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.
Highlights
Humans are well suited to running long distances, having evolved as persistence hunters, capable of covering great distances in pursuit of prey (Scheer, 2019)
All studies that examined musculoskeletal injuries (MSKI) in Ultra-endurance running (UER) were included irrespective of participants age and/or sex, detailed information of MSKI according to sex or age was not available in the majority of studies, a comprehensive breakdown of MSKI according to these parameters was not possible
The main findings of our review were: (i) MSKI in UER are common, mostly affecting the lower limbs and are of overuse in nature; (ii) MSKI differ between competition and training, with multistage events, predominantly affecting the lower leg, foot, and knee, while timed events mainly affect the ankle, Achilles tendon, and knee; (iii) Short continuous UER events off-road have the highest incidence of MSKI, mainly affecting the foot and ankle, while long continuous UER affect the knee and ankle; (iv) During training back, knee and bone stress injuries are common
Summary
Humans are well suited to running long distances, having evolved as persistence hunters, capable of covering great distances in pursuit of prey (Scheer, 2019). Ultra-endurance running (UER) tests the limits of the human body and has become increasingly popular over the last few decades, with an exponential increase that has slowed slightly since ∼2016 (Scheer, 2019). This increase is in large part due to an increase in female and master athlete (athletes ages > 35 years) participation (Eichenberger et al, 2012; Knechtle et al, 2012; Zingg et al, 2013; Scheer, 2019). The exception was 2020, with a significant reduction in UER participation and events, due to the global COVID-19 pandemic (Scheer et al, 2021)
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