Photo by Luke Baum (Unsplash)

Trail running is an outdoor sport, with an estimated 20 million runners every year, where runners confront off-road terrains, important elevation changes and distances ranging from a few kilometres to ultramarathons.

The health benefits of running are well documented, although trail running presents a high risk of injury. And even though most of trail running injuries are minor, in rare cases, they can be severe.

Identifying trail runners at risk before training and competition, may prevent injuries and ensure access to the health benefits associated with running.

A recent systematic review as tried to identify and summarise the evidence on factors associated with injury in trail running. It included 19 studies, with a total of 9 763 participants (80.6% males, 15.8% females, unidentified 3.6%) with a mean age ranging between 33 and 46 years.


Main findings

► The foot/toe, followed by the ankle, and hip/groin are the most injured body areas.

► Blisters, followed by joint sprains, and tendinopathies are the most common pathologies.

► There are a total of 17 statistically significant injury risk factors, among them:

  • Higher injury risk: neglecting a warm-up before running, not using a specialised running plan, regular training on asphalt, double training sessions per day, higher running experience and physical labour occupations.
  • Higher risk of sunburn: more than 3 hours of training per day, younger age, low skin phototypes (I and II, or clear skin) and single relationship status.
  • Higher risk of muscle cramping: prior history of cramping, higher levels of postrace blood urea nitrogen and creatine kinase and a slower race finishing time.

► Experienced trail runners seem to suffer less from blister injuries.

► There is a lack of literature on risk factors among female runners.


Use this information to prevent injuries and run healthier and safer



Trail running injury risk factors: a living systematic review. Viljoen C, Janse van Rensburg DC, van Mechelen W, et al. British Journal of Sports Medicine 2022;56:577-587.

Photo by Greg Rosenke (Unsplash)

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