Training for the Gold Coast Marathon: Common Running Injuries & How to Manage Them

by carien boshoff

Preparing for the Gold Coast Marathon is an exciting goal, but the rapid increase in training load, combined

with repetitive impact places runners at increased risk of musculoskeletal injury.

Within this scope, osteopaths may provide manual therapy, exercise prescription, load management advice,

and referral when clinically indicated, ensuring care remains safe, evidence-informed, and patient-centred.

Understanding injury risk in marathon training

Running injuries are typically multifactorial, with the most common contributors including:

• Rapid increases in weekly mileage

• Poor load management

• Reduced hip strength

• Previous injury history

• Biomechanical and training errors

• Inadequate recovery and sleep

Evidence suggests that most running injuries are overuse related rather than traumatic, meaning they

develop gradually due to repetitive stress exceeding tissue capacity.

Common running injuries in marathon training

1. Patellofemoral pain syndrome (runner’s knee)

One of the most common presentations in runners, patellofemoral pain typically presents as anterior (front) knee pain aggravated by stairs, squatting, and prolonged running.

Key contributors:

• Hip abductor weakness

• Increased dynamic knee valgus

• Training load spikes

Osteopathic management:

• Load modification and running progression advice

• Hip and quadriceps strengthening program

• Manual therapy to reduce symptom irritability

• Movement retraining (running mechanics)

Evidence supports combined education and exercise-based management as the most effective approach.

2. Medial tibial stress syndrome (shin splints)

This presents as diffuse pain along the tibial (shin bone) border, particularly early in runs or after load increases.

Risk factors:

• Sudden increase in running volume

• Reduced calf strength and endurance

• Hard surfaces or poor footwear transition

Management strategies:

• Reduce training intensity temporarily

• Calf strengthening and plyometric progression

• Gradual return to run programs

• Footwear review and load planning

Differentiation from a stress fracture is essential, requiring clinical assessment and imaging referral when

indicated.

3. Achilles tendinopathy

Achilles pain in runners is typically load related and may present as morning stiffness and pain with push

off.

Contributing factors:

• Sudden increase in hill or speed work

• Calf strength deficits

• Reduced tendon load tolerance

Evidence based management:

• Progressive loading (eccentric or heavy slow resistance training)

• Activity modification (not complete rest)

• Biomechanical and gait assessment

• Adjunct manual therapy for symptom modulation

Tendon loading programs remain the gold standard intervention.

4. Iliotibial band (ITB) related pain

Often felt on the lateral (outside) knee, particularly during downhill running or repetitive flexion& extension.

Key factors:

• Hip abductor weakness

• Training overload

• Reduced pelvic control

Management:

• Load reduction and gradual reintroduction

• Gluteal strengthening program

• Running technique modification

• Adjunct soft tissue therapy

Exercise based rehabilitation is strongly supported in clinical guidelines.

5. Plantar heel pain (plantar fasciopathy)

Characterised by first step pain in the morning and load related heel discomfort.

Management approach:

• Calf and plantar fascia loading program

• Footwear modification

• Load management strategies

• Taping or temporary orthotic support if required

Osteopathic role in marathon preparation

Within Australia, osteopaths are trained to assess and manage neuromusculoskeletal conditions using

evidence informed clinical reasoning.

Scope of practice includes:

• Comprehensive history and physical examination

• Orthopaedic and neurological testing

• Differential diagnosis and referral when required

• Manual therapy (joint mobilisation, soft tissue techniques)

• Exercise prescription and rehabilitation planning

• Advice on training load, recovery, and injury prevention

Injury prevention strategies for marathon runners

1. Gradual load progression: Avoid increasing weekly running volume by more than 10% per week.

2. Strength training (2–3x/week)

Focus areas: Gluteal strength, Calf capacity, Core stability

3. Recovery prioritisation: Sleep quality, Rest days, Active recovery sessions

4. Running technique considerations: Cadence optimisation, reduced overstride, load distribution

efficiency

5. Early symptom response: Pain that persists or worsens during training should be assessed early to

prevent progression to more significant injury.

When to seek professional assessment

Runners should seek assessment if they experience:

• Pain lasting >7–10 days

• Night pain or rest pain

• Swelling or joint instability

• Sharp, focal bone pain

• Declining performance despite rest

Early intervention improves recovery time and reduces the risk of long-term injury development.

Conclusion

Marathon training places significant demands on the musculoskeletal system. Most running injuries are load

related and highly modifiable with early intervention, strength-based rehabilitation, and appropriate

training progression. With structured preparation and early management of symptoms, runners can

significantly reduce injury risk and complete their marathon goals safely and efficiently.

References

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