David Wynne is a sports and musculoskeletal physiotherapist. As research lead of West London Physiotherapy (westlondonphysio.co.uk), he’s investigating how running biomechanics relate to lower limb injury.

It’s tricky to assess the risk of injury when training for a marathon. Some claim it’s as high as 92%, but even conservative estimates suggest the chances are almost one in five. What’s not in doubt is that you can reduce the danger. ‘Poor biomechanics and over training are the main causes of injury,’ says Wynne. ‘But common injuries can be easily avoided.’ Here’s how.

1 Runner’s knee

‘This is properly known as iliotibial band or IT band friction syndrome. The IT band is a layer of tissue that runs along the outer thigh. If your glutes and quads are weak your IT band can rub against a sac of fluid on your knee, causing pain.’


‘Strengthen these muscles with single-leg glute bridges, step-ups or lunges. Do three sets of 15 reps, building up to four sets of eight reps with heavier weights, once a week. When running, make sure your knees don’t rub together.’ 

2 Shin splints

‘Medial tibial stress syndrome relates mainly to pain originating from the inner aspect of the shinbone. It’s caused by an abrupt increase in training that doesn’t give the bone time to adapt.’


‘Runners increasing their weekly distance by more than 30% put themselves at high risk. Once you discover your base level of endurance – which you should on your first run – increase your overall weekly time or distance by no more than 10% per week, and don’t increase both at once.’

3 Achilles tendinopathy

‘The achilles runs down the back of your lower leg to your heel and is the largest tendon in the body. Pain here can arise from a change in footstrike pattern towards the front of your foot, but it’s also associated with tight or weak calves.’


‘Don’t just stretch your calf muscles – strengthen them at the same time. Stand with your heels hanging over a step. Rise onto your toes and lower slowly until your heel is below the step, then repeat. Do three sets of 15 reps. You should feel fatigue in your calves. If not, add weights.’

4 Metatarsal stress fracture

‘The metatarsals are the long bones of the foot and they have to absorb large forces, particularly when running. A sudden increase in exercise intensity or duration can lead to fracture, as can pronation, which is when your foot rolls inwards as you land.’


‘Good foot posture and control is important. Strengthen the intrinsic muscles of your foot using the STAR excursion test: stand on one leg and tap the other leg on the ground forwards, backwards and to either side as far as you can. Do five sets of five on each leg. For a greater challenge you can do it on an unstable surface such as a Bosu ball. However, the most important tip is to increase your running distance gradually by following the 10% rule.’