New tech for runners, could it be a leap forward for managing running injury?

I’ve always found emerging technology interesting, my inner geek loves unboxing a shiny new toy! In the excitement and novelty of trialling the latest gadget we should also be asking the right questions about the technology and considering if it’s fit for use in clinic. Today we’ll look at some of the new equipment and software that’s available for us in clinic and take guidance from a great ‘master class’ paper on the topic from the brilliant Rich Willy;

Innovations and pitfalls in the use of wearable devices in the prevention and rehabilitation of running related injuries (Willy 2017)

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A quick note before we start – we are not affiliated to any specific product and when we mention them on the site it is purely because we’re interested in their use for fellow runners. We receive no financial incentive for this and don’t endorse a particular brand.

Let’s start with the serious stuff! Before we talk tech we really need to be aware of the potential limitations and recognise that in some areas there can be a triumph of sales over science. Rich Willy’s recent paper provides a great overview and I highly recommend reading it in full and following Rich on Twitter via @rwilly2003. This paragraph in particular highlights the importance of ensuring data is both accurate and relevant;

“Clinicians and runners are cautioned to fully investigate the accuracy, reliability and value of any wearable device prior to incorporating them into practice. Even if accurate and reliable, many metrics provided by these devices may not relate to RRIs or performance, and hence be of little value. In a quote attributed to William Bruce Cameron, “not everything that can be counted counts, and not everything that counts can be counted” (Cameron, 1967).” Willy (2017)
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*RRI = Running Related Injury
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We can improve accuracy and reliability by identifying potential sources of error and developing consistent methods in using this technology that help address these potential errors. Rich’s paper goes on to highlight 4 key areas where wearable running technology may have a role. We’ll explore them below with some examples of equipment or software we’ve used with runners in clinic;
  1. Determine movement patterns or training loads that may be associated with injury
    • Movement analysis Apps like Hudl Technique, Coaches Eye and Dartfish allow us to examine running gait in slow motion to identify kinematics (movement patterns) that may be linked to increased load or injury. For example, increased hip adduction during stance has been linked to patellofemoral pain (Neal et al. 2015) and can usually be identified using this software (Dingenen et al. 2017). You’d be right to wonder though, is 2D video analysis reliable?  Maykut et al. (2015) used Dartfish and reported that frontal plane kinematics, including hip adduction, demonstrated high reliability. Assessment of kinetics (forces) is usually more challenging but tibial accelerometers can determine tibia shock (a corollary of loading rate and vertical ground reaction force) which may be a factor in tibial bone stress injury (as highlighted by Willy 2017). Recently we’ve used the Dorsavi ViMove2 in clinic which allows us to see changes in these measures following gait re-training cues (see example data below).

      Example running data from Dorsavi ViMove2

  2. Identify individuals who may be at risk of injury
    • This is perhaps a little more contentious! Manufacturers may promise that their products can identify those at risk of injury but we’re not yet in a position where we can assess a runner’s gait and accurately predict injury risk and there’s a danger of ‘fault finding’ in individuals with no pain or pathology. This role is probably better performed by identifying changes in training load or fatigue that may precede injury…
  3. Assess and monitor training loads and outcomes
    • Training error is thought to be responsible for 60-70% of running injury. GPS watches combined with Apps such as Strava or Garmin Connect allow us to monitor training load and look retrospectively to see if acute training changes precede an injury. There is now sophisticated software that can analyse this data and advise runners to adjust their training before injury occurs. One such system is TrainAsOne. Its creator (and mountain marathon runner) Dr Sean Radford, reports the injury rate in runners using their system may be as low as 3%. Sean is passionate about evidence-based practice and is hoping to publish research related to many aspects of their system in future.
    • TrainAsOne displays training data for the runner (see graphs below) which allows them to track acute and chronic workload, weekly training load and percentage changes. It then provides advice to modify training based on your training history and can be adapted to suit individual need for example for those with recent injury. We’re currently working with TrainAsOne to explore ways to use this software for athlete monitoring for our runners.

      TrainAsOne training charts. ATL = Acute Training Load CTL = Chronic Training Load TSB = Training Stress Balance

  4. Provide real-time feedback to assist in rehab and gait re-training
    • Many GPS watches will now provide step rate (and other measures) in real-time during a run. This is especially useful and has been used successfully with ‘in-field’ gait re-training to help runners monitor and increase step rate to reduce impact forces, hip adduction and eccentric knee joint work (Willy et al. 2015). It is a feature to look out for when selecting technology to identify real-time changes from gait re-training cues. We’ve trialled some equipment that only allows you to upload data after a run which, although still useful, lacks the advantages of real-time data.
    • A further example of technology with real-time feedback is RunCadence which we’ve featured before on the site. This provides ‘bandwidth feedback‘ (another gem from Willy 2017), an auditory or visual alarm which tells the runner that they are outside of a goal movement pattern. When running with RunCadence a metronome kicks in if the runner’s step rate falls below the target number (Garmin watches have a similar feature, chiming if you fall outside the desired range). This is a really useful technology for those aiming to increase step rate to reduce load on painful or sensitive tissues.

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In summary, emerging technology has the potential to aid in load management, reduce injury risk and assist in gait re-training, however it’s important we are clear that such technology is reliable, valid and accurate and that the data it produces is relevant to the individual.

A BIG thank you to Rich Willy whose paper was the inspiration for this piece – be sure to read it and give Rich a follow on Twitter.

In case you missed it, don’t forget to check out Nick Knight’s excellent guest blog on plantar plate injury, it’s been really popular!

The free Sports Injury videos from Clinical Edge are still available too but not for long! CLICK HERE to check those out before they go.

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