Incidence and Determinants of Lower-Extremity Running Injuries in long-distance runners
Systematic review
Key Findings
Incidence of lower-extremity running injuries across the included studies: 19.4-79.3% (a wide spread by definitions/populations)
The knee is the predominant location of injuries
Strong evidence: a long weekly training distance in male runners and a history of previous injuries were risk factors for injury
Strong evidence, in the opposite direction to intuition: an increase in weekly training distance was a protective factor for knee injuries — the review does not support "any increase in mileage = more knee injuries"
Other sites (lower leg 9.0-32.2%, foot 5.7-39.3%, upper leg 3.4-38.1%, ankle 3.9-16.6%, hip/pelvis 3.3-11.5%) and other candidate risk factors (biomechanics, foot type/arch index, shoes) are discussed in the paper but not in the abstract; the evidence for those factors is only limited (full text, checked 2026-09-28: Table 3, Results)
Practical Application
Systematic review of long-distance runners: lower-extremity injury incidence 19.4-79.3% depending on definition and population, the knee is the most common site; strong evidence that a long weekly distance (in male runners) and a previous injury are risk factors — and that an increase in weekly distance was protective for knee injuries.
Total weekly volume is the main modifiable lever in men — the injury conversation is about how much is being run; how fast volume changes is a separate question with its own, much weaker evidence (REF-565).
A previously injured site is the strongest individual flag — full rehabilitation before returning to load, and closer watching of that site when volume rises.
Not from this paper: orthotics, technique changes and foot type were not among the strong-evidence findings in the abstract; treat them as unproven fixes.
Masters runners were not separated out; with slower tissue recovery (REF-517, REF-349) their progression should be more conservative than the pooled population's — inference, not tested.
Limitations
2007 review; injury definitions are heterogeneous across studies (wide incidence spread)
Associations, not causation; many risk factors are not unambiguously confirmed
Does not separate masters runners (whose risk is probably higher)
The "long weekly distance" risk factor was found in male runners; the protective effect of increasing weekly distance was for knee injuries specifically
How this entry was checked and changed
Why this level
regraded 2026-09-27 from A: systematic review of observational studies with heterogeneous injury definitions (incidence 19.4-79.3%), best-evidence synthesis rather than meta-analysis
Content correction 2026-09-27
Entry listed "then the shin, foot/Achilles, thigh" as injury sites and "weak/conflicting evidence for pronation, foot type" as findings -> not in the abstract; removed from findings / labelled.
Entry said weekly distance is a strong predictor and framed the issue as "how much and how fast it changes" -> abstract: long weekly distance was a risk factor in MALE runners, and an INCREASE in weekly distance was PROTECTIVE for knee injuries. Lead and bullets corrected.
Level A -> A- (systematic review of observational studies, best-evidence synthesis, heterogeneous definitions). Sport line: "strength" removed (not a study discipline).
2026-09-28: lines labelled "full text; not checked" read against the open-access full text (PMC2465455): 1 confirmed, 0 corrected, 0 removed. Site ranges added from Table 3.