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How to look after your joints for a marathon

15 Feb 2024 • 9 min read

Did you know your feet take up to 3 times your body weight when you run?1 Your body’s powerful, but it needs the right care to keep you going. Here’s how to keep your joints, bones, and muscles safe if you’re running the marathon...

Joint, bone, & muscle care: Why it’s so important

Maybe you think of joint care as something for older people. Or maybe you’re used to daily twinges and groans.

Many factors increase our risk of damage as we age. Women lose about 20% of their bone mass during menopause, on top of the natural 'wear and tear' everyone has.2 But the less healthy we are when we’re young, the less mobile we’ll be when these changes happen.

Smoking, alcohol, an unbalanced diet, and injuries can weaken our body at any age.3 Unhealthy joints and bones also increase the risk of conditions like osteoarthritis and osteoporosis.4,3

The basics 

  • start training gradually – preferably months before your marathon 
  • pay attention to aches and pains 
  • take rest days throughout the week 
  • rest properly after injury 
  • alternate heavier training sessions with low-impact sports 
  • focus on technique and stretching as well as speed 
  • have plenty of nutrition, water, and sleep every day 
  • see a doctor if you’re concerned

Before the marathon 

1. Nutrition is key...

If you’ve heard it once, you’ve heard it a hundred times – food is fuel! Try to eat within 20-30 minutes of finishing a run.5

Look on your marathon’s website. It may tell you where food and drink stations are, and what they’ll provide.

Carbs
If you’re going on longer runs (an hour or more), bring an energy gel or a snack.6 Opt for complex carbohydrates (like fruit) to help keep your blood sugar levels steady and provide a more sustained source of energy.

Protein
Protein’s another magic word when it comes to training. It’s the second most abundant compound in your body after water and helps your muscles recover from exercise.7

Most moderately active people in the UK get more than enough protein. But marathon runners might need extra.7 You’ll find protein in:8,9,10
  • meat, fish, and dairy products 
  • eggs 
  • beans, peas, and lentils 
  • oats and seeds 
  • meat alternatives like tofu and tempeh 
Bone support
Pay attention to calcium, found in milk, dairy foods and fortified dairy alternatives, green leafy veg, tofu, and nuts.11 You’ll also need enough vitamin D, since it helps the body absorb calcium.11

2. ...and don’t forget to drink

Water lubricates the space between your joints, so not having enough may lead to friction and cause irritation.12

Your muscles are about 75% water, and dehydration may contribute to muscle wasting and difficulty tightening them.13

What’s more, it could put additional strain on your heart.14 So frequent drink breaks are a must.

You should drink six to eight glasses of fluid every day, but you’ll need more for intense workouts.15 If you’re not sure, check your urine – it should be clear or light yellow.16

3. Don’t run every day

It’ll only set you back! Overtraining puts stress on your body, even if you don’t realise it at the time.

Everyone is different, but according to training plans provided by St. John’s Ambulance: 
  • beginners should have at least two rest days per week, plus a day of core conditioning 17
  • intermediate runners should have at least two rest days per week, plus a day of core conditioning and/or lighter running18
  • advanced trainers should have at least one rest day per week, plus two or three easier runs and/or core training 19

Above all, listen to your body. Life gets in the way, and things like your sleep, diet, physical health, and stress levels affect how much you can handle each day.

4. Make time for low-impact exercise

Not only does low-impact activity protect your muscles from overtraining, but it gets new ones working too.

Add in a few sessions of gentle walking, cycling, yoga, or swimming per week.

5. Don’t skimp on shoes

It might leave your wallet feeling frail, but running shoes are an important investment. It’s not that the more expensive they are, the better. But it’s worth your time and money to find a pair that best suits your feet within your budget.

The right trainers will better support your feet and reduce your chance of running with poor posture or gait. Over time, this could help keep you safer as you run. You’re also less likely to experience tendon, arch, or heel pain (like plantar fasciitis) if your shoes fit well. 20 Many running shoe shops offer consultations to see which shoes could work for you. They might measure: 
  • your activity level 
  • the type of ground you run on 
  • your arch shape 
  • whether your feet turn in or out 
Some people like to rotate multiple pairs of shoes to allow each pair to recover, or to suit the type of running they’re doing that day.

On the day

1. Food for fuel

Nervous or not, you’ll need to eat on the big day.

Eating lots of carbs has been shown to delay fatigue and enhance performance in long-distance runners, since it allows the muscles to store optimum amounts of glycogen (our body’s main source of energy, stored in muscle cells).21 Again, choose complex carbs to avoid getting sluggish.

You should need about 30-60g of carbs per hour while you run to keep your muscles at their best.22

You might also want to bring electrolyte drinks with you. Intense exercise – and lots of sweating – can deplete your levels of minerals like: 
  • calcium, which helps regulate muscle contractions (including your heartbeat) 23
  • potassium, which helps control the balance of fluids in our body and helps the heart work properly 24
  • magnesium, which helps turn our food into energy and contributes to normal muscle, bone, and nervous system function 24,25,26,27
Don’t introduce any new foods – the last thing you want is an unhappy gut.

2. Stretch properly

Warm up properly before every run and stretch once you’re done.

A basic warm-up should take at least 5 minutes, but you can keep going for longer.28 Try brisk walking, slow jogging, or activity that gets your heart pumping.

After your run, cool down with gentle stretches and focus particularly on your knees, as its pretty common to have sore knees after running. The NHS recommends:29
  • knee bends 
  • thigh contractions 
  • straight leg raises 
  • hamstring stretches with thigh contractions 
  • ITB (iliotibial band) stretches 
  • squats
  • lunges – walking or stationary

After the marathon

1. Keep moving (at least a little)

As much as you’d like to collapse into bed, try to stay moving for at least 10 minutes afterwards. This will help continue the all-important flow of nutrients and oxygen to your muscles. Keep up the stretches and gentle movement in the following days.

2. Grab food and drink

It’s not just for your stomach’s benefit. You’ll replenish the glycogen used up during your run, as well as helping to repair your tired muscles.30 Keep drinking water and checking your urine, too.

Aim to eat within 30 minutes of finishing. According to the Association of UK Dietitians, a 4:1 ratio of carbs to protein is ideal.21 

Have a friend or family member ready with snacks, as you won’t want to battle the crowd.

Carbs

When you’re low on carbohydrates during extreme exercise, your body uses protein instead.31 But protein’s needed for muscle repair. Continue eating plenty of complex carbs, like: 
  • fruit and veg 
  • beans 
  • wholegrain bread, rice, pasta, and grains

Protein

Protein is important for muscle growth and repair.7 And it’s likely your muscles are the most fatigued they’ve ever been.

Research published in Nutrients journal found that a high protein intake during or directly after a marathon had few effects on muscle fatigue at first, but then showed significant improvements after 72 hours.32

3. Listen to your body

Aching’s expected. But you’ll need to check out any unusual pains.

Your body may ignore pain signals while you’re still feeling the post-run adrenaline, so take it easy and keep an eye out for any twinges in the following days.

4. Have a massage 

You shouldn’t need telling twice... Not only does a massage help release all the tension of your run, but it can release feel-good hormones like endorphins and oxytocin.33 Or use a massage gun, designed to help relieve stiffness at home.

The final say

You’ve got this! Keep it steady, eat right, and you’re on your way to a healthy race. Want to know more about staying well while you exercise? Try our guides below...

Disclaimer

 

Sources

1. Ehlers-Danlos Support UK. Footcare in hypermobile Ehlers-Danlos syndrome [Internet]. Ehlers-Danlos Support UK; 2016. Available from: https://www.ehlers-danlos.org/information/footcare-in-hypermobile-ehlers-danlos-syndrome/
2. Ji MX, Yu Q. Primary Osteoporosis in post-menopausal women [Internet]. National Library of Medicine; 2015. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5643776/
3. NHS. Bone health and falls [Internet]. NHS; [reviewed 2023 March 14]. Available from: https://www.nhsinform.scot/healthy-living/preventing-falls/keeping-well/bone-health-and-falls/
4. NHS. Osteoarthritis [Internet]. NHS; [reviewed 2023 March 20]. Available from: https://www.nhs.uk/conditions/osteoarthritis/
5. Macmillan UK. Running training plan: Half marathon beginner [Internet]. Macmillan UK; 2019. Available from: https://www.macmillan.org.uk/assets/running-training-plan-hm-beginner-v4.pdf
6. Bupa. Food for energy: before, during, and after exercise [Internet]. Bupa; 2023. Available from: https://www.bupa.co.uk/newsroom/ourviews/food-for-exercise
7. British Nutrition Foundation. Protein [Internet]. British Nutrition Foundation; [reviewed 2021 Jun]. Available from: https://www.nutrition.org.uk/healthy-sustainable-diets/protein/?level=Health%20professional
8. NHS. Eating a balanced diet [Internet]. NHS; [reviewed 2022 Jul 29]. Available from: https://www.nhs.uk/live-well/eat-well/how-to-eat-a-balanced-diet/eating-a-balanced-diet/
9. The Vegan Society. Nutritional tips for active vegans [Internet]. The Vegan Society; 2023. Available from: https://www.vegansociety.com/news/blog/nutritional-tips-active-vegans
10. Heart UK. The wonder of oats [Internet]. Heart UK. Available from: https://www.heartuk.org.uk/low-cholesterol-foods/the-wonder-of-oats-
11. NHS. Food for strong bones [Internet] NHS; [reviewed 2021 Apr 8]. Available from: https://www.nhs.uk/live-well/bone-health/food-for-strong-bones/
12. NHS. Dehydration [Internet]. NHS; [reviewed 2023 Nov 21]. Available from: https://www.nhsinform.scot/illnesses-and-conditions/nutritional/dehydration/
13. Lorenzo I, Serra-Prat M, Yébenes JC. The Role of Water Homeostasis in Muscle Function and Frailty: A Review [Internet]. National Library of Medicine; 2019. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723611/
14. Brunel University London. Effects of dehydration and hyperthermia on brain and muscle blood flow [Internet]. Brunel University London; [reviewed 2022 Apr 29]. Available from: https://www.brunel.ac.uk/research/projects/effects-of-dehydration-and-hyperthermia-on-brain-and-muscle-blood-flow
15. NHS. The Eatwell Guide [Internet]. NHS; [reviewed 2022 Nov 29]. Available from: https://www.nhs.uk/live-well/eat-well/food-guidelines-and-food-labels/the-eatwell-guide/
16. NHS. Water, drinks and hydration [Internet]. NHS; [reviewed 2023 May 17]. Available from: https://www.nhs.uk/live-well/eat-well/food-guidelines-and-food-labels/water-drinks-nutrition/
17. St John Ambulance. Marathon Training Plan: Beginner Plan [Internet]. St John Ambulance. Available from: https://www.sja.org.uk/globalassets/documents/fundraising/sja-training-plan-beginner-v1-jr.pdf
18. St John Ambulance. Marathon Training Plan: Improve Plan [Internet]. St John Ambulance. Available from: https://www.sja.org.uk/globalassets/sja-training-plan-improver-v1-jr.pdf 
 19. St John Ambulance. Marathon Training Plan: Advanced Plan [Internet]. St John Ambulance. Available from: https://www.sja.org.uk/globalassets/sja-training-plan-advanced-v1-jr.pdf
20. NHS. Plantar fasciitis [Internet]. NHS; [reviewed 2022 Feb 7]. Available from: https://www.nhs.uk/conditions/plantar-fasciitis/
21. BDA. Using evidence-based practice to run a marathon [Internet]. BDA; 2018. Available from: https://www.bda.uk.com/resource/using-evidence-based-practice-to-run-a-marathon.html22. British Heart Foundation. What should I eat before a marathon or sporting event? [Internet]. British Heart Foundation; 2021. Available from: https://www.bhf.org.uk/informationsupport/heart-matters-magazine/nutrition/what-to-eat-before-marathon
23. NHS. Calcium [Internet]. NHS; [reviewed 2020 Aug 3]. Available from: https://www.nhs.uk/conditions/vitamins-and-minerals/calcium/
24. NHS. Vitamins and minerals: Others [Internet]. NHS; [reviewed 2020 Aug 3]. Available from: https://www.nhs.uk/conditions/vitamins-and-minerals/others/
25. European Commission. Characteristics [Internet]. European Commission. Available from: https://ec.europa.eu/food/food-feed-portal/screen/health-claims/eu-register/details/POL-HC-6405
26. European Commission. Characteristics [Internet]. European Commission. Available from: https://ec.europa.eu/food/food-feed-portal/screen/health-claims/eu-register/details/POL-HC-6408
27. European Commission. Characteristics [Internet]. European Commission. Available from: https://ec.europa.eu/food/food-feed-portal/screen/health-claims/eu-register/details/POL-HC-640 
28. NHS. How to warm up before exercising [Internet]. NHS; [reviewed 2022 Jul 12]. Available from: https://www.nhs.uk/live-well/exercise/how-to-warm-up-before-exercising/
29. NHS. Knee exercises for runners [Internet]. NHS; [reviewed 2021 Jan 13]. Available from: https://www.nhs.uk/live-well/exercise/knee-exercises-for-runners/
30. The Conversation. London marathon: what to eat before, during and after the race [Internet]. The Conversation; 2022. Available from: https://theconversation.com/london-marathon-what-to-eat-before-during-and-after-the-race-191398
31. Williamson E. Nutritional implications for ultra-endurance walking and running events [Internet]. BMC; 2016. Available from: https://extremephysiolmed.biomedcentral.com/articles/10.1186/s13728-016-0054-0
32. Saunders MJ, Luden ND, DeWitt CR, Gross MC, Dillon Rios A. Protein Supplementation During or Following a Marathon Run Influences Post-Exercise Recovery [Internet]. National Library of Medicine; 2018. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5872751/
33. Patient. Can regular massages improve your mental health? [Internet]. Patient; [updated 2021 Nov 6]. Available from: https://patient.info/news-and-features/can-regular-massages-improve-your-mental-health
 
heeral-patel-bio

Heeral Patel

Reviewer

Health & Science Editor

Biomedical Sciences

Graduating from Cardiff University in Biomedical Sciences, I pursued a career related to health and medicine. Landing me my first job in pharmaceutical market research, from listening to patient stories my interest in health and wellbeing grew, leading me to work in publishing and editing content for medical education and women’s health journals. Now I am here as part of the Science team to create science and health editorial guidelines and content reviews so we can help the business with their mission of being science-led!

Something I am passionate about:
Exercise! I’m not a regular gym go-er, but I am an advocate for moving your body in some form or another, whether that’s a long walk or dancing! It’s really helped with my mental well-being, and I love getting 10,000 steps in!
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