An End to All In­juries

A Cal­gary pro­fes­sor is lead­ing the world’s largest run­ning in­jury study. He’s on the verge of fig­ur­ing out how pat­tern recog­ni­tion in biome­chan­ics could change the way we run and vir­tu­ally elim­i­nate in­juries for ev­ery­one.

Canadian Running - - FEATURES - By Sharon Crowther

Cal­gary’s Dr. Fer­ber is lead­ing the world ’s largest study of run­ning in­juries: a global ex­plo­ration into the biome­chan­ics re­spon­si­ble for your run­ner’s knee, plan­tar fasci­itis, IT band syn­drome and even that nig­gling pain in your Achilles you only feel when it’s cold. He could be on the precipice of a tech­no­log­i­cal revo­lu­tion in run­ning which could pro­duce an in­jury-free fu­ture for all run­ners.

What type of run­ner are you? It’s an of­ten asked ques­tion that might so­licit an­swers such as: com­pet­i­tive, fair-weather, ul­tra or so­cial. In many cases, and at some point for pretty much ev­ery type of run­ner the an­swer is also in­jured.

But re­search be­ing un­der­taken by Univer­sity of Cal­gary pro­fes­sor Dr. Reed Fer­ber could be about to change how we an­swer this very sim­ple ques­tion.

Dr. Fer­ber is lead­ing the world’s largest study of run­ning in­juries: a global ex­plo­ration into the biome­chan­ics re­spon­si­ble for your run­ner’s knee, plan­tar fasci­itis, IT band syn­drome and even that nig­gling pain in your Achilles that you only feel when it’s cold.

“We know that be­tween 48 and 65 per cent of run­ners sus­tain an in­jury ev­ery year” says the pro­fes­sor of ki­ne­si­ol­ogy, “and that run­ners sus­tain in­juries at an av­er­age rate of one per 100 hours of train­ing. It’s a sig­nif­i­cant risk but one we be­lieve we can mit­i­gate with greater un­der­stand­ing of the biome­chan­ics be­hind in­juries.”

More than 40 clin­ics around the world, from Aus­tralia to Europe, have been feed­ing into Dr. Fer­ber’s 3d gait anal­y­sis data­base which now has data on more than 6,000 run­ners of all ages, gen­ders and lev­els. Re­cently, I joined them.

With sen­sors fixed all over my lower back, hips, legs and shoes a vis­ual rep­re­sen­ta­tion of my skele­ton ap­pears on a screen above the tread­mill. Then me and my skele­ton go for a run. Mean­while, Dr. Fer­ber’s soft­ware an­a­lyzes ev­ery square cen­time­tre of my form: how my feet land, the de­gree of inf lec­tion from heel to toe, how long my feet are on the ground, what are my hips and knees do­ing, how are my an­kles, shin bones and pelvis ro­tat­ing. The in­for­ma­tion is fed into the data­base and my met­rics are com­pared to ev­ery­one else in my sub-group: com­pet­i­tive, fe­male run­ners with a rear foot strike.

“The data­base is all about draw­ing com­par­isons,” says Dr. Fer­ber, him­self an avid run­ner with four marathons un­der his belt. Run­ners are of­ten told not to com­pare them­selves to other run­ners, but Dr. Fer­ber sees this as an es­sen­tial form of com­par­i­son. “It lets us see what your biome­chan­ics are do­ing com­pared to your coun­ter­parts. And that way we can see what’s dif­fer­ent and po­ten­tially a prob­lem.”

Fer­ber says that men and women run dif­fer­ently, that fore­foot and rear foot strik­ers are prone to dif­fer­ent kinds of in­jury and that pace and ex­pe­ri­ence also change how we run. “By com­par­ing like with like, we can draw mean­ing­ful com­par­isons faster and with much greater ac­cu­racy.”

Dr. Fer­ber ac­cu­rately di­ag­noses an is­sue with my left ham­string which has been both­er­ing me for months. Fur­ther­more, he’s able to tell me why. “It’s ac­tu­ally stem­ming from an over-ro­ta­tion of your tibia which is most likely com­ing from a weak­ness in one of your calf mus­cles.”

With his re­search hub in the Cal­gary Run­ning In­jury Clinic, Dr. Fer­ber is able to pro­vide both in­sight and so­lu­tions to pa­tients. The physio team at the clinic pre­scribes me a pro­gram of ex­er­cises us­ing a ther­a­band – es­sen­tially a gi­ant elas­tic band – to strengthen the mus­cle re­spon­si­ble. “By get­ting to the root cause of the in­jury, we’re able to treat it suc­cess­fully from day one,” says Dr. Fer­ber. “As a re­searcher, it’s great to see my re­search in ac­tion mak­ing a dif­fer­ence to peo­ple.”

Dr. Fer­ber’s data­base has helped more than 2,000 other run­ners in the last two years with the di­ag­no­sis of of­ten chronic and pre­vi­ously un­suc­cess­fully treated in­juries: from novices train­ing for their first marathon to var­sity cross­coun­try run­ners and elite triath­letes like Cal­gary’s Ellen Pen­nock.

Pen­nock desc r ibes her s el f as “mod­er­ately in­jury prone” and con­sid­ers run­ning to be the sport in which she’s most prone to pick­ing up in­juries. Like most run­ners she feels “nig­gles” here and there as well as more se­ri­ous stress re­ac­tions and soft tis­sue strains. All of which cost her valu­able train­ing time. “It’s one of the big­gest road­blocks as an ath­lete – train­ing in­con­sis­tency due to in­jury,” she says. “It’s re­ally frus­trat­ing.”

Pen­nock es­ti­mates she’s un­able to run due to in­jury for an av­er­age of three weeks a year. Re­cently she had a 3d gait anal­y­sis with Dr. Fer­ber which shed light on where some of her “nig­gles” might be com­ing from. “The anal­y­sis showed that I switch from a fore­foot strike to a rear-foot strike de­pend­ing on what pace I’m run­ning at . It also showed that I have in­sta­bil­ity in my left side due to an­kle and hip weak­ness.”

Since un­der­tak­ing Dr. Fer­ber’s pre­scribed ex­er­cises, Pen­nock says her run­ning feels much stronger. She and her coach are us­ing the in­for­ma­tion to sup­port health­ier train­ing prac­tice as she en­ters this year’s race sea­son. “I hadn’t been feel­ing good as a run­ner for a while and I def­i­nitely feel like I’ve got­ten my flu­id­ity back. I feel more sta­ble.”

Fu­ture athletics st ars are also ben­e­fit­ing from Dr. Fer­ber’s ap­proach such as Univer­sity of Cal­gary var­sity cross-coun­try run­ner Conne Late­gan. Hav­ing suf­fered from re­cur­ring shin splints, Late­gan had missed an en­tire sea­son un­til she went for a gait anal­y­sis which, when com­par­ing her to her sub-group, re­vealed a land­ing pat­tern which was putting ex­ces­sive force on her tib­ias.

Hav­ing un­der­taken Dr. Fer­ber’s re­ha­bil­i­ta­tion plan, Late­gan is now back run­ning with her team and do­ing well.

Recre­ational run­ners like Vanessa Bar­retto are also seek­ing help. “In my 20s I trained for the Cal­gary Marathon but had to give it up due to knee pain and IT band is­sues. It’s some­thing that al­ways both­ered me.” Now 33, Bar­retto has been work­ing with Dr. Fer­ber to fix the root cause of her pain: an­kle dys­func­tion and ro­ta­tional is­sues. “It’s still early days but I’m feel­ing op­ti­mistic. I don’t know if I’ll ever do a full marathon but I’m en­joy­ing fi­nally be­ing able to in­crease my dis­tances.”

But it isn’t just in­jured run­ners who are set to ben­e­fit from Dr. Fer­ber’s re­search. The pro­fes­sor is also look­ing at healthy run­ners in a bid to demon­strate that his tech­nol­ogy can pre­dict in­juries be­fore they hap­pen.

In a re­cent study, un­der re­view by the Jour­nal of Biome­chan­ics, Dr. Fer­ber proved his the­ory by analysing 121 healthy run­ners from the Cal­gary area. The only com­mon­al­ity be­tween these run­ners was that they had sus­tained no i njury i n the last six months. Pat­tern recog­ni­tion method­ol­ogy was ap­plied to their in­di­vid­ual gait anal­y­sis which di­vided the run­ners into two “fam­i­lies” or “clus­ters” ac­cord­ing to their de­gree of in­ward knee col­lapse, knee f lex­ion, an­kle ro­ta­tion and other bio-me­chan­i­cal char­ac­ter­is­tics. Dr. Fer­ber’s team ac­cu­rately pre­dicted which clus­ter would be more prone to in­jury and then fol­lowed the run­ners for two years, prov­ing their hy­poth­e­sis.

“Prov­ing that propen­sity to in­jury is closely linked with our bio-me­chanic clus­ter means we can help peo­ple be­fore, not just af­ter in­jury,” he says. “We can also tell if peo­ple

are mov­ing into a new clus­ter, which might mean they’re be­com­ing more or less prone to in­jury.” It’s pre­ven­ta­tive medicine for run­ners at its smartest. “And the best thing about it is that as the data­base con­tin­ues to grow, it gets smarter and smarter.”

By stan­dard­iz­ing the data col­lec­tion method­ol­ogy, Dr. Fer­ber has cre­ated an in­for­ma­tion gold­mine for re­searchers. “The big­ger the data-set, the more pre­cise the sub-group­ing,” Dr. Fer­ber points out. “The more pre­cise the sub-group­ing, the more ac­cu­rate the pre­dic­tions.”

As the data­base con­tin­ues to grow, Dr. Fer­ber has as­pi­ra­tions to start sub-typ­ing run­ners by age and also plans to add an elite cat­e­gory. In the fu­ture he fore­sees adding life events to the pic­ture: women who have given birth, run­ners who have had surgery as well as dig­ging deeper into the run­ning pat­terns of peo­ple who do other types of sport such as skiers and triath­letes like Pen­nock.

“By com­par­ing run­ners within in­creas­ingly spe­cific sub-groups and as­sign­ing those run­ners to grow­ing clus­ters based on their bio-me­chan­i­cal be­hav­iour, we’re go­ing to change the way run­ners an­swer the ques­tion: what type of run­ner are you? We’re also go­ing to change the way run­ners train, coaches coach and sports brands de­velop tech­nol­ogy.”

In another re­cent study, Dr. Fer­ber and his team made a ma­jor leap for­ward in prov­ing the po­ten­tial for sports watches to be­come smarter and more use­ful to run­ners than ever be­fore. “Smart tech­nol­ogy for run­ners right now is ac­tu­ally su­per stupid. Sports watches are es­sen­tially just ex­pen­sive pe­dome­ters and calo­rie coun­ters,” he says, coun­ter­ing many of the prom­ises of the cur­rent gps brands. “But we’ve proved there’s huge po­ten­tial for them to em­u­late some as­pects of 3d gait anal­y­sis.” In his study, Dr. Fer­ber used the same tech­nol­ogy found in sports watches to iden­tify the ex­pe­ri­ence level and train­ing back­ground of 47 run­ners with 96 per cent ac­cu­racy.

“In­juries don’t hap­pen on my tread­mill, they hap­pen out on the run­ning paths. If a sports watch can iden­tify how you run, it can iden­tify when you change how you run. Typ­i­cally we change how we run when we’re on the verge of in­jury, al­ready in­jured or fa­tigued. If your sports watch could alert you in real time to sub­tle gait changes, that would be an in­cred­i­ble ad­vance­ment.”

Pen­nock agrees. “I use smart tech­nol­ogy for pac­ing and heart rate but if my watch could tell me when I’m at risk of be­com­ing in­jured so that I can do some­thing about it, that would be amaz­ing.”

Dr. Fer­ber and his team are cur­rently work­ing with sev­eral sports watch brands, in­clud­ing Garmin, to val­i­date their emerg­ing tech­nol­ogy.

“We’re con­stantly work­ing to stay on top of the lat­est re­search and we con­tinue to learn more about how form can af­fect per­for­mance and in­jury risk,” says Amy Nouri, me­dia re­la­tions as­so­ci­ate for Garmin In­ter­na­tional. “For ex­am­ple, new ways to in­ter­pret heart rate vari­abil­ity which have led to fea­tures on our watches that give users guid­ance on

re­cov­ery time post-work­out. We’ve also in­cluded met­rics that can pro­vide feed­back on a run­ner’s form like ver­ti­cal os­cil­la­tion and right-left ground con­tact time bal­ance.”

Another com­pelling study us­ing Dr. Fer­ber’s data­base and an ac­celerom­e­ter was re­cently un­der­taken at the Univer­sity of Michi­gan. It de­ter­mined that the ac­celerom­e­ter could iden­tify gait changes specif­i­cally re­lated to fa­tigue: giv­ing it the po­ten­tial to iden­tify a marathon run­ners wall, be­fore the point of no re­turn.

Dr. Fer­ber’s data­base and the re­search it en­ables could also be used to shape train­ing soft­ware and coach­ing meth­ods of the fu­ture. If a run­ner knows their biome­chan­i­cal pro­file, the char­ac­ter­is­tics that make up their own spe­cific gait, that in­for­ma­tion could shape a cus­tom­ized and there­fore far more ef­fec­tive train­ing plan than the one-size-fits-all ap­proach com­monly used.

“Pat­tern recog­ni­tion and so­phis­ti­cated gait anal­y­sis is al­low­ing us to pre­dict the fu­ture,” he says. “Cou­pled with gen­uinely smart and re­spon­sive tech­nolog y, there’s no rea­son we couldn’t get to a point where wear­able tech­nol­ogy is able to cus­tom­ize a plan, re­spond to how you’re cop­ing with that plan and in­tel­li­gently guide you to­wards your train­ing goals and keep you in­jury-free and healthy.”

The only hur­dle Dr. Fer­ber can see in get­ting to that point is nav­i­gat­ing some po­ten­tially com­plex le­gal im­pli­ca­tions. “Mak­ing claims about keep­ing ath­letes in­jury-free, when in­jury it­self is such a com­plex thing, opens brands up to le­gal is­sues which they may not be com­fort­able with. Vi­bram learned that the hard way a cou­ple of years ago. Pro­mot­ing the per­for­mance ben­e­fits rather than the in­jury pre­ven­tion side is prob­a­bly an eas­ier sell.”

“SMART TECH­NOL­OGY FOR RUN­NERS RIGHT NOW IS AC­TU­ALLY SU­PER STUPID. SPORTS WATCHES ARE ES­SEN­TIALLY JUST EX­PEN­SIVE PE­DOME­TERS AND CALO­RIE COUN­TERS.”

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