Elsevier

Gait & Posture

Volume 67, January 2019, Pages 12-24
Gait & Posture

The measurement of tibial acceleration in runners—A review of the factors that can affect tibial acceleration during running and evidence-based guidelines for its use

https://doi.org/10.1016/j.gaitpost.2018.09.017Get rights and content

Highlights

  • The link between tibial acceleration and bone strain is yet to be proven.

  • Tibial acceleration is an appropriate proxy measure of the impact forces.

  • Low mass, well affixed devices should be used to improve accuracy.

  • Triaxial accelerometers should be used, so that all components can be measured.

  • Relationships between lower limb effective mass and tibial acceleration are still unclear.

Abstract

Background

Impact loading in runners, assessed by the measurement of tibial acceleration, has attracted substantial research attention. Due to potential injury links, particularly tibial fatigue fractures, tibial acceleration is also used as a clinical monitoring metric. There are contributing factors and potential limitations that must be considered before widespread implementation.

Aim

The objective of this review is to update current knowledge of the measurement of tibial acceleration in runners and to provide recommendations for those intending on using this measurement device in research or clinical practice.

Methods

Literature relating to the measurement of tibial acceleration in steady-state running was searched. A narrative approach synthesised the information from papers written in English. A range of literature was identified documenting the selection and placement of accelerometers, the analysis of data, and the effects of intrinsic and extrinsic factors.

Results and discussion

Tibial acceleration is a proxy measurement for the impact forces experienced at the tibia commonly used by clinicians and researchers. There is an assumption that this measure is related to bone stress and strain, however this is yet to be proven. Multi-axis devices should be secured firmly to the tibia to limit movement relative to the underlying bone and enable quantification of all components of acceleration. Additional frequency analyses could be useful to provide a more thorough characterisation of the signal.

Conclusions

Tibial accelerations are clearly affected by running technique, running velocity, lower extremity stiffness, as well as surface and footwear compliance. The interrelationships between muscle pre-activation and fatigue, stiffness, effective mass and tibial acceleration still require further investigation, as well as how changes in these variables impact on injury risk.

Introduction

Running is a popular activity, but the high participation rate is accompanied by a high incidence of injuries [1]. The majority of running-related injuries occur in the lower limbs, are chronic in nature, and are related to cumulative loading [2]. The repetitive impacts associated with running is thought to play an important role in the pathophysiology of many common running injuries, especially bony fatigue fractures (commonly termed stress fractures) [[3], [4], [5]]. In runners, between 35% and 49% of all fatigue fractures occur in the tibia [[6], [7], [8], [9]].

While many factors influence bony remodeling and ultimately the manifestation of a fatigue fracture [10], biomechanics dictate the level of mechanical loading on bone during running [11,12]. When the foot strikes the ground, its velocity decelerates to zero and large ground reaction forces (GRF) are generated [13]. This momentum change produces compressive loading of the lower limbs, and results in an impact shock transmitted through the musculoskeletal system, with local segment peak accelerations occurring at successively later times [14,15]. To minimise damage to proximal structures the shock is attenuated, which is accomplished through an interaction of passive and active mechanisms [[16], [17], [18], [19], [20]]. A failure of the lower extremity muscles to adequately absorb the energy of impact may lead to an over-reliance on passive mechanisms for attenuation [20].

Direct in-vivo measurement of bone strain would be ideal for monitoring injury risk in runners, however this is invasive and impractical [21,22]. Measuring the tibial acceleration (TA) via segment mounted accelerometers is a commonly used proxy measurement for the impact forces experienced at the tibia by virtue of Newton’s second law (F = ma) [23,24]. While the relationship between TA and bone strain is unclear, and likely to be complicated by local muscle forces, peak TA measured via devices attached directly to the tibia bone have revealed reasonable correlations with key GRF parameters (vertical impact peaks r = 0.7–0.85; loading rates r = 0.87–0.99) [25]. While the correlations are weaker when using skin-mounted accelerometers, average loading rate (r = 0.274–0.439) and instantaneous loading rate (r = 0.469) of the vertical GRF have all been significantly correlated with peak TA [26]. The moderate correlation between peak TA and GRF is not surprising as the GRF represents the summed acceleration of all body segments. These points withstanding, the axial component of TA has been shown to discriminate between runners with and without tibial fatigue fractures [27], and between runners injured and uninjured limb [28]. Additionally, the likelihood of the history of tibial fatigue fracture has been shown to increase by a factor of 1.4 for every 1 g increase in axial TA [29].

Previous literature reviews on the use of accelerometers in running have highlighted some of the key elements for consideration, such as the attachment method and placement location of the accelerometer, and the need for a low mass multi-axis device for increased measurement accuracy [23,24]. Despite this, the scope of these reviews did not address many of the issues and potential limitations that must also be considered when measuring TA from runners, including the influence of running velocity, technique, fatigue and surface characteristics. The objective of this review is to update current knowledge of the measurement of TA in runners and to provide recommendations for those intending on using this assessment method in research or clinical practice.

Section snippets

Methods

PubMed, Web of Science, SPORTDiscus and Google Scholar were searched to Jan 2018 using the following terms linked with the Boolean operators (‘AND’ and ‘OR’): ‘run*’, ‘tibia* acceler*’, ‘shock’, ‘inertia*’ and ‘biomech*’, with no limits. Additional relevant studies were identified using article reference lists. Titles, abstracts and full-texts of retrieved documents were sequentially reviewed to determine their relevance. Only papers published in English, that specifically measured TA during

Definition of terms

A number of terms are used interchangeably to describe different aspects of TA, including peak TA, peak shank deceleration, peak positive acceleration and tibial shock. For the purpose of this review, axial (TA-A), anterior-posterior (TA-AP), and medio-lateral tibial acceleration (TA-ML) are used where time-domain peak acceleration magnitude components from a device aligned to the long axis of the tibia are reported. Resultant tibial acceleration (TA-R) is where the peak acceleration magnitude

Device selection

Devices contain one, two or three accelerometers mounted at right angles, each reacting to the orthogonal component acting along their axis [30]. They operate relative to the Earth’s gravitational field, constantly registering 9.81 m/s/s (1 g) as a reaction to gravitational acceleration [31]. The maximum contribution of the acceleration due to gravity is 1 g (when the shank is vertical), and some accelerometers will register 9.81 m/s/s or 1 g in this position at rest, while others may read zero

Normalisation

To account for variability in absolute magnitudes between sessions, normalisation of TA data has been proposed [65]. Expressing TA-A relative to the mean observed at the slowest running velocity, provided a ‘shock ratio’, which can be useful considering the absolute values of the peak accelerations are susceptible to noise and vibration. Focusing on the relative magnitudes of acceleration measures can be informative for many applications (e.g. cushioning properties of running shoes), however to

Outcome measures

Where triaxial devices are used, TA signals can be resolved into three acceleration components. The coordinate system axes can be defined differently, but commonly the orthogonal axes are defined with respect to the tibia: TA-A, TA-AP and TA-ML. The TA-A corresponds to a line bisecting the proximal and distal ends of the tibia in both the frontal and sagittal planes. The medio-lateral axis runs perpendicular to the axial axis and parallel to a line joining the two malleoli, and the

Running velocity

The seminal work analysing the effect of running velocity report consistently increased peak TA magnitude with faster running velocities (3.5 and 4.7 m/s) across all components of TA (TA-A, TA-AP and TA-ML) from a single recreational runner, using a bone-mounted accelerometer [58]. This increase in TA-A was also reported at a series of faster running velocities (spanning 3.4 to 5.4 m/s) from 10 well-trained runners [65]. Further to this, linear regression analysis revealed that average TA-A

Running surface

Owing to their cushioning properties, treadmills typically have a lower compliance compared to tarseal or concrete running surfaces. There is evidence to suggest that TA-A measured overground can be substantially higher than running on some treadmills under comparable conditions [51,83,106], however the relationship between TA-A magnitude and surface compliance is not straightforward. Fu et al. [107] found no differences in TA-A across a wide range of surfaces running at 3.3 m/s, whereas

Conclusions and recommendations

Clinicians and researchers commonly use tibial acceleration during running as a proxy measurement for the impact forces experienced at the tibia. There is an assumption that this measure corresponds to the acceleration of the bone, and ultimately bone stress and strain, however this is yet to be proven. For users of tibial mounted accelerometers, there are several recommendations that should be adhered to in order to achieve accurate and reproducible results. Devices should be secured firmly to

Conflict of interest

Dr. Besier is a consultant for IMeasureU-Vicon and is involved in the development of inertial sensor solutions.

Funding and acknowledgements

None.

References (118)

  • M.B. Pohl et al.

    Biomechanical predictors of retrospective tibial stress fractures in runners

    J. Biomech.

    (2008)
  • R.A. Zifchock et al.

    Side-to-side differences in overuse running injury susceptibility: a retrospective study

    Hum. Mov. Sci.

    (2008)
  • M.A. Lafortune

    Three-dimensional acceleration of the tibia during walking and running

    J. Biomech.

    (1991)
  • H.P. Crowell et al.

    Gait retraining to reduce lower extremity loading in runners

    Clin. Biomech.

    (2011)
  • C.M. Wood et al.

    Use of audio biofeedback to reduce tibial impact accelerations during running

    J. Biomech.

    (2014)
  • A.H. Gruber et al.

    Impact shock frequency components and attenuation in rearfoot and forefoot running

    J. Sport Health Sci.

    (2014)
  • A.M. Duquette et al.

    Tibialis anterior muscle fatigue leads to changes in tibial axial acceleration after impact when ankle dorsiflexion angles are visually controlled

    Hum. Mov. Sci.

    (2010)
  • M.A. Lafortune et al.

    Tibial shock measured with bone and skin mounted transducers

    J. Biomech.

    (1995)
  • S. Saha et al.

    The effect of soft tissue on wave-propagation and vibration tests for determining the in vivo properties of bone

    J. Biomech.

    (1977)
  • M.W. Creaby et al.

    Retraining running gait to reduce tibial loads with clinician or accelerometry guided feedback

    J. Sci. Med. Sport

    (2016)
  • M.F. Bobbert et al.

    Calculation of vertical ground reaction force estimates during running from positional data

    J. Biomech.

    (1991)
  • T. Oakley et al.

    Skeletal transients during heel and toe strike running and the effectiveness of some materials in their attenuation

    Clin. Biomech.

    (1988)
  • G. Montgomery et al.

    Tibial impacts and muscle activation during walking, jogging and running when performed overground, and on motorised and non-motorised treadmills

    Gait Posture

    (2016)
  • J. Hamill et al.

    Shock attenuation and stride frequency during running

    Hum. Mov. Sci.

    (1995)
  • A.S. Voloshin et al.

    Dynamic loading on the human musculoskeletal system - effect of fatigue

    Clin. Biomech.

    (1998)
  • J. Mizrahi et al.

    Shock accelerations and attenuation in downhill and level running

    Clin. Biomech.

    (2000)
  • J.M. Flynn et al.

    The effect of localized leg muscle fatigue on tibial impact acceleration

    Clin. Biomech.

    (2004)
  • J.E. Taunton et al.

    A prospective study of running injuries: the vancouver sun run “In training” clinics

    Br. J. Sports Med.

    (2003)
  • R.N. van Gent et al.

    Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review

    Br. J. Sports Med.

    (2007)
  • B.R. Beck

    Tibial stress injuries - an aetiological review for the purposes of guiding management

    Sports Med.

    (1998)
  • K. Bennell et al.

    Ground reaction forces and bone parameters in females with tibial stress fracture

    Med. Sci. Sports Exerc.

    (2004)
  • G.O. Matheson et al.

    Stress fractures in athletes. A study of 320 cases

    Am. J. Sports Med.

    (1987)
  • K. Crossley et al.

    Ground reaction forces, bone characteristics, and tibial stress fracture in male runners

    Med. Sci. Sports Exerc.

    (1999)
  • S.J. Warden et al.

    Stress fractures: pathophysiology, epidemiology, and risk factors

    Curr. Osteoporos. Reports

    (2006)
  • T.R. Derrick

    The effects of knee contact angle on impact forces and accelerations

    Med. Sci. Sports Exerc.

    (2004)
  • M.J. Lake

    Determining the protective function of sports footwear

    Ergonomics

    (2000)
  • A.A. Zadpoor et al.

    The effects of lower-extremity muscle fatigue on the vertical ground reaction force: a meta-analysis

    J. Eng. Med.

    (2012)
  • J.J. Mizrahi et al.

    Fatigue-related loading imbalance on the shank in running: a possible factor in stress fractures

    Ann. Biomed. Eng.

    (2000)
  • T.R. Derrick et al.

    Energy absorption of impacts during running at various stride lengths

    Med. Sci. Sports Exerc.

    (1998)
  • M. Norris et al.

    Method analysis of accelerometers and gyroscopes in running gait: a systematic review. Proceedings of the institution of mechanical engineers

    Part. P: J. Sports Eng. Technol.

    (2014)
  • M.J. Mathie et al.

    Accelerometry: providing an integrated, practical method for long-term, ambulatory monitoring of human movement

    Physiol. Meas.

    (2004)
  • E.M. Hennig et al.

    Relationships between ground reaction force and tibial bone acceleration parameters

    Int. J. Sport Biomechan.

    (1991)
  • A. Greenhalgh et al.

    Predicting impact shock magnitude: which ground reaction force variable should we use

    J. Sports Sci. Med.

    (2012)
  • C.E. Milner et al.

    Biomechanical factors associated with tibial stress fracture in female runners

    Med. Sci. Sports Exerc.

    (2006)
  • D.A. Winter

    Biomechanics and Motor Control of Human Movement

    (2005)
  • G.J. Pottie et al.

    Principles of Embedded Networked Systems Design

    (2005)
  • M.A. Lafortune et al.

    Contribution of angular motion and gravity to tibial acceleration

    Med. Sci. Sports Exerc.

    (1991)
  • B.M. Nigg et al.

    Impact forces during heel-toe running

    J. Appl. Biomechan.

    (1995)
  • S. Patel et al.

    A review of wearable sensors and systems with application in rehabilitation

    J. NeuroEng. Rehabil.

    (2012)
  • M. Iosa et al.

    Wearable inertial sensors for human movement analysis

    Expert Rev. Med. Devices

    (2016)
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