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Table 2 Characteristics of the included studies

From: Prevalence and incidence of low back pain among runners: a systematic review

General informations
(Author, years, study design, country)
Title of the study
Aims of the study Population Incidence or Prevalence RRI definition RUNNER definition LBP
(definition, characteristics, anatomical area)
Outcomes and outcome measures
Bach KD,
1985 [72]
Prospective Cohort study
A comparison of muscular tightness in runners and nonrunners and the relation of muscular tightness to low back pain in runners.
(The Journal Of Orthopaedic And Sports Physical Therapy)
To compare muscular tightness at the hip between runners and nonrunners, and to determine if there is a relation between muscular tightness and low back pain in runners. N = 45 Age = 18–43 years M = 28 (19.4 years) F = 17 (25.7 years)
LBP = 10 (M = 7 F = 3). Running experience > 1 years
I = 22% (1-year incidence) Injury severe enough to temporarily give up the running activity. Runners was defined according to the following criteria: individuals who run 18 or more miles per week, who run on a regular basis, and who have engaged in running for a minimum of 1 year Low Back Pain Goniometric range of motion measurements of three hip movements, abduction, flexion with the knee extended, and extension, were taken on two subject populations, runners, and non-runners, in order to determine tightness of the hip adductor, extensor, and flexor muscles, respectively.
Besomi M,
2019 [66]
Cross-sectional study
Training volume and previous injury as associated factors for Running-Related Injuries by race distance: A Cross-Sectional Study.
(Journal of Human Sport & Exercise)
To determine the relationship between weekly pre-competition running volume and the presence of running-related injuries (RRIs) by race distance. N = 4380
Age = 36
10 km = 1316 21 km = 2168 42 km = 896
LBP = 31 (point prevalence); 307 (1-year overall prevalence; 77 = 10 km; 163 = 21 km; 67 = 42 km)
Running experience = < 1 year = 704; 1–4 years = 2226; > 4 years = 1450.
P = 13.5% (1-year prevalence); 0.7%(point prevalence) A running-related injury was defined as “any injury to muscles, tendons, joints and/or bones caused by running. The injury had to be severe enough to cause or be expected to cause a reduction in distance, speed, duration, or frequency of running for at least 7 days. Conditions such as muscle soreness, blisters, and muscle cramps were not considered as injuries”. Participants was defined as runners if have competed in one of the three SM running distances (10–21-42 km) Lower Back  
Buist I,
2008 [73]
Prospective cohort study
Incidence and risk factors of running-related injuries during preparation for a 4-mile recreational running event.
(British Journal of Sports Medicine)
The purpose of this study is to determine the incidence of RRI and to identify sex-specific predictors of RRI among a group of novice and recreational runners training during an 8-week period for a 4-mile running event. N = 629
M = 207 F = 422
Age = 43.7 years
Running experience = novice runners, runners with previous experience who have taken up running again or runners who were already engaged in regular running.
LBP = 31
I = 4.8% (8 weeks) A running-related injury was defined as any musculoskeletal pain of the lower limb or back causing a restriction in running (mileage, pace or duration) for at least 1 day. The participants had to categorize themselves as novice runners, runners with previous experience who have taken up running again or runners who were already engaged in regular running.
. The training program for novice runners started with ten 1-min repetitions of running alternated by 1 min of walking. The training program for experienced runners started with 30 min of continuous running. The exposure time of running in the training program for novice and recreational runners varied, respectively, between 10 and 40 and 20–60 min per training.
Lower Back
Chang WL,
2012 [67]
Cross-sectional study
Running injuries and associated factors in participants of ing taipei marathon.
(Physical Therapy in Sports)
To investigate the distribution of lower extremity running injuries and their associated factors. N = 893 M = 714 (80%) F = 179 (20%)
Age = 20–50 y
full marathon group
(38.8 11.6 years)
10 km group
(33.6 9.8 years)
Full marathon = 127 (14.3%); Half marathon = 337 (37.7%);10 km = 429 (47.9%)
Running experience: < 1 year = 179; 1-5 years = 435; 5-10 years = 130; > 10 years = 146
LBP = 29; 8 (Full marathon); 11 (Half marathon); 10 (10 km)
P = 3.2% (lifetime prevalence) Questionnaire did not specifically ask the participants to identify if they currently had any symptoms. We would not know how many of the runners only had previous injuries or they also suffered from current injuries. The severity of the running symptoms was not defined in the questionnaire. Regular running was defined as a minimum of 30 min running at least twice a week. Lower Back Pain  
Clement DB,
1981 [69]
Retrospective survey
A survey of overuse running injuries.
(The Physician and Sportsmedicine)
To give an accurate indication of age and sex distributions, training mileage, etiological factors, and the incidence of specific disorders to physicians in sportsmedicine clinics. N = 1650
M = 987 (59.8%) F = 663 (40.2%) Age = 28 years
Running experience = recreational runners
LBP = 68 (M = 36 F = 32);
Nonspecific lower back pain = 54 M = 27 F = 27;
Sciatica = 10 M = 10 F = 3; Spondylolysis = 3 M = 2 F = 1; Spondylolisthesis = 1 F = 1;
I = 3.7% (2 years) Physician diagnosis of RRI To be regarded as a runner, a patient had to be running at least 2 miles (3 km) three days a week at the time of injury. Lower back injuries:
Nonspecific lower back pain; Sciatica; Spondylolysis; Spondylolisthesis
Dallinga J,
2019 [80]
Prospective cohort study
Injury incidence and risk factors: a cohort study of 706 8-km or 16-km recreational runners.
(BMJ Open Sport & Exercise Medicine)
To report (1) the injury incidence in recreational runners in preparation for a 8-km or 16-km running event and (2) which factors were associated with an increased injury risk. N = 706
M = 375 F = 331
Age = 43.9 years
Running experience = novice and recreational runners
LBP = 13
8 km =128
16 km = 521 both distances = 29
I = 1.9% (protocol-event incidence, 12 weeks) Every physical complaint that caused at least 1 week of training loss. Participants was defined as runners if have competed at least in one of the two distances of the run (8-16 km). Lower Back OSTRC and questionnaire of running training and injury related to running
Ellapen TJ,
2013 [70]
Retrospective descriptive study
Common running musculoskeletal injuries among recreational half-marathon runners in kwazulu-natal.
(The South African Journal of Sports Medicine)
To document the prevalence and nature of running-related musculoskeletal injuries among recreational half-marathon runners over a 12-month period (1 July 2011–31 June 2012). N = 200
M = 120 F = 80
Age = 43.6 years
Running experience = cohort regularly participated in half-marathons (21.1 km), with an average road-running history of 12.2 years.
LBP = 28.
*P = 14% (overall 1-year prevalence)
*P = 9% male
*P = 10% female
(* the data of prevalence are related to lower back/hip)
A sensation of distress or agony, and which prevented them from physical activity for a minimum of 24 h To be regarded as a runners, participants have to had run at least an half marathon (21.1 km) Lower Back/Hip  
Kluitenberg B,
2015 [76]
Prospective cohort study
The Nlstart2run Study: Incidence and risk factors of Running-Related Injuries in novice runners.
(The Scandinavian Journal of Medicine & Science in Sports)
The purposes of the study were to assess the incidence of RRIs and to identify risk factors for RRIs in a large group of novice runners. In total,1696runnersofa6-weeksupervised“StarttoRun” program were included in the NLstart2run study. N = 1696
M = 364 F = 1332
Age = 43.3 years
Running experience = novice runners
LBP = 6
I = 0.3% RRI was defined as a musculoskeletal complaint of the lower extremity or back that the participant attributed to running and hampered running ability for three consecutive training sessions at the same body part. Muscle soreness and blisters were not registered.   Pelvis/Sacrum/Buttock  
Lysholm J,
1987 [74]
Prospective cohort study
Injuries in runners.
(The American Journal of Sports Medicine)
To study injury-provoking factors in training and competition, and to compare differences in injury pattern between different groups runners. N = 60
M = 39 F = 11
Age = Sprinters (20.6 ± 3.8), middle-distance runners (18.6 ± 2.4), and long-distance/marathon runners (34.5 ± 7.4)
Running experience = 4 years (sprinters) 3 years (middle distance) 5 years (long distance/marathon)
LBP = 3
I = 5% Any injuries that markedly hampered training or competition for at least 1 week were noted. The participants have a previous experience of running training (7 h per week or more). Low Back Pain  
Marti B,
1988 [68]
Cross-sectional survey
On the epidemiology of running injuries, the 1984 bern grand-prix study.
(The American Journal of Sports Medicine)
- How frequent are jogging injuries in a representative population comparing all participants in a popular running event, and how often do such injuries lead to medical consultation and absence from work?
- Is the incidence of jogging injuries related to behavior and/or characteristics of runners (training mileage, type of running shoes, age, number of years of training, etc.)?
- What are the site and nature of the most common injuries?
- Is there a relation between specific runner characteristics and specific running injuries?
N = 4358
M = 4358
Age = 35.0 years
LBP = 30
P = 0.7% overall 1-years LBP - Grade III injuries
(2.2% lower back; 0.6% pelvic crest; 0.9% buttock)
Runners were asked to classify jogging injuries that had occurred during the previous 12 months according to their effect on running. Grade I injuries involved maintenance of full training activity in spite of symptoms; Grade II, a reduction of training activity, and Grade III, full training interruption, defined as involuntary complete interruption of running of at least two weeks’ duration.   Lower Back
Pelvic Crest
Malliaropoulos N,
2015 [64]
Cross-sectional study
Prevalence of injury in ultra trail running.
(Human Movement)
The purpose of the study was to try to determine the prevalence of lower extremity and lower back musculoskeletal injuries in ultra-trail runners by considering injuries and related symptoms. Additionally, the predicting factors associated with these injuries were investigated in order to aid in the prevention and rehabilitation of trail running injuries. N = 40 ultra-trail runners
M = 36 F = 4
Age = 38.4 years (22–59)
Running experience = Level A = 13; Level B = 27; < 6 years = 21; > 6 years = 19
LBP = 17
P = 20.2% (lifetime) If symptoms were severe enough to forgo training for at least 1 day or causing them to quit a race. According to the International Trail running Association, trail running takes place on various natural terrain (mountain, desert, or forest) while minimizing running on paved or asphalt surfaces (no more than 20% of the total distance in competition). It can involve uphill, downhill, and horizontal trails and is similar in duration to an ultra-marathon, which is considered any race beyond the marathon distance of 42.195 km. Lower Back
Lower Back Pain
Messier SP,
2018 [79]
Prospective cohort study
A 2-year prospective cohort study of overuse running injuries, the runners and injury longitudinal study (TRAILS).
(The American Journal of Sports Medicine)
To determine the risk factors that differentiate recreational runners who remain uninjured from those diagnosed with an overuse running injury during a 2-year observational period. N = 300
M = 172 F = 128
Age = 41.15
Running experience = 11.2%
LBP = 18
I = 6% (2 years) Overuse running injuries were graded with the method defined by Marti et al.: grade 1, maintained full activity in spite of symptoms; grade 2, reduced weekly mileage; and grade 3, interrupted all training for at least 2 weeks Participants was defined as runners if they run a minimum of 5 miles per week. Back -Exercise Self-efficacy Scale (0, lowest self-efficacy; 100, highest self-efficacy)—which assesses beliefs in the ability to continue to run at one’s training pace for periods of 1 to 8 weeks24.
− 12-Item Short Form Health Survey (SF-12) healthrelated quality-of-life survey (0, low; 100, high)—which measures perceived health (mental subscale) and functioning (physical subscale).
-Satisfaction With Life Scale (5, extremely dissatisfied; 35, highly satisfied)—which assesses global judgment of life satisfaction.
-Positive and Negative Affect Scale (PANAS) (10, very slightly; 50, extremely for each scale).
-State-Trait Anxiety Inventory–S Scale (20, not at all; 80, very much)—which asks participants to report how they feel right now.
-Visual analog scale for pain (0, no pain; 10, extreme pain).
Rasmussen CH,
2013 [71]
Retrospective cohort study
Weekly running volume and risk of running-related injuries among marathon runners.
(The International Journal of Sports Physical Therapy)
The purpose of this study was to investigate if the risk of injury declines with increasing weekly running volume before a marathon race N = 662
M = 535 F = 127
Age = 41.4
Running experience = marathon runners: < 2 years = 49; 2–5 years = 262; > 5 years = 351;
LBP = 3
I = 0.5% point incidence The running-related injury definition was modified based on the injury definition used by Macera et al.; a running-related injury was defined as an injury to muscles, tendons, joints and/or bones caused by running; The injury had to be severe enough to cause or be expected to cause a reduction in distance, speed, duration, or frequency of running for at least 14 days. Conditions like muscle soreness, blisters, and muscle cramps were not considered as injuries. Completion of the H.C. Andersen marathon Lower Back  
Tauton JE,
2003 [75]
Prospective cohort study
A prospective study of running injuries: the vancouver sun run “in training” clinics.
(British Journal of Sports Medicine)
To determine the injury pattern in a sample of the “In Training” clinics during their 13 weeks program, and identify associated risk factors for injury. N = 840
M = 205 F = 635
Age = 30–56 years
Running experience = novice runners
LBP = 37
I = 1.6%
Low back = 7% (4 men), =5% (10 women) -Hip/pelvis: =7% (4 men), =10% (19 women)
  -The novice group is primarily sedentary and deconditioned people interested in establishing a running program probably to improve health and fitness. The program for this group incorporates run/walk repeats that eventually lead to a continuous running session in the 12th week.
-The intermediate program is designed for people who have completed the novice walk/run program and would like to increase their running endurance and intensity in a safe and effective way. Hill training, interval, and fartlek sessions are implemented.
Low Back  
Teixeira RN,
2016 [65]
Cross-sectional study
Prevalence of musculoskeletal pain in marathon runners who compete at the elite level.
(The International Journal of Sports Physical Therapy)
The purpose of this research was to assess the prevalence, location and intensity of running related musculoskeletal pain over the previous 12 months in marathon runners who compete at the elite level and to verify whether certain training characteristics are associated with musculoskeletal pain. N = 199
M = 164 F = 35
Age = 34 (30–39)
Running experience = marathon runners at elite level, on average of 11 years;
LBP = 28
(Lumbar Spine 20; Pelvic/Sacral/Gluteus 8)
P = 14% (1-year prevalence)   Runners who compete at the elite level, defined as those competing at international and/or national level; Their training is characterized by a high training volume, with weekly training loads of up to 160 km/week. Lumbar Spine
van der Worp MP,
2016 [77]
Prospective cohort study
The 5- or 10-km Marikenloop run: a prospective study of the
etiology of running-related injuries in women.
(Journal of Orthopaedic & Sports Physical Therapy)
To determine the incidence and characteristics (site and recurrence) of running-related injuries and to identify specific risk factors for running-related injuries. N = 373 (5 km = 189; 10 km = 184)
F = 373
Age = 37.55
Running experience = novice runners
LBP = 10 (4 Lower Back; 6 Buttock)
I = 2.7% Defined as running-related pain of the lower
back and/or the lower extremity that restricted running for at least 1 day.
Adult women (aged ≥18 years) who had signed up for the ‘Marikenloop 2013’ running event were eligible for inclusion. The ‘Marikenloop’ is a run over 5- or 10 km in Nijmegen, the Netherlands, and is a female-only event. Lower Back
Von Rosen P,
2017 [78]
Prospective cohort study
Etiology of running-related injuries in women.
(The International Journal of Sports Physical Therapy)
The aims of this study were to describe the injury prevalence/incidence, severity grade, injury location, risk factors and the prevalence of illness in running (RU), orienteering (OR) and cross-country skiing athletes (CR). N = 189
F = 189
Age = range 18–24
Running experience = elite athletes
LBP = 5
I = 2.8% As any physical complaint that affected participation in normal training or competition, led to reduced training volume, experience of pain or reduced performance in sports; * A substantial injury was defined as an injury leading to moderate or severe reductions in training volume, or moderate or severe reduction in performance, or complete inability to participate in sports; * A new injury was categorized as a recurrent or a non-recurrent injury, based on if the injury occurred in the same body site as the previous injury within the last year.   Low Back Pain
Lower Back
Walter SD,
1989 [81]
Prospective cohort study
The Ontario Cohort Study of Running-Related Injuries.
(Archives of Internal Medicine)
The purpose of this study was to investigate the incidence and causes of running injuries. N = 1288
M = 985 F = 303
Age = 41.4
Running experience=
LBP = 23 new injuries; 56 old injuries
I = 1.8% (point incidence)
P = 4.3% (1-year prevalence)
  All registered entrants to these events: 16-km (10-mile) race, 4-km (2.5-mile) fun run in St Catharines. 22.4-km (14mile) run and a four-member 5.6-km (3.5-mile) team relay in Burling ton were included. Back
Back Injuries
Woolf SK,
2002 [63]
Cross-sectional survey
The Cooper River Bridge Run of low back pain in runners and walkers.
(Journal of the Southern Orthopaedic Association)
The purpose of this study was to investigate the incidence, prevalence, and possible risk factors for LBP among a group of runners and walkers. N = 436
M = 227 F = 209
Age = 36.45 years
Running experience = any kind of runner from novice to athletes
LBP = 59
P = 13.6% (point prevalence)    Low Back Pain