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Meta-Analysis
. 2021 May;51(5):1011-1039.
doi: 10.1007/s40279-020-01412-7. Epub 2021 Jan 12.

Sex-Specific Differences in Running Injuries: A Systematic Review with Meta-Analysis and Meta-Regression

Karsten Hollander  1   2 , Anna Lina Rahlf  3 , Jan Wilke  4 , Christopher Edler  5 , Simon Steib  6 , Astrid Junge  7   8 , Astrid Zech  3
Affiliations
Meta-Analysis

Sex-Specific Differences in Running Injuries: A Systematic Review with Meta-Analysis and Meta-Regression

Karsten Hollander et al. Sports Med. 2021 May.

Abstract

Background: Running is a popular sport with high injury rates. Although risk factors have intensively been investigated, synthesized knowledge about the differences in injury rates of female and male runners is scarce.

Objective: To systematically investigate the differences in injury rates and characteristics between female and male runners.

Methods: Database searches (PubMed, Web of Science, PEDro, SPORTDiscus) were conducted according to PRISMA guidelines using the keywords "running AND injur*". Prospective studies reporting running related injury rates for both sexes were included. A random-effects meta-analysis was used to pool the risk ratios (RR) for the occurrence of injuries in female vs. male runners. Potential moderators (effect modifiers) were analysed using meta-regression.

Results: After removal of duplicates, 12,215 articles were screened. Thirty-eight studies were included and the OR of 31 could be pooled in the quantitative analysis. The overall injury rate was 20.8 (95% CI 19.9-21.7) injuries per 100 female runners and 20.4 (95% CI 19.7-21.1) injuries per 100 male runners. Meta-analysis revealed no differences between sexes for overall injuries reported per 100 runners (RR 0.99, 95% CI 0.90-1.10, n = 24) and per hours or athlete exposure (RR 0.94, 95% CI 0.69-1.27, n = 6). Female sex was associated with a more frequent occurrence of bone stress injury (RR (for males) 0.52, 95% CI 0.36-0.76, n = 5) while male runners had higher risk for Achilles tendinopathies (RR 1. 86, 95% CI 1.25-2.79, n = 2). Meta-regression showed an association between a higher injury risk and competition distances of 10 km and shorter in female runners (RR 1.08, 95% CI 1.00-1.69).

Conclusion: Differences between female and male runners in specific injury diagnoses should be considered in the development of individualised and sex-specific prevention and rehabilitation strategies to manage running-related injuries.

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Conflict of interest statement

Karsten Hollander, Anna Rahlf, Jan Wilke, Christopher Edler, Simon Steib, Astrid Junge and Astrid Zech have no conflicts of interest relevant to the content of this review.

Figures

Fig. 1
Fig. 1
Flow diagram displaying the literature search
Fig. 2
Fig. 2
Funnel plot of the overall differences between injury rate of female and male runners (log risk ratios against standard error)
Fig. 3
Fig. 3
Forest plot depicting the meta-analytical results comparing risk ratios for male and female runners regarding injuries per 100 runners
Fig. 4
Fig. 4
Forest plot depicting the meta-analytical results comparing risk ratios for male and female runners regarding injuries per exposure (hours or athlete exposures)
Fig. 5
Fig. 5
Forest plot depicting the meta-analytical results for sub-analysis (competition distance) of risk ratios for male and female runners regarding injuries per 100 runners. Subgroup 1 (a) represents studies investigating runners competing in distances below or equal to 10 km and subgroup 2 (b) in distances above 10 km
Fig. 6
Fig. 6
Forest plot depicting the meta-analytical results comparing risk ratios for male and female runners regarding bone stress injuries
Fig. 7
Fig. 7
Forest plot depicting the meta-analytical results comparing risk ratios for male and female runners regarding Achilles tendinopathy
See this image and copyright information in PMC

Comment in

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