The surface upon which running is performed has been suggested as a potential cause of many running-related injuries. It remains unclear, however, what effect surface compliance has on running biomechanics. This study aimed to investigate the effect of surface compliance on overground running biomechanics through a systematic review and meta-analysis. Using the PRISMA Protocols Statement, a search was conducted in three electronic databases (CINAHL, EMBASE, EBSCO) using the following anchoring terms: running, overground surface, biomechanics, kinematics, tibial acceleration, pressure and force. Following de-duplication, title/abstract screening and full-text review, 25 articles (n = 492) were identified which met all inclusion criteria, 22 (n = 392) of which were subsequently included in quantitative synthesis. Random effects analysis found that peak tibial acceleration was significantly lower when running on softer surfaces (P = 0.01, Z = 2.51; SMD = -0.8; 95% CI =-1.42 to -0.18). However, peak vertical ground reaction force, loading rate and ground contact time were not significantly different when comparing hard and soft surfaces. Since peak tibial acceleration has been associated with an increased risk of tibial stress injuries, the results of this meta-analysis suggest that running on softer surfaces to reduce impact stress on the tibia is probably justified to lower the risk of running-related stress injuries.
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