Psychological Profile of Trail Runners Associated With Running-Related Injuries: A Prospective Study

Background: Trail running has increased in popularity due to the benefits of physical activity in nature. However, trail running has an inherent risk of running-related injuries (RRI). It is known that athletes with certain psychological traits have a greater tendency to suffer injuries; however, this is unknown in trail runners. The main objective of this study was to identify trail runners’ psychological profiles and to compare the proportion of RRI across these profiles. Hypothesis: Trail runners with psychological profiles of high stress, precompetitive anxiety, mental fatigue, competitiveness, and poor sleep quality are at increased risk of RRI. Study Design: Prospective cohort study. Level of Evidence: Level 2. Methods: A Gaussian mixture model cluster analysis was performed on 202 trail runners (55.5% male; aged 38.7 [33.4-46.2] years) with psychological stress, cognitive and somatic anxiety, self-confidence, mental fatigue, sleep quality, and competitiveness measured 4 weeks before participating in a race. The proportion of RRI during the race was recorded and compared across clusters. Results: Overall RRI proportion during competition was 11.3% (n = 24). The most common RRI were muscle (41.7%) and tendon/bursa (16.7%) injuries, affecting primarily the knee (33.3%) and lower leg (20.8%). Five psychological profiles were identified. Cluster 1 (competitive runners with moderate psychological stress and mental fatigue, low sleep quality and anxiety, and high self-confidence) had a higher RRI proportion than Cluster 3 (similar traits but lower psychological stress, mental fatigue, and higher self-confidence; 21.2% vs 3.2%; P = 0.02). Conclusion: Certain psychological profiles in trail runners were associated with higher RRI risk. Clinical Relevance: The medical team or trail running coaches should monitor runners with psychological profiles with higher psychological stress, mental fatigue, and cognitive anxiety, as well as lower self-confidence and sleep quality, to design strategies to reduce their risk of RRI.