You signed up for the Des Moines Marathon. Maybe it is your first 26.2, maybe you are chasing a PR or a Boston qualifier. Either way, you have one job between now and October 18: get to the start line healthy and run the race you trained for. Here is the part nobody warns you about. The marathon itself rarely breaks people. The training block does. The weeks of building mileage, stacking long runs, and pushing through fatigue are where knees, shins, and heels start to complain. I see it every fall in my clinic in Waukee, and almost all of it is preventable. This is the sports physical therapy playbook I give every runner who wants to train hard and still stay in one piece.
The short version: marathon training injury prevention comes down to four things. Build your mileage gradually, strength train twice a week, protect your recovery, and deal with small aches early before they turn into time off. Do those four things and you stack the odds in your favor.
Most marathon injuries are overuse injuries, and overuse injuries come from a training error: more volume or intensity than your body has had time to adapt to. Too much, too soon, too fast. Your heart and lungs get fit faster than your tendons, bones, and connective tissue can keep up, so when the mileage jumps, the tissue that lags behind is what gives out.
The numbers back this up. In one study of more than 700 first-time marathoners, nearly half picked up a minor injury during their training block, about one in ten had a major one, and one in six got hurt on race day itself (Hospital for Special Surgery). The buildup, not the finish line, is the danger zone.
If you have run before, you probably already know the cast of characters that show up when mileage climbs:
I have written about most of these on their own. If one is already nagging you, start with the deep dives on runner's knee, shin splints, Achilles pain, and plantar fasciitis. This article is about keeping all of them off your calendar in the first place.
Slowly. A reliable rule of thumb is to add no more than about 10 percent to your weekly mileage from one week to the next, and to take a cutback week (a lighter week) every third or fourth week so your body can absorb the work (Hospital for Special Surgery).
That cutback week feels counterintuitive when you are motivated and the race is on the calendar. Take it anyway. Adaptation happens during recovery, not during the run. A few practical guardrails:
The runners who get hurt are almost never the ones who built patiently. They are the ones who missed two weeks, panicked, and tried to make it all up in seven days.
Yes, and it is the most evidence-backed thing you can do for your durability as a runner. A large review in the British Journal of Sports Medicine found that strength training cut overuse injuries roughly in half, with a clear dose-response: the more consistent the strength work, the fewer the injuries. That same review found stretching did not meaningfully lower injury risk (Lauersen et al., 2014). If you only have time for one kind of cross-work, lift.
Here is what I have nearly every runner in my clinic doing twice a week:
Most runners think of physical therapy as something you do after you are already hurt. The smarter move is to use that same strength work as prehab, before anything goes wrong. And do not drop your lifting during peak mileage. That is exactly when your tissue needs it most. If you want the full barbell-athlete version of this, I broke it down in physical therapy for lifters.
The unglamorous stuff is where marathon blocks are won or lost. You can nail your mileage progression and still break down if you are sleeping six hours a night and under-eating.
None of this is exciting. All of it is the difference between toeing the line fresh and limping into October.
Normal training soreness is usually dull, shows up on both sides, and eases off as you warm up. A real injury tends to be sharp, one-sided, gets worse during or after a run, or changes the way you move. That last one matters most. If pain is altering your gait, your body is compensating, and compensation is how one problem quietly becomes three.
Stop and get it looked at if you notice:
Caught early, most of these are a minor detour. Ignored for three weeks because you did not want to lose fitness, they become the reason you miss the race.
Usually, no. This is the part I care about most. With the right adjustments, you can almost always keep training through a niggle instead of shutting everything down and watching your fitness evaporate.
When a runner comes in mid-block with a cranky knee or a hot Achilles, my first question is not "how long do we rest." It is "what can we keep doing." We adjust the volume, change the surface or the shoe, fine-tune the strength work, and load the tissue in the range it can handle so it gets stronger instead of just going quiet. Rest can make pain fade for a week. Loading makes it leave for good. I wrote about that loading-first approach in the context of sciatica, and the same principle applies to almost every running injury.
The IMT Des Moines Marathon is Sunday, October 18, 2026. Counting back from there, late June gives you a clean 18-week runway, which is plenty of time to build honestly and still hit a real taper. We have great places to log the miles around Waukee and the metro, from the Raccoon River Valley Trail to neighborhood loops to the paths around Gray's Lake.
If you want to start your block strong, the highest-value move is a quick sports physical therapy check-in before your mileage really climbs. We find the weak link (a stiff ankle, a lazy glute, a calf that cannot take the load) and shore it up before it becomes the injury that derails your fall. It is a lot easier to build a durable runner in June than to rescue an injured one in September.
You do not reach the Des Moines Marathon start line healthy by accident. You get there by building your mileage patiently, strength training twice a week, protecting your sleep and your fuel, and dealing with small aches before they become big ones. Do that, and October 18 becomes a celebration of the work instead of a test of whether your body can survive it. If you want a plan built around your body and your goal, reach out through our contact page and we will get you to the start line ready to run the race you trained for.
This article is for general education and is not a substitute for individualized medical advice. If you have pain or an injury, consult a qualified healthcare provider. Individual results may vary.
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HYROX rewards durability, not just engine. Learn the movement screens, prehab exercises, and load management strategies that keep HYROX athletes healthy from week one to race day.