 I want to introduce you to Professor Kiran Moran, who is a professor of biomechanics in the School of Human Health and Performance in DCU. He leads a large research team in the Insight Centre in DCU, and his research focuses on the use of sensor-based technologies, primarily wearable sensors, to quantify human motion outside of the laboratory setting, and to try and understand more about the causes of musculoskeletal injuries, particularly running injuries. He is currently co-lead of the Running Science Research Program in the Insight Centre, along with Barry, and he's going to speak to us about work, and I think this is on behalf of yourself and End of White. He's going to speak to us about, I think, some really nice work that's already been completed, but I think more importantly, some upcoming research, very exciting upcoming research that is about to take part, and we would very much encourage people to consider taking part in that research. Over to you, Sean. Thank you. Perfect. Thanks very much. Yep, my name is Kiran Moran. I'm a biomechanist. I study human movement, and I find this fascinating. It gives me an opportunity to see the way people move, to try and understand what might be causing injuries, and I'm giving this on behalf of myself, and End of White, who's here, who's a physiotherapist, and this is some of our team on the left-hand side here. So you're all aware of the risk of injury. We've just completed, well, I say just completed, it was over four years, and I say we, I mean my PhD students, just completed a research where we tracked runners over an 18-month period, and we found over a year period, over 52% of people got injured every single year. So it's a very significant effect, and I probably don't need to preach to you about this. And if we take Aschling's presentation earlier on, this 52% is when we have a very stringent definition of injury. If we take in the niggles to this equation, it goes up to 80-85% of people would become injured. So really what we want to know is, what's the risk of injury and can we prevent it? So what causes injuries, mainly around technique I'm interested in, but I'll allude to other aspects, and is there evidence to support this? And this is a big bug-bearer of mine, is the amount of information that's out there that isn't evidence-based against that, which is evidence-based. And then can we effectively address this? If we know what causes injuries, do we have a means of addressing that so we can reduce the likelihood of injury? So what causes injury? At one level, it's really simple. All injuries are caused by high loading on the body relative to tissue strength. And if we could understand these factors, then we have a way of moving towards identifying the likelihood of injury. So if you take rope or a spoon and you apply a load to that spoon at some point, it will break. It's wooden, by the way, it's not metal. I'm not that strong. Okay, it will break and it's that simple, except for when we look at injuries in the body, we have biological structures. And our bodies are amazing. We apply loads to them and it becomes damaged. This is like an image of micro damage in the tissue. And this is brilliant because when you train and take a rest and train again, this is what leads to tissue development and you're getting stronger tissues. The downside of it is this balance between the tissue damage, the degradation and the protein synthesis, the repairing of the tissue. And it's the balance between these two that determine our injuries. Now, the challenge to understanding this is that we're generally in running the chronic-based injuries. It's not like ACL in a sport that involves landing and we can see the event that causes that actual injury. It's very rare to see a runner, particularly a recreational runner, running and saying, yes, that action there caused the injury. Occasionally it's been captured in a lab, someone's been injured in a lab and the scientists go, yippee. But in general, we don't know this. And that's the challenge to us. And if we bring into this, Ashling's point about the different types of injuries, particularly those lower level injuries, they obviously, because of what we're saying here about the micro damage, contribute to the later injuries, what we would associate more with an injury, but very little research has been done on those. So this makes it all the more challenging. Also, the difference with the spoon, for example, is if I took five spoons, I applied the same load, each of them would break at the same point. We'd understand that relationship. The difference is that each of you are made up slightly different in the design of your body, the strength of the various tissues. So for us to identify what's causing injury becomes more complex. And what adds to the complexity of that even further is if we could measure all of that in you today on a given run, how much tissue damage you have, and we measured you tomorrow and we measured you a week from that, your body would respond slightly different in each of these situations. So this is my caveat to the whole area, the complexity of it. I'll try and give some insight to it. So we've said that injuries is high loading relative to tissue strength. Well, that's what biomechanics does. It measures all of these factors. So we have various technologies, we have motion captures, you might have come across these put little markers on people's body, and we can track to an accuracy of about two millimeters, how you use your body when you run. We have force plates embedded in the ground or in treadmills. And we can see how hard you're striking the ground and combine this information to the loading on different parts of your body. We can use muscle activity, look at pressure plates, even yourselves on your mobile phones now, you can record yourselves or your friends running with a high sampling rate and slow it down. You can see quite a bit of detail about how people run. And we use inertia sensors a lot. They can also measure the angle of your various joints and segments in your body and the amount of loading applied to different segments in the body. So from a biomechanics perspective, we have quite a lot of tools available to us, as well as our understanding of how the body works. So can we use that information? So I'm stepping forward now. Imagine I could identify the causes of injury. Can we actually change the way in which people run to reduce the likelihood of injury? In terms of changing the way people run, certainly 10 years ago as a biomechanist, we thought that we couldn't change the way that people run. But with the availability and the ability to take this technology outside of the lab, it's become very clear that we can change the way in which people run. I don't know as runners, if you feel as that's possible, but we've done numerous studies where, for example, we attach these inertia sensors, the size of a bottle cap on your water bottle there, attach them to someone's tibia, for example. You go for a run, we record that and we say, right, we want to reduce the amount of loading, how hard you strike the ground by 10%. It's very simple. We've got an app that you can go running with, it's not publicly available, but we have an app, you can go running and you can self-teach yourself to run softly. So we've been able to reduce the amount of loading on various parts of the body from 30 to 40%. Simply by giving people this feedback, each time you run, your foot strikes the ground. If it's not as low as you want it, the predefined value that you set, it gives a beep in your ear and you simply teach yourself to run softly. And various groups around the world have used this and motion capture systems and force plate systems to change the way in which people run and not just while they're using the technology, that people can retain that information and a year later still run without auto technique. So from a biomechanics perspective, we can change the way in which people run. Going back to what causes injury, high-loading relative to tissue strength, well, we also, it's not just biomechanists, clinicians can also measure things around flexibility, muscle strength and joint alignment, the way your body naturally orientates itself. And all of these factors have been looked at with regard to injury. Now on one side of this, it's still a fairly simple process of claiming that you can identify the causes of injury. I've said that all injuries are caused by high-loading relative to tissue strength. Well, if we can measure all of these, surely we can identify the causes of injuries. So in terms of load per stride when running, that means every time you strike the ground, do we know the factors that determine higher-loading or lower-loading? With regard to the number of strides, do we know what affects the number of strides? Because these two factors will combine to determine loading. And do we know what factors affect tissue strength? The answer is yes. There's good scientific evidence here relating to these factors. For example, the technique, the angle that your knee is at when you strike the ground, if your knee is more extended, you apply more loads to the knee. If it's more flexed within reason, you apply less loading to the knee. So all of these factors, how much your body goes up and down when you run, stride length, foot strike pattern, you'll be familiar with lots of these factors because there's evidence that these factors determine the amount of loading on the body. A little bit less so with regard to terrain, that's a very complex area. And I won't go into at the moment, but I can chat to people about that afterwards. Same with number of strides, same with tissue strength, all of these factors, including disease that was talked about, they all affect the strength of the tissue and the likelihood that will become injured. But there's a real challenge. There's a big difference between saying these factors are affected, load are affected by these factors, tissue strength by those mechanisms, those factors. There's a big difference between saying that and saying those factors cause injury. And that's where there's a misconception in the area. And unfortunately, to a certain extent, where beliefs are formed about certain, I can change my technique, I can change to a forefoot strike pattern and it will reduce the likelihood of injury. Because the evidence isn't there to support that. So I suppose we could take it, what approach can you take or do people take or what clinicians take to addressing this issue of injury? Well, what we could say is, well, all these factors relate to injury, so let's address them all. But that's not feasible. There's too many of them. You don't have the time to address all of these factors. Well, we could say then, let's target runners for these possible risk factors. But for factors that you're predisposed to, well, it still raises the question is, which ones? We need to know what are the cutoff values? What value of your knee flexion will it predispose you to injury? And what is that risk factor? Is it 2%? Is it 70%? Because that's going to affect whether you're going to address it or not. Or we could say, let's target particular runners who are exposed and have a previous injury. Because if we know what the specific injury is that they might get again, that would give us a better target to work with athletes. And that's probably where we apply most of our attention at the moment. But with regard to all of these, is there evidence to support this? And I think that's where the majority of my take home message is to you today is to be careful of what people are saying out there about reducing the likelihood of injury because you might be doing something that increases your risk of injury. Unfortunately, I don't have the answer that each of you could come along and say, well, this is my injury, how do I reduce it? It's a very complex area. And in some ways, that's my take home message to you. Now, I just want to say one other thing before I go on to talk about some of the risk factors is that there is this idea that we can predict the likelihood of someone becoming injured from a biomechanical perspective I'm talking about now. I'm not aware really of any evidence of this. In our large-scale study, we did a prospective study tracking these athletes for at least a year where we analyzed them. We actually tracked some people for 18 months. With all of that information, with all of these variables on the left-hand side related to loading and some of the variables on the right, we were only able to predict the likelihood of someone becoming injured to an accuracy of 30%. That was after measuring everything. Now, you might think that's quite good. I think it's extremely poor because we miss loads of athletes and we misidentify some who would become injured. And I'm still left with the question, which of these factors do I now use to predict the likelihood of someone becoming injured? So I think at the moment, it's not possible from a biomechanical perspective to predict who's going to become injured. But we might be able to identify some risk factors to give you a nudge towards the types of practices that may be effective. Okay. I just want to talk about the quality of evidence. To me, if there was something you were able to go away with from my talk today, it would be that I better understand what is good evidence when I come across it, because then you're better able to make decisions on whether to change your running technique or your training practices. Unfortunately, most of what we read out there is just people's anecdotal evidence or their opinion. And some people are very good at putting their opinion across. I mean, this goes to the side of national newspapers. I like reading The Guardian. I know this is back in 2004, but it claimed that having your foot too far out in front of you resulted in a heel strike action, and this heel strike action increased the risk of injury. Yeah, there's no evidence out there for this. I mean, does studies that some studies find that it does does equal amount of studies that don't. And when you look at the quality of evidence overall, it's not there that heel strike increases the risk of running related injuries in general. It might be related to certain specific injuries, but running injuries in general, it's not related to it. So then yesterday, I thought, well, is this still true? So I went on Google yesterday, I just put in heel strike, overuse injuries, causes injury, and I restricted it to the past month. And this was the very first site that came up. And I clicked on it. And I've just copied and pasted it here and said, the recommended foot strike for not most, but for all runners is forefoot strike, not a heel strike. Studies continue to pile up. Wow. This is amazing. Great to hear from me as a researcher, where all of these injuries are completely resolved by turning to forefoot running. Now I'm not saying you would believe this, but I'm just trying to point to the fact that people put across the idea that does evidence out there for things. And we need to understand what evidence is. So I suppose my take home message to you, one of them, I haven't finished yet, unfortunately for you, but one of my take home messages is if possible, read the original research and look at the quality of evidence there, use sources that directly refer to the original source, that reference it, and if possible, directly quote it. Then it raises the question, well, first of all, before I say how we judge quality of research, it's essential that researchers like myself, then put across information accurately in a way that you can understand them. And I think that's one of the problems of the scientific community. But if we then want to know what is the quality of evidence, I just want to point to some things that you should look for. You should look for what are called prospective studies. These are studies that will measure something now, track athletes, runners, and see if they become injured. And as scientists, we sit there for months with our fingers crossed, waiting for you all to get injured, would you do? And then we can look at the data. Unfortunately, there's lots of retrospective studies. There are studies that would take a group of injured runners, for example, not always, but a group of injured runners, a group of uninjured runners compare them and say, well, whatever the difference must have caused that injury. And unfortunately, most of the time, it's the injury that's probably caused a change in running technique. And so to a certain extent, without belittling my own research, and those of my colleagues, does not much evidence that you can take from those studies. They should only point us towards prospective studies. Okay. So you should look for prospective studies. You should look for studies that look at multiple variables, not just one, because it's that complex interaction of all the factors that's important. It should be relevant to what's important to you. If you're interested in reducing all of your running injuries, then you need to look at studies that are looking at that as a definition of injury. If it's for knee injury or patella femoral pain syndrome, or some particular injury, only go to those studies that look specifically at your injury. Assessment points. From a biomechanics perspective, most studies are down here, where we measure people at the start of the study, and we assume that no one changes the running technique. But from Ashling's work, it's clear that people have niggles, and these niggles will change the way in which you run. So even though we just spent four years, it was all based on a one off assessment at the start of when people were running. And that's a real limitation to even our own research. We need patient participant numbers up into hundreds, three hundreds plus to really have an insight, while in fact we'll see most studies are down in the area of 15. And the participants need to be similar to yourself. So if it's a study done on novice runners, does it apply to you as someone who's been running for six, seven, eight years? If it's on males, does it apply to females? So you need to take all of this into account. So that's what I mean about the quality of evidence. And I think that's really important for you to be able to read information and find out, is it of value? Now beyond that, the number of studies, we should be looking for at least 10 studies in an area before we start believing it and having consistent findings. And the effect, that it's a 20% reduction in risk or a 2% reduction in risk or an 80% reduction in risk, they need to be taken into account as well. But in terms of the quality of the study, to me, this is really important. So as I said, let's look for this evidence. So I thought what I'd do is I'd pick one study to me, which is a really good study. And it points to evidence that I think may be relevant to you. You can decide whether you would adopt this or not. But it was a study done by Zoe Chen in Hong Kong. What they did is, if you can see here, this is the trace of someone striking the ground. And it has what we call this passive peak here. And the steepness of this, it's called a rate of force application. The participants were asked to reduce this. This is a biofeedback study. So they ran, they trained over a two week period, three times a week, and they were able to teach themselves without any instruction how to do it to reduce this value here. So this wasn't a steep. So what they had then is they had a prospective study and it was an intervention study. Although it was targeting one variable, it controlled for a lot of other variables. But by definition, intervention studies can only really target one variable at a time, or very few. It was all lower limb injuries. I think that would appeal to everyone. They want to reduce any lower limb injuries. While it was only assessed a two week intervention point, at the end of the study, they reassessed all the runners to check, were they still running with this reduced load without them seeing the screen and they were. So they altered the way in which they run over a two week period. They retained that they think because they exhibited at the end of the year. And it was over 300 participants and it was novice distance runners. So you have to decide is that relevant to you or not. Okay. And what they found was that those people who had the intervention at the top there, they were able to reduce their impact loading. And amazingly, I think amazingly now is that over the 12 month period, the occurrence of injury was 62% lower. In essence, if you can run softer, if you can reduce this, those runners, novice runners, were able to reduce the number of injuries or the number of people who became injured by 62%. Now to me, that's evidence. That's what we should be looking for when we're trying to decide how to train or change our training practices. So if I flip now and try and give a summary, because I think maybe some of yous would have thought, well, tell me how I should change my running technique to reduce the likelihood of injury. Unfortunately, apart from that study, I'm just going to present to you, where is the evidence overall at the moment. And the take home message is, we don't have a huge amount of evidence at the moment because of the quality of research that's been done to date. It's getting better. But that's where Brian was alluding to the fact that there might be better ways forward. So previous injury, I put this up here because the strong evidence, all of you, I would imagine know this. If you have a previous injury, you are far more likely to re-injure yourself. And if you have a previous injury, in fact, it's not just an injury in the same location, it can also move to other locations. And you can imagine why, because you adapt your running style. And you have to remember, if you change your running technique, sometimes you're going to put loading on a different part of your body, increase loading in that area, and that's what leads to your new injury. So put that up there just to compare it to other factors. So with regard to whole body loading related to the study we just looked at, is that the rate of loading does moderate to good evidence. And we've seen this in our own research that the rate of loading on your body when you strike the ground does moderate to good evidence that that increases your risk of injury. So if you can address that, you have this capability of reducing the likelihood of injury. And there's whole debate about how it affects your performance or doesn't affect your performance. But we've had runners come in using our app, reduce the amount of loading on the body, and they can still run at the same speed. We haven't tested it for endurance capabilities, long term for a marathon, but certainly over short distances that doesn't change the amount of energy consumption. With regard to peak loading, so rate of loading, we know, by the way, from a mechanical perspective, the faster the speed of loading, the more tissue damage. We see this in animal models as well. There's only lower evidence that that increases the risk of injury. With regard to foot strike pattern, there's low evidence that foot strike pattern has an influence on overall lower limb injuries, maybe for specific injuries. But in fact, there's higher evidence that changing your foot strike pattern increases the risk of injury. So before anyone changes the foot strike pattern, they should really consider that because there's stronger evidence of that leading to injury. With regard to your knee kinematics, kinematics refers to technique. I just have to earn my money by using complex terms to justify being here. But your knee technique, your hip technique, it's unclear. There's very mixed findings. So there's not one change in technique with regard to your knee and your hip that you could change that would reduce the likelihood of injury. Now, clearly, you have to change these factors to change the rate of loading. It's just in terms of what evidence is there, and that's what I'm looking for as a scientist, it's low evidence of this and very unclear. With regard to the pelvis and trunk, there's even less in evidence because no one's really looked at them. Now, in saying that in our study, we found findings in relation to all of these with regard to foot strike pattern, we actually found that those who use a non-rear foot strike pattern, so midfoot or forefoot, had a significant higher rate of calf-based injuries. So we have to be really careful with forefoot strike patterning. I'm not saying we shouldn't do it, but we should be careful of it. With regard to the pelvis and trunk, insufficient research has been done, although we've started to see now that when people are running, if they don't rotate their pelvis enough in a horizontal plane like this, that we have an increase in lower limb injuries. Now, the reason why I've said that there's insufficient research and I've even indicated that it's lower, that's only one study. I've said that we need 10 studies out there with consistent findings to be able to get people to change or advocate for change. So even though it's something we found in what I think is a very good research design, we have to be careful with it. We also found that people who had a contralateral rotation, excessive rotation of the trunk, had an increased risk of injury. But again, I wouldn't advocate for change until we can confirm these findings in multiple studies. If you want to find excellent reviews of running technique and the research that supports it, these two researchers, Dr. Sarah Jane Dillon and Dr. Eva Burke, they've just submitted their PhDs. And in fact, they got them in on Thursday and maybe are still inebriated. And their family's good to see them and their parents thinking at last they might make some money. But I'm not sure if they're in our library yet, but you can go on to DCU Library, search for their names under thesis. If you put it in the library, you'll see where it is. You could download the whole PhD, you know, four years of work. And I guarantee in the review of literature, both have done have done an amazing job of summarizing for all the factors you might be interested in, knee extension, foot strike pattern. We together, led by Eva Burke, published a systematic review that you would have been referred to earlier on foot strike pattern. And that's in the thesis as well, which said, there's no relationship or very little evidence of any relationship between foot strike pattern and general running related injuries. But they've got two excellent reviews, very table orientated, all the values, they're all the studies very easy to follow for those who want some bedtime reading of, you know, a couple of hundred pages. Okay, but it's there, it's very well summarized. And this is not to belittle the whole research area and biomechanics. I'm a biomechanist, I need people to believe me. But I suppose if we look at specific injuries, there is a bit more evidence for it. Okay, but I thought given the length of this talk, it would be much better to give another talk on another day on a specific injury. There is a little bit more evidence around specific injuries, and how you can change running technique to address them. But my word of advice to is to be cautious of people who are claiming that they have this panacea of reducing running related injuries by changing techniques, because at the moment, that evidence isn't there. And I think the problem is, is that most studies are retrospective, looking at a single variable, measuring people on a once off, very low participant numbers 15 to 30, 40 participants. And that's what we need to change. We need to make in particular from a biomechanics perspective, we can't just do one off assessments. Yeah, we must reassess people, or if possible, get them some assessment of technique on every single run. We also have to bring in Ashling's injury continuum, because I think there's a wealth of information in terms of monitoring at this lower level to understand how this feeds in with technique, and the change in technique associated with the upper level. And at the moment, as far as I'm aware, no one is researching that area. And so we need to move all of this up towards this high quality research. And that's what we're aiming to do, myself, Brian Barry, lots of colleagues. I'm going to pose this in terms of from an injury perspective, but they're also interested in performance. And a lot of the ability of what I'm about to say now is going to build in the ability to determine performance levels and types of training people are doing, so they can look at that research question. But as I say, I'm part of the Running Injury Surveillance Center, and the second major study that we're going to do, which we think will be the largest of its kind in the world, will be around an app-based approach to research. And it will capture a whole host of information, but very quickly from runners. And Ashling's been working on that to find out what information and how much information runners are willing to do. And it will allow us to do prospective and interventional studies. It will capture data on a run-by-run basis, yeah, so that people will input information such as around menstrual cycle, how they slept, how they feel, how prepared they are for a run, how they feel after a run, because all of these are really good indicators of recovery from runs. We hope to have thousands of runners, we hope as well for some elements of it that don't need sensors across multiple countries, and will do different studies. So it won't be just one study. For example, what we want to do, I'll just go down here, is some people to wear sensors or a single sensor when they run, so we can get an indication of the technique you're using. For example, how hard you strike the ground. Some people will be willing to wear a sensor every run, others won't. And depending on which study you want to be part of would determine how much, what elements of this app are made available. So we will capture all the information along Ashling's injury continuum. We will look at multiple factors around training metrics, menstrual health, subjective measures of recovery and wellness, and others, and we'll be able to capture sense data. And what we hope then within insight is to be able to take all of this information, apply AI machine learning to it, so that we can really identify the risk factors for running injuries. That we can allow individual runners to identify factors that predispose them to injury, because what would be amazing if we had this and we collected, imagine we had data on an aspect of your running technique and how you felt and related to your recovery. So in that equation of load versus tissue strength, if we had indicators of those, but every time you went for a run, that opens the possibility of identifying the factors for you that are related to injury, rather than on an average, where we start adding noise to the information that we have. And eventually it would allow personalized and recommendation systems to be used that would say to you, you need to run softer or you need to do less training or you're too fatigued here at this stage, you shouldn't be running at all today, which you might or might not want to here, but if they're accurate and can reduce the likelihood of you becoming injured would be effective. And I'll finish there by saying if you are interested in participating, you can send an email to risk at dcu.ie and we'll eventually respond to you when the studies get up and running. I would like to say that I've got answers to how we can reduce people's running related injuries. But as I said, in general, there's a lack of evidence out there. This type of study, I hope in the future, will change that with all the expertise that insight brings together. Thanks very much. Thanks very much. Just leave the mic on just in case. Does anybody have any questions for Kieran up at the top? What is the whole of the country? Yeah. So what we'd like you so it can also link to Strava to take down all that data as well from a performance perspective. But we would like to also for only for those people who allow us to do because there's not everyone wants to share order data, but there'll be GPS data captured as well so that we can we want to do things as well. We have other experts around that could potentially determine what surface you're running on automatically because it'd be reasonably accurate GPS. And then we can start relaying it to have people what surfaces people are running on and how often they're changing those surfaces. Yeah. And now what I would say is I haven't researched it so I can't answer it. I suppose the the answer to this question is that when you strike the ground harder to enable that energy to be stored in the carbon fibers, you know, the carbon material, does that carbon material cushion you when you land? The answer must be to some extent, at least yes, else it couldn't store the energy. So it has to be cushioning, but someone would need to research that to find that out. And we have to remember to me, it's a fascinating area. In general, when you run, and this is the real challenge around running softly, is the harder you strike the ground when you run, the more efficient your running is, because your body stores that energy and releases it again afterwards. And that's why we have evolved to strike the ground hard when we run. The problem is that from an evolutionary perspective is injuries tend to lag behind. So you've passed on your genes by the time that your injuries become so delivered, strenuous, that you can no longer use that running technique. So we're designed to strike the ground hard, but that doesn't necessarily mean we should. In fact, we have shown that, you know, by striking the ground really softly, as an extreme, you burn more calories. Yeah, which would be an amazing thing to do for those who don't want to run for performance. So if you run with this type of running technique, and you have to decide whether you want to or not, you would burn more calories, reduce the likelihood of injury, potentially. Sorry, yes, sorry, God, if that wasn't clear. If you reduce it, yeah, if you reduce the rate of loading. Cadence does affect it as well. In this study, the way it was generally achieved was that people were striking the ground softer. So that can be achieved by flexing your knees a little bit more, flexing your hips a little bit more. Some people might have landed a little bit more towards the midfoot rather than hugely heel pull, but they never measured it. Okay, but they did show that by reducing that rate of loading that it significantly reduced the likelihood of injury. One more, yeah. Yeah, I'm very cautious in this. There's no evidence that it reduces the likelihood of running related injuries. When you look at those studies where people have done it and haven't done it, it's very mixed findings. So, and it probably comes down to all these other factors having an influence that have not been taken into account. And that's why we have this dream of using this app to collect really relevant data. The answer to it becomes to what extent the warm down that you do helps you, your tissues recover to become stronger earlier. And I'm not sure the evidence is out there with regard to that. But what I would say is don't abandon warming down. And there's also another side to warming up and cooling down at the end or warming down at the end. And that is the psychological aspect of it and calming your body. And I would think that's also very important, not rather than as well as any physiological adaptations that take place. Thank you very much for that. But I know from your talk, what you were trying to say was when I'm trying to conclude that my feed is that you're trying to say we should change our form. Now, I don't know if anyone in my time has changed the form of running. It's a natural way of running and it's very, very difficult to change it. But because of you on that? Yeah. So what I'm saying is definitely you can change your form of running. There's plenty of studies out there now that use this biofeedback where you use technology to help you change your running technique. I would say it's very difficult for anyone to go and change their running technique without this biofeedback, something that keeps telling you each time whether you're achieving this change or not. And what they do is you might use this technology for three of your runs in the first week, three in the second week, and then in the following week you only use it on one of your runs for two weeks and then it's withdrawn completely. And there's really strong evidence that you can change the way in which you run from the amount of hip internal external rotation you have. Slight changes of two degrees have been shown to be consistent in changing people's running patterns where someone has advocated for that change. So my belief is in the evidence is yes, you can change running technique. Where I think the evidence is lacking is what should you change to reduce the likelihood of injury? And that's where we need to catch up. I think it's not to say that it's not very difficult to change for them. It's not a switch. We're going to take one more question and then we'll... Yeah, they never looked at this. And they struggled to look at it and that's why I suggest they didn't report it because they were tracking novice runners who were training and therefore they had adaptions taking place. So no is the answer. They didn't look at it. In our own studies where we've reduced the amount of loading, we've done it on a treadmill and people were able to keep running at the same speed. But that doesn't mean that as a performer, if you wanted to train over a period of time to improve your running speed would change your running technique, reduce your capacity to run faster, if that makes sense. And again, the evidence hasn't been presented one way or the other with regard to that. Okay. Thank you very much, Kieran.