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Epidemiology of Injury and Illness Among Trail Runners: A Systematic Review

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A Correction to this article was published on 21 August 2021

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Abstract

Background

Trail running is characterised by large elevation gains/losses and uneven varying running surfaces. Limited information is available on injury and illness among trail runners to help guide injury and illness prevention strategies.

Objective

The primary aim of this review was to describe the epidemiology of injury and illness among trail runners.

Methods

Eight electronic databases were systematically searched (MEDLINE Ovid, PubMed, Scopus, SportsDiscus, CINAHL, Health Source: Nursing/Academic, Health Source: Consumer Ed., and Cochrane) from inception to November 2020. The search was conducted according to the PRISMA statement and the study was registered on PROSPERO international prospective register of systematic reviews (CRD42019135933). Full-text English and French studies that investigated injury and/or illness among trail runners participating in training/racing were included. The main outcome measurements included: trail running injury (incidence, prevalence, anatomical site, tissue type, pathology-type/specific diagnosis, severity), and illness (incidence, prevalence, symptoms, specific diagnosis, organ system, severity). The methodological quality of the included studies was assessed using an adapted Downs and Black assessment tool.

Results

Sixteen studies with 8644 participants were included. Thirteen studies investigated race-related injury and/or illness and three studies included training-related injuries. The overall incidence range was 1.6–4285.0 injuries per 1000 h of running and 65.0–6676.6 illnesses per 1000 h of running. The foot was the most common anatomical site of trail running injury followed by the knee, lower leg, thigh, and ankle. Skin lacerations/abrasions were the most common injury diagnoses followed by skin blisters, muscle strains, muscle cramping, and ligament sprains. The most common trail running illnesses reported related to the gastro-intestinal tract (GIT), followed by the metabolic, and cardiovascular systems. Symptoms of nausea and vomiting related to GIT distress and dehydration were commonly reported.

Conclusion

Current trail running literature consists mainly of injury and illness outcomes specifically in relation to single-day race participation events. Limited evidence is available on training-related injury and illness in trail running. Our review showed that injury and illness are common among trail runners, but certain studies included in this review only focused on dermatological injuries (e.g. large number of feet blisters) and GIT symptoms. Specific areas for future research were identified that could improve the management of trail running injury and illness.

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Authors and Affiliations

  1. Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa

    Carel T. Viljoen & Elzette Korkie

  2. Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Hillcrest Campus, University of Pretoria, Burnett Street, Hatfield, Pretoria, 0002, South Africa

    Carel T. Viljoen, Dina C. Janse van Rensburg & Elzette Korkie

  3. Amsterdam 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

    Carel T. Viljoen, Evert Verhagen & Willem van Mechelen

  4. Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa

    Dina C. Janse van Rensburg & Marlene Schoeman

  5. School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia

    Willem van Mechelen

  6. Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

    Willem van Mechelen

  7. School of Public Health, Physiotherapy and Population Sciences, University College Dublin, Dublin, Ireland

    Willem van Mechelen

  8. Portugal Football School, Portuguese Football Federation, Lisbon, Portugal

    Rita Tomás

  9. Department of Library Services, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa

    Susan Scheepers

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  1. Carel T. Viljoen
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Contributions

Carel T. Viljoen – Conception and design of the study, literature search, review of literature for final inclusion of relevant studies, data extraction, level of evidence rating of included studies, quality assessment of included studies, data interpretation, manuscript write-up, manuscript editing Dina C. Janse van Rensburg – Conception and design of the study, review of literature for final inclusion of relevant studies, data extraction, manuscript editing Evert Verhagen – Conception and design of the study, review of literature for final inclusion of relevant studies, data extraction, manuscript editing Willem van Mechelen – Manuscript editing Rita Tomas – Data extraction, manuscript editing Marlene Schoeman – Data extraction, manuscript editing, level of evidence rating of included studies Susan Scheepers – Literature search, manuscript editing Elzette Korkie – Quality assessment of included studies, manuscript editing

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Correspondence to Carel T. Viljoen.

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Viljoen, C.T., Janse van Rensburg, D.C., Verhagen, E. et al. Epidemiology of Injury and Illness Among Trail Runners: A Systematic Review. Sports Med 51, 917–943 (2021). https://doi.org/10.1007/s40279-020-01418-1

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