Marathon running has gained immense popularity among amateur athletes worldwide due to its physical and psychological benefits, including improved cardiovascular health, mental resilience, and overall fitness enhancement. However, the physical demands of long-distance running, particularly when training is unsupervised or suboptimal, often lead to a high incidence of musculoskeletal injuries in this population (1). These injuries not only affect performance but may also result in prolonged periods of physical inactivity or withdrawal from the sport altogether.

Previous studies have reported that the injury incidence among amateur runners ranges from 20% to 79%, with overuse injuries being the most prevalent, especially involving the lower extremities (2,3). Factors contributing to these injuries include sudden increases in training volume, inappropriate footwear, lack of cross-training, and insufficient recovery time (4,5). Among the most common conditions reported are medial tibial stress syndrome, patellofemoral pain syndrome, iliotibial band syndrome, and Achilles tendinopathy (6,7).

Despite the increasing number of amateur participants in marathons, there is limited prospective data evaluating injury patterns and the effectiveness of preventive strategies such as structured warm-up routines, strength training, and timely footwear replacement (8). Identifying modifiable risk factors and promoting evidence-based preventive measures can significantly reduce injury rates and enhance training continuity (9).

Therefore, this study aimed to assess the incidence of running-related injuries among amateur marathon runners and evaluate the effectiveness of common preventive strategies in mitigating injury risk.

Study Design and Participants

This prospective cohort study was conducted over a 16-week period prior to a scheduled city marathon. A total of 300 amateur marathon runners (180 males and 120 females), aged between 20 and 45 years, were enrolled through online advertisements and local running clubs. Participants were included if they had no prior history of professional training and had registered for a full marathon (42.195 km). Individuals with existing musculoskeletal injuries, chronic illnesses affecting mobility, or those receiving physical therapy were excluded.

Data Collection

Baseline data were collected at the time of enrollment, including age, sex, height, weight, body mass index (BMI), years of running experience, average weekly mileage, and prior injury history. Participants were also surveyed regarding their training habits, including the use of warm-up and cool-down routines, strength training, footwear usage, and cross-training practices.

Injury Surveillance

Runners were monitored weekly via a structured online questionnaire designed to capture new-onset musculoskeletal complaints. Any reported injuries were subsequently confirmed by a certified sports physician using clinical examination. Injuries were defined as any musculoskeletal complaint that led to a reduction in training volume, intensity, or withdrawal for at least seven days.

Preventive Strategy Assessment

Participants were grouped based on adherence to preventive strategies such as regular warm-up, strength training, proper footwear replacement (within 500–700 km), and participation in cross-training. These factors were self-reported and verified through training logs.

Statistical Analysis

Data were analyzed using SPSS version 25. Descriptive statistics were presented as mean ± standard deviation for continuous variables and percentages for categorical variables. The chi-square test was used to assess the association between preventive strategies and injury occurrence. Logistic regression analysis was performed to identify independent predictors of injury. A p-value of <0.05 was considered statistically significant.

Out of the 300 enrolled amateur marathon runners, 126 participants (42%) reported at least one injury during the 16-week training period. The majority of injuries affected the lower extremities, with the most common being medial tibial stress syndrome (24%), iliotibial band syndrome (19%), plantar fasciitis (15%), and Achilles tendinopathy (12%).

Injury incidence was significantly higher among participants with weekly mileage exceeding 50 km, particularly those without regular strength training routines (p=0.03). Conversely, runners who adhered to structured warm-up exercises and cross-training showed a notably lower injury incidence.

Table 1 presents the distribution of injuries by anatomical location.

Table 1: Distribution of Injuries by Anatomical Region (n = 126)

Preventive strategies demonstrated a significant impact on injury reduction. Participants who performed regular warm-up exercises had a 28% injury rate, compared to 51% in those who did not (p=0.01). Similarly, those engaging in weekly strength training reported a 30% injury rate versus 49% in those who did not (p=0.02). Footwear replacement after 500–700 km of use was associated with a 33% injury rate, compared to 50% when replaced later (p=0.04).

Table 2 summarizes the relationship between preventive strategies and injury incidence.

Table 2: Injury Incidence Based on Preventive Strategies (n = 300)

These findings indicate that proper training behaviors significantly reduce the risk of injuries in amateur marathon runners (Tables 1 and 2).

The findings of this study highlight the substantial incidence of musculoskeletal injuries among amateur marathon runners and emphasize the importance of preventive strategies in reducing injury risk. With 42% of participants reporting at least one injury during the training period, our results align with previous literature reporting injury rates ranging from 30% to 80% among non-elite distance runners (1,2). Overuse injuries such as medial tibial stress syndrome and iliotibial band syndrome were most prevalent, consistent with earlier studies attributing these conditions to repetitive loading and biomechanical stress during prolonged running (3,4).

Notably, higher weekly mileage—especially above 50 km—was significantly associated with injury incidence, supporting prior findings that training volume is a major risk factor (5). The absence of strength training further amplified injury risk, suggesting that muscular imbalances and poor joint stabilization may contribute to overuse conditions (6). Runners who incorporated regular strength training demonstrated a 23.8% lower injury incidence, in agreement with studies that advocate resistance exercise as a protective intervention (7,8).

The use of structured warm-up routines also emerged as a protective factor in our cohort, reducing injury rates from 60% to 28.2%. Similar results have been reported in randomized trials emphasizing the role of dynamic warm-ups in enhancing muscle elasticity and neuromuscular coordination (9,10). Cross-training, particularly in the form of cycling or swimming, also showed significant benefits, likely by improving cardiovascular endurance while minimizing mechanical load on joints (11).

Footwear emerged as another modifiable factor influencing injury risk. Participants who replaced their running shoes within 500–700 km had significantly fewer injuries. Prior biomechanical research has demonstrated that midsole degradation and reduced shock absorption in worn-out shoes increase stress on the lower limbs (12,13). Therefore, timely shoe replacement should be emphasized in training guidelines.

While our study strengthens the evidence for preventive strategies, it also highlights the lack of awareness and inconsistent implementation of such practices among amateur runners. Only 57% of participants engaged in strength training and 53% followed structured warm-up routines, reflecting a gap in education and coaching. Previous surveys have shown that amateur athletes often rely on informal advice or self-guided online resources, which may not always be evidence-based (14,15).

Despite the strengths of our prospective design and physician-verified injury reporting, the study has some limitations. The reliance on self-reported preventive strategies may introduce recall bias. Additionally, the generalizability is limited to urban amateur runners and may not extend to rural or elite populations.

Amateur marathon runners face a high risk of overuse injuries, particularly in the lower limbs. This study underscores the importance of structured warm-up routines, strength training, timely footwear replacement, and cross-training in significantly reducing injury incidence. Promoting awareness and adherence to these preventive strategies is essential for safer endurance training and improved athletic longevity.

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