Pain during a marathon run: Prevalence and correlates in a cross-sectional study of 1251 runners

Abstract

Background Science-based information about pain during a marathon run is scant. Based on related research it was hypothesized that: (i) most marathon runners would report moderate intensity pain, (ii) pain during the marathon would be associated with pain experienced while training as well as overall perceived exercise intensity, and (iii) females would experience pain earlier during the marathon and rate the pain intensity as higher after adjusting for expected sex-related differences in effort.Methods 1,251 runners, 550 females, ran in 252 different marathons and completed an online survey. Mile at which pain first occurred indicated pain threshold. Pain intensity was measured with a widely used 0–10 numerical graphical scale. Pearson and partial correlations examined the strength of associations. Sex-related differences in pain were tested using independent t-tests and, for the pain location data, z-scores for tests of two proportions. Effort ratings were added as a covariate in an ANCOVA to test if effort accounted for possible sex-related differences in pain.Results Most runners (99.8%) reported pain during a marathon, and most frequently in the thigh (17.1%), hamstring (10%) and calf (9.3%) body locations. The mean pain threshold occurred at 15.7 ± 6.1 miles; the mean overall pain intensity was 5.26 ± 2.45. No sex-related pain differences were found. Overall pain intensity during a marathon was significantly associated with: pain intensity of training runs (r = .39), percentage of training days with run-induced pain (r = .23), highest intensity pain ever experienced (r = .23), number of prior marathons (r = − .18) and intensity of effort (r = .11) (all P < 0.001).Conclusions Most runners experience moderate to very strong intensity pain during a marathon; the pain is independent of biological sex, and the pain is associated with marathon race experience, pain during training, race effort and the highest intensity of pain ever experienced.