Risk factors for injuries in a high-altitude ultramarathon

Is There Evidence for the Development of Sex-Specific Guidelines for Ultramarathon Coaches and Athletes? A Systematic Review

BACKGROUND

There is evidence of sex differences in the physiology of endurance exercise, yet most of the advice and guidelines on training, racing, nutrition, and recovery for ultramarathons are based on research that has largely excluded female athletes. The objective was therefore to review the current knowledge of sex differences in ultramarathon runners and determine if sufficient evidence exists for providing separate guidelines for males and females.

METHODS

This systematic review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three databases were searched for studies investigating differences in elite and recreational male and female ultramarathon runners. Studies were included if they compared males and females and looked at outcomes relating to the performance or health of ultramarathon runners. The quality of the included studies was determined using the Grading of Recommendations Assessment Development and Evaluation (GRADE) approach.

RESULTS

The search strategy identified 45 studies that met the inclusion criteria. Most studies were observational in design, with only three papers based on randomised controlled trials. The overall quality of the evidence was low. Sex differences in the predictors of ultramarathon performance; physiological responses to training, racing, and recovery; chronic and acute health issues; and pacing strategies were found. There were areas with contradictory findings, and very few studies examined specific interventions.

CONCLUSION

The results from this review suggest that the development of sex-specific guidelines for ultramarathon coaches and athletes could have a significant effect on the performance and health of female runners. At present, there is insufficient high-quality evidence on which to formulate these guidelines, and further research is required.

A narrative review of potential measures of dynamic stability to be used during outdoor locomotion on different surfaces

Dynamic stability of locomotion plays an important role in running injuries, particularly during trail running where ankle injuries occur frequently. Several studies have investigated dynamic stability of locomotion using wearable accelerometer measurements. However, no study has reviewed how dynamic stability of locomotion is quantified using accelerometry. Therefore, the present review aims to synthetise the methods and findings of studies investigating stability related parameters measured by accelerometry, during locomotion on various surfaces, and among asymptomatic participants. A systematic search of studies associated with locomotion was conducted. Only studies including assessment of dynamic stability parameters based on accelerometry, including at least one group of asymptomatic participants, and conditions that occur during trail running were considered relevant for this review. Consequently, all retrieved studies used a non-obstructive portable accelerometer or an inertial measurement unit. Fifteen studies used a single tri-axial accelerometer placed above the lumbar region allowing outdoor recordings. From trunk accelerations, a combination of index of cycle repeatability and signal dispersion can adequately be used to assess dynamic stability. However, as most studies included indoor conditions, studies addressing the biomechanics of trail running in outdoor conditions are warranted.

Prevalence of Injury in Ultra Trail Running

Purpose. The purpose of the study was to find the rate of musculoskeletal injuries in ultra-trail runners, investigate the most sensitive anatomical areas, and discover associated predicting factors to aid in the effective prevention and rapid rehabilitation of trail running injuries. Methods. Forty ultra trail runners responded to an epidemiological questionnaire. Results. At least one running injury was reported by 90% of the sample, with a total of 135 injuries were reported (111 overuse injuries, 24 appeared during competing). Lower back pain was the most common source of injury (42.5%). Running in the mountains (p = 0.0004) and following a personalized training schedule (p = 0.0995) were found to be protective factors. Runners involved in physical labor are associated with more injuries (p = 0.058). Higher-level runners are associated with more injuries than lower-level cohorts (p = 0.067), with symptoms most commonly arising in the lower back (p = 0.091), hip joint (p = 0.083), and the plantar surface of the foot (p = 0.054). Experienced runners (> 6 years) are at greater risk of developing injuries (p = 0.001), especially in the lower back (p = 0.012), tibia (p = 0.049), and the plantar surface of the foot (p = 0 .028). Double training sessions could cause hip joint injury (p = 0.060). Conclusions. In order to avoid injury, it is recommended to train mostly on mountain trails and have a training program designed by professionals.