ABSTRACT
Purpose: Given the high incidence of injury duringmarathon training, a better understanding of the factors associated with injury is needed. The purpose of the study was to investigate an expanded set of baseline factors of marathon runners to determine the association with injury during training. Method(s): Adult registrants of the 2022 New York City Marathon were recruited by email for a 16-week observational study. The baseline survey included demographics, running/injury/COVID history, race goal, orthotic use, grit scale, risk-taking scale, injury risk self-assessment, happiness and life satisfaction scales, and perceived risks of running. Injury surveys were collected weekly during training. Result(s): A total of 894 runners registered for the study and were uninjured at the start of the study. Average age was 44.5 years (standard deviation 11.8), 55% were female, and 76% had previously participated in a marathon. During the 16 weeks before the race, 221 of 894 (24.7%) experienced an injury, including 36 of 894 (4.0%) who did not participate in the race. Each of the baseline factors were assessed in a logistic regression model controlling for age, sex, body mass index, base weekly mileage, and number of prior marathons. The baseline factors associated with injury were orthotic use (odds ratio [OR] 1.75, 95% confidence interval [CI] 1.12-2.74, P = 0.01), happiness (OR 0.71, 95% CI 0.58-0.88, P = 0.001), and injury risk self-assessment (OR 1.13 for each 10% selfassessed risk, 95% CI 1.05-1.21, P = 0.001). There was no association with age, sex, body mass index, running/injury/ COVID history, race goal, grit, risk-taking behavior, life satisfaction, and perceived risks of running. Conclusion(s): Although age, sex, experience, and history of injury have been previously identified as risk factors for running-related injury, this was not the case in this large cohort of runners training for a marathon. Instead, orthotic use and self-assessed risk of injury were associated with higher rates of injury training, and a higher level of happiness was associated with lower rates of injury. Significance: The results show the value of a comprehensive running injury risk assessment, which could be standardized to facilitate comparative research. Accounting for these factors is important when assessing future injury prevention interventions.