Sky's the limit: A comprehensive narrative review on the epidemiology of injuries and illnesses in ultra trail running.

BackgroundUltra trail running is an increasingly popular, yet physically and psychologically demanding sport, associated with a high risk of injury and illness.ObjectiveUnderstanding the epidemiology of these conditions is essential to enhance both athlete safety and performance.MethodsA narrative search was conducted in PubMed, Scopus, and the Cochrane Library for studies published in English between 2004 and 2024 using keywords including "ultra trail running," "ultramarathon," "injury," "illness," "epidemiology," and "risk factors.".ResultsA total of 18 were included. The findings were categorized into three primary areas. Musculoskeletal injuries, particularly involving the lower limbs, are the most frequently reported, often resulting from overuse, inadequate recovery, or suboptimal training adaptation. Medical complications such as acute kidney injury, gastrointestinal distress, and exercise-associated hyponatremia are also common, especially in prolonged or multi-stage events. Skin-related disorders, including blisters and abrasions, frequently contribute to performance decline or race withdrawal.ConclusionThe unique demands of ultra trail running, such as prolonged exertion, uneven terrain, extreme environmental exposure, and limited recovery time, contribute to the multifactorial nature of injuries and illnesses in this sport. A multidisciplinary approach involving individualized training, preventive strategies, and athlete self-management is essential. Improving our understanding of these challenges may help optimize prevention and management, ultimately enhancing both safety and endurance performance in ultra trail athletes.