Running, as sports in general, is associated with many benefits for prevention and rehabilitation of health issues, although it also carries an injury risk.
Among the risk factors for running, we could highlight training load, anatomical and biomechanical (footwear) variables, lifestyle (drinking & smoking), health status (injuries history) and sex.
Sex has been linked to specific injuries and for overall injury risk. Using data from 14 international athletics championships a previous study showed that male athletes had lower incidence of bone stress injuries than females.
A recent systematic review of the literature on sex-related injuries found 38 studies eligible, including a total of over 35000 runners (40.8% females – 59.2% males), including road, track, cross-country and trail/orienteering runners (from recreational to elite level). The main findings follow.
Overall Injury Rates
- No difference in overall injury rates between male and female runners (around 20 injuries per 100 runners).
- In distances longer than 10 kilometres: higher injury risk in male runners.
- In distances shorter than 10 kilometres: higher injury risk in female runners.
Bone Stress Injuries
- Higher probability in female runners.
A possible explanation is their association with the female athlete triad:
low energy availability + menstrual dysfunction + low bone mineral density
Although similar symptoms have also been described in male athletes, mainly due to what is called relative energy deficiency.
- Higher probability (twice the risk) in male runners.
The Achilles tendon is key for propulsion during running but its poor blood supply makes it prone to overuse injuries (tendinopathies). The difference between this injury rates in males and females could be explained by hormonal differences.
Oestrogens, whose levels are high in women, are associated with collagen synthesis, and therefore with tendon healing capacity. Hormonal fluctuations during the menstrual cycle have not been associated with modifications of tendon function.
- Sex is not a risk factor when considering the overall occurrence of injuries in running.
- Female runners sustain more frequently bone stress injuries.
- Male runners have higher risk of developing Achilles’ tendinopathies.
- Prevention, treatment, and rehabilitation strategies would be more effective when considering sex of the individual.
What is your personal experience about injuries?
Sex-Specific Differences in Running Injuries: A Systematic Review with Meta-Analysis and Meta-Regression. Hollander, K., Rahlf, A.L., Wilke, J. et al. Sports Med (2021).