Dehydration as an injury risk in endurance athletes. Systematic review
DOI:
https://doi.org/10.70208/3007.8245.v6.n1.334Keywords:
dehydration, injury risk, endurance athletes, musculoskeletal injuries, hydration monitoringAbstract
Objective: To synthesize recent evidence (2020‑2025) on the association between dehydration and musculoskeletal injury risk in endurance athletes.Methods: PRISMA 2020 systematic review in PubMed, Google Scholar, SciELO, and Cochrane Library (2020‑2025). Original Spanish/English studies on dehydration in endurance athletes with injury assessment were included. Out of 15,653 records, 19 met criteria and were analyzed qualitatively.Results: Dehydration shows a clear dose‑response relationship with injury risk, with a critical threshold at 2 % body mass loss where risk increases significantly (40‑55 %). Lower‑extremity overuse injuries were most frequently associated (Achilles tendinopathy: 67 %; medial tibial stress syndrome: 50 %). Proposed mechanisms include impaired neuromuscular function (78 %), increased peripheral fatigue (72 %), and reduced joint stability (61 %). Runners showed higher injury prevalence (85 %) than cyclists (55 %). Environmental factors exacerbated risk.Conclusion: Dehydration is a significant risk factor for musculoskeletal injuries in endurance athletes, particularly beyond the 2 % body‑mass‑loss threshold. Systematic hydration monitoring and preventive strategies below this threshold are essential for injury prevention and athlete safety.
References
American College of Sports Medicine, Sawka, M. N., Burke, L. M., Eichner, E. R., Maughan, R. J., Montain, S. J., & Stachenfeld, N. S. (2007). Exercise and fluid replacement. Medicine & Science in Sports & Exercise, 39(2), 377–390. https://doi.org/10.1249/mss.0b013e31802ca597
Armstrong, L. E. (2021). Rehydration during endurance exercise: Challenges, research, options, methods. Nutrients, 13(3), 887. https://doi.org/10.3390/nu13030887
Armstrong, L. E., Ganio, M. S., Casa, D. J., Lee, E. C., McDermott, B. P., Klau, J. F., & Maresh, C. M. (2012). Mild dehydration affects mood in healthy young women. The Journal of Nutrition, 142(2), 382–388. https://doi.org/10.1093/jn/142.2.382
Arnaoutis, G., & Neophytou, P. (2025). The effect of acute dehydration upon muscle strength indices in elite karate athletes: A randomized crossover study. Nutrients, 17(9), 1452. https://doi.org/10.3390/nu17091452
Barley, O. R., Chapman, D. W., & Abbiss, C. R. (2020). Reviewing the current methods of assessing hydration in athletes. Journal of the International Society of Sports Nutrition, 17, Article 52. https://doi.org/10.1186/s12970-020-00381-6
Corti, D. (2021). Hidratación en deportistas de élite: Revisión bibliográfica [Tesis de licenciatura, Universidad Europea de Madrid].
Fernández-Elías, V. E., Martínez-Abellán, A., López-Gullón, J. M., Morán-Navarro, R., Pallarés, J. G., De la Cruz-Sánchez, E., & Mora-Rodríguez, R. (2014). Validity of hydration non-invasive indices during the weight cutting and official weigh-in for Olympic combat sports. PLOS ONE, 9(4), e95336. https://doi.org/10.1371/journal.pone.0095336
Grundstein, A. J., Hosokawa, Y., & Casa, D. J. (2018). Fatal exertional heat stroke and American football players: The need for regional heat-safety guidelines. Journal of Athletic Training, 53(1), 43–50. https://doi.org/10.4085/1062-6050-445-16
Grundstein, A., Knox, J. A., Vanos, J., Cooper, E. R., & Casa, D. J. (2017). American football and fatal exertional heat stroke: A case study of Korey Stringer. International Journal of Biometeorology, 61(8), 1471–1480. https://doi.org/10.1007/s00484-017-1324-2
Hernández Ponce, L., Carrasco García, M. S., Fernández Cortés, T. L., González Unzaga, M. A., & Ortiz Polo, A. (2021). Nutrición e hidratación en el deportista y su impacto en el rendimiento deportivo. Educación y Salud: Boletín Científico Instituto de Ciencias de la Salud, 9(18), 141–152. https://doi.org/10.29057/icsa.v9i18.6366
James, L. J., & Mears, S. A. (2021). Does dehydration really impair endurance performance? Recent methodological advances helping to clarify an old question. Sports Science Exchange, 29(214). Gatorade Sports Science Institute.
çKakouris, N., Yener, N., & Fong, D. T. P. (2021). A systematic review of running-related musculoskeletal injuries in runners. Journal of Sport and Health Science, 10(5), 513–522. https://doi.org/10.1016/j.jshs.2021.04.001
Khan, A., et al. (2023). Risk factors associated with dehydration among athletes. The Therapist, 4(2), Article 98. https://doi.org/10.54393/tt.v4i02.98
King, M. A., & Baker, L. B. (2020). Dehydration and exercise-induced muscle damage: Implications for recovery. Sports Science Exchange.
Maughan, R. J., & Shirreffs, S. M. (2010). Dehydration and rehydration in competitive sport. Scandinavian Journal of Medicine & Science in Sports, 20(Suppl. 3), 40–47. https://doi.org/10.1111/j.1600-0838.2010.01207.x
Métodos para la evaluación del estado de hidratación en ejercicio y deporte. (2024). Archivos de la Sociedad Chilena de Medicina del Deporte, 69(1), 35–46. https://doi.org/10.59856/arch.soc.chil.med.deporte.v69i1.84
Pfeffer Burak, F., & Torres Gutiérrez Rubio, A. (2024). Hidratación: Fundamentos en las diferentes etapas de la vida. Editorial Alfil.
Rehrer, N. J. (2001). Fluid and electrolyte balance in ultra-endurance sport. Sports Medicine, 31(10), 701–715. https://doi.org/10.2165/00007256-200131100-00001
Steinbacher, P., & Eckl, P. (2015). Impact of oxidative stress on exercising skeletal muscle. Biomolecules, 5(2), 356–377. https://doi.org/10.3390/biom5020356
The Associated Press. (2015, August 7). Ironman athlete died of dehydration, excessive exercise, coroner says. CBS News.
Walters Inc. (2018, September 21). An independent evaluation of procedures and protocols related to the June 2018 death of a University of Maryland football student-athlete [Informe]. University System of Maryland.
