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. 2024 Nov 26;10(1):127.
doi: 10.1186/s40798-024-00790-w.

Association Between Inter-Limb Asymmetry and Determinants of Middle- and Long-distance Running Performance in Healthy Populations: A Systematic Review

Joachim D'Hondt  1 , Laurent Chapelle  2 , Chris Bishop  3 , Dirk Aerenhouts  2 , Kevin De Pauw  4   5 , Peter Clarys  2 , Eva D'Hondt  2
Affiliations

Association Between Inter-Limb Asymmetry and Determinants of Middle- and Long-distance Running Performance in Healthy Populations: A Systematic Review

Joachim D'Hondt et al. Sports Med Open. .

Abstract

Background: The presence of inter-limb asymmetry in the human body has traditionally been perceived to be detrimental for athletic performance. However, a systematic review addressing and comprehensively assessing the association of asymmetry between the lower limbs and middle- and long-distance running performance-related metrics is currently lacking.

Objective: The main purpose of this systematic review was to examine the relationship between lower inter-limb asymmetry and determinants of running performance in healthy middle- and long-distance runners. The secondary objective was to identify possible avenues for further research in this area.

Methods: PubMed, Web of Science and SPORTDiscus were systematically searched for studies investigating the relationship between lower inter-limb asymmetry and (determinants of) running performance in healthy and injury-free middle- and long-distance runners. The quality of studies eligible for inclusion was assessed using the Downs and Black Quality Index Tool.

Results: Out of 4817 articles screened, 8 studies were included in this review which assessed the association between functional, morphological, kinematic and kinetic asymmetry and running performance-related metrics. The quality score of the included research varied between 5/10 and 9/10. Our results revealed mixed findings, showing both significant negative (n = 16) and positive (n = 1) associations as well as no significant associations (n = 30) between inter-limb asymmetry and running performance-related metrics.

Conclusions: A high heterogeneity across study methods and outcomes was apparent, making it difficult to draw a straightforward conclusion. Our results indicate that the majority of metrics of functional, morphological, kinematic and kinetic inter-limb asymmetry are negatively or not associated with running performance (and/or its determinants). Thus, a more extensive high-quality body of research using standardised asymmetry magnitude metrics is essential to determine whether, and to what extent asymmetry between the lower limbs could affect middle- and long-distance running performance. Future studies should establish potential trade-off values to help practitioners develop evidence-based training programs.

Key points: In the majority of the metrics, the magnitude of lower inter-limb asymmetry was negatively or not associated with middle- and long-distance running performance. Coaches, athletes and researchers should be attentive of the task, time- and metric-specificity as well as the inter- and intra- individual variability of magnitude outcomes, when assessing inter-limb asymmetries.

Keywords: Between-limb; Bilateral difference; Biomechanics; Distance running; Functional asymmetry; Kinematic asymmetry; Kinetic asymmetry; Morphological asymmetry; Running economy; Side-to-side differences.

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Conflict of interest statement

Declarations. Ethical Approval and Consent to Participate: Not applicable. Consent for Publication: Not applicable. Competing Interests: Joachim D’Hondt, Laurent Chapelle, Chris Bishop, Dirk Aerenhouts, Kevin De Pauw, Peter Clarys and Eva D’Hondt have no conflicts of interest relevant to this review.

Figures

Fig. 1
Fig. 1
Flow diagram representing the selection and identification process of studies
Fig. 2
Fig. 2
Points of attention for future researchers of inter-limb asymmetry in endurance runners
See this image and copyright information in PMC

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