Running Injuries: What a Systematic Review Tells Us About Staying Healthy
Running is one of the simplest ways to stay active. You do not need expensive equipment, and you can run almost anywhere. However, running also places repeated stress on the muscles, bones, tendons, and joints. Because of this, runners can develop injuries, especially when they train too hard or do not give their bodies enough time to recover.
A 2021 systematic review by Kakouris, N., Yener, N., and Fong, D. looked closely at running-related musculoskeletal injuries (RRMIs) and reviewed previous studies to understand which parts of the body are injured most often and which specific injuries are common among runners from non-ultramarathoners to ultramarathoners.
What Are Running-Related Injuries?
Many of these RRMIs are caused by overuse. Unlike an injury that happens suddenly on high-impact, an overuse injury can develop slowly because the body is exposed to repeated stressors. For example, a runner may increase their weekly distance too fast, too soon. Their muscles and cardiovascular system may feel ready for the extra work, but their tendons and bones may need more time to adapt. Small amounts of stress can build up and eventually cause pain or injury. Understanding where these injuries happen is important. It can help runners, coaches, and health professionals recognize problems early and develop better ways to prevent and manage them.
What Did the Researchers Do?
The systematic review looked at both incidence and prevalence of injuries related to running, and which are more common in competitive and recreational runners, and ultramarathoners.
● Incidence refers to new injuries that develop during a period of time
● Prevalence describes how common an injury is within a population.
What Did the Researchers Find?
One of the most important findings was that running injuries are fairly common. Across the studies included in the review, the average overall injury incidence was about 40.2%, while the average prevalence was about 44.6%. These numbers varied considerably between studies. This does not mean that four out of every ten runners will definitely become injured. Instead, it shows that running-related injuries are a significant issue across the research literature.
The results of the study also showed that some areas of the body are more vulnerable than others. For injury incidence, the knee, ankle, and lower leg had the highest proportions. For injury prevalence, the knee, lower leg, and foot or toes were among the most commonly affected areas.
Which Injuries Are Most Common?
The review identified several specific injuries that appeared frequently in runners:
Among non-ultramarathon runners, the injuries with some of the highest incidence proportions included:
Achilles tendinopathy
Medial tibial stress syndrome
Patellofemoral pain syndrome
Plantar fasciitis
Ankle sprains
Ultramarathon runners face a different type of challenge because their races are longer than the traditional marathon distance. The review found that the ankle, knee, and lower leg were the three most frequently injured areas among ultramarathon runners. Their most common injury pathologies included:
Anterior compartment tendinopathy
Patellofemoral pain syndrome
Achilles tendinopathy.
Interestingly, the researchers did not find a statistically significant difference in injury incidence by anatomical location between ultramarathon and non-ultramarathon runners. This suggests that, despite the difference of distances, the general areas of the body affected by running injuries can be similar
What Can We Learn From This?
The findings of the researchers are reminding us that pain should not simply be ignored. The knee, ankle, lower leg, and foot receive a great deal of repeated stress during running.
One useful lesson is the importance of patience — gradual progression of our training, and increasing distance, speed, or intensity too quickly may place more stress on the body than it can handle and allow time for recovery and pay attention to changes in pain or performance.
We must keep in mind that the review does not provide a simple formula that can guarantee injury prevention. Running injuries have many possible causes, and every individual is different. Beyond the external load or the distance, speed, and intensity of our training, we must consider other contextual factors, such as lifestyle, comorbidities, etc. and it is also important not to assume that one body feature automatically causes injury. Later research has found that evidence linking many biomechanical and musculoskeletal measurements to running injuries is limited.
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Kakouris N, Yener N, Fong DTP. A systematic review of running-related musculoskeletal injuries in runners. Journal of Sport and Health Science. 2021;10(5):513–522.
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