443 FO23 – Injury Risk Factors in Trail Running: Latest Evidence from a Living Systematic Review

Background Trail runners participate in remote natural environments posing challenges for medical providers to access and/or evacuate injured runners. This highlights the need for improved injury prevention in trail running using up-to-date evidence on factors associated with injury in trail running. Objective To systematically review and frequently update evidence on trail running injury risk factors and injury epidemiology. Design Living systematic review updated biannually over 5 years (2021–2025). Setting Eight electronic databases were searched from inception to July 2023. PROSPERO: CRD42021240832. Participants N/A. Interventions Eligibility criteria for studies included investigating injury risk factors and/or reported injury epidemiology in trail running. Risk of bias is assessed using the QUIPS tool. Main outcome measurements Injury risk factors and epidemiology (incidence, prevalanece, clinical characterists). Results Twenty-eight studies with 15105 participants are currently included. Significant factors associated with injury are reported in the domains of training (specific technical training surfaces, double training sessions per day, more training hours per day, high weekly running distance, training for longer race distances, slower race finishing time, having no warm-up or training plan), injury history (past 12 months and lifetime), menstrual dysfunction (oligomenorrheic, amenorrhoeic), running experience (more years, level A classification), psychological traits (higher sensation seeking, risk-taking, competitiveness), chronic diseases (having a chronic disease, high composite score), demographics (younger age, single, physical labour occupations), post-race biomarkers (higher blood urea nitrogen, creatine kinase), and skin characteristics (low skin phototypes). The injury incidence range is 0.7–61.2 injuries/1000h of running, and prevalence range is 1.3%-90%. The lower limb is the most reported region of injury, specifically involving joint sprains, tendinopathies, and blisters. Conclusion In the risk domains, our review found 13 intrinsic and 18 extrinsic injury risk factors. This review highlights areas for future research that may aid in designing injury prevention strategies for safer trail running participation.