Sports Medicine

, Volume 44, Issue 8, pp 1153–1163 | Cite as

What are the Main Risk Factors for Running-Related Injuries?

  • Bruno Tirotti SaragiottoEmail author
  • Tiê Parma Yamato
  • Luiz Carlos Hespanhol Junior
  • Michael J. Rainbow
  • Irene S. Davis
  • Alexandre Dias Lopes
Systematic Review



Despite several studies that have been conducted on running injuries, the risk factors for running-related injuries are still not clear in the literature.


The aim of this study was to systematically review prospective cohort studies that investigated the risk factors for running injuries in general.

Data Sources

We conducted electronic searches without restriction of language on EMBASE (1980 to Dec 2012), PUBMED (1946 to Dec 2012), CINAHL (1988 to Dec 2012) SPORTDiscus (1977 to Dec 2012), Latin American and Caribbean Centre on Health Sciences Information (1985 to Dec 2012) and Scientific Electronic Library Online (1998 to Dec 2012) databases, using subject headings, synonyms, relevant terms and variant spellings for each database.

Study Selection

Only prospective cohort studies investigating the risk factors for running-related musculoskeletal injuries were included in this review. Two independent reviewers screened each article and, if they did not reach a consensus, a third reviewer decided whether or not the article should be included.

Study Appraisal and Synthesis Methods

Year of publication, type of runners, sample size, definition of running-related musculoskeletal injury, baseline characteristics, reported risk factors and the statistical measurement of risk or protection association were extracted from the articles. A scale adapted by the authors evaluated the risk of bias of the articles.


A total of 11 articles were considered eligible in this systematic review. A total of 4,671 pooled participants were analysed and 60 different predictive factors were investigated. The main risk factor reported was previous injury (last 12 months), reported in 5 of the 8 studies that investigated previous injuries as a risk factor. Only one article met the criteria for random selection of the sample and only six articles included a follow-up of 6 months or more. There was no association between gender and running injuries in most of the studies.


It is possible that eligible articles for this review were published in journals that were not indexed in any of the searched databases. We found a great heterogeneity of statistical methods between studies, which prevented us from performing a meta-analysis.


The main risk factor identified in this review was previous injury in the last 12 months, although many risk factors had been investigated in the literature. Relatively few prospective studies were identified in this review, reducing the overall ability to detect risk factors. This highlights the need for more, well designed prospective studies in order to fully appreciate the risk factors associated with running.


Prospective Cohort Study Main Risk Factor Overuse Injury Newcastle Ottawa Scale Previous Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Luiz Carlos Hespanhol Junior is a PhD student supported by CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior), Process Number 0763-12-8, Ministry of Education, Brazil. The other authors declare that they have no competing interest and there is no funding involved in this study.

Supplementary material

40279_2014_194_MOESM1_ESM.docx (65 kb)
Supplementary material 1 (DOCX 65 kb)


  1. 1.
    Pazin J. Corredores de rua: características demográficas, treinamento e prevalência de lesões. Revista Brasileira de Cineantropometria & Desempenho Humano. 2008;10:6–11.Google Scholar
  2. 2.
    Fredericson M, Misra AK. Epidemiology and aetiology of marathon running injuries. Sports Med. 2007;37:437–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Paluska SA. An overview of hip injuries in running. Sports Med. 2005;35:991–1014.PubMedCrossRefGoogle Scholar
  4. 4.
    van Gent RN, Siem D, van Middelkoop M et al. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med. 2007;41:469–80; discussion 80.Google Scholar
  5. 5.
    Fields KB, Sykes JC, Walker KM, et al. Prevention of running injuries. Curr Sports Med Rep. 2010;9:176–82.PubMedCrossRefGoogle Scholar
  6. 6.
    Hoeberigs JH. Factors related to the incidence of running injuries. A review. Sports Med. 1992;13:408–22.PubMedCrossRefGoogle Scholar
  7. 7.
    Wen DY. Risk factors for overuse injuries in runners. Curr Sports Med Rep. 2007;6:307–13.PubMedGoogle Scholar
  8. 8.
    Hreljac A, Marshall RN, Hume PA. Evaluation of lower extremity overuse injury potential in runners. Med Sci Sports Exerc. 2000;32:1635–41.PubMedCrossRefGoogle Scholar
  9. 9.
    Hreljac A. Impact and overuse injuries in runners. Med Sci Sports Exerc. 2004;36:845–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Kretsch A, Grogan R, Duras P, et al. Melbourne marathon study. Med J Aust. 1980;1984(141):809–14.Google Scholar
  11. 11.
    Hreljac A. Etiology, prevention, and early intervention of overuse injuries in runners: a biomechanical perspective. Phys Med Rehabil Clin N Am. 2005;16:651–67, vi.Google Scholar
  12. 12.
    Bahr R. No injuries, but plenty of pain? On the methodology for recording overuse symptoms in sports. Br J Sports Med. 2009;43:966–72.PubMedCrossRefGoogle Scholar
  13. 13.
    Chang WL, Shih YF, Chen WY. Running injuries and associated factors in participants of ING Taipei Marathon. Phys Ther Sport. 2012;13:170–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Nielsen RO, Buist I, Sorensen H, et al. Training errors and running related injuries: a systematic review. Int J Sports Phys Ther. 2012;7:58–75.PubMedCentralPubMedGoogle Scholar
  15. 15.
    Bahr R, Holme I. Risk factors for sports injuries—a methodological approach. Br J Sports Med. 2003;37:384–92.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Lopes AD, Hespanhol Junior LC, Yeung SS, et al. What are the main running-related musculoskeletal injuries? a systematic review. Sports Med. 2012;42:891–905.PubMedCrossRefGoogle Scholar
  17. 17.
    Herbert R, Jamtvedt G, Mead J, et al. Practical evidence-based physiotherapy. 1st ed. London: Elsevier; 2005.Google Scholar
  18. 18.
    Verhagen E, van Mechelen W. Sports injury research. 1st ed. Oxford: Oxford University Press; 2010.Google Scholar
  19. 19.
    Wells G, Shea B, O’Connell D et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. [cited 2013 September 24].
  20. 20.
    Hartling L, Milne A, Hamm MP, et al. Testing the Newcastle Ottawa Scale showed low reliability between individual reviewers. J Clin Epidemiol. 2013;66:982–93.PubMedCrossRefGoogle Scholar
  21. 21.
    Fewtrell MS, Kennedy K, Singhal A, et al. How much loss to follow-up is acceptable in long-term randomised trials and prospective studies? Arch Dis Child. 2008;93:458–61.PubMedCrossRefGoogle Scholar
  22. 22.
    Buist I, Bredeweg SW, Lemmink KA, et al. Predictors of running-related injuries in novice runners enrolled in a systematic training program: a prospective cohort study. Am J Sports Med. 2009;38:273–80.PubMedCrossRefGoogle Scholar
  23. 23.
    Macera CA, Pate RR, Powell KE, et al. Predicting lower-extremity injuries among habitual runners. Arch Intern Med. 1989;149:2565–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Rauh MJ, Koepsell TD, Rivara FP, et al. Epidemiology of musculoskeletal injuries among high school cross-country runners. Am J Epidemiol. 2006;163:151–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Van Middelkoop M, Kolkman J, Van Ochten J, et al. Risk factors for lower extremity injuries among male marathon runners. Scand J Med Sci Sports. 2008;18:691–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Wen DY, Puffer JC, Schmalzried TP. Injuries in runners: a prospective study of alignment. Clin J Sport Med. 1998;8:187–94.PubMedCrossRefGoogle Scholar
  27. 27.
    Walter SD, Hart LE, McIntosh JM, et al. The Ontario cohort study of running-related injuries. Arch Intern Med. 1989;149:2561–4.PubMedCrossRefGoogle Scholar
  28. 28.
    Rauh MJ, Koepsell TD, Rivara FP, et al. Quadriceps angle and risk of injury among high school cross-country runners. J Orthop Sports Phys Ther. 2007;37:725–33.PubMedCrossRefGoogle Scholar
  29. 29.
    Taunton JE, Ryan MB, Clement DB, et al. A prospective study of running injuries: the Vancouver Sun Run “In Training” clinics. Br J Sports Med. 2003;37:239–44.PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Pileggi P, Gualano B, Souza M, et al. Incidência e fatores de risco de lesões osteomioarticulares em corredores: um estudo de coorte prospectivo. Revista Brasileira de Educação Física e Esporte. 2010;24:453–62.Google Scholar
  31. 31.
    Lun V, Meeuwisse WH, Stergiou P, et al. Relation between running injury and static lower limb alignment in recreational runners. Br J Sports Med. 2004;38:576–80.PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Fields KB, Delaney M, Hinkle JS. A prospective study of type A behavior and running injuries. J Fam Pract. 1990;30:425–9.PubMedGoogle Scholar
  33. 33.
    Bredeweg SW, Kluitenberg B, Bessem B, et al. Differences in kinetic variables between injured and noninjured novice runners: a prospective cohort study. J Sci Med Sport. 2012;16:205–10.PubMedCrossRefGoogle Scholar
  34. 34.
    Fuller CW, Bahr R, Dick RW, et al. A framework for recording recurrences, reinjuries, and exacerbations in injury surveillance. Clin J Sport Med. 2007;17:197–200.PubMedCrossRefGoogle Scholar
  35. 35.
    Lankhorst NE, Bierma-Zeinstra SM, van Middelkoop M. Factors associated with patellofemoral pain syndrome: a systematic review. Br J Sports Med. 2013;47:193–206.PubMedCrossRefGoogle Scholar
  36. 36.
    Livingston LA. The quadriceps angle: a review of the literature. J Orthop Sports Phys Ther. 1998;28:105–9.PubMedCrossRefGoogle Scholar
  37. 37.
    van Mechelen W. Running injuries. A review of the epidemiological literature. Sports Med. 1992;14:320–35.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Bruno Tirotti Saragiotto
    • 1
    • 4
    Email author
  • Tiê Parma Yamato
    • 1
  • Luiz Carlos Hespanhol Junior
    • 1
    • 2
  • Michael J. Rainbow
    • 3
  • Irene S. Davis
    • 3
  • Alexandre Dias Lopes
    • 1
  1. 1.Master and Doctoral Program in Physical Therapy, São Paulo Running Injury Group (SPRunIG)Universidade Cidade de São PauloSão PauloBrazil
  2. 2.Department of Public and Occupational Health and EMGO Institute for Health and Care ResearchVU University Medical CenterAmsterdamThe Netherlands
  3. 3.Spaulding National Running Center, Department of Physical Medicine and RehabilitationHarvard Medical SchoolCambridgeUSA
  4. 4.Universidade Cidade de São PauloSão PauloBrazil

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