No matter what monitoring system is in use, the value of live data can’t be underestimated. The ability to share objective data within performance departments and with athletes, particularly during rehabilitation, can be the difference between a smooth process and RTP (return-to-performance) feeling disjointed. The disjointed feeling can be exacerbated further during long RTP journeys when monotony can creep in and engagement with athletes is essential.
David Power is Junior Academy Physiotherapist at Leicester Tigers in Premiership Rugby, England’s top division of rugby. Although David is assigned to the academy, his role also extends into working with senior players. In November 2019, a senior player at the Tigers suffered a full tibial shaft fracture. This injury occured after managing a stress response in his fifth metatarsal on the same leg for a number of weeks. The club’s medical department turned to IMU Step to help with the return-to-performance process.
“We wanted to use IMU Step more for rehab and reloading as an athlete comes back from injury. We thought it could give us vital information on asymmetries for load tolerance and weight-bearing as athletes progress to RTP.”
Integrating IMU Step alongside GPS
“Although, like many other clubs, we use GPS (global positioning system) to monitor global training load, we are always looking for other technology that can help us in different, more specific situations. We wanted to use IMU Step more for rehab and reloading as an athlete comes back from injury. We thought it could give us vital information on asymmetries for load tolerance and weight bearing as athletes progress through our RTP process.”
It quickly became clear to the medical and performance team that IMU Step could be utilized in this specific use case.
“We went into the trial process with a very open mind. But very quickly we realized that it would be great to use it with one of our rehabbing athletes because he is so load-compromised. Before this incident, the athlete was managing a stress response in his foot over a number of games. So naturally the additional information would be of interest regarding loading. He then had a direct impact on his left tibia from a heavy collision during a game. This caused a full tibial shaft fracture. This resulted in an intramedullary nailing operation – basically a long nail being inserted vertically into the length of his tibia.”
“We thought IMU Step could work really well alongside the GPS, or even in the rehab stages prior to GPS usage, to give us objective limb-specific load and deeper insights into the work we were implementing. He had the surgery in November and we got access to IMU Step during January when he was still walking with an obvious limp due to pain at the fracture site, as you would expect at this stage. We immediately knew that we could get some really good objective data from the technology to plan his rehabilitation.”
As with many cases, previous injuries added a layer of complexity to this player’s rehabilitation. However, that led to opportunities for the medical team to address potential underlying mechanical and movement pattern issues. They hoped that addressing these issues would reduce the chances of re-injury.
“We then used the live data capabilities within IMU Step to look at asymmetries and cue the athlete based on what we saw from the live data. Just a basic cue such as ‘put more weight through your right leg’ was enough to have him adjust his pattern.“
Introducing live data into the rehabilitation process
“Although quite a severe surgery, the recovery period is reasonably quick. He was weight bearing, although with a limp, after only two to three weeks, which is extremely quick for such a significant surgery. This athlete has had a previous ACL reconstruction on the same side which adds a completely different dimension to the rehab. So we are basically rehabbing an ankle, knee and foot at the same time. And not to mention previous groin injuries on the same side too.”
Throughout this process, the IMU Step live data video overlay feature has led to increased athlete buy-in. As well as this, it has allowed the medical team to track progress with visual aids.
“The IMU Step video overlay has been incredibly helpful in his low speed change of direction (COD) work. He’s not running fluidly linearly, but laterally he’s pretty good. As a rule of thumb, we as a department try incorporate a stream of COD into rehab as soon as athletes can tolerate it. Even if it’s just walking progressions with a technique emphasis. This athlete ruptured his ACL, partly due to his COD technique which often includes a very wide plant and step off his left side. We wanted to use this time to see whether we could coach him into safer ranges and patterns. And that is where the video in IMU Step has been invaluable.”
Using IMU Step in conjunction with an AlterG
“We firstly got the athlete on the AlterG, reducing body mass and monitoring impact load based on some of the work from the Aspetar group, looking at reductions in body weight percentages, speed and respective plantar load estimations. We then used the live capabilities within IMU step to look at asymmetries and cue the athlete based on what we saw from the live data. Just a basic cue of “put more weight through your right leg” was enough to have him adjust his pattern.
Because of his previous ACL injury, we quickly realized that this athlete wasn’t fully aware of what symmetrical felt like. He is now so used to relying on his right side, he wasn’t aware of what he was doing. IMU Step allowed us to recognise this with ease, and most importantly, change it. In the footage, it is quite easy for the athlete to see where the cue is given to actually go back to symmetry. It’s been great for him to feel and see what symmetry is actually like.”
During the time spent on the AlterG while measuring asymmetries with IMU Step, David and the team have been able to clearly define when symmetry breaks down.
“As we progressed to jogging, using IMU Step and the footnote feature we were able to see the speed and percentage of body weight where the symmetry broke down. This stopped us from over-cooking the athlete and feeding into them compensatory patterns.”
“The athlete really enjoyed the feedback. The video has changed everything with IMU Step in my opinion. Having the data overlay and seeing exactly when loading occurs, it gives the data more meaning to the athlete.”
The impact of live data on athlete buy-in
“The athlete really enjoyed the feedback. The video has changed everything with IMU Step in my opinion. Having the data overlay and seeing exactly when loading occurs, it gives the data more meaning to the athlete. The speed of getting information to the player has dramatically increased because of this. And because of the accessibility of the data among the performance team, no matter who is rehabbing the player on a given day, everyone can access the data to see where he is at.”
As David progresses this athlete through the return-to-performance journey, he plans to incorporate IMU Step even further.
“As he continues to move through low-level plyometrics, we are planning on using IMU Step even more. We are really keen to know what our plyometric progressions look like. “How much load is he putting through each limb during our exercises and drills? And is this transferable to other players?” would be a great questions to answer. Again, this is where the video comes in. We can immediately show the athlete the differences between left and right on a jump seconds after he has performed it.”
The current situation with COVID-19 is creating unforeseen challenges for clubs worldwide. This has led to searches for solutions for managing both fit and injured players remotely. David thinks that with the help of IMU Step, they may have found a solution.
“It’s not ideal working with players without face-to-face contact. But luckily this player has his own iPad and recently installed the IMU Step app. We have given him sensors to take with him, and to continue to use during his impact-based rehab sessions at home, whether that be indoor jumps or outdoor running and COD progressions. With this, he can use the live recording feature and screen record this as a video on his own iPad. He can then send the footage back to me in Leicester to the analyze his progress. Using something as simple as a screen-share from a video call allows us to watch this back together. We can then discuss certain movement patterns, and compare what I’m seeing to what he feels.”
“The team were hoping to get this athlete back in May, but because of COVID-19, that may be extended slightly. We haven’t utilized the new Total Impact Load quite yet. But we think it could be another layer of information looking at loading volumes for this athlete. This could be particularly useful now in the earlier stages of on-feet reconditioning. As he won’t have GPS at home, we can now still monitor load through ‘total impact load’ from IMeasureU. I doubt many clubs have the capacity currently.”
This case study builds on concepts we’ve explored in-depth at IMeasureU. Follow the links below to learn more –
IMU Step: Helping to monitor chaos during rehab?
How to Improve Patient Outcomes with Objective Data
Using inertial sensors to improve the return-to-play process: A case study with Loughborough University
Have an injured athlete? Get in touch with us and ask about a free trial of IMU Step to see how we can help your return-to-play.