CASE STUDY: Beating the Clock: A Marathon Runner’s Pre-Race Comeback

Event: Athens Marathon 9th November 2025 Injury: Left hip adductor strain Rehab window: 4 sessions over 2 weeks Goal: Complete the marathon pain-free

The Challenge

With less than three weeks to go before the Athens Marathon, James presented to Wimbledon Physiotherapy and Sporting Injuries Clinic (23rd October 2025) with a gradually worsening left hip adductor pain that had been limiting training since mid-September.

• Pain consistently began after 2-3 km of running
• Symptoms reached 6-7/10 at worst
• Swimming breaststroke also aggravated symptoms
• Short periods of rest helped, but pain returned once training resumed

With race day fast approaching, the objective was clear: reduce pain, restore movement efficiency, and arrive on the start line confident and prepared.

Initial Assessment - Key Findings

A comprehensive assessment was carried out, focusing not only on the painful area but on how strength, mobility, and running mechanics were interacting under marathon training load.

Key findings included:

• Hip tightness and reduced mobility, particularly evident during the FABER (Flexion, Abduction, External Rotation) test
  • Left hip: knee positioned 5 inches from the plinth
  • Right hip: knee positioned 8 inches from the plinth
• Symptoms reproduced on resisted hip abduction
  • No tenderness on palpation of the adductors on either side
  • Clear strength asymmetries using Kinvent Dynamometer:
• Side-lying hip abduction showed a 30.9% asymmetry
• Supine hip adduction showed an 11.1% asymmetry
  • Running gait analysis revealed increased out-toeing on the left side
  • The symptomatic side was also the stronger side, a common feature in overuse injuries where altered movement strategy leads to excessive loading

These findings highlighted that restricted hip mobility, strength imbalance, and running mechanics were collectively contributing to ongoing adductor overload.

The Rehabilitation Strategy

Given the limited time before race day, rehabilitation needed to be highly targeted, efficient, and marathon-specific.

Session 1 - Assessment & Load Management

• Full kinetic chain assessment
• Identification of priority areas impacting running performance
• Immediate training-load modification to protect the adductors while maintaining fitness

Session 2 - Gait Analysis & Strength Rebalancing

• Detailed running gait analysis
• Identification of excessive out-toeing contributing to asymmetrical loading
• Progressive bilateral hip adductor and abductor strengthening to restore balance

Session 3 - Mobility & Tissue Preparation

• Reassessment showed improvements in hip mobility
• Continued progression of strength work
• Soft tissue massage to reduce adductor tension

Session 4 -Taper & Race Readiness

• Final soft tissue treatment
• Careful tapering of running volume and rehab exercises
• Focus on recovery, freshness, and confidence ahead of race day

The Results

Despite the short rehabilitation window, measurable improvements were achieved:

• Hip mobility (FABER test)
  • Left hip improved from 5 inches to 3 inches from the plinth
  • Right hip improved from 8 inches to 4 inches
• Hip adduction strength
  • Improved to 11.2 kg (left) and 10.36 kg (right)
  • Strength asymmetry reduced from 11.1% to 8.7%
• Running and swimming symptoms settled
• Athens Marathon completed in 4 hours 20 minutes

Athlete Feedback

“Hi Sadiq,

Many thanks to you and Tatiana for your support.

I managed to complete the Athens Marathon in 4hrs 20. Very grateful for your advice and physio which got me round.

Cheers, James”

Why This Case Matters - This case demonstrates how addressing hip mobility, strength asymmetry, and running mechanics rather than pain alone can allow athletes to perform even when time is tight.

Written by Sadiq Sallah January 2026