Inside the Miami Marathon: Most Common Injuries We See Year to Year
Every Year, the Same Injuries Show Up
Every year, thousands of runners line up at the Miami Marathon, excited and prepared after months of training. But whether you’re a first-time marathoner or an experienced veteran, the physical toll of 26.2 miles can lead to injuries — both during training and on race day itself.
Understanding which injuries are most common, why they happen, and how to prevent them can make all the difference. This article breaks down the most frequent injuries seen year to year from marathon runners, what causes them, and how runners and clinicians can work to prevent and manage them.
How Common Are Marathon Injuries?
Before we talk about specific injuries, it’s important to understand how often they happen.
Studies show that nearly 40–45% of marathon runners report injuries during training or the marathon itself. In a large cohort study of more than 1,000 marathon runners, injuries were reported by almost 43% of participants across training and race day combined.
This high injury rate highlights the physical stress that marathon training and racing places on the body, especially on the lower limbs.
Why Injuries Happen in Marathon Running
Marathon running involves repetitive impact and high training loads, which create stress on muscle, bone, tendon, and soft tissue over time. When the body’s tissues cannot recover fully between sessions or when training increases too quickly, the risk of injury rises.
A large systematic review of running-related musculoskeletal injuries found that the knee, ankle, lower leg, and foot are the most commonly injured regions in runners, largely due to overuse and repetitive stress patterns.
Top Injuries Seen in Marathon Runners
Below are the most common injury types seen year after year among marathon runners — both during training and on race day.
1. Knee Pain — Patellofemoral Pain Syndrome and Iliotibial Band Syndrome
What it is:
Knee pain in runners often shows up as patellofemoral pain syndrome (PFPS) or iliotibial band syndrome (ITBS). These conditions involve irritation of structures around the knee caused by repetitive running. PFPS causes pain around or behind the kneecap, while ITBS usually causes pain on the outside of the knee.
How common it is:
Knee injuries — including PFPS and ITBS — are consistently among the most reported injuries in marathon runners. In a prospective Boston Marathon sample, knee pain was one of the most common problems reported both during training and on race day.
Why it happens:
Training too quickly without gradual progression
Weak hip or core muscles that fail to control knee alignment
Biomechanical inefficiencies like overpronation or imbalance in leg mechanics
2. Foot and Ankle Pain — Plantar Fasciitis and Achilles Tendinopathy
What it is:
Plantar fasciitis causes sharp or stabbing heel pain, especially with the first steps in the morning or after prolonged standing or running. Achilles tendinopathy results in pain and stiffness along the back of the heel and lower calf.
How common it is:
Foot and ankle injuries are among the top reported injury locations in marathon runners, with symptoms frequently emerging during longer training runs and during the marathon itself.
Why it happens:
Repeated impact on hard surfaces
Sudden increases in mileage
Tight calf muscles
Inadequate footwear support
3. Calf Strains and Lower Leg Issues
What it is:
Calf strains occur when the muscles at the back of the lower leg are overloaded and small tears develop. Medial tibial stress syndrome — commonly called “shin splints” — causes pain along the inside of the shin bone and is linked to stress reactions in the bone and soft tissue.
How common it is:
Lower leg injuries, including calf strains and shin pain, are frequently seen in marathon runners, with studies reporting them as leading causes of discomfort during training cycles.
Why it happens:
Weakness in lower leg muscles
Training on uneven or hard surfaces
Excessive cumulative mileage without rest
4. Hamstring and Thigh Muscle Injuries
What it is:
Hamstring strains and thigh muscle injuries occur when the muscles in the back of the thigh are overloaded or fatigued. This type of injury can be acute — happening suddenly — or a result of repetitive stress building over time.
How common it is:
In large marathon injury datasets, hamstring strains were among the most frequently diagnosed conditions.
Why it happens:
Muscle fatigue due to poor recovery
Inadequate warm-up or muscle activation
Running mechanics that overuse posterior chain muscles
5. Overuse Bone Stress — Stress Fractures
What it is:
Stress fractures are tiny cracks in the bones caused by repetitive overload. These injuries often occur in the metatarsals (foot bones), tibia (shin), or pelvis.
How common it is:
Though less common than soft tissue injuries, stress fractures are serious and can prematurely end training cycles if not managed properly.
Why it happens:
Rapid increases in training load
Inadequate rest days
Caloric deficiency or low bone density
Training vs. Race Day Injuries
Interestingly, the pattern of injuries can differ between the training cycle and the marathon itself.
A large cohort study that followed runners training for an annual marathon found:
During training, foot, knee, and hip injuries were most common
During the race, knee, thigh, and foot injuries became more prevalent
Overuse injuries increased steadily over training, while acute injuries stayed relatively constant throughout the training period.
This suggests that the cumulative load of training plays a significant role in injury development, while race-specific factors like fatigue and duration contribute to problems on race day.
Risk Factors That Increase Injury Likelihood
Understanding common risk factors helps runners and clinicians better plan prevention:
1. Sudden Increases in Training Load
Jumping mileage too quickly — especially without cross-training and strength work — is one of the biggest contributors to injury. Research supports structured progression to reduce stress on tissues.
2. Weakness in Stabilizer Muscles
Weak glutes, hips, and core muscles can reduce the body’s ability to stabilize joints, shifting stress onto knees, Achilles tendons, and feet during long runs.
3. Biomechanical Inefficiencies
Issues like overpronation, leg length differences, and poor running form can lead to uneven distribution of forces and increased injury risk.
4. Inadequate Recovery
Not allowing enough rest between hard runs limits tissue repair and increases the risk of developing overuse injuries.
5. Footwear and Surface
Running in worn-out shoes or on hard surfaces without alternating terrain and shoes is associated with higher rates of stress reactions and soft tissue irritation.
What Can Runners and Clinicians Do?
The good news is that most of these injuries are preventable with smart training and targeted strategies.
1. Structured Training Plans
Avoid large jumps in weekly mileage and incorporate easy runs, cross-training, and recovery weeks.
2. Strength and Conditioning
Adding strength work — particularly for the hips, glutes, core, and lower leg — has been shown to significantly reduce injury rates in runners.
3. Monitoring Running Form
Working with a coach or clinician to analyze gait and mechanics can reduce stress on vulnerable areas.
4. Recovery and Load Management
Runners should prioritize sleep, hydration, and rest days, and use tools like foam rolling, massage, and mobility drills appropriately.
5. Seeking Early Care
Seeing a physical therapist early — rather than waiting for pain to become severe — allows for corrective exercises and manual treatments that prevent small issues from becoming big problems.
How Clinicians Assess Marathon Injuries
Licensed physical therapists and sports clinicians use a combination of:
Gait analysis
Strength and flexibility testing
Biomechanical assessment
Training history review
This helps determine whether an injury is:
Soft tissue (like tendon or muscle overload)
Bone stress reaction
Joint irritation
Biomechanical stress
A tailored plan is then developed to reduce pain, restore function, and prevent recurrence.
What This Means for Miami Marathon Runners
Injuries are common among marathon runners — both during training and on race day. Nearly half of runners report injury at some point, most often in the knee, foot, and lower leg, and usually from overuse patterns rather than sudden trauma.
But with structured training, strength and stability work, and early clinical intervention, many injuries can be prevented or managed effectively.
Understanding these patterns gives runners a better chance of not just finishing their next marathon — but doing it healthy and strong.