Musculoskeletal Injuries in Ultra-Endurance Running: A Scoping Review

Abstract

Ultra-endurance running (UER) has seen an important increase in participation over the last few decades. Long hours of UER can lead to excessive stress on the body, resulting in musculoskeletal injuries (MSKI). UER is not a uniform sport and events can differ considerably in distance (over 42.195 km), time (e.g., events over 6 h) and multi-day or multi-stage events on various surfaces (e.g., track, on-road, off-road). The aims of this scoping review were therefore: (1) to examine the current evidence of MSKI, providing a synthesis of the most common MSKI by anatomical region and specific diagnosis; (2) categorize MSKI by type of UER activity (competition: time-limited; multi-stage; continuous UER events and training); (3) describe knowledge gaps in the literature and provide advice on potential further research. Our electronic literature search (PubMed, SPORTDiscus, Web of Science) identified a total of 13 studies (9 in competition, and 4 in training). Anatomical site, diagnosis and rate of injuries differ between competition and training as well as between different UER types. MSKI are observed in 18% of multi-stage events (0.7–1.8 injuries/runner and 7.2 injuries/1000 h). Most MSKI involve the lower leg (35.0%), ankle (16.8%), knee (13.1%) and foot (12.6%), with main diagnosis of medial tibial stress syndrome (30.1%) and patella femoral pain syndrome (PFPS; 7.2%). Single, continuous UER events differ between a 1005 km road race with almost all of the injuries due to overuse, with the main anatomical site of the knee (31%), ankle (28%) and lower leg (14%) and main diagnosis of PFPS (15.6%), compared to a 65 km trail race, with 32.8% of MSKI, mainly on the foot [plantar fasciitis (28.6%)], ankle [sprain (28.6%)] and knee. Timed-UER events (injury rate of 2.1 injuries/athlete) observed most injuries on the ankle (36%) and knee (19%), with the main diagnosis of tendinitis of the foot dorsiflexors (30%). Injuries during training most commonly affect, the back (42%), and knee (40%) and bone stress injuries (22%). Main diagnoses include ankle sprain (18%), iliotibial band injury (16%) and Achilles tendinopathy (11%). Future considerations include examining MSKI in different UER events, environments and surfaces, and on larger study populations. Establishing risk factors, examining sex differences and using a standard reporting system of MSKI in UER are also important.

Potential Long-Term Health Problems Associated with Ultra-Endurance Running: A Narrative Review

“…Musculoskeletal injuries are common in UER and may affect bones, joints, cartilage/menisci, muscles, tendons, ligaments, and bursae [ 104 – 107 ]. Around 90% of injuries in UER are overuse in nature [ 104 , 105 , 108 – 110 ].…”

Extreme Ultra-Trail Race Induces Muscular Damage, Risk for Acute Kidney Injury and Hyponatremia: A Case Report

“…Several studies has proved that some biomarkers related to ER, increase their values during the race and even some days after completing the test [30,31]. The main markers related to ER in scientific reports are Lactodeshidrogenasa (LDH) and creatine kinase (CK) among liver alterations and inflammatory biomarkers such as leucocytes and protein c-reactive [32][33][34]. The diagnosis of ER remains unclear though, with many different values existing to match ER criteria [24].…”

Injury Incidence and Pattern in Elite Young Male and Female Trail Runners

“…These same studies also suggested that this increase might be caused by a rise in intensity. The review on ultra-endurance runners conducted by Scheer and Krabak [28] also suggested that the body region, diagnosis, and rate of injuries differed between competition and training as well as between different ultra-endurance races. While the back, knee, and bone stress injuries are common during training, in short ultra-trail races (65 km), the incidence is higher and it mainly affects the foot (plantar fasciitis), ankle (ankle sprain), and knee.…”

“…It was found that there are differences in risk taking between male and female runners [27], being males more prone to sports accidents. However, not only that but there are also sex differences in the type of predominant injuries in male and female ultra-runners [28].…”