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Berlin Marathon Preparation: Leentje’s Story


• Written by Kurt Schutte

 

Leentje Hellemans, mother of two, started running five years ago. She has already completed several races including two marathons with one being a silver medal of 3hours 9min! Unfortunately, due to covid-lockdowns last year she suffered from her second consecutive stress fracture. During the lockdown period she couldn't see her physiotherapist (Bart Dingenen - Motion to Balance) often enough to work on her running technique and form. This year she is ready for her comeback and her goal is to run the Berlin Marathon under three hours without injury. Runeasi was recently introduced into her marathon preparation to help her achieve this goal.

First evaluation: Treadmill Running test with biofeedback

Bart had Leentje run at two speeds, one slower (13km/hr) and one faster (18km/hr). He used the biofeedback mode to see her impact in real-time while the Runeasi biomechanics sensor measured her impacts for ~1-2 minutes at each speed. At the slower speed the biofeedback showed that she had already crossed the yellow threshold (elevated) for impact and the red threshold (very high) for peak rates in her left leg. Both of these kinetic metrics are important to look at since it gives a clear view on how large (impact) and how fast (peak rate) the shock wave travels through the leg immediately after the foot lands on the ground. 

Patient: "It’s feels really good to know how much impact I have while running. It was surprising to see the imbalance between my left and right legs” – Leentje Hellemans

At the higher speed her peak rates were very high for both legs. Bart immediately used several cues on her running technique to work on reducing her peak rates. He also observed that she didn’t have her own running shoes that she normally runs in which was probably playing a role in her unexpectedly high impact.

Physiotherapist: “Now we can detect in real-time. Now we always test before recommending a cue. Now we can work more individualized. It's a real added value to clinical reasoning.” – Bart Dingenen

Follow-up evaluation: Outdoor run

One week later Leentje returned to Motion to Balance for an outdoor run – this time with her normal running shoes. She ran an easy pace is the forest alongside the physiotherapy practice. Bart sent her off for a brief run along the dirt track after he quickly attached her Runeasi biomechanics sensor and pressed record in the APP. When she returned her data automatically synced and together they analyzed her biomechanics. 

Physiotherapist: "Getting data in the exact environment gives more specific information to give our patients and athletes. ” – Bart Dingenen

Indoor vs. outdoor results

Her impact and peak rates showed interesting changes on her follow-up session outdoors (see picture of comparison below). The most striking differences were the reduction in impact by 39% in her left leg and 23% in her right leg; as well as the reduction in peak rates by 35% in her left leg and 48% in her right leg. These results indicate that her ability to absorb impact shocks is sensitive to the type of surface terrain she runs on and the type of shoes she runs in (and probably an interaction of the two!). 

Patient: "I think this is a great tool to measure aspects of my running that could explain my overuse injuries.” – Leentje Hellemans

Summary

As Leentje progresses her training loads to prepare for her marathon she will need to find the healthy balance between the load capacity of her body's structures and the actual load on her body. Her history of stress fractures suggests that finding this balance and knowing when too much is too much is not always so easy without professional guidance from a physiotherapist. She will need to produce adequate muscular force to counter the ground reaction forces for every single running step (i.e., local tissue capacity). She will also need the ability to perform (and withstand) the demand of her marathon training and event in Berlin (i.e., sport-specific capacity). These are important considerations explained in a recent article published in the British Journal of Sports Medicine by Gabbett, Sancho, Dingenen, and Willy., 2021. A nice infographic explaining these considerations can be found here. This framework fits perfectly with Runeasi measurements. By measuring her impact and knowing how her body responds to that impact will help her progress with confidence at the most critical moments during her marathon training plan. Knowing when to push and when to rest is a key insight into avoiding an overuse injury. With covid-lockdowns a thing of the past (hopefully) she can work on these aspects with Bart with regular follow-up examinations as she nears closer to her race date. We wish Leentje the best of luck!

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