What are the Differences in Injury Proportions Between Different Populations of Runners? A Systematic Review and Meta-Analysis

Bas Kluitenberg, Marienke van Middelkoop, Ron Diercks, Henk van der Worp

Many runners suffer from injuries. No information on high-risk populations is available so far though. The aims of this study were to systematically review injury proportions in different populations of runners and to compare injury locations between these populations. An electronic search with no date restrictions was conducted up to February 2014 in the PubMed, Embase, SPORTDiscus and Web of Science databases. The search was limited to original articles written in English. The reference lists of the included articles were checked for potentially relevant studies. Studies were eligible when the proportion of running injuries was reported and the participants belonged to one or more homogeneous populations of runners that were clearly described. Study selection was conducted by two independent reviewers, and disagreements were resolved in a consensus meeting. Details of the study design, population of runners, sample size, injury definition, method of injury assessment, number of injuries and injury locations were extracted from the articles. The risk of bias was assessed with a scale consisting of eight items, which was specifically developed for studies focusing on musculoskeletal complaints. A total of 86 articles were included in this review. Where possible, injury proportions were pooled for each identified population of runners, using a random-effects model. Injury proportions were affected by injury definitions and durations of follow-up. Large differences between populations existed. The number of medical-attention injuries during an event was small for most populations of runners, except for ultra-marathon runners, in which the pooled estimate was 65.6 %. Time-loss injury proportions between different populations of runners ranged from 3.2 % in cross-country runners to 84.9 % in novice runners. Overall, the proportions were highest among short-distance track runners and ultra-marathon runners. The results were pooled by stratification of studies according to the population, injury definition and follow-up/recall period; however, heterogeneity was high. Large differences in injury proportions between different populations of runners existed. Injury proportions were affected by the duration of follow-up. A U-shaped pattern between the running distance and the time-loss injury proportion seemed to exist. Future prospective studies of injury surveillance are highly recommended to take running exposure and censoring into account.