Gepubliceerd op: 16 Apr 2025
Enhancing Running Performance and Preventing Injury: A New Era in Physiotherapy CPD and Sports Science
In the fast-paced world of endurance sport, running remains a cornerstone of human movement—and a frequent source of musculoskeletal injury. Research suggests that up to 50% of runners drop out annually due to injury, with hamstring strains and overuse injuries leading the list. For physiotherapists and performance specialists, the mission to keep runners healthy, efficient, and competitive continues to evolve.
A major step forward has emerged from the PhD research of Bas Van Hooren, recently honoured with the British Journal of Sports Medicine PhD Academy Award. His work, which integrates hamstring strengthening, biomechanics, wearable technology, and data science, presents a new framework for understanding and managing running-related injuries. This article distils his research into clinically relevant insights for continuing professional development (CPD) in physiotherapy, offering practical takeaways for injury prevention and performance optimisation.
Hamstring Strengthening: The Role of Eccentric Loading in Rehabilitation
At the core of Van Hooren’s work was the prevention of both sprint-related and long-distance running injuries, with a specific focus on hamstring rehabilitation. Using musculoskeletal modelling and dynamic ultrasound imaging, he investigated the mechanical loading of various hamstring exercises. The Nordic hamstring curl (NHC) emerged as the standout intervention, delivering the highest peak force and the greatest fascicle lengthening compared to deadlifts and Roman chair holds (Van Hooren et al., 2022).
From a physiotherapy perspective, these findings support the use of the NHC as a cornerstone in hamstring injury prevention programmes, especially for athletes at risk of strain injuries. Notably, follow-up imaging revealed reduced activation of the long head of the biceps femoris in previously injured athletes, despite no structural abnormalities (Van Hooren et al., 2023). This underlines the presence of neuromuscular inhibition post-injury, pointing to the need for sensorimotor retraining or neuromotor re-education in post-rehabilitation care.
Running Technique, Biomechanics, and Performance
Beyond isolated muscle strengthening, Van Hooren's research examined the biomechanical determinants of running economy (RE)—a critical factor in both performance and injury risk. Through a systematic review and meta-analysis, followed by data collection using 3D motion capture, gas exchange, and neural networks, several key variables associated with improved RE were identified: increased leg stiffness, higher step frequency, and optimised sagittal-plane kinematics (Van Hooren et al., 2024a; 2024b).
These findings are directly translatable to clinical gait retraining. Physiotherapists working with runners can now identify inefficiencies such as overstriding or excessive vertical oscillation and address them using targeted biomechanical cues. Importantly, Van Hooren demonstrated that computer vision tools like OpenPose and DeepLabCut can deliver accurate gait analysis without lab constraints (Van Hooren et al., 2023). This marks a breakthrough for field-based biomechanical assessments, making advanced motion capture accessible in real-world clinical environments.
Wearable Technology in Physiotherapy: Real-Time Feedback and Load Monitoring
One of the most transformative aspects of the research was the integration of wearable sensor technology with machine learning algorithms. Using instrumented insoles capable of measuring ground reaction forces and estimating tissue loading, Van Hooren and colleagues conducted a large-scale randomised controlled trial (RCT). The intervention group received real-time feedback on mechanical loading, while the control group did not. Results were striking: the feedback group experienced lower injury rates and measurable improvements in running economy (Van Hooren et al., 2024d; 2024e).
This innovation redefines how physiotherapists can monitor, evaluate, and adjust training in real time. Rather than relying solely on subjective reporting or retrospective injury logs, clinicians can now integrate data-informed decision making directly into their practice. For example, wearable insoles could alert therapists to excessive load patterns during a session, prompting immediate gait modification to reduce injury risk.
Clinical Applications and CPD Implications for Physiotherapists
The clinical relevance of this work is profound. For physiotherapists specialising in running injuries, several key takeaways emerge:
- Eccentric exercises like the NHC should be prioritised for improving fascicle length and tissue resilience.
- Neuromuscular retraining is essential for athletes post-injury to address lingering inhibition and restore full motor function.
- Gait retraining strategies informed by biomechanical research can reduce energy expenditure and prevent common overuse injuries.
- Wearable technology provides physiotherapists with new tools for monitoring tissue stress and applying real-time corrections during running.
For CPD programme development, this research offers a robust foundation for new learning modules. Topics such as markerless motion capture, real-time feedback systems, AI in sports biomechanics, and individualised gait retraining are highly relevant for advancing both clinical practice and educational offerings.
A Precision Medicine Approach to Running Injury Prevention
Van Hooren’s work also aligns with the growing shift toward precision rehabilitation in physiotherapy. By leveraging wearable sensors and predictive modelling, clinicians can develop personalised treatment plans that evolve in response to live data. This represents a move from reactive treatment toward proactive, data-driven care, placing the patient at the centre of a dynamic feedback loop.
Rethinking Running Education and Coaching
The research challenges conventional views on running technique, reframing it not as a stylistic choice but as a modifiable variable with significant implications for both injury risk and performance. As such, there is a growing need for interdisciplinary CPD education—combining clinical physiotherapy with biomechanics, data science, and sports technology.
Courses that incorporate real-world motion capture, machine learning applications, and evidence-based gait interventions could significantly upskill physiotherapists, coaches, and sports scientists alike.
Conclusion
Bas Van Hooren’s PhD research offers a powerful, evidence-based framework for physiotherapists aiming to improve running performance and injury prevention. By combining traditional rehabilitation with modern tools such as wearable technology, machine learning, and field-based biomechanics, his work bridges the gap between clinical theory and athletic practice.
For physiotherapy CPD providers, the implications are clear: the future lies in merging scientific rigour with technological innovation, delivering education that empowers clinicians to practice smarter, intervene earlier, and support runners across all levels—from recreational athletes to elite performers.
References
Van Hooren, B., Plasqui, G., & Meijer, K. (2024). The Effect of Wearable-Based Real-Time Feedback on Running Injuries and Running Performance: A Randomized Controlled Trial. American Journal of Sports Medicine, 52, 750–765.
Van Hooren, B., Vanwanseele, B., van Rossom, S., et al. (2022). Muscle forces and fascicle behavior during three hamstring exercises. Scandinavian Journal of Medicine & Science in Sports, 32, 997–1012.
Van Hooren, B., Vicente-Mampel, J., Piqueras-Sanchiz, F., et al. (2023). T2 Hamstring Muscle Activation during the Single-Leg Roman Chair: Impact of Prior Injury. Exercise Sport Movement, 1, 1–8.
Van Hooren, B., Pecasse, N., Meijer, K., et al. (2023). The accuracy of markerless motion capture combined with computer vision techniques for measuring running kinematics. Scandinavian Journal of Medicine & Science in Sports, 33, 966–978.
Van Hooren, B., Jukic, I., Cox, M., et al. (2024a). The Relationship Between Running Biomechanics and Running Economy: A Systematic Review and Meta-Analysis of Observational Studies. Sports Medicine, 54, 1269–1316.
Van Hooren, B., Lennartz, R., Cox, M., et al. (2024b). Differences in running technique between runners with better and poorer running economy and lower and higher mileage: An artificial neural network approach. Scandinavian Journal of Medicine & Science in Sports, 34, e14605.
Van Hooren, B., Van Rengs, L., Meijer, K. (2024c). Predicting Musculoskeletal Loading at Common Running Injury Locations Using Machine Learning and Instrumented Insoles. Medicine & Science in Sports & Exercise, 56, 2059–2075.
Van Hooren, B., Willems, P., Plasqui, G., et al. (2024d). Changes in running economy and running technique following 6 months of running with and without wearable-based real-time feedback. Scandinavian Journal of Medicine & Science in Sports, 34, e14565.