Marathon Training Pains You Shouldn't Push Through

Marathon training asks a lot from your body. By the time you reach your peak training weeks, you have spent months increasing mileage, extending long runs, and preparing your body to handle 26.2 miles.

Some soreness comes with that work. A challenging long run or harder-than-usual workout can leave your muscles tired and achy afterward. Delayed-onset muscle soreness is a recognized response to strenuous or unfamiliar exercise and does not automatically mean you are injured. [1]

The problem is assuming every pain is normal training soreness. Pain that becomes more intense, changes the way you run, repeatedly returns, or begins interfering with normal activity deserves a different response.

Knowing when to push through a difficult workout and when to back off can be the difference between adjusting a few training days and losing much more time to an injury.

Normal Training Soreness vs. Injury Pain

There is no perfect pain test that tells every runner whether to keep going. What matters is how the symptom behaves.

General muscle soreness after a demanding workout usually affects the muscles that did the work. You may feel stiff or tender, but the discomfort should improve as you recover.

Running-related injuries often develop differently. Overuse injuries are common among runners, particularly in the knee, lower leg, ankle, and foot. They develop when repeated loading exceeds what a tissue can tolerate and recover from at that point in training. [2]

Pay attention to the pattern rather than trying to assign every ache a diagnosis yourself. A symptom is more concerning when it becomes increasingly localized, worsens as you continue running, repeatedly returns at the same point in a workout, changes your stride, or begins affecting walking and other normal activities.

1. Pain That Gets Worse the Longer You Run

A minor ache that fades as your body warms up is different from pain that becomes progressively harder to ignore with every mile.

This pattern can occur with several running-related overuse injuries. The exact cause depends on where the pain is located and what movements aggravate it. For example, patellofemoral pain commonly affects the front or area around the knee and can become more noticeable during running and other activities that repeatedly load a bent knee. [3]

IT band problems, tendon irritation, shin pain, and other conditions can also appear only after a runner reaches a certain distance or level of fatigue.

If you regularly think, “It starts hurting around mile eight, but I can force myself through the rest,” pay attention to that pattern. Repeatedly reaching the same pain threshold does not tell you that your body is adapting. It may mean the current training load is exceeding what the irritated area can tolerate.

If your pain is centered around the knee, our guide to runner's knee vs. IT band syndrome explains some of the differences a physical therapist looks for when evaluating running-related knee pain.

2. Very Localized Pain Over a Bone

A small, specific area of pain along the shin, foot, hip, or another bone deserves more caution than general muscle soreness.

Bone stress injuries occur when repeated loading exceeds the bone's ability to repair and adapt. They are particularly relevant to distance runners because running repeatedly loads the lower extremities. [4]

Early symptoms may only appear during running. As a bone stress injury progresses, pain can become more noticeable during walking, standing, and eventually even at rest. [4]

This is one type of pain you should not try to “run off.”

Shin pain can be particularly confusing because medial tibial stress syndrome, commonly called shin splints, and a bone stress injury can occur in the same general area. A physical examination can help determine whether your symptoms are consistent with a common overuse problem or need further medical evaluation.

If your shins have been giving you trouble as mileage increases, read our guide to preventing shin splints.

3. Pain That Changes the Way You Run

When pain causes you to limp, shorten your stride dramatically, avoid putting weight on one side, or otherwise change your normal running pattern, your body is telling you that something is not tolerating the workload well.

Continuing the workout may also make it harder to determine what the original problem is. Once you start compensating for one painful area, other muscles and joints have to work differently.

A physical therapist may watch you walk or run to see how the painful area affects the rest of your movement. The evaluation can also include strength, mobility, balance, and functional testing based on where you hurt.

The important point is not that every minor change in running form signals an injury. Fatigue naturally affects movement. The concern is pain forcing you to move differently to protect one area of your body.

At that point, finishing the mileage on your training schedule should no longer be the priority.

4. Swelling, Giving Way, Catching, or Locking

Running soreness should not make a joint repeatedly give way, catch, lock, or develop significant swelling.

Those symptoms can occur with different orthopedic conditions and cannot be diagnosed from symptoms alone. They do tell your therapist that this is more than a question of tired muscles after a long run.

The same applies to a sudden loss of normal motion. If your knee, ankle, or hip suddenly does not move the way it normally does, continuing to run is not a useful test.

A physical therapist can evaluate your movement and determine whether rehabilitation is appropriate or whether you should be referred to an orthopedic provider for additional assessment.

5. Achilles Pain That Keeps Returning

Your Achilles tendon takes repeated load with every running stride, making it another area to watch as marathon mileage increases.

Achilles tendinopathy generally presents with localized tendon pain and reduced function during activities that load the tendon. Pain, stiffness, and sometimes swelling can develop gradually rather than after one obvious injury. [5]

That does not mean every stiff Achilles tendon requires you to stop running completely. Modern tendinopathy rehabilitation often involves appropriately managed loading rather than prolonged total rest. [5]

The key word is managed.

If Achilles pain keeps returning, becomes more intense as training increases, or begins limiting your normal running mechanics, the answer should not be to repeatedly test how much pain you can tolerate. Your physical therapist can assess the tendon, your current training demands, strength, and other factors to determine how activity should be modified.

Sudden severe pain or a popping sensation at the back of the ankle is different from gradual overuse pain and should be medically evaluated rather than treated as routine marathon soreness.

6. Pain That Starts Following You Outside Your Runs

One useful question is: What happens after I stop running?

An overworked muscle may be sore after a long run. More concerning symptoms begin interfering with things that normally do not hurt.

Maybe your shin now hurts when you walk to work. Your knee bothers you going down stairs the next morning. You notice hip pain during normal daily movement, or a previously exercise-only pain starts appearing while you are resting.

With bone stress injuries in particular, symptoms can progress from pain during exercise to pain with normal weight-bearing and, in more advanced cases, pain at rest. [4]

A trend toward more frequent symptoms is more useful than judging one isolated bad training day. When pain starts requiring less and less activity to appear, your current workload probably needs to be reassessed.

What Should You Do Instead of Pushing Through?

Backing off does not always mean stopping all exercise.

The right response depends on the injury. A suspected bone stress injury needs a different approach than patellofemoral pain or Achilles tendinopathy. That is why identifying what is actually causing the symptoms matters.

Your physical therapist may temporarily reduce the running activity that triggers your pain while maintaining fitness through exercises your body can tolerate. Rehabilitation may include targeted strengthening, mobility work, balance training, progressive loading, and changes to your running schedule.

As symptoms improve, running can be reintroduced or progressed based on how your body responds.

This is different from repeatedly taking a few days off until the pain disappears and immediately returning to the same mileage that caused it. If the underlying load or physical limitation has not changed, the pain may return as soon as training resumes.

Do You Need to Stop Running Completely?

Not every running injury requires complete rest.

For some conditions, reducing distance, intensity, hills, speed work, or frequency may allow rehabilitation to continue while the irritated area recovers. Other injuries, particularly suspected bone stress injuries or significant acute injuries, may require you to stop running for a period.

The answer depends on what is injured and how severe the problem is.

This is one reason a physical therapist can be helpful during marathon training. Instead of giving every runner the same instruction to “rest,” your therapist can determine what you can safely continue doing and what needs to change.

ASPT's existing marathon training guide also covers how structured training, recovery, and physical therapy fit into marathon preparation. ASPT currently provides physical therapy, sports medicine, surgery rehabilitation, orthopedic rehabilitation, and return-to-play services.

How Physical Therapy Helps When Training Starts to Hurt

You do not have to wait until pain makes running impossible to see a physical therapist.

An evaluation starts with understanding the symptom itself. Where does it hurt? When does it begin? What type of workout triggers it? Does it disappear after the run or linger into the next day? What changed in your training before the pain began?

Your therapist may then assess:

• Strength and mobility
• Balance and single-leg control
• Walking or running mechanics when relevant
• The painful area and surrounding joints
• Functional movements related to running
• Your recent mileage and training changes
• How symptoms respond to different levels of activity

Treatment should address what the evaluation actually finds. A runner with a strength deficit may need a different program than someone whose primary issue is excessive workload or an irritated tendon.

The goal is not simply to make the pain disappear for a few days. It is to build enough capacity for your body to tolerate the running you are asking it to do.

When Pain Needs an Orthopedic Evaluation

Physical therapy can manage many running-related musculoskeletal problems, but some symptoms need an orthopedic evaluation.

That is particularly important when you have severe or rapidly worsening pain, significant swelling, inability to bear weight normally, repeated joint instability, locking or catching, a suspected bone stress injury, or symptoms that are not progressing as expected with rehabilitation.

Our companion New York Bone & Joint Specialists article, Fall Marathon Season: Protecting Your Knees and Hips During Peak Training, explains common knee and hip problems during peak marathon training and when persistent joint pain deserves an orthopedic assessment.

ASPT works with New York Bone & Joint Specialists when a runner needs medical evaluation in addition to rehabilitation.

A Missed Run Is Better Than a Missed Race

Marathon plans are built around consistency, so skipping or changing a workout can feel like you are falling behind.

But a training plan is supposed to prepare your body for race day. It should not require you to ignore progressively worsening pain to complete every scheduled mile.

Pay attention to patterns. Muscle soreness after a demanding run is different from pain that becomes increasingly focal, worsens as the run continues, changes your stride, produces swelling or instability, or begins interfering with normal walking and daily activity.

At All Sports Physical Therapy, our therapists work with runners and other athletes to evaluate pain, modify training when needed, rebuild strength and movement, and progress safely back to activity.

If pain is beginning to interfere with your marathon training, schedule an appointment before another long run becomes another test of how much discomfort you can tolerate.

FAQ'S

How do I know if marathon training pain is normal soreness or an injury?

Normal post-workout muscle soreness is usually related to muscles that were heavily worked and improves as you recover. Injury-related pain is more concerning when it becomes increasingly localized, worsens during activity, repeatedly returns, changes the way you run, causes swelling, or begins affecting normal daily activity. There is no single symptom that identifies every injury, so persistent or worsening pain should be evaluated. [1][2]

Should I keep running if the pain goes away after I warm up?

Not automatically. Some musculoskeletal conditions can feel better temporarily as you warm up and then become painful again as loading continues. Achilles tendinopathy, for example, can cause activity-related tendon pain and stiffness. The more useful question is how the pain behaves throughout the run and afterward. Repeated pain that returns with training should be assessed rather than continually tested. [5]

Is shin pain normal during marathon training?

Shin pain should not automatically be considered a normal part of increasing mileage. Medial tibial stress syndrome is a common running-related overuse condition, but localized bone pain can also occur with a bone stress injury. If shin pain becomes increasingly focal, worsens with weight-bearing, or begins hurting during walking or rest, stop progressing your running and seek an evaluation. [4]

Should I stop running completely if something hurts?

It depends on the cause and severity of the pain. Some running-related problems can be managed by temporarily modifying distance, intensity, frequency, or terrain while rehabilitation continues. Other injuries require a period without running. A physical therapist can help determine what activity is appropriate based on your symptoms and examination.

Why does my pain always start at the same point in a long run?

Pain that consistently appears after a certain distance may indicate that a tissue is reaching the limit of what it currently tolerates under repeated loading. Fatigue, training load, the injured structure, and individual physical factors can all play a role. It is worth evaluating the pattern instead of repeatedly running until the same symptom appears.

Can physical therapy help without making me stop marathon training completely?

Sometimes. The answer depends on the injury. Physical therapy may involve modifying specific running demands while maintaining other appropriate activity, then progressively restoring your running load. If the therapist suspects an injury that requires medical evaluation or a period without impact, the recommendation will be different.

When should a runner see an orthopedist instead of continuing physical therapy?

An orthopedic evaluation may be appropriate for severe or rapidly worsening pain, significant swelling, inability to bear weight, repeated instability, catching or locking, suspected bone injury, or symptoms that fail to improve as expected. ASPT can coordinate with New York Bone & Joint Specialists when additional medical assessment is needed.

Peer-Reviewed Clinical References

[1] Cheung K, Hume P, Maxwell L. Delayed Onset Muscle Soreness: Treatment Strategies and Performance Factors. Sports Medicine. 2003;33(2):145-164.

[2] Kakouris N, Yener N, Fong DTP. A Systematic Review of Running-Related Musculoskeletal Injuries in Runners. Journal of Sport and Health Science. 2021;10(5):513-522.

[3] Esculier JF, Maggs K, Maggs E, Dubois B. A Contemporary Approach to Patellofemoral Pain in Runners. Journal of Athletic Training. 2020.

[4] Beck B, Drysdale L. Risk Factors, Diagnosis and Management of Bone Stress Injuries in Adolescent Athletes: A Narrative Review. Sports. 2021;9(4):52.

[5] Silbernagel KG, Hanlon S, Sprague A. Current Clinical Concepts: Conservative Management of Achilles Tendinopathy. Journal of Athletic Training. 2020;55(5):438-447.