Injury Prevention, Safe Training Techniques, Rehabilitation, and Return to Sport in Trail Runners

Abstract

This current concept, narrative review provides the latest integrated evidence of the musculoskeletal injuries involved with trail running and therapeutic strategies to prevent injury and promote safe participation. Running activities that comprise any form of off-road running (trail running, orienteering, short-long distance, different terrain, and climate) are relevant to this review. Literature searches were conducted to 1) identify types and mechanisms of acute and chronic/ overuse musculoskeletal injuries in trail runners, 2) injury prevention techniques most relevant to running trails, 3) safe methods of participation and rehabilitation timelines in the sport. The majority of acute and chronic trail running-related musculoskeletal injuries in trail running occur in the lower leg, primarily in the knee and ankle. More than 70% are due to overuse, and ankle sprains are the most common acute injury. Key mechanisms underlying injury and injury progression include inadequate neuromotor control-balance-coordination, running through fatigue, and abnormal kinematics on variable terrain. Complete kinetic chain prehabilitation programs consisting of dynamic flexibility, neuromotor strength and balance, and plyometrics exercise can foster stable, controlled movement on trails. Patient education about early musculoskeletal pain symptoms and training adjustment can help prevent injury from progressing to serious overuse injuries. Real-time adjustments to cadence, step length, and knee flexion on the trail may also mitigate impactrelated risk for injury. After injury occurs, rehabilitation will involve similar exercise components, but it will also incorporate rest and active rest based on the type of injury. Multicomponent prehabilitation can help prevent musculoskeletal injuries in trail runners through movement control and fatigue resistance.

Anxiety state impact on recovery of runners with lower extremity injuries

“…Recovering from a physical injury may require refraining from running temporarily and can involve various medical management approaches depending on the type and severity of the injury. Soft tissue injuries may be managed with therapy with minimal running time lost (e.g., patellofemoral pain), whereas critical stress fractures (e.g., femoral neck fracture) may require significant time away from running therapy and gradual return-to-run during a six-month period (summarized in [8]). Withdrawal from participation in running and other sports can cause mental stress, such as anxiety, depression and mood disturbance [9][10][11].…”

Resistance Exercise for Improving Running Economy and Running Biomechanics and Decreasing Running-Related Injury Risk: A Narrative Review

“…The purpose of this section is to summarize the available evidence of the effectiveness of RE for reducing the risk of running-related injuries. According to Vincent et al [ 112 ], more than 70% of running injuries are of the overuse nature, but inadequate running techniques and poor neuromuscular control are also key mechanisms for the occurrence of injuries. In trail runners, running experience, neglecting warm-ups, having no specialized running plan, training on asphalt, and double training sessions per day contribute significantly to injury risk [ 113 ].…”

Flat Versus Simulated Mountain Trail Running: A Multidisciplinary Comparison in Well-Trained Runners

“…Running on trails requires the rapid cognitive processing of the environment, responsiveness to variations in the ground surface, the avoidance of obstacles and adjustment to elevations in terrain. To maintain stability, runners use anticipatory, predictive and reactive balance control strategies [ 17 , 18 ].…”

“…However, off-road running takes place in more complex environments and conditions, which imply a high number of complex unpredictable variables. This can make off-road running a high-risk discipline for lower limb extremity injuries [ 23 ], with the majority of acute and chronic musculoskeletal injuries occurring in the knee and ankle [ 18 ]. Even though the surface itself does not represent the primary cause of injury, deficits in the neuromotor control of the lower extremity joints and the abnormal motion of loaded joints are potential mechanisms.…”

“…Being able to effectively move over diverse terrain conditions has been an integral part of this performance model, and it is fundamental for injury prevention [ 18 ].…”