Benedikt Fasel

Potential Mechanisms Leading to Overuse Injuries of the Back in Alpine Ski Racing: A Descriptive Biomechanical Study

Background: Overuse injuries of the back are a common complaint among top athletes and of competitive alpine skiers in particular. However, there is limited understanding about the sport-specific causes of these injuries that is essential for their prevention. Purpose/Hypothesis: This study was undertaken to describe the sport-specific, overall trunk kinematics and skiers’ loading during giant slalom turns and to assess the plausibility of the hypothesis that a combination of frontal bending, lateral bending, and/or torsion in the loaded trunk might be a potential mechanism leading to overuse injuries of the back in alpine ski racing. Study Design: Descriptive laboratory study. Methods: Eight European Cup–level athletes performed giant slalom runs with 2 different pairs of skis (varying in length, width, and sidecut). They were analyzed with respect to selected kinematic variables related to spinal disc loading. The overall trunk movement components (frontal bending, lateral bending, and torsion) were measured using 2 inertial measurement units fixed on the sacrum and sternum. Total ground-reaction forces were measured by pressure insoles. Results: During the turn phase in which the total ground-reaction forces were the greatest (up to 2.89 times the body weight), the highest average values of frontal bending (38.7°), lateral bending (14.7°), and torsion (7.7°) in the trunk occurred. Similar magnitudes were observed when skiing on longer, giant slalom skis with less width and sidecut. Conclusion: The typical loading patterns of the back in alpine ski racing include a combined occurrence of frontal bending, lateral bending, and torsion in the loaded trunk. Because these factors are known to be related to high spinal disc loading, they may be considered important components of mechanisms leading to overuse injuries of the back in alpine ski racing. Clinical Relevance: Prevention measures should aim to control and/or reduce the magnitude of frontal bending, lateral bending, and torsion in the trunk, as well as the peak loads, while skiing.

Three-Dimensional Body and Centre of Mass Kinematics in Alpine Ski Racing Using Differential GNSS and Inertial Sensors

A key point in human movement analysis is measuring the trajectory of a person’s center of mass (CoM). For outdoor applications, differential Global Navigation Satellite Systems (GNSS) can be used for tracking persons since they allow measuring the trajectory and speed of the GNSS antenna with centimeter accuracy. However, the antenna cannot be placed exactly at the person’s CoM, but rather on the head or upper back. Thus, a model is needed to relate the measured antenna trajectory to the CoM trajectory. In this paper we propose to estimate the person’s posture based on measurements obtained from inertial sensors. From this estimated posture the CoM is computed relative to the antenna position and finally fused with the GNSS trajectory information to obtain the absolute CoM trajectory. In a biomechanical field experiment, the method has been applied to alpine ski racing and validated against a camera-based stereo photogrammetric system. CoM position accuracy and precision was found to be 0.08 m and 0.04 m, respectively. CoM speed accuracy and precision was 0.04 m/s and 0.14 m/s, respectively. The observed accuracy and precision might be sufficient for measuring performance- or equipment-related trajectory differences in alpine ski racing. Moreover, the CoM estimation was not based on a movement-specific model and could be used for other skiing disciplines or sports as well.

An inertial sensor-based system for spatio-temporal analysis in classic cross-country skiing diagonal technique.

The present study proposes a method based on ski fixed inertial sensors to automatically compute spatio-temporal parameters (phase durations, cycle speed and cycle length) for the diagonal stride in classical cross-country skiing. The proposed system was validated against a marker-based motion capture system during indoor treadmill skiing. Skiing movement of 10 junior to world-cup athletes was measured for four different conditions. The accuracy (i.e. median error) and precision (i.e. interquartile range of error) of the system was below 6 ms for cycle duration and ski thrust duration and below 35 ms for pole push duration. Cycle speed precision (accuracy) was below 0.1m/s (0.00 5m/s) and cycle length precision (accuracy) was below 0.15m (0.005 m). The system was sensitive to changes of conditions and was accurate enough to detect significant differences reported in previous studies. Since capture volume is not limited and setup is simple, the system would be well suited for outdoor measurements on snow.

Course Setting as a Prevention Measure for Overuse Injuries of the Back in Alpine Ski Racing: A Kinematic and Kinetic Study of Giant Slalom and Slalom

Background: A combination of frontal bending, lateral bending, and torsion in the loaded trunk has been suggested to be a mechanism leading to overuse injuries of the back in Alpine ski racing. However, there is limited knowledge about the effect of course setting on the aforementioned back-loading patterns. Purpose: To investigate the effect of increased gate offset on the skier’s overall trunk kinematics and the occurring ground-reaction forces and to compare these variables between the competition disciplines giant slalom (GS) and slalom (SL). Study Design: Controlled laboratory study. Methods: Ten top-level athletes were divided into GS and SL groups. Both groups performed a total of 240 GS and 240 SL turns at 2 different course settings. The overall trunk movement components (frontal bending, lateral bending, and torsion angle) were measured using 2 inertial measurement units fixed on the sacrum and sternum. Total ground-reaction forces were measured by pressure insoles. Results: In SL, ground-reaction force peaks were significantly lower when the gate offset was increased, while in GS, no differences between course settings were observed. During the turn phase in which the highest spinal disc loading is expected to occur, the back-loading patterns in both GS and SL included a combination of frontal bending, lateral bending, and torsion in the loaded trunk. SL was characterized by shorter turns, lower frontal and lateral bending angles after gate passage, and a trend toward greater total ground-reaction force peaks compared with GS. Conclusion: Course setting is a reasonable measure to reduce the skier’s overall back loading in SL but not in GS. The distinct differences observed between GS and SL should be taken into account when defining discipline-specific prevention measures for back overuse injuries. Clinical Relevance: To reduce the magnitude of the overall back loading, in SL, minimal gate offsets should be avoided. Prevention measures in GS might particularly need to control and/or reduce the magnitude of frontal and lateral bending in the loaded trunk, whereas prevention measures in SL might especially need to mitigate the short and high total ground-reaction force peaks.

Joint Inertial Sensor Orientation Drift Reduction for Highly Dynamic Movements

Inertial sensor drift is usually corrected on a single-sensor unit level. When multiple sensor units are used, mutual information from different units can be exploited for drift correction. This study introduces a method for a drift-reduced estimation of three dimensional (3-D) segment orientations and joint angles for motion capture of highly dynamic movements as present in many sports. 3-D acceleration measured on two adjacent segments is mapped to the connecting joint. Drift is estimated and reduced based on the mapped accelerations’ vector orientation differences in the global frame. Algorithm validity is assessed on the example of alpine ski racing. Shank, thigh, and trunk inclination as well as knee and hip flexion were compared to a multicamera-based reference system. For specific leg angles and trunk segment inclination mean accuracy and precision were below 3.9° and 6.0°, respectively. The errors were similar to errors reported in other studies for lower dynamic movements. Drift increased axis misalignment and mainly affected joint and segment angles of highly flexed joints such as the knee or hip during a ski turn.

Validation of functional calibration and strap-down joint drift correction for computing 3D joint angles of knee, hip, and trunk in alpine skiing

To obtain valid 3D joint angles with inertial sensors careful sensor-to-segment calibration (i.e. functional or anatomical calibration) is required and measured angular velocity at each sensor needs to be integrated to obtain segment and joint orientation (i.e. joint angles). Existing functional and anatomical calibration procedures were optimized for gait analysis and calibration movements were impractical to perform in outdoor settings. Thus, the aims of this study were 1) to propose and validate a set of calibration movements that were optimized for alpine skiing and could be performed outdoors and 2) to validate the 3D joint angles of the knee, hip, and trunk during alpine skiing. The proposed functional calibration movements consisted of squats, trunk rotations, hip ad/abductions, and upright standing. The joint drift correction previously proposed for alpine ski racing was improved by adding a second step to reduce separately azimuth drift. The system was validated indoors on a skiing carpet at the maximum belt speed of 21 km/h and for measurement durations of 120 seconds. Calibration repeatability was on average <2.7° (i.e. 3D joint angles changed on average <2.7° for two repeated sets of calibration movements) and all movements could be executed wearing ski-boots. Joint angle precision was <4.9° for all angles and accuracy ranged from -10.7° to 4.2° where the presence of an athlete-specific bias was observed especially for the flexion angle. The improved joint drift correction reduced azimuth drift from over 25° to less than 5°. In conclusion, the system was valid for measuring 3D joint angles during alpine skiing and could be used outdoors. Errors were similar to the values reported in other studies for gait. The system may be well suited for within-athlete analysis but care should be taken for between-athlete analysis because of a possible athlete-specific joint angle bias.

Measuring spatio-temporal parameters of uphill ski-mountaineering with ski-fixed inertial sensors

In this study an algorithm designed for the diagonal stride in classical cross-country skiing was adapted to compute spatio-temporal parameters for uphill ski mountaineering using a ski fixed inertial sensor. Cycle duration, thrust duration, cycle speed, cycle distance, elevation gain, and slope angle were computed and validated against a marker-based motion capture system during indoor treadmill skiing. Skiing movement of 12 experienced, recreational level athletes was measured for nine different speed and slope angle combinations. The accuracy (i.e. mean error) and precision (i.e. standard deviation of the error) were below 3ms and 13ms for the cycle duration and thrust duration, respectively. Accuracy (precision) for cycle speed, cycle distance and elevation gain were -0.013m/s (0.032m/s), -0.027m (0.018m), and 0.006m (0.011m), respectively. Slope angle accuracy and precision were 0.40° and 0.32°, respectively. If the cross-country skiing algorithm would be used without adaptations, errors would be up to one order of magnitude larger. The adapted algorithm proved valid for measuring spatio-temporal parameters for ski-mountaineering on treadmill. It is expected that the algorithm shows similar performance on snow.

A wrist sensor and algorithm to determine instantaneous walking cadence and speed in daily life walking

In daily life, a person’s gait—an important marker for his/her health status—is usually assessed using inertial sensors fixed to lower limbs or trunk. Such sensor locations are not well suited for continuous and long duration measurements. A better location would be the wrist but with the drawback of the presence of perturbative movements independent of walking. The aim of this study was to devise and validate an algorithm able to accurately estimate walking cadence and speed for daily life walking in various environments based on acceleration measured at the wrist. To this end, a cadence likelihood measure was designed, automatically filtering out perturbative movements and amplifying the periodic wrist movement characteristic of walking. Speed was estimated using a piecewise linear model. The algorithm was validated for outdoor walking in various and challenging environments (e.g., trail, uphill, downhill). Cadence and speed were successfully estimated for all conditions. Overall median (interquartile range) relative errors were −0.13% (−1.72 2.04%) for instantaneous cadence and −0.67% (−6.52 6.23%) for instantaneous speed. The performance was comparable to existing algorithms for trunk- or lower limb-fixed sensors. The algorithm’s low complexity would also allow a real-time implementation in a watch.

The use of body worn sensors for detecting the vibrations acting on the lower back in alpine ski racing

This study explored the use of body worn sensors to evaluate the vibrations that act on the human body in alpine ski racing from a general and a back overuse injury prevention perspective. In the course of a biomechanical field experiment, six male European Cup-level athletes each performed two runs on a typical giant slalom (GS) and slalom (SL) course, resulting in a total of 192 analyzed turns. Three-dimensional accelerations were measured by six inertial measurement units placed on the right and left shanks, right and left thighs, sacrum, and sternum. Based on these data, power spectral density (PSD; i.e., the signals power distribution over frequency) was determined for all segments analyzed. Additionally, as a measure expressing the severity of vibration exposure, root-mean-square (RMS) acceleration acting on the lower back was calculated based on the inertial acceleration along the sacrums longitudinal axis. In both GS and SL skiing, the PSD values of the vibrations acting at the shank were found to be largest for frequencies below 30 Hz. While being transmitted through the body, these vibrations were successively attenuated by the knee and hip joint. At the lower back (i.e., sacrum sensor), PSD values were especially pronounced for frequencies between 4 and 10 Hz, whereas a corresponding comparison between GS and SL revealed higher PSD values and larger RMS values for GS. Because vibrations in this particular range (i.e., 4 to 10 Hz) include the spines resonant frequency and are known to increase the risk of structural deteriorations/abnormalities of the spine, they may be considered potential components of mechanisms leading to overuse injuries of the back in alpine ski racing. Accordingly, any measure to control and/or reduce such skiing-related vibrations to a minimum should be recognized and applied. In this connection, wearable sensor technologies might help to better monitor and manage the overall back overuse-relevant vibration exposure of athletes in regular training and or competition settings in the near future.

An Inertial Sensor-Based Method for Estimating the Athlete's Relative Joint Center Positions and Center of Mass Kinematics in Alpine Ski Racing

For the purpose of gaining a deeper understanding of the relationship between external training load and health in competitive alpine skiing, an accurate and precise estimation of the athletes kinematics is an essential methodological prerequisite. This study proposes an inertial sensor-based method to estimate the athletes relative joint center positions and center of mass (CoM) kinematics in alpine skiing. Eleven inertial sensors were fixed to the lower and upper limbs, trunk, and head. The relative positions of the ankle, knee, hip, shoulder, elbow, and wrist joint centers, as well as the athletes CoM kinematics were validated against a marker-based optoelectronic motion capture system during indoor carpet skiing. For all joints centers analyzed, position accuracy (mean error) was below 110 mm and precision (error standard deviation) was below 30 mm. CoM position accuracy and precision were 25.7 and 6.7 mm, respectively. Both the accuracy and precision of the system to estimate the distance between the ankle of the outside leg and CoM (measure quantifying the skiers overall vertical motion) were found to be below 11 mm. Some poorer accuracy and precision values (below 77 mm) were observed for the athletes fore-aft position (i.e., the projection of the outer ankle-CoM vector onto the line corresponding to the projection of skis longitudinal axis on the snow surface). In addition, the system was found to be sensitive enough to distinguish between different types of turns (wide/narrow). Thus, the method proposed in this paper may also provide a useful, pervasive way to monitor and control adverse external loading patterns that occur during regular on-snow training. Moreover, as demonstrated earlier, such an approach might have a certain potential to quantify competition time, movement repetitions and/or the accelerations acting on the different segments of the human body. However, prior to getting feasible for applications in daily training, future studies should primarily focus on a simplification of the sensor setup, as well as a fusion with global navigation satellite systems (i.e., the estimation of the absolute joint and CoM positions).