Figure 1
Flowchart of articles selection procedure.
Table 1
Description of studies included.
| STUDY | PARTICIPANTS | AGE | COUNTRY OF ORIGIN | RACE SETTING | RISK FACTORS | INJURY RATE | INJURY REGION | TYPE OF INJURY |
|---|---|---|---|---|---|---|---|---|
| Knobloch et al. (2008) | N = 291 (248 males, 41 females and) | 42 ± 9 years | Germany | / | Running surface and running experience | The injury rate was 0.08/1000 km (2.93 per runner) | Achilles tendon, knee, tibia, and plantar | Achilles tendon overuse injury (56.6%), anterior knee pain (46.4%), shin splints (35.7%), and plantar fasciitis (12.7%) |
| Scheer et al. (2011) | N = 69 (48 males and 21 females) | Male: 46 years, female: 40 years | Spain | A 219-km, 5-day competition | Musculoskeletal, dermatological and other illness | 39 runners (or 56.5 %) were deemed to have a medical condition | Hip, knee, Achilles, ankle and muscle | Foot blisters (33.3%), chafing (9.1%). Lower body musculoskeletal injuries (22.2%) |
| Krabak et al. (2011) | N = 407 (323 males and 84 females) | / | USA | 7 days, staged, 240-km ultramarathon running race | Age and sex | The injury or illness rates were 3.86 per runner and 65 per 1000 h | Foot (73.7%), lower limb (8.6%), ankle (4.9%), and knee (3.5%) | Skin-related disorders (74.3%), musculoskeletal injuries (18.2%), and medical illnesses (7.5%) |
| Graham et al. (2012) | N = 11 (11 males) | 33 ± 11 years | Scotland | 150 miles in 7 days, Gobi Desert, Mongolia | Mood alterations and sleep duration | The injury rate was 100% | Lower limb | Skin and soft tissue injuries |
| Scheer et al. (2014) | N = 50 (30 males and 20 females) | 40.4 ± 7.9 years | Spain | Al Andalus Ultimate Trail (219 km) | Race experience | A blistering incident was reported in 76% of the participants | Toes (65%), ball of the foot (16%), heel (14%), and sole (5%) | Blisters |
| Hoffman et al. (2015) | N = 376 (320 males and 56 females) | / | USA | A 161-km ultramarathon | Muscle fatigue | The prevalence of cramping was 14.3%, and near cramping was 26.8% | Calf (54%), quadriceps (44%), and hamstring (33%) muscles | Muscle cramping (14.3%) and near cramping (26.8%) |
| Malliaropoulos et al. (2015) | N = 40 (36 males and 4 females) | 38.4 ± 8.73 years | Greece | / | Training and surfaces | At least one injury was reported by 90% of the runner | Lower back, Achilles tendon and hip joint | Overuse bone stress injuries (22%) and iliotibial band syndrome (16%) |
| Giandolini et al. (2016) | N = 23 (23 males) | 39 ± 11 years | France | A downhill route of 6.5 km, consisting primarily of forest trails, that descends 1264 m. | Musculoskeletal damage and fatigue | / | Knee and plantar | Deficit in voluntary activation |
| Vercruyssen et al. (2016) | N = 13 (13 males) | 38.2 ± 4.8 years | France | An 18.4-km trail running exercise | Footwear | / | Calf | Calf pain |
| Vernillo et al. (2016) | N = 77 (64 males and 13 females) | 43.6 ± 10.9 years | Italy | A 65-km race (altitude between 725 and 2100 m) | General fatigue and muscle cramps | The overall injuries/illnesses were 1.9 per runner and 13.1/1000 h | Plantar (28.6%), ankle (28.6%), knee (14.3%), thigh (14.3%), Achilles (7.1%) and neck/cervical spine strain (7.1%) | Medical illnesses (50.3%), musculoskeletal injuries (32.8 %), and skin related disorders (16.9 %) |
| von Rosen et al. (2016) | N = 64 (31 males and 33 females) | 17 ± 1 years | Sweden | / | Training volume, competition time and surfaces | The injury incidence rate was 18/1000h of training | Foot/lower leg (48.6%), knee (22.9%), hip (11.9%) and lower back (6.4%) | Overuse injuries (78.0%,) and acute injuries (22.0%) |
| Hespanhol et al. (2017) | N = 228 (171 males and 57 females) | 43.4 years | Netherlands | The median of the distance was 28.0 km, ranging from 3 to 230 km | / | The injury rate was 10.7 injuries per 1000 h and the mean prevalence of RRIs (22.4%) | Knee, Achilles tendon, calf and ankle | Achilles tendon injury (12.8%), calf muscle injury (10.7%), knee pain undiagnosed (8.7%) and ankle sprain (7.0%). |
| Kerhervé et al. (2017) | N = 14 (14 males) | 21.7 ± 3.0 years | France | Two 24-km trail runs | Calf compression sleeves | / | Achilles tendon and calf | Achilles tendon pain and delayed onset calf muscles soreness |
| Matos et al. (2020) | N = 719 (529 males and 190 females) | 38.01 ± 7.78 years | Portugal | / | Exposure time | 87.8% of the sample reported an injury, the injury rate was 10.0 per 1000 h | Toenail (24.8%), knee (17.5%), and ankle (14.5%) | Blisters (20%), irritation (chafing) (14%), superficial wounds (12%), sprains (11%), and iliotibial band syndrome (7%) |
| Gajardo-Burgos et al. (2021) | N = 654 (413 males and 241 females) | 36.2 years | Chile | Several trail runs from 11 to 63 km | Training following injury | Injury frequency rates (31.3%) and illness frequency rates (22.3%) | Knee | gradual onset injuries |
| Temesi et al. (2021) | N = 32 (32 males) | Long group: 38 ± 10 years, short group: 35 ± 8 years | France | Long race (>100 km) or short race (<60 km) | Race distance | / | Knee and plantar | Muscle contractile property impairment |
| Viljoen et al. (2021a) | N = 152 (120 males, 32 females) | 37.1 ± 9.1 years | South Africa | / | A history of previous injury and chronic disease | A mean prevalence of 12.3% and an overall injury rate of 19.6 injuries per 1000 hours | Knee (29.8%), shin/lower leg (18.0%) and foot/toes (13.7%) | Tendinopathies (27.8%), muscle injuries (20.5%) and joint sprains (8.8%) |
| Viljoen et al. (2021c) | N = 2824 (1597 males and 1227 females) | / | South Africa | A 10-km and a 22-km race | Distance, chronic disease and history of allergies | The annual incidence of injuries (13%) | Knee (35%), shin/lower leg/calf (16%) and thigh (11%) | Iliotibial band syndrome (22%), Achilles tendon injury (10%) and hamstring injury (9%) |
| Viljoen et al. (2021d) | N = 305 (213 males and 92 females) | 38.3 years | South Africa | 2019 Sky Run races | Training and demographic variables | The incidence was 49.5 injuries per 1000h | Knee (26.5%), ankle (21.6%), and foot (16.7%) | Tendinopathy (27.5%), joint sprain (19.6%), and muscle injury (15.7%) |
| Hamill et al. (2022) | N = 1016 (518 males and 498 females) | 39.0 ±13.2 years | USA | N/A | Trails, terrains and footwear | Injury was reported by 39.8% of the runner during running on a trail | Ankle, foot, Shin, hip, plantar, knee, Achilles | Ankle sprain, hip stress fractures |
| Sanchez-Garcia et al. (2022) | N = 51 (35 males and 16 females) | 15 to 22 years | Spain | N/A | The characteristics of the mountain terrain | 2.2±1.8 injuries per 1000 h | Ankle (49.5%), knee (17.9%), and lower leg (9.5%), | Joint sprain (43.2%), tendinopathy (18.9%) and non-specific injuries (11.6%) |
| Jooste et al. (2023) | N = 251 (181 males and 70 females) | 40 years | South Africa | 2021 Mac Ultra race | / | The incidence was 19.92/100 runner | Lower limb (26%), thigh (22%), ankle and foot (13%) | Muscle injury (36%), tendinopathy (24%), and joint sprain (9%) |
| Owen et al. (2024) | N = 9835 (4725 males and 5110 females) | / | USA | N/A | Sex, age and racial disparities | / | Females: elbow, wrist, knee, lower leg, and ankle; males: shoulder, upper trunk, and hand | Females: strains/sprains and fractures; males: lacerations |
| Viljoen et al. (2024) | N = 162 (103 males and 59 females) | / | South Africa | 2022 Mac Ultra races (46 km, 80 km, 161 km, and 322 km) | Race distance categories | The injury rate was 1.66 injuries per 1000 h | Knee (28%), (19%), and lower leg (17%) | Muscle and tendon tissue injuries (56%), muscle injuries (31%) and tendinopathies (25%) |
Figure 2
Characteristic information: (a) Gender distribution of runners, (b) The number of studies according to the nationality.