Can Osteopathy Support Marathon Training or Triathlon Preparation?

Training for a marathon or triathlon is hugely rewarding — but it places significant, repetitive stress on the body. Whether you’re preparing for the London Marathon or building towards your first Olympic-distance triathlon, the combination of mileage, intensity and time pressure increases your risk of overload injuries.

This is where osteopathy can play a valuable role.

At Back to Back in Wandsworth SW18, we regularly support runners and triathletes through structured training blocks — not just when they’re injured, but proactively to keep them moving well.

The Demands of Marathon & Triathlon Training

Marathon training typically involves:

• Progressive weekly mileage

• Long runs placing sustained load through the calves, Achilles and hips

• Speed sessions stressing hamstrings and hip flexors

• Reduced recovery time during peak blocks

Triathlon preparation adds:

• High cycling volume (hip flexor dominance, lumbar flexion posture)

• Swimming (shoulder load and thoracic rotation demands)

• Transition training, where fatigue alters running mechanics

When training volume increases faster than tissue capacity adapts, problems arise.

Common issues we see include:

• Achilles tendinopathy

• Patellofemoral pain

• IT band irritation

• Hamstring overload

• Bone stress reactions

• Lower back stiffness linked to cycling

These are rarely “random injuries.” They are usually load-management or biomechanics problems that build over time.

How Osteopathy Supports Performance

1. Early Identification of Overload Patterns

Before pain becomes an injury, the body often gives warning signs:

• Persistent tightness in one calf

• Reduced hip extension on one side

• Subtle asymmetry in single-leg strength

• Increasing fatigue that doesn’t resolve with rest

Osteopaths are trained to assess movement patterns, joint mobility and tissue load tolerance. Identifying these early allows adjustments before full injury develops.

For example:

• A restricted ankle joint may increase Achilles strain.

• Reduced thoracic rotation from cycling may alter arm swing in running.

• Gluteal weakness may overload the hamstrings late in long runs.

Addressing these proactively keeps training consistent — and consistency is everything in endurance sport.

2. Optimising Biomechanics

Marathon and triathlon performance relies on efficiency. Small mechanical inefficiencies repeated over thousands of steps become significant.

Osteopathic assessment looks at:

• Hip extension and pelvic control

• Ankle mobility and calf capacity

• Thoracic rotation

• Rib and breathing mechanics

• Lumbar spine load distribution

Manual therapy can improve joint mobility and reduce protective muscle tone, but this is only part of the picture. The goal isn’t just to “loosen” tissues — it’s to restore optimal movement so force is distributed more evenly.

3. Strength & Load Guidance

Endurance athletes often focus heavily on mileage but neglect strength.

Evidence consistently shows that strength training:

• Reduces running injury risk

• Improves running economy

• Supports tendon resilience

• Enhances late-race performance

Osteopaths can guide:

• Single-leg control work

• Calf capacity progression

• Hip abductor and glute strength

• Plyometric progression for race readiness

• Core and trunk endurance

This becomes especially important for triathletes managing cumulative fatigue across three disciplines.

4. Managing Recovery During Peak Blocks

During high-load weeks, athletes may experience:

• DOMS that lingers longer than expected

• Calf tightness after speed work

• Shoulder stiffness from increased swim volume

• Low back ache from long rides

Osteopathic treatment during these periods can help maintain joint mobility, improve circulation to overloaded tissues, and reduce compensatory patterns.

Importantly, treatment should be integrated into the training plan — not used as a last-minute fix when things break down.

5. Supporting Return from Niggles

Very few athletes complete a full marathon or triathlon block without any niggle.

The key is not eliminating discomfort entirely — it’s understanding when discomfort is acceptable and when it signals tissue overload.

An osteopath can help distinguish between:

• Normal training soreness

• Tendon overload

• Early bone stress reactions

• Neural irritation

• Joint-related referral pain

This clarity allows smarter decisions around:

• Whether to continue training

• How to modify load

• When to cross-train

• When imaging or GP referral is required

This is particularly relevant in marathon build-ups where ignoring early bone stress symptoms can end a season.

Osteopathy Is Not Just “Treatment”

The biggest shift in modern sports osteopathy is moving away from purely passive treatment.

Effective support involves:

• Movement assessment

• Load management advice

• Evidence-based strength programming

• Biomechanical optimisation

• Clear return-to-run frameworks

Manual therapy is a tool — not the entire solution.

When Should You See an Osteopath During Training?

Consider booking if:

• You notice asymmetry developing

• A niggle persists beyond 7–10 days

• You are increasing mileage significantly

• You’re entering peak training

• You have a history of recurrent injury

• You’re returning after time off

You don’t need to wait for a full injury.

Final Thoughts

Marathon and triathlon preparation place extraordinary demands on the body. The difference between successful completion and frustrating injury is often proactive management.

Osteopathy can support:

• Injury prevention

• Movement efficiency

• Strength integration

• Recovery management

• Smarter training decisions

Whether you’re building towards your first race or chasing a PB, structured musculoskeletal support can make training more resilient and more sustainable.

And ultimately, staying healthy through the build-up is what gets you to the start line confident — and to the finish line strong.

Back to Back Osteopaths is a trusted resource for marathon runner and triathletes alike. But we also see athletes from most other sporting disciplines.

By James Dodd BSc (hons) Ost. FAFS.

GOsC registered

Book an appointment online today. Or not sure if your symptoms need treatment? Feel free to call our clinic in Wandsworth and we’ll happily advise.

Why Strength Training Is Essential for Injury Protection in the London Marathon

Training for the London Marathon is a huge physical undertaking. Over 26.2 miles, your body absorbs thousands of repetitive loading cycles. Every step places forces of two to three times bodyweight through your feet, ankles, knees and hips. Multiply that by 35,000–45,000 steps and it’s easy to see why injury rates in marathon training are high.

The common misconception? That more running is always the answer.

In reality, strength training is one of the most effective tools we have for injury protection in marathon runners. At our clinic in SW18, we regularly see runners who could have avoided weeks off training with a smarter strength foundation.

Here’s why it matters — and what to focus on.

The Marathon Is a Muscular Endurance Event

Marathon training is not just cardiovascular — it is muscular endurance under fatigue.

As fatigue builds:

• Stride length shortens

• Cadence drops

• Hip control reduces

• Ground contact time increases

This alters load distribution through the lower limb. When tissues fatigue, joints absorb more force. That’s when problems start.

Common marathon injuries include:

• Achilles tendinopathy

• Plantar fascia irritation

• Patellofemoral knee pain

• IT band pain

• Bone stress injuries

In many cases, the root cause is not “tightness” — it’s insufficient strength and tissue capacity for the demands placed upon them.

Strength Improves Tissue Capacity

Every tendon, muscle and bone has a load tolerance threshold. Training increases that threshold.

When you perform progressive strength training:

• Tendons become stiffer and more resilient

• Muscles generate force more efficiently

• Bones respond to loading by strengthening

• Neuromuscular control improves

This creates what we call load capacity — the ability to tolerate marathon training without breaking down.

Without this, your running volume can outpace your body’s ability to adapt.

The Calf Complex: The Unsung Hero

The calf complex (gastrocnemius and soleus) is one of the most overloaded structures in marathon running.

The soleus, in particular, works tirelessly to control forward momentum and absorb force during stance phase. As fatigue builds late in the race, reduced calf capacity often leads to:

• Achilles overload

• Plantar fascia strain

• Shin pain

Specific strength work should include:

• Straight-leg calf raises (gastrocnemius bias)

• Bent-knee calf raises (soleus bias)

• Heavy, slow resistance work

• High-repetition endurance sets

Many runners underestimate how strong their calves need to be for 26.2 miles.

Hip Strength Protects the Knee (your knee IS your hip!!!)

Poor hip strength and control can increase load through the knee and IT band.

When the gluteal muscles fatigue:

• The knee drifts inward

• Femoral rotation increases

• Patellofemoral stress rises

Over thousands of strides, this becomes painful.

Key exercises include:

• Single-leg deadlifts

• Split squats

• Step-downs

• Lateral band walks

• Side planks

The goal is not bodybuilding. It is controlled, unilateral strength under load.

Strength Reduces Fatigue-Related Breakdown

Research consistently shows that strength training:

• Improves running economy

• Reduces ground contact time

• Enhances force production

Better economy means less energy cost per stride. That translates to reduced fatigue late in the race — and fewer compensatory movement patterns.

Injury risk increases significantly in the final third of marathon training blocks, when mileage peaks and cumulative fatigue is highest. Runners who maintain strength work during this phase tend to cope better.

“But I Don’t Want to Be Too Sore to Run”

A common concern.

The solution is intelligent programming:

• Two sessions per week

• 30–40 minutes

• Focus on lower limb and trunk

• Avoid excessive new exercises during peak mileage

• Reduce volume slightly in taper phase

Strength training should complement running, not compromise it.

Heavy lifting during base phase. Maintenance during peak weeks. Light activation during taper.

Bone Health and Stress Fracture Protection

Bone responds positively to load — but it needs varied stimulus.

Running is repetitive. Strength training introduces different loading patterns that stimulate bone adaptation.

This is especially important for:

• Female athletes

• Masters runners

• Runners increasing mileage

• Those with a history of bone stress injury

Under-fuelling combined with high mileage and no strength training is a high-risk scenario.

Practical Weekly Structure (just some ideas…)

A simple template might look like:

Day 1: Lower Limb Strength

• Split squats

• Romanian deadlifts

• Straight-leg calf raises

• Core control

Day 2: Stability and Endurance

• Step-downs

• Bent-knee calf raises

• Single-leg bridges

• Side planks

Keep it progressive. Add load when movements feel controlled and technically sound.

Strength Training Is Performance Training

This isn’t just about avoiding injury.

Stronger runners:

• Maintain pace longer

• Resist form breakdown

• Produce more force per stride

• Feel more robust during peak training

The London Marathon rewards durability.

Final Thoughts

Marathon training already places huge demand on the body. Relying on running alone is often not enough to prepare tissues for the cumulative load of 26.2 miles.

Strength training:

• Increases tissue capacity

• Reduces fatigue-related movement breakdown

• Protects against common overuse injuries

• Improves performance

If you’re building towards the London Marathon, investing in strength now could be the difference between standing on the start line — or sitting out injured.

Run consistently. Lift intelligently. Arrive strong.

For more advice book into see one of our osteopaths at the clinic in Wandsworth SW18.

Look at our blog on bone stress injuries here

By James Dodd BSc (hons) Ost. FAFS.

GOsC registered

Telehealth /Videolink consultations at Back to Back

Don’t despair if you are in pain or need advice! #Telehealth is here!!!

What is Telehealth?

Telehealth is the delivery of rehabilitation services through online video and phone technology. It does not entirely replace in-person care, but allows osteopaths to provide virtual assessments, coaching and supervision, and prescribe at-home treatment plans to keep your recovery moving forward.

This could be to:

• Diagnose and manage acute injuries

• Continue and progress your home exercise programme

• Discuss changes to your symptoms

• Just for some help and advice

Many people will be thinking ‘What can they do from a Telehealth video call’? Each session includes a detailed case history, virtual examination, diagnosis and a custom rehabilitation plan.

Research is already suggesting really good outcomes from this kind of intervention.

Another really great advantage of Telehealth consults is that we are ‘Functional Osteopaths’, so that we can take you though a really good examination and start to give you some movements and exercises straight away.

It is also a great way to enable us to diagnostically rule out any concerns that we may have and if you do need further investigations, we are able to sort this out for you.

What you need:

• Access to of the following devices:

• A computer/Laptop with camera and microphone
• A tablet or Apple or Android smart phone
• Access to an internet connection.
• An adequate quiet space, cleared to perform some movements and exercises during the appointment
• No special software is needed

IF you think you will benefit from a #Telehealth appointment, call 07813 811 421 or email on james@backtoback432.co.uk

The Christmas Fair in Earlsfield. Back to Back was there supporting the community.

EARLSFIELD CHRISTMAS FAIR

Last week the team braved the cold at the Christmas Fair in Earlsfield with the help of hot drinks. They answered many questions and gave out key information to those that needed it. It was a privilege to have been there.

It was wonderful to see so many of you out there that had already had been helped by the clinic.

Sports Massage… the low down

Here is a great write up by Bhavesh Joshi about the benefits of Sports Massage.  It does make a difference and people do report that they feel and notice the difference.  With those of you that are training for an event such as the London Marathon or triathlons in the near future, make sure that you try a regular sports massage to keep your muscles less tight and feeling better!

Bhavesh says…..

Research shows that there is moderate data supporting the use of massage to facilitate recovery from repetitive muscular contractions, as well as being effective in alleviating DOMS (delayed onset muscle soreness – that achey feeling you get after tough exercise) by approximately 30%.

Dry Needling and Neck pain

A study (see link) published in 2014  in the Journal of Orthopaedic and Sports Physical Therapy has found patients who received dry needling for their neck pain showed significantly better improvement than the untreated group.  It was a small study, but always a good place to start.  The patients reported 33% less pain immediately after treatment and 66% less pain a week later.

Most of our osteopaths have completed their acupuncture training with the British Medical Acupuncture Society (BMAS) and it is a hugely effective method of treatment, especially when used in combination with osteopathy.  We often use this for neck and lower back pain, hip and shoulder pain along with many other injuries.

Effective Spinal Manipulation….. what osteopaths do best!

An interesting paper here on the effectiveness of spinal manipulation….

The results of this study confirm that lumbar mobilisation treatment has an immediate effect in relieving low back pain, however the specific technique used seems unimportant.  More research is probably needed here to find about more specific techniques and how they work…..  Techniques between Osteopaths, Chiropractors and physiotherapists can differ hugely and this needs to be reviewed too!

Statin use and Arthopathies…

A recent US study has recently found that  “Musculoskeletal (MsK) conditions, arthopathies, injuries and pain are MORE common among statin users than among similar non statin-users.

The researchers concluded:

To our knowledge, this is the first study, using propensity score matching, to show that statin use is associated with an increased likelihood of diagnoses of MsK conditions, arthropathies and injuries.  These findings are concerning because starting statin therapy at a young age for prevention of primary cardiovascular disease is widely advocated….. 

Some other articles that highlight this:

http://archinte.jamanetwork.com/article.aspx?articleID=1691918

http://journals.lww.com/amjmedsci/Abstract/2013/05000/Incidence_of_Musculoskeletal_and_Neoplastic.3.aspx

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266514/

Get Wise for CrossFit – and keep safe!

The first affiliated CrossFit (CF) gym was opened in Santa Cruz in 1995 and was founded and developed by the coach Greg Glassman.  Over his years of watching the fitness industry, his idea was to create versatile athletes (gymnastics and weightlifting) through primal movements and intense training.  It has since gained worldwide momentum and a huge following.

The typical workout or WOD may involve intense drills of weightlifting (squats, deadlifting and carrying odd objects or kettlebells etc) box jumps, burpees, sprinting and using gymnastic rings to name a few.  Most activities are all well and good and with a structured and progressive integration into your lifestyle and using the basic premise of not walking before your can crawl and not running before you walk.  This puts in place not just the neurological inputs that are needed to perform and function, but embeds some firm foundations of the chain reaction needed for movement and structural control.

I see and treat a fair amount of injuries sustained through CrossFit and whilst injury is often seen to be part of any intense exercise, I do feel some of these could be avoided.

CrossFit is massively intense and with that comes excitement and vigor and over time, a body that develops in power, coordination and agility.  But I feel that with this excitement and vigor often comes lack of care for ones self and the idea that if your push yourself harder, you get faster results.

Let me use the example of running again.  If we have a basic level of fitness, most of us assume we should be able to run.  Running is composed of lots of hops and leaps.  When treating/rehabbing athletes, I am often asked “am I ready to run yet?”…… and I ask them “can you repeatedly hop and leap?” and then depending on their answer we watch and see…… and we see if they can or if they fail.  That gives us the answer and often, they cannot hop and leap!  So surely, they should not run!

My point of this is much more about creating the foundations much deeper than you think you need.  To enable Mo Farah’s fabulous achievements at the 2012 Olympic Games, he would have run around those tracks hundreds if not thousands of times and known that if he gets a PB, it will probably be within a certain amount of time.

So doing 25 squats with 100kgs if you have only ever twice before would be foolish.  Doing 25 squats with 100kgs should ok if you are regularly doing 25 times 90kgs.

To enable good technique with power moves such as deadlifts and squats you don’t just need good technique, you really need good functional mechanics such as sufficient ankle, knee and hip movement and these need to be able to load the weight correctly.  If they cannot do this, somewhere else will take the hit….and this hit maybe your lower back, shoulder or neck!

Over the next few months I will be working with Tom and Harri Bold from CrossFit Bold and other coaches from Athletic Alliance to develop some easy strategies to enhance movement and control, which we will be sharing with all the members.  All with the idea injury avoidance!  But in the meantime, please be careful of your form and technique and keep your ego in check and don’t find yourself where you are trying to push your body to a place where it has not been before too quickly.

Ignore the figures but, think of it like an iceberg – 70% underneath and 30% on top…..