Muscle, Neuromuscular, and Cardiac Damage in Trail Running: A Systematic Review.

Area of Science:

• Exercise physiology
• Sports medicine
• Endurance sports research

Background:

• Trail running (TR) involves prolonged exercise on challenging terrain with significant elevation changes.
• These conditions increase eccentric muscular load, potentially leading to muscular, neuromuscular, and cardiac damage.
• Understanding these physiological impacts is crucial for athlete health and performance.

Purpose of the Study:

• To systematically review existing evidence on muscular, neuromuscular, and cardiac damage in trail runners.
• To synthesize findings regarding the physiological stress induced by trail running participation.
• To inform best practices for training, recovery, and injury prevention in this discipline.

Main Methods:

• Systematic review adhering to PRISMA 2020 guidelines, registered on PROSPERO.
• Comprehensive search of five major scientific databases up to August 2025.
• Inclusion of observational, longitudinal, prospective, and case studies on healthy adolescent and adult trail runners, analyzing muscle, neuromuscular, and cardiac biomarkers.

Main Results:

• Fifteen studies involving 247 participants were included.
• Consistent findings of elevated muscle damage biomarkers and reduced neuromuscular performance post-race.
• Transient increases in cardiac biomarkers indicated acute, reversible cardiac stress after trail running events.

Conclusions:

• Trail running induces significant acute muscular, neuromuscular, and cardiac stress, particularly in events with high eccentric loading.
• Biochemical and neuromuscular monitoring can aid in optimizing training loads and recovery strategies.
• This approach may contribute to enhanced injury prevention for trail runners.