Pain During a Marathon Run: Prevalence and Correlates in a Cross-Sectional Study of 1,251 Recreational Runners in 251 Marathons

This cross-sectional study aimed to obtain fundamental knowledge about pain during a marathon run. During the first seven months of 2007, announcements on websites of interest to marathon runners were used to recruit participants. A total of 1,251 runners (550 female runners) completed a 41-question online survey about the location and intensity of their primary pain during their last marathon and potentially related variables [perception of effort during the marathon, number of prior marathons run, typical pain intensity during training runs, percentage of training days with run-induced pain, highest intensity pain ever experienced]. Pain location was selected from a list of 27 specified body sites covering the entire body. Kilometer at which pain first occurred indexed pain threshold. Pain intensity at the primary location of pain was measured with a standardized, well-validated 0–10 pain intensity scale. Pearson correlations and multiple regression quantified the associations between average pain intensity and other variables. Sex-related differences in pain were tested using independent t-tests. Effort ratings (6–20) were added as a covariate in an ANCOVA to test if perceived effort accounted for possible sex-related differences in pain. Based on the available research, it was hypothesized that: (i) most runners would report moderate intensity pain, (ii) pain would be associated with both exercise intensity during the marathon and pain during training, and (iii) after adjusting for expected sex-related differences in perceived effort, females would experience pain earlier and rate the pain intensity as higher. All but two runners (99.8%) reported pain during a marathon, and most frequently in the anterior/medial thigh (17.1%), hamstring (10%), and calf (9.3%) locations. Pain threshold occurred at 25.3 ± 9.8 km (15.7 ± 6.1 miles) and the overall pain intensity of the run was 5.26 ± 2.45. No sex-related pain differences were found. Overall pain intensity during a marathon was significantly associated with: pain intensity during training runs (r = 0.39), percentage of training days with run-induced pain (r = 0.23), highest intensity pain ever experienced (r = 0.23), number of prior marathons (r = −0.18), and intensity of effort (r = 0.11) (all P < 0.001). Most runners experience moderate to very strong intensity pain during a marathon; the pain was independent of biological sex, and the pain is weakly associated with marathon race experience, pain during training, race effort, and the highest intensity of pain ever experienced.