The diaspora and excitement of New York City’s marathon has turned the first Sunday in November into an annual 5-borough tribute to the sport of running. Runners need not be reminded about properly training for a marathon, yet every year we see hundreds of runner-related issues, and would you believe that 90% of these injuries are due to the increased volume in training in advance of the marathon?

What we commonly find are overuse injuries arising from the microscopic strains and tears on soft tissue and bone. A classic overuse injury is the runner’s knee, often caused by too much pressure on the kneecap. As runners ramp up the distance or speed of their training runs, the tissue surrounding the kneecap undergoes a considerable amount of stress because of its central role in anchoring the large muscles of the quadriceps.

Runner’s knee can be a road bump in a training regime, but that’s all it ever should be. Icing your knee and taking anti-inflammatory medicine should be enough to get you back to light exercise, but if the pain persists your orthopedist may recommend some form of physical therapy.

But what about the 10% of runners whose injuries aren’t caused by overuse? Overuse injuries are often aches that go away after about 15 minutes into a jog. If, however, the pain increases throughout one’s run, then it is likely a more serious injury to the underlying tissue. These injuries can creep into one’s daily life. Climbing stairs is painful; sitting and standing becomes an achy chore. These injuries can range from torn ligaments or tendons to stress fractures and should be addressed by your orthopedist at once, especially before any more marathon training.

That brings us to the question of whether you can continue to work out while experiencing one of the above symptoms. The answer ought to be self-explanatory, but if there is ever any doubt it’s best to take a break no matter what and do the proper stretching and icing regime.

What about shoes? We’ve said it before, but the quality of one’s shoes plays an outsized role in keeping your legs in top shape because fresh shoes with the right fit go a long way in preventing overuse injuries.

While training for a marathon, give yourself a minimum of four months in which to prepare, and try not to increase your mileage more than 10% per week. A few smart steps, both physically and mentally, can go a long way to having an injury-free New York City marathon.

But even the best preparation can’t always prevent a few small aches here and there—Manhattan Orthopedic and Sports Medical Group wants to help you in the long run, whether it’s a marathon or a quick lap around the park, we’re here to make sure you keep running.

And running.

And running.

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