🎧 Biofeedback, Beats, and Biomechanics: A Critical Review of Van den Berghe et al.’s Music-Based Running Retraining Study | Find Your Stride | Edinburgh Podiatrist

Introduction

In the search for smarter, safer, and more engaging ways to train runners, a recent study published in Scandinavian Journal of Medicine & Science in Sports titled Reducing the peak tibial acceleration of running by music- based biofeedback offers a compelling case for tuning into your stride—literally. Van den Berghe et al. (2022) present a quasi-randomized controlled trial that examines whether music-based biofeedback can reduce peak tibial acceleration (PTAa), a biomechanical proxy for impact loading linked to running injuries.

Music-based biofeedback could become a cheap, widely available tool to reduce impact and injury risk

The concept is innovative: use real-time auditory feedback (distorted music) triggered by high tibial shock, delivered through a wearable system. If your impact is too high, the music gets fuzzier—your brain wants it clear, so you (hopefully) adjust your gait. The study promises a shift from sterile lab environments to real-world applicability. But does it hold up under scrutiny?

Study Design: Solid, but Small

The authors recruited 20 recreational runners with high PTAa and split them into two groups: one received the full biofeedback treatment, the other only heard beat-matched music (a placebo). The biofeedback group reduced their PTAa by 25.5% over six sessions, a statistically and clinically meaningful result.

However, the sample size was small—10 participants per group—limiting generalisability. The trial is also quasi-randomised, not fully randomised, which may introduce allocation bias. While statistical significance was reached, the effect size must be interpreted cautiously in light of these design limitations.

Innovation & Implementation: A Sonic Step Forward

This study shines in its innovative use of wearable technology and musical sonification. The integration of tempo-synced music with real-time feedback is not only technically impressive but also offers a motivational advantage—a rare blend of neuroscience, biomechanics, and user-centred design.

The faded feedback strategy, grounded in motor learning theory, encourages runners to internalise gait changes over time rather than become dependent on the feedback. That’s a major strength and shows thoughtful application of behavioural science.

One key advantage is that running cadence remained unchanged. This suggests participants weren’t just taking quicker steps to reduce impact—a strategy with its own trade-offs but instead were finding individualised, potentially more sustainable solutions.

Limitations and Lingering Questions

Despite the promising findings, several questions remain:

1. Retention and Injury Outcomes – Does reduced PTAa persist after the feedback stops? And does it actually reduce injury risk? The study stops short of measuring long-term outcomes.

2. Mechanism Unclear – The study doesn’t capture how runners altered their mechanics. Was it footstrike? Knee flexion? Trunk position? Understanding the strategy could help tailor future interventions.

3. Population Constraints – Only runners with already high PTAa were included. Would this method benefit all runners, or just those at the extreme end of the spectrum?

4. Ecological Validity – The study took place indoors with controlled speed. It’s not yet clear how the approach performs in potentially chaotic, outdoor running environments.

Final Thoughts: Promising, but Not a Silver Bullet

Van den Berghe et al. (2022) deserve credit for pushing gait retraining beyond the lab and into the training environment using an engaging, wearable, feedback-rich system. Their work demonstrates the feasibility and effectiveness of real-time, music-based feedback to reduce biomechanical loading, opening doors for applications in injury prevention and performance.

Still, caution is warranted. The small sample size, short duration, and absence of injury tracking mean this isn’t a plug-and-play solution just yet. But as a proof-of-concept with strong theoretical underpinnings, it hits the right notes.

Find Your Stride!