Top 5 Injuries in Marathoners — And How Denver Runners Can Avoid Them

Marathon training in Denver is both exhilarating and challenging. From the flat stretches along Cherry Creek Trail to the elevation shifts of City Park to Washington Park loops, local runners face unique demands that can increase the risk of overuse injuries. While logging miles is essential for endurance, repetitive stress without proper mechanics, strength, and recovery can lead to nagging injuries that derail your training. At Rise Rehabilitation and Sport Performance, we help Denver runners understand the most common marathon injuries and provide evidence-based strategies to prevent them.

1. Runner’s Knee (Patellofemoral Pain Syndrome)

Anatomy:Runner’s knee primarily affects the patellofemoral joint, where the patella (kneecap) glides over the femoral trochlea during knee flexion and extension. Proper alignment is critical—if the patella tracks too far laterally, it can irritate the surrounding cartilage, synovium, and retinacular ligaments. Weakness in the gluteus medius, vastus medialis oblique (VMO), or altered hip and knee mechanics can cause abnormal patellar tracking, increasing joint stress.

Why Denver runners are at risk:Hills on trails like Green Mountain or Lookout Mountain require repetitive knee flexion under load. Elevation-induced fatigue can impair hip and quadriceps stabilization, increasing lateral stress on the patella.

Prevention:

• Hip and glute strengthening (side-lying leg lifts, monster walks)

• Quadriceps balance exercises

• Running gait assessment to correct abnormal tracking

• Gradual mileage increases and proper hill progression

2. Shin Splints (Medial Tibial Stress Syndrome)

Anatomy: Shin splints involve the medial tibial border and associated periosteum, often aggravated by the repeated pull of muscles attaching to this region:

• Tibialis posterior

• Soleus

• Flexor digitorum longus

Overuse causes microtrauma to the periosteum and underlying bone, leading to pain along the inner shin. Poor foot mechanics, limited ankle dorsiflexion, or calf tightness exacerbate stress on these structures.

Why Denver runners are at risk: Hard surfaces, abrupt mileage increases, and technical trails like South Table Mountain create repetitive loading on the tibia. Elevation-related muscle fatigue reduces shock absorption, increasing periosteal stress.

Prevention:

• Progressive mileage increases (≤10% per week)

• Calf and ankle mobility drills

• Foot strengthening (toe curls, short foot exercises)

• Surface rotation: mix trail and road running

3. Iliotibial (IT) Band Syndrome

Anatomy: The IT band is a dense fibrous structure running along the lateral thigh, from the iliac crest to the lateral tibial condyle (Gerdy’s tubercle). It functions to stabilize the lateral knee and assist in hip abduction. IT band syndrome occurs when excessive friction develops as the band passes over the lateral femoral epicondyle, often due to weak gluteus medius or hip external rotators.

Why Denver runners are at risk: Cambered roads, trail inclines, and prolonged downhill runs stress the IT band. Weak lateral hip stabilizers, combined with fatigue from elevation, increase lateral tension and friction at the knee.

Prevention:

• Gluteus medius and hip rotator strengthening

• Foam rolling of the lateral thigh

• Avoiding abrupt changes in terrain or training volume

• Cross-training to reduce overuse

4. Achilles Tendinopathy

Anatomy: The Achilles tendon connects the gastrocnemius and soleus muscles to the calcaneus (heel bone). Its primary function is to transmit force during plantarflexion for push-off in running. Tendinopathy develops from microtears and collagen disorganization due to repetitive loading, especially when eccentric control is insufficient.

Why Denver runners are at risk: Steep inclines and uneven trails require frequent plantarflexion under load. Tight calves, sudden mileage increases, and high-intensity hill repeats can strain the tendon, leading to pain, swelling, or morning stiffness.

Prevention:

• Calf stretches and eccentric heel drop exercises

• Gradual introduction of hill or speed work

• Proper footwear with supportive heel-to-toe drop

• PT-guided load management during peak training

5. Plantar Fasciitis

Anatomy: The plantar fascia is a thick connective tissue running from the medial calcaneal tubercle to the base of the toes, supporting the arch of the foot. Repetitive stress causes microtears and inflammation at the calcaneal insertion, leading to characteristic heel pain, especially with the first steps in the morning.

Why Denver runners are at risk: Hard roads, post-hiking runs, or skiing can increase tensile load on the plantar fascia. Flat or unstable surfaces challenge intrinsic foot muscles, reducing arch support and increasing strain.

Prevention:

• Calf and plantar fascia stretches (towel stretch, wall stretch)

• Strengthen intrinsic foot muscles with short foot exercises

• Gradual mileage increases

• Consider supportive footwear or orthotics if indicated

How Physical Therapy Can Help Denver Marathoners

At Rise Rehabilitation and Sport Performance, we focus on prevention, performance, and longevity with strategies like:

1. Movement Analysis Related to Running Evaluating stride mechanics, ground contact, and joint alignment to detect risky patterns.

2. Joint and Muscle Pattern Assessment Examining hip, knee, and ankle mobility, along with activation patterns in glutes, core, and calves.

3. Objective Muscle Strength Testing Quantifying deficits to guide strengthening and track progress.

4. Sport-Specific Training Recommendations Tailored drills to help Denver runners handle hills, trails, and elevation changes safely.

Training Tips for Denver Marathoners

• Progression is key: Avoid sudden mileage spikes or excessive hill repeats.

• Incorporate strength training: Target hips, core, and lower limb muscles.

• Cross-train: Cycling, swimming, or rowing maintains cardiovascular fitness while reducing repetitive stress.

• Monitor recovery: Elevation and seasonal conditions can impact fatigue—prioritize sleep, hydration, and nutrition.

• Listen to your body: Early intervention prevents minor aches from becoming chronic injuries.

Takeaways

Marathon training is rewarding, but repetitive stress injuries are common—especially for Denver athletes navigating elevation, trails, and city roads. Common injuries like runner’s knee, shin splints, IT band syndrome, Achilles tendinopathy, and plantar fasciitis have distinct anatomical causes but are preventable with proper biomechanics, strength, and recovery strategies.

At Rise Rehabilitation and Sport Performance, we combine movement analysis, joint and muscle assessment, objective strength testing, and tailored rehab programs to help Denver marathoners train smarter and run stronger. Don’t let minor aches become a marathon roadblock—get assessed early, strengthen intelligently, and enjoy the miles ahead pain-free.

Call us at (720) 248-4386 to schedule your free discovery call and start your plan today.