You backed off your mileage last week, exactly like the plan said. And now your calf is talking to you, or your knee has an ache that was not there in September, or your heel is stiff for the first ten minutes every morning.
You did everything right and your body picked this week to complain. I hear this from runners every October, usually by text, usually with a question mark and a nervous emoji.
The Des Moines Marathon is Sunday, October 18. If you are inside the last two weeks, you have no time to build fitness and no reason to panic. What you do have is a decision to make about each ache: run on it, change it, or get eyes on it.
Here is how I sort them.
Short answer: Most aches that appear in the last two weeks before a marathon are taper related, not new injuries, and you can usually keep running on them. The ones worth checking are pain that is focal to one small spot on a bone, pain that wakes you up or sits there at rest, and pain that gets worse as a run goes on instead of better. In Iowa you can start physical therapy without a physician referral. Fortitude & Freedom Performance Therapy treats runners in Waukee, Iowa.
The taper is doing exactly what it is supposed to do. A meta-analysis of 27 tapering studies found that cutting training volume while holding intensity produces a real performance gain, and that a two week taper with volume dropped 41% to 60% was the most effective version [1]. A more recent systematic review across endurance sports landed in the same place: the largest effect came from an 8 to 14 day taper with volume down 41% to 60%, intensity and frequency held [2].
So the fatigue is lifting. Tissue that has been quietly repairing under a training load for four months is now repairing with the load pulled off. That process is not silent.
There is a second thing happening that has nothing to do with tissue. During peak weeks you were too tired and too busy to notice a warm spot in your arch. In the taper you have spare attention, and you point it at your legs. A sensation that was always there becomes a signal.
Both of these are normal. Neither of them is a reason to change your race.
I do not worry about an ache that behaves like this:
If your ache does all five of those, you have a taper ache. Run your plan.
Four things change my answer. These come straight out of the bone stress literature, because that is the injury that turns a finish into a DNF.
1. Pain you can cover with one fingertip, on bone. Diffuse muscle soreness spreads. Bone stress injuries localize. Runners who can point to one small spot on the shin, the top of the foot, the heel bone, or the front of the hip should get it looked at rather than run through it [3].
2. Pain at rest, or pain at night. Pain that sits there while you are still, or wakes you up, means the problem has moved past an early irritation [3].
3. Pain that builds during the run. A taper ache fades as you warm up. A bone that is unhappy gets worse the longer you are on it, and then hurts on the walk back to the car.
4. A changed stride. If you are limping, shortening one side, or landing differently to protect something, the compensations will cost you more than the original ache.
Some sites matter more than others. Pain at the front of the hip, the front edge of the shin, the inside of the midfoot, or the outside of the foot near the base of the little toe sits in the higher risk group and deserves faster attention [3]. I am not diagnosing anyone over the internet. I am telling you which four things are worth a phone call instead of a wait and see.
If you are not sure whether your thing qualifies, when an athlete should see a physical therapist walks through the same call.
The instinct in race week is to stop everything and hope. That instinct costs you.
Even with a confirmed low risk bone stress injury in the shin or the foot, the modern approach is managed loading rather than complete rest, because bone adapts to load and detrains without it [4]. Tendons work the same way. The 2024 clinical practice guideline for midportion Achilles tendinopathy recommends loading at least three times a week, at an intensity as high as you tolerate, using isometric and isotonic work and progressing toward plyometrics, with volume adjusted to how irritable the tendon is [5].
Translated to your next fourteen days:
These four account for most of the October texts I get. Each one has a full breakdown if you want to go deeper.
Achilles. Stiff in the morning, better after ten minutes, sore again the evening after a faster session. This is the most common taper flare I see, and it responds well to loading rather than rest. Full detail in Achilles tendon pain treatment for runners and lifters.
Shin. The one to be careful with, because this is where the diffuse version and the focal version look similar on Monday and very different on Saturday. Diffuse along the inside border and warming up is usually manageable. One fingertip spot on the front edge is not. See shin splints in runners and lifters.
Front of the knee. Aches on stairs and after sitting, grumbles on downhills. The Des Moines course has enough rolling to find it. See runner's knee treatment.
Heel and arch. Worst on the first steps out of bed, better once you move. Almost always manageable through a race with load tweaks and a calf that is doing its share. See plantar fasciitis.
If none of those describe your thing, that is fine. The four tests in the section above still apply.
Keep it short and keep it familiar. You are not building anything at 7:30 in the morning on October 18.
Then stand still, stay warm, and go run the first three miles slower than you want to. Most of the pain I hear about after a marathon was decided in the first 5K, not the last.
You will feel worse on Monday than you did on Sunday afternoon. That is normal.
When you come back, come back gradually. The structured version of that is in return to sport physical therapy.
Most aches in the last two weeks are the taper doing its job plus you paying closer attention. Run on those. The four that change my answer are a fingertip spot on bone, pain at rest or at night, pain that builds through a run, and a stride that has changed.
Keep the intensity, cut the volume, keep loading. Do not introduce anything new. And if something is on the short list, get it looked at this week instead of finding out at mile 18.
If you are in the Des Moines metro and you want an actual plan before the 18th rather than a guess, book a free discovery call here. I will tell you straight whether it is a run on it or a look at it.
If your race is further out and you want the training block version of this, it is in how to train for the Des Moines Marathon without getting hurt.
Should I skip my last long run if something hurts?
Usually no. Shorten it or slow it before you delete it. The exception is an ache that fails the four tests above, and in that case the question is not the long run, it is getting the thing assessed.
Is it too late to fix an injury before October 18?
It is too late to build fitness. It is not too late to change how something loads, to get a tendon calmer, or to find out that the thing you are worried about is not the thing you think it is. Two weeks is plenty of time for all three.
Can I take something for the pain on race day?
Ask your physician or pharmacist about medication. That is outside what I can advise on, and it matters more than people assume during a marathon.
Do I need a referral to see a physical therapist in Iowa?
No. Iowa has direct access, so you can start physical therapy without a physician referral.
My pain is only on one side. Does that mean something is wrong?
Not by itself. Most runners are asymmetric. One sided pain matters when it is focal, present at rest, building through runs, or changing your stride.
What if the ache goes away and then comes back race week?
That pattern is common in the taper and usually not meaningful. Judge it by the four tests each time it appears, not by how many times it has come and gone.
Medical disclaimer: This article is for educational purposes and is not personal medical advice. Consult a healthcare provider about your specific situation. Individual results may vary.
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This content is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician, and reading it does not create a patient relationship. Talk to a qualified health professional about your own symptoms before you act on anything here. If you have severe, sudden, or worsening symptoms, seek medical care right away.
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