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Should Adolescents Run Marathons?: Youth Marathon Training Injury Epidemiology and Risk Factors

Objective: Youth participation in distance running has increased, yet little data exist about the injury patterns and safety of such activity. This study seeks to determine the types and rates of injuries seen in an adolescent marathon training program. Design: Observational prospective cohort study. Setting: Community-based adolescent marathon training program. Participants: The study enrolled 1927 students from 50 high schools (HS) and 34 middle schools (MS) participating in the 2017 to 2018 Students Run Los Angeles marathon training program. Assessment of Risk Factors: Weekly injury reports completed by running coaches. Data elements included participant demographics, weekly training distance, injury type, injury acuity, and missed training time. Main Outcome Measures: Epidemiology of self-reported injury in adolescent runners. Results: A total of 583 injuries occurred in 18% of runners during the training program. High schools runners were more likely to be injured than MS runners (20.8% vs 14.2%, P < 0.001). Seventy-two percent of injuries were acute with a mean missed training time of 4.8 days (SD 4.8). The most frequent site of injury was the knee (33%). Overall, runners with injuries ran a significantly greater distance per week than uninjured runners (14.6 mi vs 12.0 mi, P < 0.001). Ninety-nine percent of marathon participants completed the race. Conclusions: During a 28-week marathon training program, 18% of adolescent participants reported an injury. More injuries occurred in HS students, were acute, and involved the knee. This study represents one of the largest descriptions of injury prevalence in adolescent distance running and highlights a lower injury rate than adults during marathon training.