy Runner for life.

 

 

Listen to Episode 307 of the Healthy Runner Podcast

 

 

Want to hear the full conversation?

 

In Episode 307: 3 Common Marathon Injuries: How to Treat Them Without Giving Up Running with Carolyn Coffin, we go deeper into proximal hamstring tendinopathy, IT band syndrome, Achilles tendinopathy, training modifications, footwear, strength training, warm-ups, and what runners can do to stay healthy throughout marathon training.

 

🎧 Listen to Episode 307 of the Healthy Runner Podcast

📺 Watch the full conversation on YouTube

 

Choose Your FREE Running Injury Playbook

 

If you’re currently dealing with one of the three injuries we discussed, don’t just guess about what to do next.

 

Choose the free resource that matches your pain:

🦵🏼 IT Band Pain → [Download the Ultimate IT Band Pain Playbook]

🦶🏼 Achilles Pain → [Download the Ultimate Achilles Pain Playbook]

🏃🏻‍♀️ High Hamstring Pain → [Download the Proximal Hamstring Tendinopathy Playbook]

 

Start addressing the problem today so you can get stronger, stay consistent, and keep moving toward your running goals.

 

 

 

 

A big thanks to Kila for your support for this episode!

 

 

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As a running physical therapist and coach, I appreciate that Kila provides a more dynamic alternative to traditional rigid orthotics while allowing your feet to move more naturally. 

 

Visit kilarun.com and use code HEALTHYRUNNER to get $50 off your first order!

 

 

 

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🎁 Free Resource: Marathon Training Guide

 

Want a clear, proven roadmap to train smarter and feel strong on race day?

 

The Ultimate Marathon Training Guide to Master Your Marathon Feeling Strong

 

 

Inside, you’ll learn:

-How to choose the right training plan

-How to balance strength training with running

-Nutrition and recovery strategies

-Common mistakes to avoid

-Race day strategy and travel tips

 

Claim your free copy here!

 

If you’re ready to train smarter and finally feel strong and confident in your running again, join the Healthy Runner Academy.

 

This membership is designed for adult runners who want to run pain-free, build strength, and stay consistent — for life.

 

 

The Healthy Runner Academy provides you the step-by-step system to finally stay consistent, avoid burnout, and prevent nagging injuries — all with expert coaching and a supportive community behind you.

 

Perfect for adult runners who want to:

– Stop nagging injuries
– Build a resilient running body
– Get faster and stronger
– Enjoy pain-free, consistent training

 

Click here to join the waitlist today and be first in line when doors open (only 3x/year) + get a special bonus to reset your running journey!

 

Looking for 1-on-1 guidance, structure, support, and accountability?  Check out our signature Spark Healthy Runner Coaching here!

 

 

 

 

Listen to my previous episode on how older runners can still get faster here!

Listen to my previous episode with Carolyn as we celebrated 200 episodes here!

Listen to my previous episode with Carolyn about running terminology 101 here!

 

There are six parts of your running journey that need to be optimized so you can run strong and last long!  Learn them here.

 

 

Want Dr. Duane to answer your question on the podcast?  Submit your running and health questions here

 

 

Connect with Carolyn Coffin:

-Email Carolyn: inspiredsolescast@gmail.com

-Inspired Soles Instagram: @inspiredsolescast

-Carolyn’s Instagram: @carolyn.c.coffin

 

Carolyn Coffin is a certified Running & Health Coach with an educational background in physiotherapy and kinesiology. Her coaching is centered around sensible training, lifestyle modifications and a focused mindset. Carolyn is the host of Inspired Soles, a podcast that fuels your passion for running and helps you achieve peak performance with every stride. Carolyn talks with industry experts, coaches, Olympians and everyday runners to educate and inspire you to take your running to the next level. 

 

 

Get my full personal running story here

 

 

 

There are six parts of your running journey that need to be optimized so you can run strong and last long! Learn them here.

 

 

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Thanks for reading!

 

Yours in health,

Duane

 

 

Connect with Dr. Duane:

 

 

Dr. Duane Scotti, DPT, PhD, OCS is a running physical therapist, run coach, host of the Healthy Runner podcast, and founder of Spark Healthy Runner and has been a leader in the rehab and running community for 20+ years.

 

Duane initially started running as an adult, wanting to add some cardio to his gym sessions. After having hip surgery, his doctor advised him to get off the treadmill and run outside. Without having fully recovered, Duane suffered his first running-related hamstring tendon injury and many others as a novice runner early on.

 

As a coach, he has guided thousands of athletes back to running, finishing their first marathon, crushing a personal best, and even the elusive Boston Marathon qualifying time.

 

After 19 years teaching in higher education, Duane decided to step away as a Clinical Associate Professor of Physical Therapy to pursue his passion educating the running community.  Through his signature 1:1 coaching program, Healthy Runner Academy membership, weekly videos, and podcast episodes, he empowers runners to get stronger, run faster, and enjoy lifelong injury free running without having to stop running to get over an injury.  Dr. Duane truly believes that anyone can run and that all runners should be treated differently when recovering from an injury.  He is on a mission to change the traditional thinking that running causes “overuse injuries” or “your body is just not meant to run” and you must “take a break” to get better.  Through strength and run specific training you can grow a strong mind, strong body, and just keep running!

 

Duane received his Bachelor of Health Science degree and Master of Physical Therapy degree from Quinnipiac University in 2001 and 2003. He then went on to receive a clinical Doctor of Physical Therapy and a Ph.D. in Physical Therapy from Nova Southeastern University in 2017. Duane is a board-certified Orthopaedic Clinical Specialist, RRCA Certified Running Coach, Certified Mulligan Practitioner, certified in dry needling and has advanced training in spinal manipulation and rehabilitation for runners.

 

As an athlete, Duane is an adult-onset runner, 6x marathoner, avid half marathoner, and enjoys challenging himself to learn and grow in his personal running journey!

 

A native New Yorker from Long Island, Duane currently lives in Cheshire, Connecticut with his wife Deb and his two teenage daughters who are competitive volleyball players.  They all love to explore new beaches along the east coast.

 

-Instagram – @sparkhealthyrunner

 

–Join Our Healthy Runner Facebook Community

 

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–duane@sparkhealthyrunner.com

 

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