Prehab, Not Just Rehab

Setting Up Your Body for a Strong NYC Marathon Build

If you're reading this, chances are you’re kicking off your training block for this November's New York City Marathon. Congratulations — and welcome to the part of training nobody hypes up on social media: prehab.

As a physical therapist who works almost exclusively with runners, I see the same story every fall. Someone ran a smart, injury-free spring cycle, or maybe this is their very first marathon build, and by week 6 of training they're in my office with a nagging hip, a cranky Achilles, or shin pain that "came out of nowhere." It rarely comes out of nowhere. It comes from jumping straight into mileage and workouts without giving your tissues, joints, and movement patterns a chance to catch up to the demand.

Prehab is exactly what it sounds like: rehab before you need it. It's the 15–20 minutes a few times a week that keeps you out of my treatment room and on the start line in Staten Island come November.

Why Prehab Matters More for Novice and Intermediate Runners

If you've been running for years and your body has adapted to high mileage, your tissues have already built up tolerance. If you're newer to the sport, or you're stepping up from 5Ks and half marathons into your first or second full, your bones, tendons, and connective tissue haven't yet been exposed to marathon-level loading. That adaptation takes months, not weeks — which is exactly why prehab work should start now, before your mileage ramps up, not after something starts hurting.

The good news: you don't need a gym membership or two hours a day. You need consistency in a few key areas.

The Four Areas I Prioritize With Every Marathon Patient

1. Hip and Glute Strength

Weak or under-recruited glutes are the number one thing I see contributing to knee pain, IT band irritation, and even lower back tightness in runners. Your glutes control your pelvis and knee alignment with every single stride — over 40,000 strides in a marathon.

Try: Side star planks, single-leg glute bridges, and lateral toe taps, 2–3x per week.

2. Calf and Achilles Capacity

The Achilles and calf complex absorb enormous force on every step, and this is one of the slowest-adapting tissues in the body. This is especially important if you're upping your mileage quickly or adding speed work for the first time.

Try: Slow eccentric heel drops off a step, and progressing to single-leg calf raises for both strength and endurance capacity.

3. Foot and Ankle Stability

NYC's course isn't flat — the bridges (looking at you, Queensboro and Verrazzano), the subtle camber of the roads, and the cobblestones in a couple of spots all demand more from your feet and ankles than a treadmill or flat West Side Highway run does.

Try: Single-leg balance work, short foot and toe yoga exercises, and calf raises on an uneven surface a couple times a week.

4. Core and Trunk Control

Marathon fatigue shows up as form breakdown late in the race, and that usually starts at the trunk, not the legs. A stable core keeps your pelvis and hips doing their job even in mile 22.

Try: Dead bugs, side planks, and anti-rotation presses — quality over quantity here.

A Simple Weekly Structure

You don't need a separate hour-long routine. I typically have patients build this in around 2–3 of their easy run days:

- 2x/week: Strength circuit (hips, glutes, calves) — 15–20 minutes

- 2–3x/week: Short foot/ankle and balance work — 5 minutes, can be done while brushing your teeth

- 1x/week: Longer mobility or dedicated core session

NYC-Specific Considerations

Training for this particular course means thinking about hills (Central Park, the bridges) and crowds (pacing discipline in the first few miles when adrenaline is high). Prehab work that builds single-leg stability and eccentric strength pays off directly on the bridges, where fatigue and elevation change combine to challenge form.

A Note on Timing

If you're building toward the first Sunday in November, most training blocks start in earnest around late July to August. That means the next few weeks are your best window to build this foundation — before volume climbs and your legs are more focused on absorbing mileage than adapting to new stimuli.

The Bottom Line

Prehab isn't glamorous, and it won't show up on your Strava feed the way a 20-miler does. But it's the difference between toeing the line in Staten Island feeling strong, and spending your taper worried about a nagging injury instead of trusting your training. Start now, stay consistent, and your body will thank you at mile 24 in Central Park.

If you're dealing with a specific ache or pain as you ramp up training, don't wait it out — early intervention is almost always easier to resolve than something that's been compensated around for weeks.