Joachim et al. 2024, injury risk factors in cross-country runners (review)

Systematic review in the Journal of Orthopaedic & Sports Physical Therapy of risk factors for running-related injury in high-school and collegiate cross-country runners, covering 24 studies. The strongest predictors were female sex and a history of prior injury, both non-modifiable. A low step rate was flagged for bone stress injury; a quadriceps angle above 20° and weaker thigh musculature raised risk; and elevated risk factors for Relative Energy Deficiency in Sport raised overall and bone-stress injury risk (moderate certainty). Modifiable signals such as spikes in training volume, poor sleep and early specialisation may raise risk but rest on low-certainty evidence. Varied, challenging footing is noted as a plausible contributor but is not itself quantified. The authors rate the overall certainty of evidence as low to moderate.