 I'd like now to introduce you to Ashley and Lacey as she gets herself ready. Yeah, don't stick it in the eye. Thanks. Ashley is a certified athletic therapist and a second year MSc student in the School of Health and Human Performance in DCU. She is there studying the risk factors for running related injuries. To date she has completed a lot of qualitative research investigating runners use of running technologies, their engagement and long-term research and their perceptions around running related injuries. So I think what she is going to talk to you about here this morning is essentially what you've been telling her and I think it's a very interesting talk. Ashley is a Gaelic football and basketball player and as she calls herself a very recreational runner. Yeah, off season, reluctantly. Thank you. Perfect. Thanks, Brian. So I'm going to chat to you today about research we've been doing in DCU on runner's perspectives of running related injuries. So firstly, what is a running related injury? So running injuries are different to other high impact sport injuries like ACL tears and football or shoulder dislocations and rubble and they're chronic and insidious and onset. So they develop gradually over time, but how are they defined in the research? So there have been a variety of definitions used to define injury and research and they use different criteria. And this makes it hard to compare findings between studies. So a consensus definition was developed in 2015 that defined a running related injury as musculoskeletal pain in the lower limbs or lower back. So that was the first thing it had to have pain. Secondly, it either had to cause a stoppage or restriction to training or require medical attention. So we felt there were a couple of limitations to this about this definition of injury because it doesn't quite capture that chronic onset of injury and it also uses a time-lapse definition. So it has to cause a restriction or stoppage to training when we know that runners continue to train with injuries. And thirdly, it was developed through the opinions of researchers, which were very appropriate, but we felt we wanted to include the opinions of the people who experience these injuries. So we conducted a focus group study where we interviewed 31 runners across seven focus groups. We had 13 male and 18 female and they were from a variety of running backgrounds. So we had some sprinters, some middle distance marathon, ultramarathon. Each focus group was about two hours in duration. And they were recorded when transcribed and then we analyzed the data. So we came up with a number of core categories, teams and sub themes from this data. We extracted the data and then analyzed the data. And we came up with our findings. So when we firstly posed the question to runners about how they define and describe injury, they came up with a number of expected terms that we thought would come up that mapped quite well with this definition of injury, things like pain, being unable to run, frustrated, limping, a bit affecting their daily life or needing medical attention. But as we kind of chatted more and discussed further, we got a more nuanced version of injury and more progressive definition of injury, I suppose, and things like discomfort or tightness, stiffness, awareness, being cautious, running through it and ignoring it. These terms came up. So we combined all of these together and we came up with our findings and this is what we found. So the first thing is that runners perceive injury on a continuum. And this continuum goes from its lowest point at running smooth to its highest point as a career ending injury. And there are seven other points then along this continuum that run through discomfort, niggle, twinge, persistent niggle, non-responsive injury, an injury with an acute effect and an injury with a chronic effect. And these points were arrived at based on how runners physically describe each stage, how they psychologically describe this, the effect it had on their performance and the effect it had on their daily life. We also asked then how runners manage injury and typically they do three things. So either they do nothing, they use self-management strategies or they look towards external sources. Then we also found that this is very individual and how this is perceived and managed is different for each runner. And a lot of different factors come in to influence this. So things like age or previous injury or whether someone has children or they're moved on a particular date, this all comes into play to influence how this is perceived. So I'm going to just briefly chat through each point and describe what each one is. So the first one is running smooth and this is the first, the lowest level and it was injury-free and pain-free. There was full training, so there was no interference to training. There was no effect on daily life and no management. So it was fairly straightforward. The next stage was discomfort. And this was the first description of a complaint. And words like stiffness or tightness or tiredness were used to describe this stage, but it was something that was temporary. So typically it might be felt before your session, you'd go for a run and then it'd be gone. You'd loosen out. Again, full training could continue. There was no influence to training. There was no effect on daily life, but runners discussed this kind of mental fatigue. They felt sluggish at this point. It was kind of psychologically, they just felt a bit slow. For the majority, there was no management involved, although some started to increase their stretching and they might turn towards external sources like looking up exercises on YouTube or then chatting to their friends, typically people they would run with, so people with experience of running. The next point was a word used by every runner in every focus group. And we wanted to find out what is a niggle. And a lot of different terms were used to describe this. And these were some of the most common discomfort, low pain, and increased awareness of an area. But how it differed from the previous point was that it's something that's repeated. So it happens more than once and you're more aware of it and it's kind of niggling and it's going on and on. And it was also described as this kind of constant state. So people constantly have niggles and they live in this niggle city. It was just standard. But again, for the majority, there was full training. So people train and run through niggles. But at this point, some people started to change their training so they'd either reduce their distance or their pace or they'd focus more on their warm-ups to do a longer, more intense warm-up. Again, it didn't filter into the rest of their day but they were cautious and had a bit of a fear of more serious injuries. So they're starting to think, should this be something I'm worried about? The majority, again, don't really manage it. Some, a few more, start to increase their stretching. They take a rest day maybe. Again, they're looking at Google, YouTube, or chatting to their friends. The twinge, this is an outlier. It's the rest of the continuum and that's why it sits above because it's something that's quite intense and painful and things like darting pain or cramp were used to describe it but it's short-lived and it comes and goes really quickly. But it's severe enough that it causes someone to have to either slow down during their run or stop their run. But it doesn't last and it's not there the next time you run. Again, it still didn't filter into the rest of their day but it's annoying and it's something that they think, should I be worried about this? Probably not, it's not a big deal. At this point, all runners are doing something. So either with self-management, or they're taking another rest day. They're using ice or they're stretching. They're Googling, they're chatting to their friends, or now they're looking for more expert opinion and they're turning to a coach. Moving back onto the main continuum, this is this persistent niggle and how it differs from the niggle is that it's more intense and it's lasting longer. So there's no longer description of kind of more benign terms like stiffness or tightness and it's now pain. And it's something that's persistent and it's not going away. By this point, all runners are starting to change their load. So either overall load, distance, intensity, or more rest days are being taken here. Again, there's no real effect on the rest of their day. It's still only during their running session that they feel it, but now they're worried about it. So now we have anxiety about it and this is something that I'm worrying about. Again, alter training is how they manage it or they're starting to take medication to manage their pain or using ice and heat to manage pain. So the kind of self-management is more looking towards pain management. They're still chatting to friends and coaches and now we have the first onset of some sort of medical intervention. So whether it's physio or AT. This brings us up to about the halfway mark and this non-responsive injury was a point to describe our runners that all attempts to manage the complaint this far have failed and now they need to make a decision about what am I going to do? Do I stop running? Do I power through? Do I go get help? Like it's not responding to what I'm doing. So how do I manage it? And we're now into more pain. So pain is ramping up. It's something that's still persistent and now it's constant. So it's every run all the time I feel it. Again, how they're managing it is with reduced load. They're starting to introduce some sort of walk-run strategy. They feel they shouldn't be running but a lot will continue to run but some will choose now to stop running at this point. And this is the point now where it starts to drip into the rest of their day. So things like climbing the stairs or bringing in the shopping now they feel it outside of their normal running session. And again, they're worried about it and they're concerned about it. And self-management involves load management, joint supports and like checking their footwear maybe using orthotics, different kind of external sources of help and more reliance on that medical intervention. This point then is the point that maps closest with this consensus definition. So we can see all the detail before this that is potentially being missed if we only rely on this consensus definition. So pain is really starting to ramp up here. We're talking severe discomfort, high pain, sharp pain. A few will continue running again with altered training so either reduced load, distance, pace, but the majority will stop now in the short term. So this is for a number of weeks they've had to stop running. And again, pain is outside their normal session and they're starting to make conscious efforts to offload the injured areas. So they're driving instead of walking. And again, they're very worried about it. This is kind of increasing all the time. They're still doing pain relief and management and heavier reliance now on external management strategies. So this is the second last point then and this is an injury with a chronic effect. And again, the physical pain is starting to ramp up again we're talking extreme discomfort, sharp pain and very high pain. And all runners now have stopped at this point so no one's running and a lot are actually unable to run. So this is a long-term stop running for a number of months. And pain outside running again, similar to the previous point they're making those conscious efforts to offload it. They're still very worried about it and now they're getting frustrated. Less reliance on physio or AT input and more kind of specialist intervention and we're looking at imaging and scans to try and find out what's going on. Then the maximum point of this continuum was this career-ending injury. And this is something that was associated with very high pain and ill ability to run and potentially never running again. So again, frustration and now the onset of depression at this point, kind of last resort medical specialist and potential surgery to manage this complaint. So I suppose what did we want to take from this? And we wanted to highlight this progressive nature of injury and hopefully correlate that with this progressive perception of injury and highlight that this continuum is progressive and that runners will move along it in a fluid manner depending on how they manage it. But again, it's very individual for each runner and all these factors are going to influence how it's perceived. So not all runners agreed on each point and you may not agree on every point but hopefully runners will move along it as they perceive it. And then how we hope to use this. So the ultimate aim is to reduce the amount of running-related injuries. So we hope to use this continuum in a smartphone app to monitor runners over a 12-month period and monitor their training and use this continuum to capture all these stages of injury and monitor these complaints and hopefully no career-ending injuries. I don't know how we're doing for time but I think that's me.