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Shen W, Yu Y, Frias Bocanegra J, Wheeler PC, Fong DTP. Enhancing running injury prevention strategies with real-time biofeedback: A systematic review and meta-analysis. J Sports Sci 2024:1-12. [PMID: 38967313 DOI: 10.1080/02640414.2024.2374637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 06/23/2024] [Indexed: 07/06/2024]
Abstract
The number of runners and the incidence of running-related injuries (RRIs) are on the rise. Real-time biofeedback gait retraining offers a promising approach to RRIs prevention. However, due to the diversity in study designs and reported outcomes, there remains uncertainty regarding the efficacy of different forms of feedback on running gait biomechanics. Three databases: MEDLINE, PUBMED, and SPORTDiscus were searched to identify relevant studies published up to March 2024, yielding 4646 articles for review. The quality of the included studies was assessed using the Downs and Black Quality checklist. Primary outcomes, including Peak Tibial Acceleration (PTA), Vertical Average Loading Rate (VALR), and Vertical Instantaneous Loading Rate (VILR), were analysed through meta-analysis. 24 studies met the inclusion criteria and were analysed in this review.17 used visual biofeedback (VB) while 14 chose auditory biofeedback (AB). The meta-analysis revealed a reduction in loading variables both immediately following the intervention and after extended training, with both visual and auditory feedback. Notably, the decrease in loading variables was more pronounced post-training and VB proved to be more effective than AB. Real-time biofeedback interventions are effective in lowering loading variables associated with RRIs. The impact is more substantial with sustained training, and VB outperforms AB in terms of effectiveness.
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Affiliation(s)
- Wei Shen
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Yifan Yu
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Jose Frias Bocanegra
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Patrick C Wheeler
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Department of Musculoskeletal, Sport & Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Daniel T P Fong
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Rodríguez J, Marín J, Royo AC, Padrón L, Pérez-Soto M, Marín JJ. KeepRunning: A MoCap-Based Rapid Test to Prevent Musculoskeletal Running Injuries. SENSORS (BASEL, SWITZERLAND) 2023; 23:9336. [PMID: 38067707 PMCID: PMC10708810 DOI: 10.3390/s23239336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/10/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023]
Abstract
The worldwide popularisation of running as a sport and recreational practice has led to a high rate of musculoskeletal injuries, usually caused by a lack of knowledge about the most suitable running technique for each runner. This running technique is determined by a runner's anthropometric body characteristics, dexterity and skill. Therefore, this study aims to develop a motion capture-based running analysis test on a treadmill called KeepRunning to obtain running patterns rapidly, which will aid coaches and clinicians in assessing changes in running technique considering changes in the study variables. Therefore, a review and proposal of the most representative events and variables of analysis in running was conducted to develop the KeepRunning test. Likewise, the minimal detectable change (MDC) in these variables was obtained using test-retest reliability to demonstrate the reproducibility and viability of the test, as well as the use of MDC as a threshold for future assessments. The test-retest consisted of 32 healthy volunteer athletes with a running training routine of at least 15 km per week repeating the test twice. In each test, clusters of markers were placed on the runners' body segments using elastic bands and the volunteers' movements were captured while running on a treadmill. In this study, reproducibility was defined by the intraclass correlation coefficient (ICC) and MDC, obtaining a mean value of ICC = 0.94 ± 0.05 for all variables and MDC = 2.73 ± 1.16° for the angular kinematic variables. The results obtained in the test-retest reveal that the reproducibility of the test was similar or better than that found in the literature. KeepRunning is a running analysis test that provides data from the involved body segments rapidly and easily interpretable. This data allows clinicians and coaches to objectively provide indications for runners to improve their running technique and avoid possible injury. The proposed test can be used in the future with inertial motion capture and other wearable technologies.
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Affiliation(s)
- Javier Rodríguez
- IDERGO (Research and Development in Ergonomics), I3A (Instituto de Investigación en Ingeniería de Aragón), University of Zaragoza, C/María de Luna, 3, 50018 Zaragoza, Spain (A.C.R.); (L.P.); (M.P.-S.); (J.J.M.)
| | - Javier Marín
- IDERGO (Research and Development in Ergonomics), I3A (Instituto de Investigación en Ingeniería de Aragón), University of Zaragoza, C/María de Luna, 3, 50018 Zaragoza, Spain (A.C.R.); (L.P.); (M.P.-S.); (J.J.M.)
- Department of Design and Manufacturing Engineering, University of Zaragoza, C/María de Luna, 3, 50018 Zaragoza, Spain
| | - Ana C. Royo
- IDERGO (Research and Development in Ergonomics), I3A (Instituto de Investigación en Ingeniería de Aragón), University of Zaragoza, C/María de Luna, 3, 50018 Zaragoza, Spain (A.C.R.); (L.P.); (M.P.-S.); (J.J.M.)
- Department of Design and Manufacturing Engineering, University of Zaragoza, C/María de Luna, 3, 50018 Zaragoza, Spain
| | - Luis Padrón
- IDERGO (Research and Development in Ergonomics), I3A (Instituto de Investigación en Ingeniería de Aragón), University of Zaragoza, C/María de Luna, 3, 50018 Zaragoza, Spain (A.C.R.); (L.P.); (M.P.-S.); (J.J.M.)
- Department of Biomedical Engineering, University of Zaragoza, C/Mariano Esquillor s/n, 50018 Zaragoza, Spain
| | - Manuel Pérez-Soto
- IDERGO (Research and Development in Ergonomics), I3A (Instituto de Investigación en Ingeniería de Aragón), University of Zaragoza, C/María de Luna, 3, 50018 Zaragoza, Spain (A.C.R.); (L.P.); (M.P.-S.); (J.J.M.)
- Department of Design and Manufacturing Engineering, University of Zaragoza, C/María de Luna, 3, 50018 Zaragoza, Spain
| | - José J. Marín
- IDERGO (Research and Development in Ergonomics), I3A (Instituto de Investigación en Ingeniería de Aragón), University of Zaragoza, C/María de Luna, 3, 50018 Zaragoza, Spain (A.C.R.); (L.P.); (M.P.-S.); (J.J.M.)
- Department of Design and Manufacturing Engineering, University of Zaragoza, C/María de Luna, 3, 50018 Zaragoza, Spain
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Mason R, Pearson LT, Barry G, Young F, Lennon O, Godfrey A, Stuart S. Wearables for Running Gait Analysis: A Systematic Review. Sports Med 2023; 53:241-268. [PMID: 36242762 PMCID: PMC9807497 DOI: 10.1007/s40279-022-01760-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Running gait assessment has traditionally been performed using subjective observation or expensive laboratory-based objective technologies, such as three-dimensional motion capture or force plates. However, recent developments in wearable devices allow for continuous monitoring and analysis of running mechanics in any environment. Objective measurement of running gait is an important (clinical) tool for injury assessment and provides measures that can be used to enhance performance. OBJECTIVES We aimed to systematically review the available literature investigating how wearable technology is being used for running gait analysis in adults. METHODS A systematic search of the literature was conducted in the following scientific databases: PubMed, Scopus, Web of Science and SPORTDiscus. Information was extracted from each included article regarding the type of study, participants, protocol, wearable device(s), main outcomes/measures, analysis and key findings. RESULTS A total of 131 articles were reviewed: 56 investigated the validity of wearable technology, 22 examined the reliability and 77 focused on applied use. Most studies used inertial measurement units (n = 62) [i.e. a combination of accelerometers, gyroscopes and magnetometers in a single unit] or solely accelerometers (n = 40), with one using gyroscopes alone and 31 using pressure sensors. On average, studies used one wearable device to examine running gait. Wearable locations were distributed among the shank, shoe and waist. The mean number of participants was 26 (± 27), with an average age of 28.3 (± 7.0) years. Most studies took place indoors (n = 93), using a treadmill (n = 62), with the main aims seeking to identify running gait outcomes or investigate the effects of injury, fatigue, intrinsic factors (e.g. age, sex, morphology) or footwear on running gait outcomes. Generally, wearables were found to be valid and reliable tools for assessing running gait compared to reference standards. CONCLUSIONS This comprehensive review highlighted that most studies that have examined running gait using wearable sensors have done so with young adult recreational runners, using one inertial measurement unit sensor, with participants running on a treadmill and reporting outcomes of ground contact time, stride length, stride frequency and tibial acceleration. Future studies are required to obtain consensus regarding terminology, protocols for testing validity and the reliability of devices and suitability of gait outcomes. CLINICAL TRIAL REGISTRATION CRD42021235527.
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Affiliation(s)
- Rachel Mason
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Liam T Pearson
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Gillian Barry
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Fraser Young
- Department of Computer and Information Sciences, Northumbria University, Newcastle upon Tyne, UK
| | | | - Alan Godfrey
- Department of Computer and Information Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Samuel Stuart
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK.
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK.
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Gaudette LW, Bradach MM, de Souza Junior JR, Heiderscheit B, Johnson CD, Posilkin J, Rauh MJ, Sara LK, Wasserman L, Hollander K, Tenforde AS. Clinical Application of Gait Retraining in the Injured Runner. J Clin Med 2022; 11:6497. [PMID: 36362725 PMCID: PMC9655004 DOI: 10.3390/jcm11216497] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 06/22/2024] Open
Abstract
Despite its positive influence on physical and mental wellbeing, running is associated with a high incidence of musculoskeletal injury. Potential modifiable risk factors for running-related injury have been identified, including running biomechanics. Gait retraining is used to address these biomechanical risk factors in injured runners. While recent systematic reviews of biomechanical risk factors for running-related injury and gait retraining have been conducted, there is a lack of information surrounding the translation of gait retraining for injured runners into clinical settings. Gait retraining studies in patients with patellofemoral pain syndrome have shown a decrease in pain and increase in functionality through increasing cadence, decreasing hip adduction, transitioning to a non-rearfoot strike pattern, increasing forward trunk lean, or a combination of some of these techniques. This literature suggests that gait retraining could be applied to the treatment of other injuries in runners, although there is limited evidence to support this specific to other running-related injuries. Components of successful gait retraining to treat injured runners with running-related injuries are presented.
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Affiliation(s)
- Logan W. Gaudette
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
| | - Molly M. Bradach
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
| | - José Roberto de Souza Junior
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
- Graduate Program of Sciences and Technologies in Health, University of Brasilia, Brasilia 72220-275, DF, Brazil
| | - Bryan Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI 53706, USA
| | - Caleb D. Johnson
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
- United States Army Research Institute for Environmental Medicine, Military Performance Division, Natick, MA 01760, USA
| | - Joshua Posilkin
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
| | - Mitchell J. Rauh
- Doctor of Physical Therapy Program, San Diego State University, San Diego, CA 92182, USA
| | - Lauren K. Sara
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
| | - Lindsay Wasserman
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
| | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, Faculty of Medicine, MSH, Medical School Hamburg, 20457 Hamburg, Germany
| | - Adam S. Tenforde
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
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Review of Real-Time Biomechanical Feedback Systems in Sport and Rehabilitation. SENSORS 2022; 22:s22083006. [PMID: 35458991 PMCID: PMC9028061 DOI: 10.3390/s22083006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/01/2022] [Accepted: 04/11/2022] [Indexed: 02/04/2023]
Abstract
Real-time biomechanical feedback (BMF) is a relatively new area of research. The potential of using advanced technology to improve motion skills in sport and accelerate physical rehabilitation has been demonstrated in a number of studies. This paper provides a literature review of BMF systems in sports and rehabilitation. Our motivation was to examine the history of the field to capture its evolution over time, particularly how technologies are used and implemented in BMF systems, and to identify the most recent studies showing novel solutions and remarkable implementations. We searched for papers in three research databases: Scopus, Web of Science, and PubMed. The initial search yielded 1167 unique papers. After a rigorous and challenging exclusion process, 144 papers were eventually included in this report. We focused on papers describing applications and systems that implement a complete real-time feedback loop, which must include the use of sensors, real-time processing, and concurrent feedback. A number of research questions were raised, and the papers were studied and evaluated accordingly. We identified different types of physical activities, sensors, modalities, actuators, communications, settings and end users. A subset of the included papers, showing the most perspectives, was reviewed in depth to highlight and present their innovative research approaches and techniques. Real-time BMF has great potential in many areas. In recent years, sensors have been the main focus of these studies, but new types of processing devices, methods, and algorithms, actuators, and communication technologies and protocols will be explored in more depth in the future. This paper presents a broad insight into the field of BMF.
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Goss DL, Watson DJ, Miller EM, Weart AN, Szymanek EB, Freisinger GM. Wearable Technology May Assist in Retraining Foot Strike Patterns in Previously Injured Military Service Members: A Prospective Case Series. Front Sports Act Living 2021; 3:630937. [PMID: 33718868 PMCID: PMC7952986 DOI: 10.3389/fspor.2021.630937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/27/2021] [Indexed: 12/13/2022] Open
Abstract
A rearfoot strike (RFS) pattern with increased average vertical loading rates (AVLR) while running has been associated with injury. This study evaluated the ability of an instrumented sock, which provides real-time foot strike and cadence audio biofeedback, to transition previously injured military service members from a RFS to a non-rearfoot strike (NRFS) running pattern. Nineteen RFS runners (10 males, 9 females) were instructed to wear the instrumented socks to facilitate a change in foot strike while completing an independent walk-to-run progression and lower extremity exercise program. Kinetic data were collected during treadmill running while foot strike was determined using video analysis at initial (T1), post-intervention (T2), and follow-up (T3) data collections. Nearly all runners (18/19) transitioned to a NRFS pattern following intervention (8 ± 2.4 weeks after the initial visit). Most participants (16/18) maintained the transition at follow-up (5 ± 0.8 weeks after the post-intervention visit). AVLR of the involved and uninvolved limb decreased 29% from initial [54.7 ± 13.2 bodyweights per sec (BW/s) and 55.1 ± 12.7 BW/s] to post-intervention (38.7 ± 10.1 BW/s and 38.9 ± 10.0 BW/s), respectively. This effect persisted 5-weeks later at follow-up, representing an overall 30% reduction on the involved limb and 24% reduction on the uninvolved limb. Cadence increased from the initial to the post-intervention time-point (p = 0.045); however, this effect did not persist at follow-up (p = 0.08). With technology provided feedback from instrumented socks, approximately 90% of participants transitioned to a NRFS pattern, decreased AVLR, reduced stance time and maintained these running adaptations 5-weeks later.
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Affiliation(s)
- Donald L Goss
- Department of Physical Therapy, High Point University, High Point, NC, United States
| | - Daniel J Watson
- 15th Medical Group, Joint Base Pearl Harbor-Hickam, Honolulu, HI, United States
| | - Erin M Miller
- Baylor University-Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, West Point, NY, United States
| | - Amy N Weart
- Department of Physical Therapy, Keller Army Community Hospital, West Point, NY, United States
| | | | - Gregory M Freisinger
- Department of Civil and Mechanical Engineering, United States Military Academy, West Point, NY, United States
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Garofolini A, Oppici L, Taylor S. A real-time feedback method to reduce loading rate during running: Effect of combining direct and indirect feedback. J Sports Sci 2020; 38:2446-2453. [PMID: 32627694 DOI: 10.1080/02640414.2020.1788288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Impact loading plays a key role in the pathophysiology of running-related injuries. Providing real-time feedback may be an effective strategy to reduce impact loading; however, it is currently unclear what an effective training method to help runners achieve a habitual low loading rate is. We subjected 20 healthy non-runners to a structured sequence of direct and indirect biofeedback designed to facilitate broader exploration of neuro-mechanical workspace for potential movement solutions (indirect feedback on cadence and foot-strike angle) and to refine and converge upon an optimal sub-set of that space to match the task goal (direct feedback on loading rate). While indirect biofeedback on foot-strike angle yielded a lower impact load than providing direct biofeedback on loading rate, compared to indirect biofeedback on foot-strike angle, providing direct feedback on loading rate statistically increased (+58%, p = 0.007) the range of goal-relevant solutions participants used to lower their impact loading. Results showed that structured feedback was effective in increasing the range of input parameters that match the task goal, hence expanding the size of goal-relevant solutions, which may benefit running performance under changing environmental constraints.
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Affiliation(s)
| | - Luca Oppici
- Psychology of Learning and Instruction, Department of Psychology, School of Science, Technische Universität Dresden , Dresden, Germany.,Centre for Tactile Internet with Human-in-the-Loop (Ceti), Technische Universität Dresden , Dresden, Germany
| | - Simon Taylor
- Institute for Health and Sport (IHES), Victoria University , Melbourne, Australia
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