Incidence, Prevalence, and Risk Factors of Running-Related Injuries: An Epidemiologic Review

This chapter aimed to review the literature and identify studies that discuss the rate of injury and risk factors related to running-related injuries (RRIs). Only systematic review studies were used in this chapter. The decision to not use individual studies as references in this chapter was to decrease my inclination (bias) about the topic, and systematic review studies are classified with the highest level of evidence compared with all other types of study designs. All references used in this section provide data related to injury rate and risk factors for RRIs and come from systematic review articles published during the last 10 years.

Main Injuries

Studies have been conducted to identify the most common injuries among runners. Unfortunately, most articles do not describe RRIs appropriately, opting only to report the anatomical location of RRIs, such as “knee injury” or “ankle injury.” However, in 2012, the first systematic review of articles that fully reported the type of injury, anatomical region, and incidence or prevalence rates of RRIs was published. Eight studies were considered eligible for the review, and a total of 28 RRIs were found. The main RRIs were medial tibial stress syndrome (incidence ranging from 13.6% to 20.0%; prevalence of 9.5%), Achilles tendinopathy (incidence ranging from 9.1% to 10.9%; prevalence ranging from 6.2% to 9.5%), and plantar fasciitis (incidence ranging from 4.5% to 10.0%; prevalence ranging from 5.2% to 17.5%). Despite some studies reporting that patellofemoral syndrome is the most common RRI, this systematic review revealed a different picture. Patellofemoral syndrome did not present with the highest incidence or prevalence rate of general RRIs. The authors of this study mentioned that the term “runner's knee” has been used synonymously with patellofemoral syndrome. They also suggested that the term “runner's knee” should be avoided when describing injury around the knee area.

Most of the injuries observed in this study are related to overuse, in other words, overloading the musculoskeletal structures of the runners. The RRIs were predominantly below the knee. Table 1.1 shows the main injuries identified in the study.

Table 1.1
Incidence and Prevalence of the Running-Related Injuries.
Data from Lopes et al., 2012.
RRI Incidence (%) a No. of Articles that Reported the RRI b Prevalence (%) a No of Articles that Reported the RRI b
Medial tibial stress syndrome 13.6–20.0 3/3 9.5 2/2
Achilles tendinopathy 9.1–10.9 3/3 6.2–9.5 2/2
Plantar fasciitis 4.5–10.0 3/3 5.2–17.5 2/2
Patellar tendinopathy 5.5–22.7 2/3 12.5 1/2
Ankle sprain 10.9–15.0 2/3 9.5 1/2
Iliotibial band syndrome 1.8–9.1 2/3 10.5 1/2
Hamstring muscle injury 10.9 1/3 6.7 1/2
Tibial stress fracture 9.1 1/3 4.5 1/2
Hamstring tendinopathy 7.3 1/3 12.5 1/2
Patellofemoral syndrome c 5.5 1/3 5.5 1/2
Gastrocnemius muscle injury 3.6–4.5 2/3
Trochanteric bursitis 9.1 1/3
Low back pain 5.5 1/3
Costal fracture 5.0 1/3
Knee sprain 5.0 1/3
Hip adductor muscle injury 4.5 1/3
Iliac crest stress fracture 4.5 1/3
Infrapatellar bursitis 4.5 1/3
Hip adductor tendinopathy 3.6 1/3
Tibialis posterior tendinopathy 3.6 1/3
Meniscal injury 3.5 1/2
RRI = running-related injury.

a Data are presented in single percentages or ranges where specified.

b Number of articles that reported RRI refers to the number of articles that reported the incidence (total of incidence articles = 3) or prevalence (total of prevalence articles not conducted in ultra-marathon races = 2) of each RRI.

c Represents patellofemoral syndrome and patellofemoral pain.

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