By Dr. Dipan Patel
The TCS New York City Marathon is Sunday, November 1. That means September is not “base.” It is the month a lot of New Jersey adults jump mileage, add a long run they have not earned, and treat a Tuesday 5K in the park like a dress rehearsal for Staten Island.
I am all for it. A fall race is one of the better reasons to get after it. I am also the person who sees what happens when someone goes from summer 5Ks to a 16-mile Saturday because a plan they downloaded said so.
You do not need to be an elite to get this wrong. You need a bib, a calendar, and a body that has been sitting at a desk five days a week.
The Injury Nobody Talks About: It Is Not the Race. It Is the Build.
Most people think marathon injuries happen at mile 22. In clinic, they happen in September, on a random weekday, after a “easy” 10 that was not easy.
The most destructive moment in a fall buildup is a sudden jump. Your lungs can handle the extra 2 miles. Your bones, tendons, and lumbar discs cannot. They adapt on a slower clock than your ego and your group chat.
That is how a long run on the Hudson waterfront, or a tempo around the reservoir, becomes a limp into my Clifton or Hazlet office in October. The race did not break you. The build did.
The Three Places September Mileage Punishes Adults
1. The Knee: The Mileage You Added Too Fast
The kneecap and the IT band take the extra load first. Downhills and cambered roads (most NJ shoulder running) make it worse.
- The risk: patellofemoral pain, IT-band irritation, and early meniscus flares that feel like “just tightness” until they do not.
- The fix: hold weekly mileage increases to about 10 percent. If last week was 20, this week is 22, not 28. Cut a long run before you cut sleep. A shorter long run that you can walk the next day beats a hero long run you pay for until November.
2. The Lower Leg: Bone and Tendon Do Not Care About Your Calendar
Shin pain and Achilles stiffness are the two I see when adults stack speed work on top of new miles.
- The risk: medial tibial stress reaction (the step before a stress fracture) and Achilles tendinopathy that turns a morning shuffle into a month off.
- The fix: one hard session a week, not three. If the shin is sore at the start, eases, then comes back worse the next morning, that is not a warm-up problem. That is a stop-and-get-seen problem. Swap a run for a bike or a pool session before you “push through.”
3. The Spine: The Long Run Your Back Was Not in On
Every footstrike loads the lumbar discs. Add a long run on tired hips, and the low back starts doing work the glutes should be doing. A lot of “tight hip flexors” after 12 miles is a lumbar problem wearing a disguise.
- The risk: facet irritation, a disc flare, or sciatica that shows up the night after the long run, not during it.
- The fix: strength twice a week. Hips, calves, and a simple core. If you only run, the spine becomes the shock absorber. Also check your shoes. Dead foam on a 14-miler is a lumbar tax.
What Actually Protects You
Train the week you are in, not the week the plan wishes you were in. If you missed 10 days in August, you do not “make it up” in September. You adjust the plan.
Sleep and easy days are training. The long run only works if the days around it are honestly easy.
Do one race-pace session, not a weekly beatdown. Most adults I treat in October did too much “quality” in September.
If you are 35 or older and new to this cycle, get a baseline. Old ankle, old disc, old knee: tell someone before the 16-miler, not after.
The Signs That It Is More Than Training Soreness
Heavy legs after a long run are expected. These are not:
- Shin pain that is worse the next morning, or point tenderness on the bone
- Achilles pain that is sharp when you take the first steps out of bed
- Knee swelling, or pain that changes how you walk
- Pain, tingling, or numbness down the leg after a run
- Back pain that climbs over two to three days instead of fading
A pop, night pain, or a limp that is not clearly better in 24 hours is a specialist visit, not a foam-roller project.
We Are Local, and November 1 Comes Fast
A lot of my patients will be on the Verrazzano that Sunday, or in a local 5K that is supposed to be a tune-up. Offices in Clifton, Jersey City, West Orange, Edison, Morris County, and Hazlet will see the September buildup crowd: adults who did this right last year, and adults who tried to do 12 weeks in 6.
Most of these injuries do not need surgery. They need an honest exam, a short period of unloading, and, when it is indicated, a targeted injection or a regenerative option so the tissue can actually heal. The goal is the start line, not a DNF in week eight.
If something is off, come in before the next long run. That is the better training decision.
Dipan Patel, MD
Double Board-Certified Spine & Joint Specialist
