García-Valiente et al. 2026, Muscle, neuromuscular and cardiac damage in trail running

PRISMA 2020 systematic review registered in PROSPERO (Muscles, 5(1):9; 15 studies, 247 participants, databases searched to August 2025). Trail running consistently produces marked post-race elevations in muscle-damage biomarkers (creatine kinase, ALT), significant reductions in neuromuscular force production lasting several days, and transient cardiac biomarker elevations. Eccentric load from downhill running is identified as the primary driver of quadriceps damage and force loss. Moderate.