Electromyography patterns during running in injured versus healthy runners: a systematic review

Running injuries are frequently linked to biomechanical factors. Although there has been substantial research investigating the link between kinematic factors and running injury, there has been comparatively less focus on the role of muscle coordination. Previous literature has identified that altered EMG patterns may contribute to the overloading of tissues and to the development or persistence of injury. Therefore, the aim of this systematic review was to synthesize previous research comparing Electromyography (EMG) patterns between injured (Patellofemoral Pain, Achilles Tendinopathy, Iliotibial Band Syndrome, Medial Tibial Stress Syndrome and Hamstring Strain Injury) and uninjured runners.

Six databases (CINAHL, MEDLINE, ProQuest, Scopus, Google Scholar, and Web of Science) were searched from inception to February 2025. Included studies assessed muscle activation via EMG during treadmill or overground running or sprinting. Methodological quality was rated independently by two reviewers using a modified Downs and Black checklist. Meta-analyses were deemed appropriate if more than two studies measured the same outcome parameter. Seventeen studies were included.

Strong evidence indicated no consistent differences in Gluteus Maximus or Gluteus Medius amplitude, or in the onset and duration of Gluteus Medius, Vastus Medialis Oblique, or Vastus Lateralis activity between runners with patellofemoral pain and uninjured runners. These conclusions were based on pooled analyses of relevant subsets of patellofemoral pain studies for each outcome, rather than the full body of included literature. Furthermore, strong evidence indicated no differences in Gluteus Medius amplitude, onset and duration in all running injury populations compared to controls. These conclusions were based on pooled analyses of relevant subsets studies that measured Gluteus Medius for each outcome.

These findings suggest neuromuscular deficits are not present across or within specific injury types (Patellofemoral Pain, Achilles Tendinopathy, Iliotibial Band Syndrome, Medial Tibial Stress Syndrome and Hamstring Strain Injury). The findings may reflect methodological inconsistencies across studies, such as electrode placement, EMG normalisation, task design, and participant characteristics. Future research should adopt standardised EMG protocols, consider the role of the entire kinetic chain, and thoroughly report participant running profiles.