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

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.