Interview with Dr. Reed Ferber: Running Injuries, Barefoot Running, 3-D Gait Analysis and More

3D Gait Analysis

There are millions of runners in Canada. Of all these runners, approximately 50% get injured every year. What if we could reduce this number by 5%?  This could save the Canadian health care system a whopping one billion dollars. A win-win if you ask me.

I was fortunate enough to have a 30-minute conversation with Dr. Reed Ferber, Director of the Running Injury Clinic and Assistant Professor in the Faculties of Kinesiology and Nursing at the University of Calgary. We talked about the clinic’s new initiative (One Percent to be Active), 3D gait analysis to diagnose/treat running injuries, barefoot running, running injury predictors and running performance analysis.

One Percent to be Active Program

Since 1981, obesity rates have tripled. If we are to have any chance at nipping this epidemic in the bud, it’s clear that we need to start with children.

The Running Injury Clinic, along with the Faculty of Kinesiology at the University of Calgary, have decided to start a program to help fight obesity and to promote an active lifestyle. Dr. Reed Ferber, the Director of the clinic, was inspired by a similar program (1% For the Planet) that was started by the founder of Patagonia, Yvon Chouinard. Dr. Ferber’s initiative is called One Percent To Be Active.

Health care practitioners, clinics and other businesses that decide to participate in the One Percent To Be Active will donate 1% of their gross revenue to provide Kinesiology students with the means to develop ideas to promote active lifestyles in children. Not only will all donors be contributing to a very serious and worthy cause, all donations will be considered charitable and the donor will receive a tax receipt from the University of Calgary.

Students may work individually or as a team. Ideas will be presented in a Dragon’s Den format to the Kinesiology Faculty, and the best will be funded and given the “green light”. There are 800 creative and talented Kinesiology students at the University and Dr. Ferber believes empowering them with money and accountability will provide some amazing results with a hugely positive impact for children.

Healthynomic’s new online store, Foot Forward Training Systems, focuses on running injury rehabilitation and performance tools.  Foot Forward is excited to announce its participation in the program to help children lead active lifestyles when One Percent to be Active is officially rolled out later in the year.

3D Gait Analysis System to Help Prevent and Treat Running Injuries

Are you ready to learn about the most sophisticated assessment tool available in the world in terms of walking and running patterns?

The Running Injury Clinic at the University of Calgary is a research lab at heart, but also provides clinical 3-dimensional gait analysis to the general public. A gait analysis at the Running Injury Clinic utilizes an 8-camera motion capture system that analyzes running and/or walking biomechanics. Your biomechanics are analyzed as they relate to your strength, flexibility and alignment.

In order to provide this technology to all runners, the Running Injury Clinic asked themselves how they could provide other clinicians with a tool to perform a 3D gait analysis.

Since 1990, research has shown that a 2-dimensional analysis is highly inaccurate (there can margins of error of up to 30 percent). In the past 10 years there has been a big surge in evidence-based medicine; making clinical decisions based on evidence found in research. Making gait analysis decisions based on 2D analysis (using one video camera) is not therefore considered evidence based. As a result, Dr. Ferber’s clinic partnered with Vicon, world leaders in motion analysis technology, to develop a 3-camera system that can be installed in a clinic setting.

The 3D gait analysis system is linked up to the Running Injury Clinic’s enormous research data base through custom written software. A patient’s data can then be compared to a research database that Dr. Ferber’s team has been collecting for the last 6 years – giving the injured runner an accurate injury risk assessment score. The lower your injury risk assessment score, the better. A score of 70% means that you have a 70% chance of getting or remaining injured (sample injury assessment report).

The 3D gait analysis can also tell a runner for example you how much their foot pronates, how quickly it pronates, at what point in the stance (planting) it pronates or how much their knee rotates, pelvis drops etc. Clinicians can use this information to optimize the assessment of the injury and ultimately, successfully treat the running injury.

Currently there are only a handful of Dr. Ferber’s 3D gait analysis systems around the world (Calgary, Banff and Lethbridge, Alberta and Victoria, British Columbia), but further systems are planned. The Running Injury Clinic would like to roll out 500 more systems world-wide in the next year.

Have a look at the video below of the roll-out and great explanation of the 3D gait analysis system at Parkway Physiotherapy in my hometown of Victoria, British Columbia.

Performance Evaluation

50% of runners get injured every year – this statistic hasn’t changed in 30 years.  This tells us that not much has progressed despite the advancements made in running shoe technology. It’s much more than the shoe or the training program.  Every runner is a complex and sophisticated puzzle.

If you help people achieve their running goals, they will stay in the sport which is good from a healthy aging standpoint.  In order to keep runners off the injury shelf, the Running Injury Clinic also is also developing a performance analysis for runners.  Half of runners are motivated to perform better and with an aging population, performance analysis will help runners achieve their goals and keep them running.

The Running Injury Clinic has taken the same program/software from its 3D gait analysis system and is working with coaches to develop an accurate method of performance analysis. Say for example, you want to qualify for Boston and currently run a 3:33 marathon, but want to run 3:15. A performance analysis will provide you with information to help you run at your desired speed. Where does your performance breakdown at the speed you’re trying to train? A performance-based analysis will give coaches an evidence based tool to alter the runner’s biomechanics and provide answers.

To date, research has not defined commonalities for specific running injuries.  It’s a very complex system but as the Running Injury Clinic collects more data, commonalities will hopefully be revealed. We do know that healthy runners have certain movement patterns.  Dr. Ferber’s clinic found that when you get stronger, you develop a more consistent and predictable pattern of movement. When you’re injured and weak however, you’re movement patterns will be much more varied and less predictable.  As you get stronger and pain decreases, runners have a more consistent foot fall.

Dr. Ferber hopes down the road, data like this may be able to help identify when a runner is on the verge of an injury and then clinicians can intervene to stop injury from ever happening.

Barefoot running

There is no doubt that barefoot running and minimalist running shoes have featured in many headlines in the news over the past couple of years. Dr. Ferber is trying to better understand the current hype and has taken to barefoot running (in Vibram Fivefingers) as an

experiment. He has emphasized that anyone looking to start barefoot running needs to start off very gradually. He started with just 10 minutes on the treadmill and is building up from there. Dr. Ferber’s suggested that anyone looking to start barefoot running needs to realize that:

1. Your biomechanics will be significantly altered.
2. You better have enough strength and flexibility in the calves, feet, arches and ankles.
3. You better have a “normal foot”, which 85% of people do
4. You must drop your training rate down and build back up.

Dr. Ferber has seen many runners show up in his clinic that are injured from barefoot running. They have basically done too much, too soon. There is no clinical research to date that shows barefoot running to be injury protective or injury causative.

What does the research show? Simply put, running barefoot is different and cannot be started without sufficient ankle stabilizing muscle strength. The Running Injury Clinic posted a barefoot running training program for those runners looking to give it a try.

Running Injury Predictors

Is there any effective way to predict whether a runner will become injured?

I asked Dr. Ferber is there are any good tests that can be used as predictor of chance of injury. He stated research out of the University of Delaware and the University of Kentucky shows that the single leg squat is one of the best indicators. As mentioned earlier, 50% of runners will get injury every year. Of those injured runners, 50% will have a knee injury. Oddly enough, the high incidence of knee injuries rarely has anything to do with the knee itself.

Where do we start? The hips.

If a runner is weak in the hip abductors , their knee will gravitate inwards during the squat. The inward movement of the knee shows that the runner lacks the core / hip strength to control their knee. If you cannot control your own body weight, you are very likely to get injured.

The main stabilizer of your leg when standing on one leg is the gluteus medius. When you run, you’re essentially landing and balancing on one leg hundreds, even thousands of times in a row. If this hip stabilizing muscle is not strong enough, it will not be a good stabilizer, leaving the runner at risk for a running injury. The Running Injury Clinic has posted some exercises to help strengthen the hip abductors.

Hip Strengthening Resources for Runners:

1. Straight From the Hip
2. Hip Muscle Strengthening

Closing Thoughts

People run the way they run because they are weak in certain areas, stronger in others, inflexible in some spots and more flexible in others. Moreover, the way you’re built plays a big role in how you run. It’s not really about changing your biomechanics to improve your running and reduce chance of a running injury. It’s much more of a puzzle. For example, you may need to get a little stronger in one area and more flexible in another. Once this happens, your biomechanics will change as a result and you will once again run pain free.

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