There were no differences between female and male runners in overall injury rates. |
Female runners had more bone stress injuries. |
Male runners had more Achilles tendon injuries. |
Shorter competition distances increase the risk of injury for female runners. |
1 Introduction
2 Methods
2.1 Search Strategy and Inclusion Criteria
2.2 Data Extraction
2.3 Study Quality Assessment
Question | Rating |
---|---|
Are the sources and methods of participant recruitment clearly described? | Yes (1), no (0) |
Are the relevant characteristics (n, age, sex, sport, level of competition) of the study population reported? | Yes (1), no (0) |
Does the study cover season and/or tournaments/championships? | Season (2), tournaments (1), not reported (0) |
Are exposure data recorded? | Yes (1), no (0) |
Is the frequency of data collection reported? | Yes (1), no (0) |
If yes: | ≥ Daily (3), ≥ weekly (2), ≥ monthly (1), not reported (0) |
Is a clear injury definition provided? | Yes (1), no (0) |
If yes: | Medical attention (3), time loss (2), other (1), no clear definition (0) |
Is the method for assessing exposure described? | Yes (1), no (0) |
If yes: | Individual data collection (2), exposure estimated (1), not reported (0) |
Is the method for assessing injury reported? | Yes (1), no (0) |
If yes: | Briefed medical personnel (3), medical personnel (2), coach, self-report, media reports (1), not reported (0) |
Are characteristics of injury reported (location, type, mechanism, severity, recurrent)? | Yes (1), no (0) |
If yes: | Complete (2), partly (1), no (0) |
Is the drop out < 30% drop out? | Yes (1), no (0) |
2.4 Data Synthesis and Statistics
3 Results
3.1 Search Results
3.2 Characteristics of Included Studies
Study | Sport | Cohort/populations, (Country) | Level | Number of participants (female/male) | Age (years) | Duration of data collection | Injury definition | Exposure measurement | Injury rates (overall) | Injury rates (female/male) | Risk of bias score |
---|---|---|---|---|---|---|---|---|---|---|---|
Nicholl et al. [54] | Marathon | Sheffield Marathon (1982) participants | Recreational | 53/2236 | over 18 | 1 day | Contact with medical staff at first-aid posts | One full marathon | 18 injured runners per 100 marathon runners | Female: 32 injured runners per 100 marathon runners; Male: 17.5 injured runners per 100 marathon runners | 14 |
Hughes et al. [47] | Road racing | Chicago Distance Classic (20 km) | Recreational | 188/1071 | 32.3 (range 9—75) | 1 day | Self-reported specific orthopaedic problems | 20 km race | 28.4 injured runners per 100 runners | Female: 54.3 injured runners per 100 runners; Male: 31.6 injured runners per 100 runners | 11 |
Johansson [49] | Orienteers | College students | Elite | 33/56 | 17.5 ± 1.5 | 1 year | Time loss training or competition injuries | Daily training logs, monthly reports of training | 3 injuries per 1000 h; 74 injuries per 100 runners | Female: 72.7 injuries per 100 runners; Male: 75.0 injuries per 100 runners | 20 |
de Loes and Goldie [38] | Road/Trail | Population based (Sweden) | Recreational | 2505/3530 | 15–59 | 1 year | Medically diagnosed: injury registry from hospitals and sports medicine physician. Validated by telephone interview | Data were collected from representative sample via questionnaire, then extrapolation to whole population | 0.7 injuries per 1000 h | Female: 0.7 injuries per 1000 h; Male: 0.7 injuries per 1000 h | 14 |
McLain and Reynolds [52] | Cross-country | High school students | Competitive (high school) | 40/54 | NA | 1 year | Athletic trainer: Any time loss incident resulting from athletic participation | NA | 10.7 injuries per 100 runners | Female: 7 injured runners per 100 runners; Male: 13 injured runners per 100 runners | 11 |
Walter et al. [63] | Road runners (10 Miles) | Community running events (4–22.4 km) in Ontario | Recreational | 301/980 | over 14 | 52 weeks | Injuries severe enough to reduce the number of miles run, take medicine, or see a health professional | NA | 48.4 injured runners per 100 runners | Female: 45.5 injured runners per 100 runners; Male: 49.3 injured runners per 100 runners | 13 |
Bennell et al. [35] | Track | Victoria athletics | Competitive (college) | 26/28 | 17–26 | 48 weeks | Stress fracture: medical imaging after clinical evaluation | Structured interview: hours per week, weeks without running, | 0.7 stress fractures per 1000 h 25.9 runners with stress fractures per 100 runners | Female: 30.8 runners with stress fractures per 100 runners; Male: 21.4 runners with stress fractures per 100 runners | 21 |
Beachy et al. [34] | Cross-country | High school students (Punahou, Hawai) | Competitive (high school) | 787/501 | NA | 8 years | Any athlete complaint that required the attention of the athletic trainer, regardless of the time lost from activity | NA | 65 injuries per 100 runners | Female: 65 injuries per 100 girls; Male: 66 injuries per 100 boys | 14 |
Colbert et al. [36] | Road running | Patients from Cooper Clinic | Recreational | 220/1771 | NA | 8 years | Clinical visit | NA | 26.3 injured runners per 100 runners | Female: 25.0 injured runners per 100 runners; Male: 26.4 injured runners per 100 runners | 9 |
Rauh et al. [58] | Cross country | High school students (Washington state) | Competitive (high school) | 1202/2031 | NA | 15 years | An injury was defined as a medical problem resulting from athletic participation that required an athlete to be removed from a practice or competitive event or to miss a subsequent practice or competitive event | An AE was defined as any practice or meet (competition) in which there was the possibility of sustaining an athletic injury | 13.1 injuries per 1000 AEs | Female: 16.7 injuries per 1000 AEs; Male: 10.9 injuries per 1000 AEs | 18 |
Steinacker et al. [61] | Marathon | Berlin Marathon participants | Recreational | 22/36 | 44.5 | 24 weeks | Self-reported orthopaedic problems (Survey) | NA | 46.6 injured runners per 100 runner | Female: 41.6 injured runners per 100 runners; Male: 54.5 injured runners per 100 runners | 11 |
Taunton et al. [62] | Road race (10 km) | Vancouver Sun Run (10 km) | Recreational | 635/205 | NA | 13 weeks | Self-reported pain (Survey) with medical confirmation | NA | 29.5 injured runners per 100 runner | Female: 30.2 injured runners per 100 runners; Male: 28.3 injured runners per 100 runners | 14 |
Dane et al. [37] | Road running | College students | Competitive (college) | 47/45 | 17–28 | One season (12 weeks) | Medically diagnosed: contusions, bleeding, wounds, and fractures, except small bruises, were classified as injuries | NA | 57.1 injured runners per 100 runners | Female: 52 injured runners per 100 runners; Male: 60 injured runners per 100 runners | 10 |
Rauh et al. [57] | Cross country | College students (Seattle) | Competitive (college) | 186/235 | NA | One season | Muscle, joint, or bone problem/injuries of the back or lower extremity requiring the runner to be removed from a practice or meet or to miss a subsequent one | An AE was any practice or competitive event where a runner was at risk of sustaining an injury | 17.0 injuries per 1000 AEs | Female: 19.6 injuries per 1000 AEs; Male: 15.0 injuries per 1000 AEs | 20 |
Plisky et al. [56] | Cross country | High school students (Wisconsin) | Competitive (college) | 46/59 | NA | 13 weeks | Medial tibial stress fracture: pain in the tibial region, exacerbated with repetitive weight-bearing activity, and localized pain with pal- pation along the distal two thirds of the posterior-medial tibia | AE: any practice or competitive event | 2.8 stress fractures per 1000 AEs | Female: 4.3 stress fractures per 1000 AEs; Male: 1.7 stress fractures per 1000 AEs | 21 |
Alonso et al. [32] | Track + Marathon | 2007 IAAF World championships (Osaka) participants | Elite | 249/267 | 17–37 | 9 days | All musculoskeletal injuries regardless of the consequences with respect to the athlete’s absence from competition or training | Number of competing athletes | 150 competition injuries per 1000 athletes | Time-loss injuries per 1000 registered athletes - Female: 800 m: 22, 1500 m: 26, 3000 m SC: 48, 5000 m: 38, 10000 m: 158, marathon 61; - Male: 800 m: 43, 1500 m: 24, 3000 m SC: 79, 10000 m: 91, marathon: 118 | 22 |
Alonso et al. [33] | Track + Marathon | 2009 IAAF World championships (Berlin) participants | Elite | 244/312 | NA | 9 days | All time-loss musculoskeletal injuries (traumatic and overuse) regardless of the consequences with respect to the athlete’s absence from competition or training | The number of competing athletes was defined as all athletes who started at least once in a discipline | MD: 173.3 injuries per 1000 registered athlete LD: 151.1 injuries per 1000 registered athletes | Injuries per 1000 registered athletes - Female: 800 m 46.5 1500 m 71.4 3000 m SC: 48.8 5000 m 43.5 10000 m 90.9 Marathon 0 - Male: 800 m 0 1500 m 37.0 3000 m SC: 26.5 5000 m 102.6 10000 m 32.3 Marathon 30.6 | 22 |
Buist et al. [7] | Road racing (4 Miles) | Groningen 4 mile | Recreational | 422/207 | 43.7 ± 9.5 | 8 weeks | Any time loss running-related musculoskeletal pain at the lower extremity or back | Exposure as given by training programme | 25.9 injured runner per 100 runners; 30.1 injuries per 1000 h | Injury incidence rate per 1000 h - Female: 27.5, Male: 35.0 Mean Prevalence - Female: 23.4 injured runners per 100 runners Male: 31.4 injured runners per 100 runners | 18 |
Alonso et al. [31] | Track + Marathon | 2011 IAAF World championship (Daegue) participants | Elite | 208/268 | 17–42 | 9 days | All musculoskeletal injuries regardless of the consequences with respect to the athlete’s absence from competition or training | Number of competing athletes | MD: 176.1 injuries per 1000 registered athletes LD: 187.8 injuries per 1000 registered athletes | Time-loss injuries per 1000 registered athletes - Female: 800 m: 55.6, 1500 m: 57.1, 3000 m SC: 0, 5000 m: 125 injuries, 10000 m: 52.6,, marathon 53.6; - Male: 800 m: 22.7, 1500 m: 76.9, 3000 m SC: 0, 5000 m: 122 injuries, 10000 m: 47.6 injuries marathon: 220.6 | 22 |
Jacobsson et al. [48] | Track (MD + LD) | Swedish national team | Elite | 54/55 | 17–37 | 52 weeks | Self-reported musculoskeletal pain, soreness or injury with time loss or changes in normal training/competition | Self-reported athletic training participation | 83 injured runners per 100 runners | Adults: Female: 74 injured runners per 100 runners; Male: 81 injured runners per 100 runners Youth: Female: 57 injured runners per 100 runners; Male: 58 injured runners per 100 runners | 19 |
Edouard et al. [40] | Track (MD) | European Athletics indoor championships Paris 2011 participants | Elite | 125/75 | NA | 3 days | Any musculoskeletal complaint and concussion that received medical attention regardless of time loss | Athletes’ exposure in competition | MD: 53 injuries per 1000 registered athletes | Injuries per 1000 registered athletes – Female: 800 m: 47.6 3000 m 150.0 - Male: 800 m: 107.1 3000 m 34.5 | 21 |
Nielsen et al. [55] | Road racing | DANO-RUN study | Novice runners | 441/432 | 37.2 ± 10.3 | 1 year | Any musculoskeletal complaint of the lower extremity or back caused by running that restricted the amount of running for at least 1 week | Online diary: GPS or manually kilometers | 23.1 injured runner per 100 runners | Female: 21.8 injured runners per 100 runners; Male: 24.5 injured runners per 100 runners | 23 |
Edouard et al. [39] | Track (MD) | European Athletics championships Helsinki 2012 participants | Elite | 66/164 | NA | 3 days | Any musculoskeletal complaint and concussion that received medical attention regardless of time loss | Athletes’ exposure in competition | MD: 53 injuries per 1000 registered athletes | Injuries per 1000 registered athletes -Female: 800 m: 41.7 1500 m: 30.3 3000 m: 142.9 5000 m: 347.8 10000 m: 176.5 - Male: 800 m: 69.8, 1500 m: 171.4, 3000 m: 275.9 5000 m: 71.4 10000 m 103.4 | 21 |
Changstrom et al. [24] | Cross-country | National High School Sports- Related Injury Surveillance System (2011–2012), (USA) | Competitive (high school) | NA | 13–19 | 2 years | (Stress) fractures, concussions and dental injuries with or without time loss. All injuries with time loss requiring medical attention | Athlete exposure (AE) | 7.8 stress fractures per 100,000 AEs | Female: 10.6 stress fractures per 100,000 AEs; Male: 5.4 stress fractures per 100,000 AEs | 19 |
Edouard et al. [19] | Track + Marathon | All athletic world championships (2007–2014) | Elite | 1302/1573 | NA | (3–9 days per championship) | All musculoskeletal injuries (traumatic and overuse) and concussion newly incurred during competition or training regardless of the consequences with respect to the athlete’s absence from competition or training | Total number of registered athletes | N/A | Injuries per 1000 registered athletes - Female: MD 94.6 LD 155.3 Marathon 153.3 - Male: MD 108.5 LD 141.4 Marathon 195.5 | 21 |
Kluitenberg et al. [50] | Road racing | NLstart2run | Novice runners | 1332/364 | 43.3 | 6 weeks | A musculoskeletal complaint of the lower extremity or back that hampered running ability for three consecutive training sessions | Weekly running frequency and running exposure (in minutes) for each training session | 27.5 injuries per 1000 h | Female: 10.4 injured runners per 100 runners; Male: 12.6 injured runners per 100 runners | 17 |
Hespanhol Junior et al. [45] | Road racing (10 Miles) | Tilburg Ten Miles | Recreational | 31/22 | 44.1 | 18 weeks | OSTRC: All running-related injuries | Online questionnaires completed every fortnight | Mean prevalence: 30.8 injured runners per 100 runners and cumulative prevalence 60.4 injured runners per 100 runners | Mean prevalence Female: 11.5% injured runners per 100 runners Male: 19.3 injured runners per 100 runners | 18 |
Hespanhol Junior et al. [44] | Trailrunning | Dutch trail runners | Recreational | 57/171 | 43.4 | 6 months | OSTRC: All running-related injuries | Online questionnaires completed every fortnight | 10.7 injuries per 1000 h; mean prevalence 22.4% | Injury incidence rate per 1000 h - Female 9.1 Male: 11.3 Mean Prevalence: Female: 20.7%; Male: 23.0% | 17 |
Rizzone et al. [59] | Cross country | NCAA (2004–2014) | Competitive (college) | NA | NA | 9 years | Time loss stress fractures that required medical attention: (1) occurred due to participation in a school-sanctioned practice or competition, (2) required attention from an AT or physician, (3) resulted in at least 24 h of time missed from participation, and (4) had a reported diagnosis of stress fracture | AE: 1 student-athlete participating in 1 NCAA-sanctioned practice or competition | 22.4 stress fractures per 100,000 AEs | Female: 28.6 stress fractures per 100,000 AEs; Male: 16.1 stress fractures per 100,000 AEs | 18 |
Messier et al. [53] | Road racing | TRAILS study | Recreational | 128/172 | Range 18—60 | 104 weeks | Overuse running injuries: grade 1, maintained full activity in spite of symptoms; grade 2, reduced weekly mileage; and grade 3, interrupted all training for at least 2 weeks | NA | 66 injured runners per 100 runners | Female: 73 injured runners per 100 runners; Male: 62 injured runners per 100 runners | 15 |
Winter et al. [64] | Road running | Runners from local running club | Recreational + Competitive | 35/57 | 18—65 | 52 weeks | Pain preventing the runner from performing or completing at least one training session | Training diary with information on running sessions per week, distance and duration of runs | 51.3 injured runners per 100 runners | Female: 54.8 injured runners per 100 runners; Male: 48.9 injured runners per 100 runners | 20 |
Fokkema et al. [42] | Road racing | INSPIRE trial (NN City Pier City The Hague, NN Marathon Rotterdam, Ladies Run Rotterdam) | Recreational | 553/629 (Control group) | 41.4 ± 12 | 4.5 ± 1.6 months | Injuries of the lower back or lower extremities caused by running with change of training for at least 1 week, a medical visit or medication | NA | 36.7 injured runners per 100 runners | Female: 35.8 injured runners per 100 runners; Male: 38.3 injured runners per 100 runners | 15 |
Hayes et al. [43] | Cross-country | NCAA (Ivy League & New England Small College Athletics) | Competitive (college) | 57/10 | 17–21 | 1 US-cross-country season | Self-reported Injuries that were not present during administration of the pre-season survey | Average and maximum weekly mileage in increments of 10 miles (e.g. 31–40 miles per week) | 53 injured runners per 100 runners (over one season) | Female: 51 injured runners per 100 runners; Male: 55 injured runners per 100 runners | 12 |
Lagas et al. [51] | Road racing | INSPIRE trial (NN City Pier City The Hague, NN Marathon Rotterdam, Ladies Run Rotterdam) | Recreational | 909/1020 | 41.9 ± 12.1 | 20.5 ± 7 weeks | Self-reported Achilles tendinopathy caused by running with change of training for at least 1 week, a medical visit or medication | NA | 5.2 injured runners per 100 runners | Female: 3.6 injured runners per 100 runners; Male: 6.6 injured runners per 100 runners | 12 |
Ruffe et al. [60] | Cross-country | High school students (California) | Competitive (high school) | 80/68 | 15.6 | 1 US-cross-country season | Muscle, bone, or joint problem/injury of the low back or lower extremity requiring removal from training/competitions or leading to missed subsequent training/ competitions | Runners’ daily participation in practices and competitive events | 33.1 injured runners per 100 runners (over one season) | Female: 38.8 injured runners per 100 runners; Male: 26.5 injured runners per 100 runners | 16 |
Winter et al. [65] | Road running | Runners from local running club | Recreational + Competitive | 35/57 | 18—65 | 52 weeks | Pain preventing the runner from performing or completing at least one training session assessed by an experienced health or medical professional | Average kilometers per week; average duration (minutes) per week; average frequency per week | 51.3 injured runners per 100 runners | Female: 54.8 injured runners per 100 runners; Male: 48.9 injured runners per 100 runners | 21 |
Edouard et al. [41] | Track + Marathon | IAAF World and European Championships participants | Elite | MD: 742/943; LD 656/793; Marathon 464/550 | NA | 78 days (3–9 days per championship) | All musculoskeletal injuries (traumatic and overuse) and concussion newly incurred during competition or training regardless of the consequences with respect to the athlete’s absence from competition or training | Total number of registered athletes | Injuries per 1000 registered athletes—MD: 97 LD: 126 Marathon: 139 | Injuries per 1000 registered athletes - Female: MD 84.9 LD 128 Marathon 118.5 Male: MD 106 LD 123.6 Marathon 156.4 | 19 |
Hofstede et al. [46] | Half- + Marathon | SUMMUM study (Utrecht Marathon) | Recreational | 71/90 | 40.7 ± 11.7 | 16 weeks | OSTRC questionnaire, injuries with a moderate to severe reduction in training or competition or time loss | NA | 44.1 substantial injuries per 100 runners | Female: 52.1 substantial injuries per 100 runners; Male: 37.8 substantial injuries per 100 runners | 14 |
3.3 Study Quality
3.4 Overall Injury Rates
3.5 Meta-Regression
Moderator | No of comparisons (k) | Z | p | Risk ratio estimate (95% CI) | Tau2/Q |
---|---|---|---|---|---|
Risk of bias | 22 | 0.0299/68.1 | |||
Intercept | − 0.88 | 0.378 | − 0.051 (− 0.167 to 0.063) | ||
Moderator | 1.42 | 0.156 | 0.151 (− 0.058 to 0.359) | ||
Level | 20 | 0.0385/63.1 | |||
Intercept | 0.68 | 0.495 | 0.044 (− 0.083 to 0.171) | ||
Moderator | 1.05 | 0.293 | 0.110 (− 0.095 to 0.316) | ||
Age | 15 | 0.0224/27.3 | |||
Intercept | 0.87 | 0.387 | 0.116 (− 0.146 to 0.378) | ||
Moderator | − 0.81 | 0.419 | − 0.119 (− 0.407 to 0.170) | ||
Competition distance | 14 | 0.0311/44.7 | |||
Intercept | 1.71 | 0.088 | 0.144 (− 0.021 to 0.309) | ||
Moderator | − 3.05 | 0.002 | − 0.387 (− 0.636 to − 0.138) |