Strength training to prevent overuse injuries for first-time marathon runners
I want to run the NYC marathon. A new study suggests that I shouldn't be strength training while doing so, but I don't agree with it. Here's why.
Top of the morning, sapien. Welcome to Common Sense Medicine, where I try and keep you up to date on the latest and greatest in longevity science. This week, I have some good news—I’ve made great progress rehabilitating my Achilles tendon using eccentric heel drops rather than shockwave therapy. While some heel pain remains, focusing on form, adding mobility work and yoga, and following insights from mobility expert Kelly Starrett have helped tremendously.
Watching the NYC Marathon runners earlier this month was a powerful inspiration. Seeing so many committed individuals made me set a bold goal: I want to run the NYC Marathon someday. Though my Achilles needs more care, having a structured training plan makes this feel achievable. Here’s my roadmap: finish my current 12-week training cycle, transition to a hypertrophy phase from January to May of 2025, train for a half marathon over the summer, focus on strength in the fall, and finally, prepare for a marathon finish in 2026.
That said, I tried to look for a paper this week which encompassed how to build in strength training into the prep for a marathon — very applicable to me coming off of a tendon overuse injury.
THE WEEKLY DOSE
Strength training for runners, does it help?
In recent years, there’s been a movement to move towards a notion of a hybrid athlete—someone who can run really far but also has the physique you could mistake at a bodybuilding competition. I think it’s definitely been something of a goal of mine to be well-rounded athletically. Toresdahl et al investigated part of this question when they implemented a strength training program for athletes who were going to compete in the New York City Marathon, particularly to strengthen hip abductor and quadriceps and prevent overuse injuries in this subpopulation of athletes.1
What did they do?
Most of the studies in the injury prevention space for running are focused on pre-conditioning and warm-ups; however, this study specifically wanted to see whether a self-directed training program would help prevent overuse injuries in marathon specific runners rather than small distance runners (4-13.1 mile races). In this study, the investigators recruited participants who were at least 18 years old without a current injury and who had never completed a marathon. They separated the participants into two groups, one who would be doing the strength training routine (10-minute instructional video) 3 times per week focusing on core, hip abductor, and quadriceps strengthening with both beginner and advanced track.
To collect data, investigators used biweekly surveys in the 12 weeks leading up to the marathon, and another survey one week post-marathon to identify any injuries during the race and race performance. They also saw whether there was any need for medical attention or perceived benefit of the strength training program.
So did the strength training help?
The headline of this article was that overuse injuries are the most common form of injuries in marathon noncompletion (shocker!) but also that the strength training program which was outlined in this study did not make a significant contribution to the prevention of overuse injuries as self-reported by the runners (7.3% in the observation group, 7.1% in the strength training group, p=0.9). The most common overuse injury which was reported was bone stress injuries (38% of the injuries which were reported overall), and most of the injuries happened after week 6 of the training plan, which is shown in the figure below. Minor injuries, which didn’t hinder completion of the race, also weren’t significant between the two groups, which were 16.1% and 14.7% respectively (p=0.62). Most of the runners who had minor injuries reported unspecified knee pain, calf strain, medial tibial stress syndrome, iliotibial band syndrome, and Achilles tendinitis.
Will I give up on my hybrid athlete goals?
This paper doesn’t change my thinking on hybrid training: I still believe that one should optimize for strength training and running. First, the routine that was prescribed was voluntary — there were noncompliant strength training group participants who were included in the study and were compared via sub-groups. In this subgroup analysis, they also included those who were in the observation group. These runners were already doing strength training on their own plus training for the marathon, and they paradoxically had lower rates of major injuries and similar rates of overuse injuries than the compliant and non-compliant strength training groups (see figure below)
This study, I think, suffers from the limitations of using a convenience sample: since they used the NY Road Runners email list to recruit participants, they shouldn’t be surprised that people already doing strength training on top of running are enrolling in this program. In fact, they might have had people who were doing more effective personal training but they imposed a subpar routine for them to do for 30 minutes per week. In fact, looking at their “strength training routine,” it doesn’t have any option for proper loading or practicing how biomechanics will load onto the posterior chain. If people weren’t using the proper form while doing crunches or not warming up with proper mobility work, they might have even gotten injuries from doing the “strength" training that was prescribed during this program. True strength training lies in progressive overload, and for athletes who are trying to do a marathon, they need to be able to load their ankle joints with 6x their weight for thousands of steps. This simply cannot only happen through a bodyweight exercise training routine, but rather through controlled progressive overload of weighted exercises. I suspect that the independent strength training group was using alternative exercises instead of those prescribed by the investigators.
I think what this paper does reinforce, to me, is that overuse injuries are so commonplace that it’s important to build up to actually run those types of distances. I’m going to try and really harp on recovery days, and focus on “recovering hard.” Sleep, nourishment, and yoga have been my 3 pillars to do that — but I’m going to try and focus on really honing those in the last weeks of the year to hopefully start a slow gradual taper to actually running.
REMEMBER, IT’S JUST COMMON SENSE.
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See you next week,
Shree (@shree_nadkarni)
The information provided here is not medical advice. This does not constitute a doctor patient relationship and this content is intended for entertainment, informational, and educational purposes only. Always consult with a doctor before starting new supplementation protocols.
Toresdahl BG, McElheny K, Metzl J, Ammerman B, Chang B, Kinderknecht J. A Randomized Study of a Strength Training Program to Prevent Injuries in Runners of the New York City Marathon. Sports Health. 2020;12(1):74-79. doi:10.1177/1941738119877180