Training for the London Marathon is a significant, but hugely exciting physical undertaking. As mileage starts to climb and sessions become more demanding, it’s natural to focus on cardiovascular fitness and weekly distance, trusting that your body will simply adapt along the way. However, every marathon season at Pure Sports Medicine, we see motivated, well-conditioned runners sidelined not because they aren’t fit enough, but because their bodies weren’t fully prepared for the demands being placed upon them.

This is where prehab running can make a meaningful difference to your training. Prehabilitation is all about building resilience early, before pain or injury develops. By addressing potential weaknesses and improving how your body copes with load, prehab allows you to train with confidence and consistency, rather than reacting to problems once they’ve already started to interfere with your progress.

“Prehab isn’t about doing more, it’s about doing the right things early so your body can tolerate the miles ahead,” explains Gabrielle Conroy, Podiatrist at Pure Sports Medicine.

Are You Marathon Ready?

Prehab running involves proactive strategies designed to prepare your body for the training loads ahead. Unlike rehab running, which focuses primarily on recovery after injury, prehab aims to reduce your injury risk by improving tissue capacity, strength, and movement efficiency ahead of time.

From a clinical perspective, most running injuries are not simply the result of overtraining. They tend to occur when training demands exceed what your tissues are currently able to tolerate. Research consistently highlights this mismatch between load and capacity as a key driver of overuse injuries in runners.

For marathon runners, this risk is magnified. Repetitive loading over thousands of steps per session places sustained stress on the knees, calves, Achilles tendons, hips, and feet. For this reason, prehabilitation helps ensure these structures are properly prepared before training demands escalate, rather than trying to catch up once symptoms appear.

Dawn Nunes, Sport Physiotherapist at Pure Sports Medicine explains: “Preparing your body, making it stronger and more resilient, is a much better pro-active approach rather than if you sustain an injury and you then need to be reactive in dealing with an injury and the imbalances which may have contributed to the injury.”

Marathon training requires gradual increases in volume, intensity, and often pace-specific work. While your cardiovascular system adapts relatively quickly, muscles, tendons, and joints take longer to respond to increased demands. Without adequate preparation, this imbalance can lead to symptoms that start subtly and gradually worsen as training progresses.

Previous injuries, sudden changes in training load, and strength deficits can all increase the likelihood of running-related injuries. These factors are especially relevant during marathon build-ups, where runners may feel additional pressure to “push through” early warning signs in order to stay on plan.

Common issues seen during marathon preparation include patellofemoral pain (runner’s knee), ITB friction syndrome, Achilles tendinopathy, calf strains, and hip overload. However, the encouraging news is that many of these conditions are highly preventable with targeted prehab exercises and appropriate clinical guidance.

“As a runner, your ‘engine’ is often only as good as the chassis it sits on. In the clinic, we use objective testing to look past the surface and identify where a runner might be carrying specific deficits in the lower limbs, explains John Daly, Sports Physiotherapist at Pure Sports Medicine. “This is especially important if you have a history of injury, old niggles often leave a legacy of subtle weaknesses or compensations that generic strength plans simply won’t fix.”

“I’ve experienced this myself. In the lead-up to a marathon last year, I went through my own clinical testing which highlighted a strength deficit in my calves. This was a lingering effect from an old Achilles injury that I thought I’d moved past. Having that data changed my approach I knew exactly where the deficit was and could focus on the specific loading required to fix it.

“By quantifying these areas, we can move away from “one-size-fits-all” exercises and develop an individualised programme that targets your specific needs. The goal here isn’t just to keep you out of the treatment room. By building targeted strength is a performance tool, it improves your running economy by making you more efficient with every stride and increases your tissues’ ability to handle high training loads, reducing your risk of injury. Ultimately, a more robust runner recovers faster and stays more consistent, which is the real secret to long-term progress.”

How to Avoid Injury When Marathon Training

Knee pain continues to be one of the most common reasons that runners seek support during their marathon training. Conditions such as runner’s knee often develop when training volume increases faster than the knee’s ability to tolerate load.

A well-designed, tailored knee prehab routine focuses on improving strength, movement control, and load management around the knee joint. This usually includes progressive quadriceps and gluteal strengthening, better single-leg control, and a gradual introduction to impact forces that are specific to running.

At Pure Sports Medicine, our structured Knee Programme Package has been developed specifically for runners who want to prevent knee pain from disrupting their training. It is particularly well suited for those with a history of knee symptoms, early warning signs during marathon preparation, or previous marathon-related setbacks. Our programme combines expert assessment, a personalised exercise prescription, and clear progression guidance, helping runners to continue training safely and move closer to achieving their marathon personal best!

Preventing Overuse Injuries in Long Distance Running

Achilles tendinopathy and calf strains are common issues for runners building toward long-distance events, especially when speed work, hills, or sudden mileage increases are added too quickly. These tissues are under huge demand, and without the right preparation, they can become a limiting factor in your training.

One key thing to understand is that tendons adapt more slowly than muscles. While your muscles may feel ready for bigger training loads, your tendons need steady, progressive exposure to stress to become stronger and more resilient. Rushing this process can lead to irritation or injury.

At Pure Sports Medicine, our prehab approach focuses on gradually building tendon and calf capacity through structured strength work and careful progression. We also keep a close eye on how your body responds after runs, monitoring stiffness and soreness helps guide how much load is appropriate at each stage.

“Effective rehabilitation and performance training for the calf–Achilles complex requires a nuanced approach to loading,” explains John. “We tailor loading strategies to each runner’s tissue capacity, and the deficits identified through objective testing.”

Isometric loading – holding a weighted position without movement is often used early on to calm an irritable Achilles and build foundational strength. “Isometrics help maintain neuromuscular activation and develop force-holding capacity, without the repetitive stress of full-range movement,” John notes.

We typically progress through three stages of loading. Isometric exercises (holding a weighted position without movement) are often used early to calm a sensitive Achilles and build baseline strength. “Isometrics maintain muscle activation and force-holding capacity without repetitive strain,” John says.

Next comes isotonic loading, such as heel raises through a full range of motion, to address strength deficits in the calf and build tendon and muscle capacity for higher training volumes.

The final stage involves plyometric or ‘spring-like’ exercises, such as pogo jumps and hopping drills. These movements train the Achilles to store and release energy efficiently. “If the calf complex can’t tolerate these reactive loads in the gym, it will struggle during the thousands of repetitions required in a race,” he adds.

The final stage involves plyometric or ‘spring-like’ exercises, such as hopping and pogo drills, which train the Achilles to store and release energy efficiently. “If the calf complex can’t tolerate these reactive loads in the gym, it will struggle during the thousands of repetitions in a race.”

By combining these three types of loading, we aim to make the lower limb strong, resilient, and efficient, ready to propel you forward mile after mile.

“Plyometrics should be introduced carefully and progressed gradually,” adds Dawn. “A simple weighted isometric hold, like a lunge hold on your toes, is a safe way to start loading the calf complex.”

Avoid Running Injuries Be Marathon Ready

An effective prehab workout focuses on building the physical qualities you need to cope with the demands of running.

Strength training is one of the most powerful tools for reducing injury risk. For runners, that means developing strong knees, hips, calves, and feet and ankles. Trail runners may need extra work on balance and lateral stability, while road runners often benefit from exercises that improve impact control.

Movement quality matters just as much as strength. Prehab should help you feel stable on one leg, maintain good pelvic and core control, and hold efficient form when you’re tired. These skills reduce unnecessary strain on your joints and tissues, especially during long runs and in the later stages of races.

“Not only does this reduce your injury risk, but will allow you to maintain your form under fatigue and to recover more effectively between sessions,” adds Gabrielle.

“In clinic, we often see runners with great fitness but limited musculoskeletal capacity,” explains John. “Running builds your aerobic engine, but it doesn’t automatically make your body structurally robust. Strength training is key for improving running efficiency and resilience.”

“Strength work improves how your nervous system and muscles work together, helping your tendons and muscles store and release energy more effectively, essentially making your stride springier and more efficient. It also increases the amount of load your tissues can tolerate, which is crucial for areas like the Achilles and calf that often limit performance”

“Objective testing can highlight where you’re losing efficiency or carrying weaknesses. Addressing these gaps with targeted strength training doesn’t just reduce injury risk, it makes you more durable, improves recovery, and supports higher training volumes. In short, strength training isn’t optional; it’s a foundation of successful, sustainable running. Soft tissue therapy can also be helpful alongside this. While it doesn’t replace strength work, it can ease discomfort, support recovery, and help you move more freely.”

Generic injury-prevention advice often overlooks how different every runner is. At Pure Sports Medicine, we use objective testing to tailor prehab programmes based on real data, not guesswork.

A comprehensive biomechanical and running assessment can highlight inefficiencies in gait, load distribution, cadence, and how your form changes with fatigue. This allows us to target the areas that truly matter, rather than relying on one-size-fits-all recommendations.

ForceDeck testing adds another layer of insight, revealing limb asymmetries, landing mechanics, and how quickly you can produce force. This is especially valuable for runners returning from injury or those dealing with recurring niggles that haven’t improved with standard training tweaks.

“In clinic, there’s a big difference between feeling ready and being objectively capable of handling load,” says John. “Objective testing helps us move beyond guesswork and break the cycle of repeated injury by quantifying how much force a limb can produce and absorb.”

He adds: “The real value is in uncovering hidden asymmetries. A runner might look symmetrical on video, but testing often reveals a 15–20% strength deficit in a calf or hip. That hidden weakness is frequently the root cause of recurring issues or stalled performance. Having baseline data means your training is targeted and purposeful.”

Objective testing also provides a clear benchmark for progress. “We can track how your body is adapting in real time,” John explains. “If capacity is improving, we safely progress training. If it stalls, we adjust early, before injury happens.”

Alongside this, exercise physiology testing, including lactate threshold assessment, helps runners train at the right intensities. Understanding your thresholds can improve pacing, manage fatigue, and reduce overload during marathon preparation.

How to Balance Pain and Exercise

Ideally, investing in prehabilitation should begin before your marathon training starts. However, runners can benefit at any stage of their preparation. Those with a history of injury, noticeable movement asymmetries, persistent stiffness, or uncertainty about training readiness are particularly likely to benefit from early assessment with us.

Lastly, prehab works best when it is integrated into your training, rather than added as a luxury add on later down the line. Small, consistent interventions introduced early often prevent much larger problems later in the training cycle.

At Pure Sports Medicine, we provide integrated, bespoke, evidence-based care at every stage of your marathon preparation. Our skilled multidisciplinary team includes specialist Physiotherapists, Sports and Exercise Medicine consultants, Podiatrists, Exercise Physiologists, and Soft Tissue Therapists.

From detailed running assessments to structured programmes such as our Knee Programme Package, our approach is designed to support your training, so you remain consistent, ensure intelligent load management, and promote your long-term running health, helping you arrive on the start line prepared, confident, and ready to perform.