I wrote this piece during PT school and it is something I am very proud of, both because of the effort put in and the product produced. At the time (and to this day) I was unable to find another single resource on this topic that so clearly and comprehensively reviewed the evidence base. As my understanding of the science progresses I realize some aspects of this piece need to be revised (a non-comprehensive list of the biggest revisions necessary is below) but to this day I stand by it as possibly the best single reference for a deep overview of the topic. Finally, of note is that I never made a bibliography for the article (I wrote this for barely any credit🤓and formatting citations is my least favorite thing IN THE WORLD) so if you want the citation information or research manuscripts feel free to contact me directly.
Most significant revisions necessary:
Ground Reaction Force Metrics Are Not Strongly Correlated With Tibial Bone Load When Running Across Speeds and Slopes: Implications for Science, Sport and Wearable Tech - Matejevich 2019
Axioms regarding the connection between certain ground reaction force measures (GRFs) and bone loading (and thus parameters that affect bone stress injury risk) have been systematically misrepresented both in the literature and in commercial wearable technology. Specifically, when measuring tibial bone load at different speeds and slopes, typical GRF metrics such as the average vertical loading rate, impact peak, and total vertical impulse were not well (and often negatively 😲!) correlated with with tibial bone stress, although peak GRF of the entire stance phase was somewhat good at predicting bone load (r=.7). As an intuitive example of how this works, tibial strain goes up significantly when running uphill because of the increased demand on the calf and associated muscular contribution to tibial strain, although GRF metrics are generally low (i.e. footsteps tend to be quieter running up hills). This means that the conclusions of a large portion of salient literature must be re-interpreted and that the recommendations given by many wearable products may provide dangerous recommendations to those at risk for bone stress injuries.
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