Marathon training - Here's how to tell if that pain is a problem.
If you're training for a fall marathon, congratulations, you're officially in it now.
The easy weeks are gone. Long runs are stretching into double digits (or beyond), mileage is climbing, and recovery matters more than it did in June. Whether you're headed to Chicago, NYC, Philly, or Marine Corps — this is the stretch of training that separates the runners who make it to the start line from the ones whose bodies start sending up flares.
And every fall, without fail, my schedule fills up with the same injuries: bone stress injuries, achilles and tendon flare-ups, plantar heel pain, forefoot pain. Stuff that was a whisper at mile 6 in August becomes impossible to ignore at mile 18 in September.
So — how do you know when to push through and when to pump the brakes?
I know — this is the hardest sentence in this email. You've built your whole weekend around that 18-miler. Maybe your training group is doing it together. Maybe you already booked the Airbnb for race weekend.
None of that changes what's actually happening in your bone or tendon.
A stress reaction, caught early, is often just a matter of modifying load and getting smart about the next few weeks. Keep pounding through it to "stay on schedule," and that stress reaction can become a stress fracture — and a fracture can become a DNS. Same logic applies to tendons: there's a world of difference between calming down an irritated tendon and rehabbing one that's actually torn.
Sore ≠ hurt
Soreness is the tax you pay for training hard. Some fatigue and stiffness is expected — it's part of how your body adapts.
Pain is a different conversation. Here's what makes me sit up in my clinic:
It's getting worse run over run, not better
It starts earlier in the run each time
There's one specific spot on a bone that's tender to press
There's new swelling
It's there during normal daily activity, not just running
You're changing your gait or limping to get through it
It's still there the next morning
You're popping ibuprofen just to hit your mileage
None of that means you need to toughen up. It means something needs eyes on it.
Missing one long run will not ruin your marathon
Most runners avoid coming in because they think I'm going to say "stop running." That's rarely the actual answer.
My job is to figure out what's going on, why it's happening, and whether it's safe to keep training through it. Sometimes that's a mileage tweak. Sometimes it's swapping a workout for cross-training, adjusting footwear or mechanics, or course of shockwave therapy.
But that call should come from an actual diagnosis — not from gritting your teeth and hoping, and not from panicking and bailing on your training the second something feels off.
Your body has put in serious work to get you this far. This is the point in the cycle to listen to it, not override it.
The runners who make it to the start line healthy aren't the ones who can tolerate the most pain — they're the ones who know which pain to respect.
