Ask the Experts: Marathon Injury Prevention Q+A with Sarah Connors

ASICS Super Six physio and ASICS PRO Team member Sarah Connors will be online between 1.30pm and 2.30pm today to answer your marathon - and half-marathon - injury questions.

Sarah is a chartered physiotherapist who has specialised in treating track and field athletes for the past 20 years. She has worked for the British Athletics Team and was lead physio for the English Institute of Sport in London before setting up a successful sports injuries clinic.

If you've got any aches or niggles from your training, then Sarah's on hand with expert advice to get you running fit again.

We're opening the discussion now so Sarah will be able to get stuck in straight away at 1.30pm (rather than having to deal with too many questions all at once). That's enough from me - time to get posting!

Dominique RW



  • Hi

    I ran my 1stHalf Marathon 2 weekends ago at Silverstone.

     I've trained over 12 weeks, gradually increasing time/distance without any injuries or pain. I have had a weeks rest since the event but ran 3.5 miles Tuesday and the sides of both of knees now hurt (feels like bruising).

     Could you offer any idea as to what I may have done or what may have caused this pain?

     Many thanks

    Neil Mayo

  • Hi,


    Target is Paris Marathon, so just over 3 weeks to go.


    Running >60mpw average for 10 weeks, >40mpw for 8 weeks prior to that. Hardly a niggle.

    Ran a HM last Sunday not quite all out. Fairly sharp localised pain inside the knee joint/just above and behind the medial side of the patella appeared about 7 hours after the race (did 1-2 mile jogged cool down but then stuck in a car for hours due to a break-down so knees were flexed for ages).

    This is supposed to be my last big week pre 3 week taper.

    Took Mon/Tue off, felt fine Wed am, ran 5m slow, no pain during run, pain returned later that day. Felt fine Thurs, ran pm, 5m slow (tender on occasion), pain returned half hour after run but no worse, in fact slightly milder.

    Cycled Monday (not since) and that was by far the worst thing for the pain.

    No pain under load/impact point when running, happens during flexion. Going downstairs isn’t great.

    No swelling. No pain when static in any position.

    Tempted to try to run through it.


    Just a bit of bruising that will ease or is it cartilage issue that will just get worse with running on it?

    Do I bother going to a physio?

    Do I just stop running for the next 3 days and then hope it is OK next Monday and switch to a bizarre 1 week massive cut back, 1 week decent easy mileage then 2 week taper?

    Thanks. Apologies for long-winded post.

  • Hello Sarah,
    is there any merit in a general stretching regime?  I'm very lax at stretching post-exercise, but could find 10-15 minutes in my early morning routine.  Is this enough time and is there any benefit to stretching non-exercised muscles?


  • Hi

    I've been plaged with it band issues whilst trainning for Brighton. I've been able to pack away some nice LSR, but they take a week to recover from due to knee pain. My 20 miler was last saturday and between taping and pills I made it around in a great time. Alas my knees still slighly ache.

    Can I not run until Brighton but keep my fitness level up by swimmimg and cycling 4 times per week or should I test the waters and attempt a few runs in my taper? 



  • Hi Sarah,
    I've been running on roads up to half marathon distance for the last few years with no injuries
    Tried a treadmill 3 weeks ago and ever sinse I've been suffering shin splints in my left leg (outside of shin). rested for 2 weeks and tried again but felt pain after 10 mins.
    What is the fastest way to get back running?
    Total rest or are there any exercises/stretches which could help?
    I have a race in may which I am trying to train for.


  • Hi Sarah,

     I've been running 10k 3 times a week since early January with a local running club.  I had the usual aches and pains to start with but I've got a achey feeling in my right hamstring for about 2 weeks.

    It doesnt stop me from running, there is no direct pain or bruising but I feel it more when I'm sitting down.  I regularly stretch after running and only run slowly before starting any run.

    I was wondering whether I need to stop running or whether I need to perform specific hamstring relative stretches to help?


  • Hi there

     Took a calf strain on sunday morn, which at the time was v painful,  no bruising though tender to touch, walking in shoes ok, feel it a bit barefoot and on stairs but can't believe how much better it is already.

      Don't want to start running again until I'm completely sure I have recovered.  Given that its not too bad how long do you think I should wait and what sort of programme should I follow...I live in a very hilly area and was running 6miles x 4 weekly.  (not currently training for anything, just love running).

     Many thanks!

  • Hi I had a Stress Fracture/Stress Reaction 3/4 of the way up Tibia back in May (only diagnosed via isotope bone scan, as MRI came back negative), took 4 months off from running completely and have since Sept been back running, without major issues (except occassional tightness in tibialis anterior)

    SInce returning and building up distances the highest MPW i have done is about 40 (prior to injury it was consistant 80-100)...and been fearful to do too much.

    My question: is there a period of time after which you would consider a SF/Reaction to be 'better'...? Or is it a case of suck it and see? 

    I believe that a follow-up bone scan would come back positive, due to slow renewal of bone am i correct to assume it is simply a case of 'be careful with mileage build up and stop if it hurts'...?


  • Hi Sarah,

    I have just had to withdraw from this years VLM due to Retrocalaneal Bursitis. It flared up on a run back on the 7th Jan. After a good solid 10 weeks of training before hand 

     I have laid off Running ( still cycling and swimming) and taking Anti Inflams ( diclofenac and Iburprofen - Not at the same time I might add) Raising it, icing it etc etc.

     Runners weren't old only had 100miles in and the same model as always use ( kayano's) although the model number had increased from a 16 to a 17, normally just cosmetic changes I believe but wondering if this has had an effect. Subsequently changed to Brooks and these feel far more comfortable.

     Every time it has felt better and I start running again it flairs back up ( been having some ultrasound). Currently 2 weeks into 3 weeks of total running abstinence but it just not feeling quite right.

    I am starting to get very frustrated that it just won't go away. Any suggestions or exercises to accelerate things? I have weekly ultrasound and massage also. Desperate to get back out running.

     Thank-You in advance 

  • Hi Sarah,

    I'm training for VLM and doing 4 runs a week 1 LSR 1 interval 1 easy 1 steady at ~40 miles a week. All going ok until Essex 20 when at around 10 miles I could feel my left quad (inside middle to lower side) started to tighten. Finished but was very sore at end. Went for easy run 2 days later and stopped at 3.5 miles as it kept getting sore but would go as soon as I stopped running. Rested until friday and went for 8 easy and no issues So did LSR off road (22m) again no real problems, Did another 8 easy following day legs felt heavy and a little sore but that went next day. Decided to do intervals and no issues until last rep when got tight again. I ice and stretch every night on it and also use foam roller.  I have not run since yesterday morning  and will not run again until Sunday (have a half marathon).

    Is there anything I can do to stop getting tight in that area or could it be a pull or strain that I just need to rest?

  • Hi Sarah

     I have similar problem to _Ciaran.

    I am running Brighton.  I did a 20miler two weeks ago & last weekend a half-marathon.  In between the two I started get problems above the knees.  Chiro' said IT probs so take it easy.  Did two 6milers this week but it's much sorer - not awful - I just know it's there.  Anyway, my regular Chiro is away so the new person said it's actually TFL probs - gave me laser treatment told me to miss long run this weekend & just do 4/5miles.  She said I should be ok if I pace myself.  My question is - have I peaked too early with my long run (next weekend I should start to taper with a 15, then 12 then race).  Should I attempt another 20 miler next weekend - or should my 20miler (5 weeks before race) be sufficient?  Also, is my chiro correct in saying I can carry on running (I have no pain at all when I walk)?

    Sorry for warbling on....Liam

  • Hi

    At the beginning of my marathon training, back in December, I stuffed with a lot of pain in my knee at the end of a 13 mile run, with pain also going across the top of my thigh.  I visited a sports injury clinic who put it down to having a tight hip flexor.  After having regular sports massages and doing lets of form rolling, I have been able to complete my training for Brighton without much problem.

     However, I did a HM on Sunday, where I put in a high pace and, come mile 12, my knee began to hurt a lot.  However, as I was on path for a PB I continued and, at the end of the race, had extereme pain in my knee on the outside, and also the top, and found it hard to walk for a few days.  Whilst it feels ok now, I had a sports massage on Wednesday and was told that I might have inflamed my ACL and to not do any running for a week.

    My concern is that, with three weeks to go, whilst I realise I should be tapper, is doing nothing for a whole week going to set me back.  Also, if I have inflamed my ACL, am I going to be ok to run a marathon in three weeks. I don't want to do it and injury myself further.

    Thanks, Tori

  • Hi Sarah,

    I was on a run nearly 3 weeks ago and I've done something to my achilles.

    It felt tight when I started running, but I hoped it would ease up. After the run though, it felt very tender

    I rested for 3 days and tried a short run, then rested for 5 days before trying again. Both times the pain was there as soon as I started running, although bearable.  I have run 3 miles this morning,  after 9 days rest, and the pain is back with a vengeance.

    How long should I be resting for? I have pulled out of the Wilmslow half on 27th March, but I am so looking forward  to running the Chester half on 15th May.

    I really don't want to lose any training time! Can you recommend any home treatments?



  • Hi there,

     I am running the Brighton Marathon in three weeks, my first for 15 years.  Training was going well until I went out for a run on Feb 27th when I had pains in my inner thigh.  I assume this is a groin strain, so I stopped training for a week.  I then did the Eastbourne Half on March 6th without too much difficulty but the pain in my thigh returned the day after.

     So I rested again and waited until the pain subsided before doing a 20 mile run at the weekend.  Now the pain has come back again and this time does not seem to be subsiding too quickly.

     I guess I am returning to running too quickly?  In which case what should be my strategy to ensure I am recovered for Brighton April 10th? 

     Thanks, Rob

  • I've got ITB pain below the knee after ramping up mileage significantly and never had it before. Is this an indication of TFL weakness, or some other muscle structures meaning it's getting overloaded?
  • Hi Sarah

    Having just finished a eight week treatment course with a local pysio, for a reoccurring achilles problem in both feet, I have now started doing short 10 - 15 minute runs twice a week in woodland and lots of stretching after each run, apart for some slight soreness in my right foot everything seems ok

    Is it now a case of listening to my body and increasing pace and distance gradually ?
    I currently run in Asics 1150 shoes as I slightly pronate would I get better support if I was to purchase a more expensive support shoe from the Asic`s range? If so could you recommend any ?


  • Hi Neil,

    is it the inside or outside of the knees that aches.


  • Hi Galbraith,

    this sounds like your quad muscle is tight and it's compressing the patella which is why sore sitting and down stairs. Try and stretch the quad as shown in the video and also hamstringabut concentrate on the quads.

    This should ease your pain straight away, if no change see a physio as quad ttightness may be coming from lower back which will need mobilising. Also try foam rolling the hip flexor that sits on the outside of the hip.

     Don't leave it to chance and do nothing as it will still be there.

    Good luck


  • Hi Sarah,

    I've had a problem with my right knee for some time. Its on the outside of the knee, slightly below my knee cap. It comes on about 3 miles into my run and then hurts when I bend the knee so I have to stop. The pain immediately goes when I walk but comes back as soon as I try to run again. It sometimes swells a bit if I push it too much and it hurts for a few days after, particularly going downstairs.

    I've been to a physio and she said there were no problems with cartilage/ligaments and wasn't sure what it was so suggested strengthening my inner quads and getting some insoles as I have quite flat feet. I've been doing the exercises religiously and got some insoles but it hasn't seemed to help. I've also been using a foam roller and doing ITB stretches, doing things like body pump and pilates to try and improve my general strength. I had been building up training very gradually to run a marathon in may, I ran 2 half marathons at the end of last year very comfortably and hadn't really upped my training since then, but the problem started in late January.

    Please can you recommend anything at all? I'm desperate to get back to running. I've now had to pull out of the Edinburgh marathon which I was really looking forward to. image

    Many thanks
  • Hi Ferrous,

     I'm an advocate of stretching I stretch before I run and if I get a chance at another time. I think running is such a wind up sport of the same muscles it's really good to unwind them. If cold starts slowly and stretch gently at first.

    Hip flexors, hamstrings gluts and clafs are the key runners areas and try and do some lower back stretches too.

    see the video on stretching for the key ones I use.


  • Hi Kate,

    the numbness in the cocyxx won't be coming from the pirifomis, you should get your back looked at by a physio and see what the cause of this is. Is there any pain at night or weakness around that arae?


  • Hi Sarah

    I run mainly off road but have recently started back on tarmac, after about six or seven miles I get a very sharp pain in the third and fourth toe on my left foot, it doesnt matter what shoes or socks I am wearing it is just very painful, there are no nasty after effects and the pain subsides when I stop, any ideas?

    Many thanks


  • Hi Ciaran,

    you need to find the cause of your ITB tightness, is the TFL which is your hip flexor tight? Or are your gluts weak or are your shoes correct for you or worn out.

    Do you use a foam roller on your TFL which is at the top of the ITB just to the front of the hip. This muscle pulls the ITB tight and overworks when the gluts fatigue. Bridging is a great exercise to strengthen your gluts and take some pressure of the TFL. I'm sure bridging is described earlier on this website.

    Let me know your thoughts on the above.


  • Hi Kevin,

    when you talk about the outside of your shin do you mean the small bone that runs along the outside or the outer part of the tibia the large shin bone more at the front. If the second one can come from having to lift the foot more on a treadmill. It could just be a build up of forces and caused the start of a stress reaction in the bone. Is the bone tender to touch? Is there pain at rest or at night and any pain on hopping? Lots of these point to bone ie a stress reaction that needs rst and cross training.


  • Hi Steven,

    it sounds like its more of a dural (nerve ) pian coming form tightness in the lower back rather than just the muscle which is why you can't stretch it. Try and stretch the hip flexors first and do some gentle roration stretches for the lower back ie on back rotate one leg across the body to the floor. Then try lying on back with leg in the air and pull the foot down 3x10 to release the sciatic nerve, don't hold this position. Then try and strech the hamstring which should be easier. If no change try and see someone to mobilise your lower bcak then look at core work to strengthen the area.


  • Hello Sarah

    I got half way through training for a HM last year but got a groin injury (tendonopathy i think ) and stopped training.  I've been favouring the rest and hope it gets better approach but clearly not been working.  I went out for a 2 mile run a couple of weeks ago, first time in about 9 months, since the injury happened but still feel it achy.

    can you recommend any stretches or a course of action i could try?  especially as i would like to try a half marathon mid-end june (and all going well, possibly a marathon later this year).

    any comments or advice appreciated.



  • Sarah

    The main pain is on the left side of the left knee. The Hip flexor is not tight. I have three pairs of shoes (brooks GTS) which i alternate on each run, and my gait has been checked. I can do squats and lunges and walk with out problem, 

    I sometimesdoubt is is an IT Band issue and could be Lateral Collateral Ligamen issues as that is the location of the pain.

    Post race I do the whole RICE sheebang and in a few days it is ok.

    Thanks for the Bridging tips I'll add them to my daily routines



  • Hi Moorunner,

    you need to strengthen and stretch the area prior to running again so you know it will cope.

    Try the usual calf stretches leaning into a wall then bend the knee. Then as thtas ok drop your heel down on a step.

    To strengthen start with 2 feet calf raises on the ground nad progress to one leg as able, upto 3x 20 then go to a step and drop the heel and lift 2 legs then one, this will help you with the hills.

    You can also try some circuits step ups squats lunges etc to help strengthen around the calf.

    If you can hope pain free once done all that then you should be fine to run.


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