Falls and Ankle Rolls in 227 Distance Trail Runners: Incidence and Contributing Factors Including Neurocognitive...

Trail running involves navigating complex and unstable terrains, increasing the risk of falls or ankle rolls. We aimed to determine the incidence and the role of a multitask assessment in the prediction of injurious mechanisms in trail races ranging from 20 to 50 km.

Prospective cohort.

A total of 227 runners (41.4 [11.2] y) across 9 trail-running races completed a prerace multitask neurocognitive assessment evaluating motor and cognitive performance. After the race, participants reported perceived exertion and any events experienced (falls and ankle rolls), and finish times were recorded from the race clock. Course characteristics, including elevation gain, single-track percentage, and median finish time, were used to describe race difficulty.

Falls and ankle rolls were reported by 27.3% (95% CI, 21.5 to 33.1) and 23.3% (95% CI, 17.8 to 28.8) of runners, respectively. Event frequency was higher in races with faster finishing times, less elevation gain, and a higher proportion of single-track trail. Mixed-effects negative binomial regression models showed that higher motor accuracy was associated with a greater fall rate (incidence rate ratio = 1.12, 95% CI, 1.00 to 1.25, P = .04), whereas cognitive accuracy and reaction time were not significant predictors. A modest cognitive × motor accuracy interaction (P = .03) suggested limited interplay between attentional and motor control processes. Faster running pace and greater perceived effort were the most consistent predictors of falls and combined outcomes (pace incidence rate ratio ≈ 0.88, P < .05; effort incidence rate ratio ≈ 1.31, P < .02).

Falls and ankle rolls were common in trail races, occurring most often in faster and more technical events. Although neurocognitive performance showed limited contribution, the relationship between cognitive and motor accuracy may modestly influence fall risk. Injury-related mechanisms in trail running appear to be multifactorial, with pace, terrain, and perceived effort exerting stronger influence than prerace neurocognitive performance.