Biomechanical and musculoskeletal measures as risk factors for running-related injury in non-elite runners a systematic review and meta-analysis

Introduction: Recreational running is among the most popular forms of physical activity, worldwide. Although associated with numerous health and wellbeing benefits, participation is accompanied by high rates of running-related injury (RRI). Biomechanical and musculoskeletal measurements have been purported to influence a runner’s risk of RRI, however prospective evidence for these relationships is inconclusive. The objective of this systematic review was to synthesise the currently available prospective data for the relationship between all types of biomechanical and musculoskeletal characteristics, and the risk of RRI in non-elite runners. Methods: This study was a systematic review and meta-analysis of prospective studies. Electronic searching of MEDLINE, EMBASE, CINAHL, SPORTDiscus, AMED, and The Cochrane Library, was conducted from inception until January 13th, 2021, in addition to searching grey literature and reference lists of included studies. The following eligibility criteria for selecting studies were applied: prospective studies of non-elite adult runners that measured a relationship between biomechanical and musculoskeletal measures and the incidence of any type of RRI subsequent to that assessment. Studies were in which runners were provided with any non-running intervention, such as footwear or an injury prevention program, were excluded. Record screening, quality appraisal, and data extraction were performed independently by two reviewers. Results: Thirty studies (3404 runners), testing over 100 discrete biomechanical and musculoskeletal risk factors for RRI, were included. Meta-analyses were conducted combining the data from nineteen studies in twenty-five separate pooled analyses. Meta-analysis of four studies detected a significant trivial relationship between knee extension strength and incidence of RRI (SMD -0.19, 95%CI -0.36 to -0.02, p=0.03). A meta-analysis of two studies detected a significant relationship between hip adduction velocity and RRI (MD -12.80, 95%CI -25.22 to -0.38, p=0.04). Remaining meta-analyses found no significant relationship between biomechanical or musculoskeletal variables and the incidence of RRI. Discussion: This findings of this systematic review and meta-analysis do not generally support the association between biomechanical or musculoskeletal measures and the incidence of RRI in non-elite runners. Significant results from two pooled analyses should be considered in the context of their trivial to small effect sizes, and their clinical applicability should not be overstated. Until further evidence becomes available, biomechanical and musculoskeletal measures should not be used to determine a runner’s risk of RRI, and recommendations for injury prevention in non-elite runners should be focused on better established risk factors for RRI, such as previous injury and training characteristics. Conflict of interest statement: Five of the authors of this systematic review (BP, MS, FH, RC, VC) contributed unpublished data, from an ongoing study of which they are also authors, for re-analysis in this review. The authors declare no other competing interests.