Fall Marathon Season: Protecting Your Knees and Hips During Peak Training

By September, many fall marathon runners are entering the most demanding part of their training plan. Long runs are getting longer, weekly mileage is high, and speed or race-pace workouts may be layered on top of an already significant training load.

That is when a small ache can become difficult to ignore.

Some muscle soreness is expected when you challenge your body. Persistent knee or hip pain is different. When symptoms repeatedly return during runs, become more intense as mileage increases, or begin affecting the way you move, continuing to push through them can turn a manageable problem into something that interferes with training altogether.

The goal is not to make it through every scheduled mile at any cost. It is to arrive at the starting line healthy enough to actually run the race.

Why Peak Marathon Training Can Bring Out Knee and Hip Pain

Running injuries are often related to repeated loading rather than one dramatic moment. As marathon training progresses, your body has to tolerate longer runs, greater cumulative mileage, harder workouts, and less time between demanding sessions.

Research on running-related injuries shows that training characteristics, previous injury, and individual factors all influence injury risk. There is no single mileage number or percentage increase that predicts injury for every runner. [1][2]

That is important during peak training because many runners are tempted to follow the plan even when their bodies are telling them something has changed. A missed workout can feel like lost fitness, especially with race day getting closer.

But the training plan is not more important than the runner.

If increasing mileage or intensity repeatedly causes pain, swelling, limping, or a noticeable loss of function, that symptom pattern deserves attention.

Does Marathon Training Wear Out Your Knees and Hips?

Not automatically.

The idea that every mile gradually “wears out” healthy knees and hips is too simple. Research examining marathon runners and other recreational runners has not shown that running inevitably leads to hip or knee arthritis. In a large study of marathon runners, factors such as age, body mass index, previous hip or knee injury, and family history were more strongly associated with arthritis than cumulative running history. [3]

A long-term prospective study likewise found that long-distance running was not associated with accelerated radiographic knee osteoarthritis among healthy older runners. [4]

That does not mean runners cannot hurt their joints. An existing injury, cartilage problem, poor recovery, or a rapidly changing workload can alter the situation. NYBJ has also emphasized that running should be considered in the context of the individual runner’s joint health rather than treated as inherently damaging.

The better question is not whether running itself is bad for your knees and hips. It is whether your knees and hips are tolerating your current training load.

Where Marathon Runners Commonly Feel Knee and Hip Pain

The location of pain can help narrow down what may be irritated, although symptoms alone cannot provide a diagnosis.

Where You Feel Pain	Possible Running-Related Problem	What You May Notice
Front or around the kneecap	Patellofemoral pain	Aching around or behind the kneecap that may worsen with running, stairs, squatting, or prolonged sitting
Outside of the knee	Iliotibial band syndrome	Aching or burning along the outer knee that tends to develop with activity
Outside of the hip	Lateral hip soft-tissue irritation, including gluteal tendon or bursal irritation	Tenderness or aching over the side of the hip, sometimes worse with prolonged activity or lying on that side
Front of the hip or groin	Hip flexor strain or irritation; other hip conditions can cause similar symptoms	Pain with running, lifting the knee, or movements that load the front of the hip
Very focal pain that worsens with impact	Bone stress injury	Increasingly localized pain that may progress from running pain to discomfort with walking or other daily activity
Deep hip or groin pain with catching or restricted movement	Joint-related hip problem	Pain deeper in the joint, sometimes accompanied by catching, stiffness, or loss of motion

Patellofemoral pain commonly causes pain around or behind the kneecap and is aggravated by activities that repeatedly load a bent knee, including running. IT band syndrome commonly causes activity-related aching or burning along the outside of the knee or hip.

Hip pain can be more difficult to interpret because muscles, tendons, bursae, the hip joint, and even the lower back can produce symptoms in a similar area. NYBJ’s current hip guidance notes that hip flexor strains can cause front-of-hip pain, tenderness, stiffness, and pain during running or when lifting the knee.

If you are not sure what is causing your symptoms, an orthopedic examination is more useful than trying to diagnose the problem based only on where it hurts.

Knee Pain During Marathon Training

Knee pain is one of the better-known complaints among runners, but “runner’s knee” does not describe every running-related knee problem.

Patellofemoral Pain

Patellofemoral pain generally occurs around or behind the kneecap. Symptoms often become more noticeable during activities that repeatedly bend and load the knee, including running, squatting, stairs, and jumping. Changes in activity level or training intensity can also aggravate symptoms.

The problem can involve multiple factors rather than one single defect. Strength, movement patterns, training load, and the way force is distributed through the lower extremity may all matter. Rehabilitation programs targeting the hip, core, or knee musculature have been shown to improve pain and function in people with patellofemoral pain. [5]

That does not mean every runner with pain needs the same strengthening program. It means persistent symptoms should be assessed so treatment can address the factors that actually apply to you.

IT Band Syndrome

The iliotibial band runs along the outside of the thigh and is associated with pain along the outer knee and sometimes the outer hip when irritated. It is particularly associated with repetitive activities such as running.

NYBJ includes IT band syndrome among the common running injuries treated by its sports medicine team and recommends considering factors such as training progression and hip strength when managing running-related symptoms.

If outer knee pain consistently appears at a predictable point in your run and returns each time you train, simply trying to run farther before it starts hurting is not a treatment plan.

Hip Pain During Peak Training

Hip pain can be easy to dismiss because runners often describe it as tightness rather than pain. The important question is whether that sensation loosens as you warm up and stays manageable or whether it keeps returning, intensifies, changes your stride, or affects normal movement afterward.

Hip flexor strains and irritation can cause pain at the front of the hip, particularly when lifting the knee or running. Muscle strains may also cause tenderness, weakness, reduced range of motion, and pain when the affected muscle is used.

Pain on the outside of the hip can come from different soft tissues around the joint. Greater trochanteric pain, including irritation involving the tissues around the outside of the hip, may worsen with prolonged walking, running, stairs, or lying on the affected side.

Deep groin pain is another reason to pay attention. The hip joint itself can produce groin or deep hip symptoms, and persistent pain may require examination to distinguish a muscle or tendon problem from an injury within the joint.

NYBJ’s hip specialists evaluate both soft-tissue and joint-related causes of hip pain.

Protecting Your Knees and Hips During Peak Mileage

There is no way to eliminate every running injury. You can, however, avoid several common mistakes that make it harder for your body to recover between workouts.

Avoid Stacking Too Many Training Changes at Once

A longer long run, more weekly mileage, faster intervals, and additional hill work all increase demand in different ways. Adding several of them simultaneously makes it harder to determine which change your body is struggling to tolerate.

Progression should be individualized. Research has not established one universal percentage by which every runner can safely increase mileage each week. [1][2]

If your knee or hip starts hurting after your training changes, review what changed before deciding the answer is simply to push harder.

Make Recovery Part of the Training Plan

Adaptation happens between workouts as well as during them. Peak training does not mean every run should be hard.

Easy days, rest, sleep, and adequate recovery between demanding sessions give muscles and other tissues time to respond to training. If symptoms are accumulating from one workout to the next rather than resolving, reducing the immediate workload may be more productive than forcing yourself through another scheduled session.

Keep Strength Work in the Program

As running volume climbs, strength work is sometimes the first part of training runners abandon because they are tired or short on time.

That can be a mistake, particularly if your program was addressing a known weakness or previous injury. Hip-, core-, and knee-focused strengthening are established components of treatment for problems such as patellofemoral pain. [5]

Strength training is not a guarantee against injury, and there is no single “runner’s exercise” that protects everyone. The goal is to maintain the strength and control needed to support your individual running mechanics and workload.

Pay Attention to Changes in Your Running Form

Fatigue changes the way we move. Toward the end of long runs, you may notice your stride shortening, your posture changing, or one leg beginning to feel different from the other.

A temporary change when you are tired is not automatically an injury. But pain that causes you to limp, avoid loading one side, or consciously alter your stride is different. Continuing to run with a significant compensation can shift stress elsewhere in the body.

Soreness You Can Monitor vs. Pain You Should Not Ignore

One of the hardest decisions during marathon training is determining when discomfort is part of normal training and when it has crossed into something that needs attention.

Ordinary muscle soreness is typically diffuse and related to muscles that were worked. It should improve as you recover.

More concerning pain tends to behave differently. It may become increasingly localized, worsen as you continue running, repeatedly return at the same point in a workout, cause swelling, alter your stride, or begin affecting walking and daily activities.

Bone stress injuries are an important example. Stress-fracture pain commonly develops gradually and worsens with weight-bearing activity. As the injury progresses, pain may begin to occur during regular walking, cause a limp, or even be noticeable at rest or at night.

Our companion All Sports Physical Therapy article, Marathon Training Pains You Shouldn’t Push Through, takes a closer look at the symptoms runners should monitor during training and how physical therapists decide when a workout should be modified.

When Should a Runner See an Orthopedic Specialist?

You do not need to schedule an appointment for every stiff muscle after a long run. But persistent or worsening symptoms should not simply become another part of your training routine.

Consider an orthopedic evaluation if:

• Knee or hip pain is becoming worse rather than better
• Pain repeatedly returns when you run
• You develop significant or recurrent swelling
• Pain causes you to limp or change your stride
• A joint feels unstable or gives way
• You experience catching, locking, or loss of motion
• Pain becomes very focal over a bone
• Symptoms begin affecting normal walking or daily activity
• Pain starts occurring at rest or at night
• Reducing training does not lead to meaningful improvement

An examination can help determine whether you are dealing with an overuse problem that can be treated conservatively or an injury that requires imaging or a more specific treatment plan.

NYBJ’s knee specialists and hip specialists evaluate persistent running-related joint pain as well as acute injuries. The practice also provides physical therapy for conditions including patellofemoral pain, IT band syndrome, hip flexor strains, and other hip and knee problems.

Do Not Sacrifice Race Day to Finish the Training Plan

Marathon preparation rewards consistency, which can make runners reluctant to change the plan when something begins to hurt.

But missing or modifying a few workouts does not automatically erase months of training. Continuing to aggravate an injury can create a much bigger interruption. Pay attention to trends. If your knees and hips continue handling longer distances and recovering normally, that is useful information. If pain is becoming more persistent, more intense, or harder to recover from, that is useful information too.

At New York Bone & Joint Specialists, our sports medicine team treats runners with knee, hip, and other musculoskeletal injuries at every level of competition. If knee or hip pain is starting to interfere with your fall marathon training, schedule an evaluation. Finding out what is causing the pain now may give you a better chance of addressing the problem before race day.

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Frequently Asked Questions

Is knee pain normal during marathon training?

Some temporary muscle soreness can occur as training increases, but persistent knee pain should not automatically be considered normal. Pain that worsens while running, repeatedly returns, causes swelling, alters your stride, or affects daily activities deserves evaluation. Patellofemoral pain and IT band syndrome are two conditions commonly associated with running-related knee pain.

Is marathon running bad for your knees?

Research does not show that marathon or recreational running inevitably causes knee arthritis. Studies of runners suggest factors such as previous injury, age, body mass index, and other individual characteristics may be more important than running history alone. [3][4]

Why does my hip hurt during long runs?

Hip pain can come from several structures, including muscles, tendons, tissues around the outside of the hip, or the hip joint itself. Front-of-hip pain may occur with a hip flexor problem, while outer hip pain may involve lateral soft tissues. Persistent deep hip or groin pain should be evaluated because symptoms alone cannot reliably identify the injured structure.

Should I stop running if my knee starts hurting?

It depends on the pain. A mild symptom that resolves quickly may only require monitoring or a temporary training adjustment. Pain that increases as you continue, changes your gait, produces swelling, or continues affecting you after the run is a stronger reason to stop the workout and have the problem assessed.

How quickly should I increase marathon mileage?

There is no evidence-based percentage that is safe for every runner. Appropriate progression depends on your recent training history, experience, injury history, intensity, total workload, and recovery. Research supports considering training load as one part of injury risk rather than relying on a universal mileage rule. [1][2]

When is running pain a sign of a stress injury?

Bone stress pain often becomes increasingly focal and worsens with repeated impact or weight-bearing. As it progresses, it may begin affecting normal walking, cause limping, or occur at rest or at night. Those symptoms warrant medical evaluation.

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Peer-Reviewed Clinical References

[1] Kakouris N, Yener N, Fong DTP. A Systematic Review of Running-Related Musculoskeletal Injuries in Runners. Journal of Sport and Health Science. 2021. PMID: 33862272.

[2] Fredette A, Roy JS, Perreault K, et al. The Association Between Running Injuries and Training Parameters: A Systematic Review. Journal of Athletic Training. 2022. PMID: 34478518.

[3] Hartwell MJ, Fong S, Colvin AC, et al. Does Running Increase the Risk of Hip and Knee Arthritis? A Survey of 3,804 Recreational Marathon Runners. Sports Health. 2024. PMID: 37555313.

[4] Chakravarty EF, Hubert HB, Lingala VB, Zatarain E, Fries JF. Long Distance Running and Knee Osteoarthritis: A Prospective Study. American Journal of Preventive Medicine. 2008;35(2):133-138. PMID: 18550323.

[5] Ferber R, Bolgla L, Earl-Boehm JE, Emery C, Hamstra-Wright K. Strengthening of the Hip and Core Versus Knee Muscles for the Treatment of Patellofemoral Pain: A Multicenter Randomized Controlled Trial. Journal of Athletic Training. 2015;50(4):366-377. PMID: 25365133.

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