DEAR MAYO CLINIC: For the past several years, I've been competing in half-marathons. This year, I've decided to challenge myself and enter full marathons. What recommendations do you have for preventing sports injuries as I go to this next level?

ANSWER: Congratulations on continuing to stretch your goals — and for thinking about preventing injury before you begin more intense workouts. For anyone striving to boost their performance, injury prevention shouldn't be separate from your training program; it should be embedded into it. That includes incorporating it into warmups, strength sessions and practice design.

Preventing sports injuries

What does that look like? Starting with your warmup, think of it as preparing your system for the activity you're about to do. Your warmup should go beyond static stretching and focus on dynamic movements that activate the muscles that you're going to use in training and competition.

Then add sports-specific patterns to your warmup. For example, if you're a basketball player, jumping is a key movement. So, add that to your warmup. Not only does jumping mimic gameplay, but it also raises your heart rate and preps your system for the activity.

Remember, when you're designing your training program, you’re training for capacity, not just the sport itself. That means building general strength, having a good aerobic base, and sound technique and movement quality. 

That's what underlies your ability to progress to a higher level. Even elite athletes have become injured because they haven't built that capacity. Sudden spikes in the intensity and volume of exercise can lead to overuse injuries.

One of the key elements of building capacity and preventing injuries is progressive load management. The principle behind progressive load management means not going from zero to 100, but gradually increasing volume or intensity to build capacity.

Before you take any activity to the next level, address any underlying conditions. If you have knee pain while running, work with a physical therapist or an orthopedic or sports medicine clinician so you're not pushing through an injury and potentially making it worse.

Looking at your own experience, you've already built the capacity for running a half-marathon. A full marathon doubles the distance, making it a perfect example of how to apply progressive load management. That increased distance is a significant load not only on your cardiovascular system, but also on the orthopedic structures like bones, tendons and ligaments.

To condition your body and build capacity, design your running program so that over the next several months, you gradually increase mileage each week until you're at full marathon distance.

For someone who is coming back from a sports injury, the same progressive load management applies. A sports medicine specialist will work with the athlete to gradually rebuild strength, measuring progress along the way. Before getting back onto the court or field where they'll be expected to deliver 100%, they'll need to simulate the sport. 

One group of athletes particularly susceptible to overuse injuries is youth and adolescents. While participation in multiple sports is encouraged, young athletes still need time to build the physical capacity required for each sport as they transition between seasons. Gradually increasing training demands, rather than jumping from zero to 100, is key to reducing the risk of injury.

Pitchers are particularly vulnerable to overuse injuries. Finding the right balance between adequate time off and maintaining arm strength and conditioning can be challenging. Although there are published recommendations for annual time away from throwing, many athletes enter the season having done little or no arm-specific training in the offseason.

To reduce injury risk, conditioning and capacity building should begin well before the season starts. High-quality return-to-throwing programs, which are available both in person and online, can help guide athletes through a structured, progressive plan to safely get back in the game.

While the emphasis in youth sports is often on pitchers, catchers also throw at similar or higher volumes. They may not be throwing at the same velocity, but the volume is there. It's important to take this into consideration when tracking pitch counts. Pitching and catching in the same game should be avoided in most situations.

For student athletes, single-sport specialization and year-round competition are not in their best interest when it comes to injury prevention. Athletes need time away from each sport to allow their bodies to recover.

Participating in multiple sports is generally better for any athlete's overall physical health and helps reduce the risk of overuse injuries. It also promotes broader skill development and improved overall athleticism. By varying movement patterns and training demands, the body becomes more adaptable and is given a break from repetitive stress. Athletes often gain transferable skills that improve performance in their primary sport while also enhancing motivation and mental well-being.

Taylor North, D.O., Sports Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin

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