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The findings were categorized into three primary areas. Musculoskeletal injuries, particularly involving the lower limbs, are the most frequently reported, often resulting from overuse, inadequate recovery, or suboptimal training adaptation. Medical complications such as acute kidney injury, gastrointestinal distress, and exercise-associated hyponatremia are also common, especially in prolonged or multi-stage events. Skin-related disorders, including blisters and abrasions, frequently contribute to performance decline or race withdrawal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The unique demands of ultra trail running, such as prolonged exertion, uneven terrain, extreme environmental exposure, and limited recovery time, contribute to the multifactorial nature of injuries and illnesses in this sport. A multidisciplinary approach involving individualized training, preventive strategies, and athlete self-management is essential. Improving our understanding of these challenges may help optimize prevention and management, ultimately enhancing both safety and endurance performance in ultra trail athletes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10538127261446412","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T20:41:02Z","timestamp":1777408862000},"page":"1859-1870","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Sky's the limit: A comprehensive narrative review on the epidemiology of injuries and illnesses in ultra trail running"],"prefix":"10.1177","volume":"39","author":[{"given":"Giorgio Carmelo","family":"Basile","sequence":"first","affiliation":[{"name":"Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"Alito","sequence":"additional","affiliation":[{"name":"Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"de Sire","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro \u201cMagna Graecia\u201d, Catanzaro, Italy"},{"name":"Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro \u201cMagna Graecia\u201d, Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Cova","sequence":"additional","affiliation":[{"name":"Research Laboratory in Biomechanics, Rehabilitation and Ergonomics, IRCCS, Istituto Auxologico Italiano, Verbania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Filardi","sequence":"additional","affiliation":[{"name":"D.A. 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