Preserving your joints this marathon season
Knee, Hip and Ankle Pain Management With Hyaluronic Acid
Training for a marathon, or an iron man involves months of progressive loading, consistency, and discipline. For many runners, particularly those returning to marathon distance or increasing mileage after injury, joint pain becomes the limiting factor rather than cardiovascular fitness.
Knee, hip, and ankle pain are among the most common reasons runners reduce training volume, miss key sessions, or abandon marathon plans altogether. While muscle soreness and fatigue are expected during marathon preparation, persistent joint pain and stiffness are not. These symptoms often indicate early joint overload or the onset of degenerative change rather than simple training fatigue.
At Physio Edge, we increasingly see runners seeking support to manage joint pain proactively so they can continue training safely and consistently.
Why Joint Pain Is Common During Marathon Training
Marathon training places repetitive cyclical loads through the lower limb joints. Even in well-conditioned runners, this can lead to:
Reduced joint lubrication
Increased cartilage stress
Inflammation within the joint capsule
Pain that progresses with weekly mileage
Runners over the age of 35, those with a history of joint injury, or individuals with early osteoarthritis are particularly vulnerable. Pain often begins subtly (appearing after long runs or speed sessions) and may progress to stiffness or discomfort during daily activities.
Continuing to train through persistent joint pain often leads to worsening symptoms, longer recovery times, and disrupted training blocks.
Understanding Hyaluronic Acid and Joint Health
Hyaluronic acid (HA) is a naturally occurring substance found in high concentrations within healthy joints. Its key roles include:
Lubricating joint surfaces to reduce friction
Absorbing shock during impact activities
Supporting cartilage nutrition and joint homeostasis
In joints affected by overload or early osteoarthritis, both the quality and concentration of hyaluronic acid decline, leading to reduced movement efficiency and increased pain.
Hyaluronic acid injections aim to restore the joint environment, rather than simply masking pain or suppressing inflammation.
How Hyaluronic Acid Injections Differ From Painkillers or Steroids
For marathon runners, the distinction between treatments matters:
Oral painkillers may reduce symptoms but do not address joint mechanics and carry systemic side effects.
Steroid injections reduce inflammation but may temporarily weaken joint tissues and are not ideal during heavy training phases.
Hyaluronic acid injections work mechanically and biologically, improving joint lubrication and reducing friction during movement.
This makes HA injections particularly suitable for runners who want to continue training safely, rather than masking pain and risking further joint deterioration.
Which Joints Can Benefit During Marathon Preparation?
Knee Joint
The knee is the most commonly affected joint in distance runners. Hyaluronic acid injections may be helpful for runners with:
Early knee osteoarthritis
Persistent anterior knee pain
Load-related swelling during training
Hip Joint
Hip pain often emerges later in marathon preparation as mileage increases. HA injections may be considered for:
Early hip joint degeneration
Deep groin pain aggravated by running
Reduced hip mobility affecting stride efficiency
Ankle Joint
Ankle stiffness or post-traumatic arthritis can significantly alter running mechanics. HA injections may help runners with:
Post-injury ankle arthritis
Chronic stiffness limiting push-off
Pain following long runs or uneven terrain
What the Injection Procedure Involves at Physio Edge
At Physio Edge, hyaluronic acid injections are performed by our clinical lead as part of a comprehensive musculoskeletal assessment, not as a standalone procedure. This includes:
Detailed clinical evaluation of symptoms and training load
Diagnostic ultrasound where appropriate
Ultrasound-guided injection to ensure accurate placement
Individualised aftercare and return-to-running guidance
Ultrasound guidance is particularly important for deeper joints such as the hip and ankle, where accuracy directly influences outcomes.
Timing Hyaluronic Acid Injections During Marathon Training
Hyaluronic acid injections are not instant painkillers. Benefits typically develop gradually over several weeks.
Most runners experience:
Progressive reduction in pain over 2–6 weeks
Improved tolerance to training load
Reduced post-run stiffness
When timed appropriately, HA injections can support:
Base-building phases
Peak mileage blocks
Marathon taper and race preparation
Early assessment is preferable to last-minute intervention close to race day.
Integrating Injections Into a Broader Training Strategy
Hyaluronic acid injections work best as part of a wider joint management plan, not in isolation. At Physio Edge, this includes:
Strength and conditioning programmes
Load management and recovery planning
Physiotherapy-led movement optimisation
Footwear and surface guidance
This integrated approach allows runners to maintain training consistency while protecting long-term joint health.
Preparing for Marathon season 2026 With Joint Health in Mind
Completing a Marathon is not just about race-day performance, it is about sustaining months of training without injury setbacks. Persistent knee, hip, or ankle pain should never be ignored, particularly when it begins to affect training quality or daily activities.
For appropriately selected runners, hyaluronic acid injections may offer a safe and effective option to reduce pain, maintain training momentum, and protect joint health during marathon preparation.
With careful assessment, appropriate timing, and a structured rehabilitation strategy, crossing the finish line remains achievable, even for runners managing early joint degeneration.
Book a Marathon-Focused Joint Assessment
If knee, hip, or ankle pain is affecting your preparation for the marathon season 2026, a specialist assessment can help determine whether hyaluronic acid injections or alternative treatments are appropriate.
👉 Book an ultrasound scan or assessment appointment online
👉 View injection pricing
👉 Contact Physio Edge
