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Trail running injury risk factors: a living systematic review
  1. Carel Viljoen1,2,3,
  2. Dina C (Christa) Janse van Rensburg4,5,
  3. Willem van Mechelen2,6,7,8,
  4. Evert Verhagen2,
  5. Bruno Silva9,10,
  6. Volker Scheer11,
  7. Manuela Besomi12,
  8. Rubén Gajardo-Burgos13,
  9. Sérgio Matos9,14,
  10. Marlene Schoeman4,
  11. Audrey Jansen van Rensburg4,
  12. Nicol van Dyk15,
  13. Susan Scheepers16,
  14. Tanita Botha17
  1. 1Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
  2. 2Amsterdam Collaboration for Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam University Medical Centers, location VU University Medical Center, Amsterdam, The Netherlands
  3. 3Sport, Exercise Medicine and Lifestyle Institute (SEMLI), University of Pretoria, Pretoria, South Africa
  4. 4Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
  5. 5Medical Board Member, World Netball, Manchester, UK
  6. 6School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia
  7. 7Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
  8. 8School of Public Health, Physiotherapy and Population Sciences, University College Dublin, Dublin, Ireland
  9. 9School of Sports and Leisure, Department of Sports Science, Tourism and Leisure, Polytechnic Institute of Viana do Castelo, Melgaço, Portugal
  10. 10Research Center in Sports Science, Health Science and Human Development (CIDESD), University of Tras-os-Montes e Alto Douro, Vila Real, Portugal
  11. 11Ultra Sports Science Foundation (USSF), Pierre-Benite, France
  12. 12Carrera de Kinesiología, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
  13. 13Escuela de Kinesiología, Instituto de Aparato Locomotor y Rehabilitación, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
  14. 14Department of Sports, Higher Institute of Educational Sciences of the Douro, Penafiel, Portugal
  15. 15High Performance Unit, Irish Rugby Football Union, Dublin, Ireland
  16. 16Department of Library Services, University of Pretoria, Pretoria, South Africa
  17. 17Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria, South Africa
  1. Correspondence to Carel Viljoen, Department of Physiotherapy, University of Pretoria, Pretoria, South Africa; carel.viljoen{at}up.ac.za

Abstract

Objective To review and frequently update the available evidence on injury risk factors and epidemiology of injury in trail running.

Design Living systematic review. Updated searches will be done every 6 months for a minimum period of 5 years.

Data sources Eight electronic databases were searched from inception to 18 March 2021.

Eligibility criteria Studies that investigated injury risk factors and/or reported the epidemiology of injury in trail running.

Results Nineteen eligible studies were included, of which 10 studies investigated injury risk factors among 2 785 participants. Significant intrinsic factors associated with injury are: more running experience, level A runner and higher total propensity to sports accident questionnaire (PAD-22) score. Previous history of cramping and postrace biomarkers of muscle damage is associated with cramping. Younger age and low skin phototypes are associated with sunburn. Significant extrinsic factors associated with injury are neglecting warm-up, no specialised running plan, training on asphalt, double training sessions per day and physical labour occupations. A slower race finishing time is associated with cramping, while more than 3 hours of training per day, shade as the primary mode of sun protection and being single are associated with sunburn. An injury incidence range 0.7–61.2 injuries/1000 hours of running and prevalence range 1.3% to 90% were reported. The lower limb was the most reported region of injury, specifically involving blisters of the foot/toe.

Conclusion Limited studies investigated injury risk factors in trail running. Our review found eight intrinsic and nine extrinsic injury risk factors. This review highlighted areas for future research that may aid in designing injury risk management strategies for safer trail running participation.

PROSPERO registration number

CRD42021240832.

  • risk factor
  • epidemiology
  • running

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Footnotes

  • Twitter @CarelViljoen, @ChristaJVR, @WvanMechelen, @Evertverhagen, @ManuelaBesomi, @NicolvanDyk

  • Contributors CTV: conception and design of the study, literature search, review of literature for final inclusion of relevant studies, data extraction, data interpretation, manuscript write-up, manuscript editing. DCJvR: conception and design of the study, manuscript editing. WvM: conception and design of the study, data extraction, quality assessment, manuscript editing. EV: conception and design of the study, data extraction, data interpretation, manuscript editing. BS: conception and design of the study, review of literature for final inclusion of relevant studies, quality and level of evidence rating, manuscript editing. VS: data extraction, data interpretation, manuscript editing. MB: quality assessment, data extraction, data interpretation, manuscript editing. RG-B: quality and level of evidence rating, data interpretation, manuscript editing. SM: level of evidence rating, data interpretation, manuscript editing. MS: quality assessment, data interpretation, manuscript editing. AJvR: data extraction, level of evidence rating, manuscript editing. NvD: data interpretation, manuscript editing. SS: literature search, manuscript editing. TC: data interpretation, manuscript editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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