Gait Retraining From Rearfoot Strike to Forefoot Strike does not change Running Economy

2017 ◽  
Vol 38 (14) ◽  
pp. 1076-1082 ◽  
Author(s):  
Jenevieve Roper ◽  
Deborah Doerfler ◽  
Len Kravitz ◽  
Janet Dufek ◽  
Christine Mermier
Keyword(s):  
Heart Rate ◽  
Knee Pain ◽  
Respiratory Exchange Ratio ◽  
Patellofemoral Pain ◽  
Running Economy ◽  
Control Group ◽  
Gait Retraining ◽  
Common Ailment ◽  
Foot Strike ◽  
Recreational Runners

AbstractGait retraining is a method for management of patellofemoral pain, which is a common ailment among recreational runners. The present study investigated the effects of gait retraining from rearfoot strike to forefoot strike on running economy, heart rate, and respiratory exchange ratio immediately post-retraining and one-month post-retraining in recreational runners with patellofemoral pain. Knee pain was also measured. Sixteen participants (n=16) were randomly placed in the control (n=8) or experimental (n=8) group. A 10-minute treadmill RE test was performed by all subjects. The experimental group performed eight gait retraining running sessions where foot strike pattern was switched from rearfoot strike to forefoot strike, while the control group received no intervention. There were no significant differences for running economy (p=0.26), respiratory exchange ratio (p=0.258), or heart rate (p=0.248) between the groups. Knee pain reported on a visual analog scale was also significantly reduced (p<0.05) as a result of retraining. The present study demonstrates that retraining from rearfoot strike to forefoot strike did not affect running economy up to one-month post-retraining while reducing running-related patellofemoral pain.

scholarly journals Effects of gait retraining with focus on impact versus gait retraining with focus on cadence on pain, function and lower limb kinematics in runners with patellofemoral pain: Protocol of a randomized, blinded, parallel group trial with 6-month follow-up

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0250965
Author(s):  
José Roberto de Souza Júnior ◽  
Pedro Henrique Reis Rabelo ◽  
Thiago Vilela Lemos ◽  
Jean-Francois Esculier ◽  
João Pedro da Silva Carto ◽  
...  
Keyword(s):  
Lower Limb ◽  
Intervention Group ◽  
Patellofemoral Pain ◽  
Control Group ◽  
Gait Retraining ◽  
Positive Effects ◽  
Clinical Applicability ◽  
Limb Kinematics ◽  
Lower Limb Kinematics

Patellofemoral pain (PFP) is one of the most prevalent injuries in runners. Unfortunately, a substantial part of injured athletes do not recover fully from PFP in the long-term. Although previous studies have shown positive effects of gait retraining in this condition, retraining protocols often lack clinical applicability because they are time-consuming, costly for patients and require a treadmill. The primary objective of this study will be to compare the effects of two different two-week partially supervised gait retraining programs, with a control intervention; on pain, function and lower limb kinematics of runners with PFP. It will be a single-blind randomized clinical trial with six-month follow-up. The study will be composed of three groups: a group focusing on impact (group A), a group focusing on cadence (group B), and a control group that will not perform any intervention (group C). The primary outcome measure will be pain assessed using the Visual Analog Pain scale during running. Secondary outcomes will include pain during daily activities (usual), symptoms assessed using the Patellofemoral Disorders Scale and lower limb running kinematics in the frontal (contralateral pelvic drop; hip adduction) and sagittal planes (foot inclination; tibia inclination; ankle dorsiflexion; knee flexion) assessed using the MyoResearch 3.14—MyoVideo (Noraxon U.S.A. Inc.). The study outcomes will be evaluated before (t0), immediately after (t2), and six months (t24) after starting the protocol. Our hypothesis is that both partially supervised gait retraining programs will be more effective in reducing pain, improving symptoms, and modifying lower limb kinematics during running compared with the control group, and that the positive effects from these programs will persist for six months. Also, we believe that one gait retraining group will not be superior to the other. Results from this study will help improve care in runners with PFP, while maximizing clinical applicability as well as time and cost-effectiveness.

Patellofemoral Pain Syndrome and Its Association with Hip, Ankle, and Foot Function in 16- to 18-Year-Old High School Students

2011 ◽  
Vol 101 (3) ◽  
pp. 215-222 ◽  
Author(s):  
Carsten Mølgaard ◽  
Michael Skovdal Rathleff ◽  
Ole Simonsen
Keyword(s):  
High School ◽  
High School Students ◽  
Knee Pain ◽  
Pain Syndrome ◽  
Patellofemoral Pain ◽  
Control Group ◽  
School Students ◽  
Navicular Drop ◽  
Foot Posture ◽  
Hip Rotation

Background: An increased pronated foot posture is believed to contribute to patellofemoral pain syndrome (PFPS), but the relationship between these phenomena is still controversial. The objectives of this study were to investigate the prevalence of PFPS in high school students and to compare passive internal and external hip rotation, passive dorsiflexion, and navicular drop and drift between healthy high school students and students with PFPS. Methods: All 16- to 18-year-old students in a Danish high school were invited to join this single-blind case-control study (N = 299). All of the students received a questionnaire regarding knee pain. The main outcome measurements were prevalence of PFPS, navicular drop and drift, passive ankle dorsiflexion, passive hip rotation in the prone position, and activity level. The case group consisted of all students with PFPS. From the same population, a randomly chosen control group was formed. Results: The prevalence of knee pain was 25%. Of the 24 students with knee pain, 13 were diagnosed as having PFPS. This corresponds to a PFPS prevalence of 6%. Mean navicular drop and drift were higher in the PFPS group versus the control group (navicular drop: 4.2 mm [95% confidence interval (CI), 3.2–5.3 mm] versus 2.9 mm [95% CI, 2.5–3.3 mm]; and navicular drift: 2.6 mm [95% CI, 1.6–3.7 mm] versus 1.4 mm [95% CI, 0.9–2.0 mm]). Higher passive ankle dorsiflexion was also identified in the PFPS group (22.2° [95% CI, 18°–26°] versus 17.7° [95% CI, 15°–20°]). Conclusions: This study demonstrated greater navicular drop, navicular drift, and dorsiflexion in high school students with PFPS compared with healthy students and highlights that foot posture is important to consider as a factor where patients with PFPS diverge from healthy individuals. (J Am Podiatr Med Assoc 101(3): 215–222, 2011)

scholarly journals Gait Retraining With Visual Biofeedback Reduces Rearfoot Pressure and Foot Pronation in Recreational Runners

2021 ◽  
pp. 1-9
Author(s):  
Warlindo Carneiro da Silva Neto ◽  
Alexandre Dias Lopes ◽  
Ana Paula Ribeiro
Keyword(s):  
Pressure Distribution ◽  
Plantar Pressure ◽  
Control Group ◽  
Gait Retraining ◽  
Visual Biofeedback ◽  
Plantar Pressure Distribution ◽  
Foot Posture ◽  
Foot Pronation ◽  
Recreational Runners ◽  
Arch Index

Context: Running is a popular sport globally. Previous studies have used a gait retraining program to successfully lower impact loading, which has been associated with lower injury rates in recreational runners. However, there is an absence of studies on the effect of this training program on the plantar pressure distribution pattern during running. Objective: To investigate the short-term effect of a gait retraining strategy that uses visual biofeedback on the plantar pressure distribution pattern and foot posture in recreational runners. Design: Randomized controlled trial. Setting: Biomechanics laboratory. Participants: Twenty-four recreational runners were evaluated (n = 12 gait retraining group and n = 12 control group). Intervention: Those in the gait retraining group underwent a 2-week program (4 sessions/wk, 30 min/session, and 8 sessions). The participants in the control group were also invited to the laboratory (8 times in 2 wk), but no feedback on their running biomechanics was provided. Main Outcome Measures: The primary outcome measures were plantar pressure distribution and plantar arch index using a pressure platform. The secondary outcome measure was the foot posture index. Results: The gait retraining program with visual biofeedback was effective in reducing medial and lateral rearfoot plantar pressure after intervention and when compared with the control group. In the static condition, the pressure peak and maximum force on the forefoot and midfoot were reduced, and arch index was increased after intervention. After static training intervention, the foot posture index showed a decrease in the foot pronation. Conclusions: A 2-week gait retraining program with visual biofeedback was effective in lowering rearfoot plantar pressure, favoring better support of the arch index in recreational runners. In addition, static training was effective in reducing foot pronation. Most importantly, these observations will help healthcare professionals understand the importance of a gait retraining program with visual biofeedback to improve plantar loading and pronation during rehabilitation.

scholarly journals Short foot exercises have additional effects on knee pain, foot biomechanics, and lower extremity muscle strength in patients with patellofemoral pain

2021 ◽  
pp. 1-12
Author(s):  
Pınar Kısacık ◽  
Volga Bayrakcı Tunay ◽  
Nilgün Bek ◽  
Özgür Ahmet Atay ◽  
James Selfe ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Lower Extremity ◽  
Knee Pain ◽  
Patellofemoral Pain ◽  
Control Group ◽  
Significant Group ◽  
Positive Effects ◽  
Lower Extremity Muscle ◽  
Foot Biomechanics ◽  
Foot Posture

BACKGROUND: Patellofemoral pain (PFP) is a common knee problem. The foot posture in a relaxed stance is reported as a distal factor of PFP. However, the effects of short foot exercise (SFE) on the knee and functional factors have not yet been investigated in patients with PFP. OBJECTIVE: This study aimed to investigate the additional effects of SFE on knee pain, foot biomechanics, and lower extremity muscle strength in patients with PFP following a standard exercise program. METHODS: Thirty patients with a ‘weak and pronated’ foot subgroup of PFP were randomized into a control group (ConG, n= 15) and a short foot exercise group (SFEG, n= 15) with concealed allocation and blinded to the group assignment. The program of ConG consisted of hip and knee strengthening and stretching exercises. SFEG program consisted of additional SFE. Both groups performed the supervised training protocol two times per week for 6 weeks. Assessment measures were pain visual analog scale (pVAS), Kujala Patellofemoral Score (KPS), navicular drop test (NDT), rearfoot angle (RA), foot posture index (FPI), and strength tests of the lower extremity muscles. RESULTS: Both groups displayed decreases in pVAS scores, but it was only significant in favor of SFEG. NDT, RA, and FPI scores decreased in SFEG whereas they increased in ConG. There was a significant group-by-time interaction effect in hip extensor strength and between-group difference was found to be significantly in favor of SFEG. CONCLUSIONS: An intervention program consisting of additional SFE had positive effects on knee pain, navicular position, and rearfoot posture. An increase in the strength of the hip extensors may also be associated with stabilization with SFE.

scholarly journals Bioelectrical Activity of Vastus Medialis and Rectus Femoris Muscles in Recreational Runners with Anterior Knee Pain

2019 ◽  
Vol 66 (1) ◽  
pp. 81-88 ◽  
Author(s):  
Piotr Gawda ◽  
Michał Ginszt ◽  
Magdalena Zawadka ◽  
Maria Skublewska-Paszkowska ◽  
Jakub Smołka ◽  
...  
Keyword(s):  
Knee Pain ◽  
Anterior Knee Pain ◽  
Rectus Femoris ◽  
Control Group ◽  
Common Source ◽  
Median Frequency ◽  
Vastus Medialis ◽  
Bioelectric Activity ◽  
Recreational Runners ◽  
Anterior Knee

Abstract Patellofemoral pain syndrome (PFPS), the most common source of knee pain among physically active individuals, is defined as anterior knee pain involving the patella and retinaculum that excludes other intraarticular and peri-patellar pathology. Differences in the activation and endurance of the quadriceps components, causing an imbalance in the forces controlling patellar tracking during flexion and extension in the knee joint, appear to be the most commonly reported risk factors for PFPS. The aim of this study was to determine the differences in bioelectric activity of vastus medialis and rectus femoris muscles during half knee bend position in runners with PFPS. The sample comprised 20 recreational runners (15 males, 5 females; aged 27 ± 5 years) reporting knee pain and diagnosed with PFPS. The age- and sex-matched control group consisted of recreational runners who did not report knee pain. The myon electromyographic system was used to determine the changes in the electromyographic median frequency during a half squat position. The decrease in the median frequency of vastus medialis and rectus femoris muscles was significantly greater in runners with PFPS in comparison to the control group (p < 0.01 for right and left vastus medialis and right rectus femoris; p < 0.05 for left rectus femoris). There is a relationship between knee pain related to PFPS and the imbalance of bioelectric activity of vastus medialis and rectus femoris muscles. Achieving the muscular balance within the thigh muscles can be an important factor in the rehabilitation process of PFPS.

scholarly journals Concentric and Eccentric Torque of the Hip Musculature in Individuals With and Without Patellofemoral Pain

2009 ◽  
Vol 44 (1) ◽  
pp. 7-13 ◽  
Author(s):  
Michelle C. Boling ◽  
Darin A. Padua ◽  
R. Alexander Creighton
Keyword(s):  
Knee Pain ◽  
External Rotation ◽  
Patellofemoral Pain ◽  
Stair Climbing ◽  
Lower Extremity Injury ◽  
Control Group ◽  
Prior History ◽  
Pain Group ◽  
Limited Participation ◽  
Hip Abduction

Abstract Context: Individuals suffering from patellofemoral pain have previously been reported to have decreased isometric strength of the hip musculature; however, no researchers have investigated concentric and eccentric torque of the hip musculature in individuals with patellofemoral pain. Objective: To compare concentric and eccentric torque of the hip musculature in individuals with and without patellofemoral pain. Design: Case control. Setting: Research laboratory. Patients or Other Participants: Twenty participants with patellofemoral pain (age  =  26.8 ± 4.5 years, height  =  171.8 ± 8.4 cm, mass  =  72.4 ± 16.8 kg) and 20 control participants (age  =  25.6 ± 2.8 years, height  =  169.5 ± 8.9 cm, mass  =  70.0 ± 16.9 kg) were tested. Volunteers with patellofemoral pain met the following criteria: knee pain greater than or equal to 3 cm on a 10-cm visual analog scale, insidious onset of symptoms not related to trauma, pain with palpation of the patellar facets, and knee pain during 2 of the following activities: stair climbing, jumping or running, squatting, kneeling, or prolonged sitting. Control participants were excluded if they had a prior history of patellofemoral pain, knee surgery in the past 2 years, or current lower extremity injury that limited participation in physical activity. Intervention(s): Concentric and eccentric torque of the hip musculature was measured on an isokinetic dynamometer. All volunteers performed 5 repetitions of each strength test. Separate multivariate analyses of variance were performed to compare concentric and eccentric torque of the hip extensors, abductors, and external rotators between groups. Main Outcome Measure(s): Average and peak concentric and eccentric torque of the hip extensors, abductors, and external rotators. Torque measures were normalized to the participant's body weight multiplied by height. Results: The patellofemoral pain group was weaker than the control group for peak eccentric hip abduction torque (F1,38  =  6.630, P  =  .014), and average concentric (F1,38  =  4.156, P  =  .048) and eccentric (F1,38  =  4.963, P  =  .032) hip external rotation torque. Conclusions: The patellofemoral pain group displayed weakness in eccentric hip abduction and hip external rotation, which may allow for increased hip adduction and internal rotation during functional movements.

The Reliability and Variability of Running Economy in 7-, 8-, and 9-Year-Old Children

1994 ◽  
Vol 6 (3) ◽  
pp. 287-296 ◽  
Author(s):  
Danette M. Rogers ◽  
Kenneth R. Turley ◽  
Kathleen I. Kujawa ◽  
Kevin M. Harper ◽  
Jack H. Wilmore
Keyword(s):  
Heart Rate ◽  
Oxygen Consumption ◽  
Body Surface ◽  
Stride Length ◽  
Respiratory Exchange Ratio ◽  
Running Economy ◽  
Intraindividual Variability ◽  
Stride Frequency ◽  
Single Test ◽  
Reliability Estimates

This study was designed to examine the reliability and variability of running economy in 7-, 8-, and 9-year-old boys and girls. Forty-two children (21 boys and 21 girls) participated in two submaximal treadmill tests to determine running economy at two absolute work rates (5 mph and 6 mph). Reliability and variability were determined for oxygen consumption (V̇O2), heart rate (HR), respiratory exchange ratio (RER), stride frequency, and stride length. With the exception of RER and V̇O2 relative to body surface area, reliability estimates were moderate to high (.80 to .94). Mean variability of all responses were similar to those reported for adults, however, the range of intraindividual variability was slightly greater. These results indicate that two submaximal measurements result in higher reliability estimates than a single test and may therefore provide a more appropriate description of a child’s running economy.

scholarly journals Gait Retraining With Real-Time Visual Feedback to Treat Patellofemoral Pain in Adult Recreational Runners: A Critically Appraised Topic

2020 ◽  
Vol 29 (5) ◽  
pp. 675-679
Author(s):  
Marcie Fyock ◽  
Nelson Cortes ◽  
Alex Hulse ◽  
Joel Martin
Keyword(s):  
Real Time ◽  
Visual Feedback ◽  
Patellofemoral Pain ◽  
Bottom Line ◽  
Gait Retraining ◽  
Short And Long Term ◽  
Recreational Runners ◽  
Level 2

Clinical Scenario: Patellofemoral pain (PFP) is a common knee injury in recreational adult runners, possibly caused by faulty mechanics. One possible approach to reduce this pain is to retrain the runner’s gait. Current research suggests that no definitive gold standard treatment for PFP exists. Gait retraining utilizing visual feedback may reduce PFP in both the short and long term. Clinical Question: In adult runners diagnosed with PFP, does gait retraining with real-time visual feedback lead to a decrease in pain? Summary of Key Findings: A literature search was performed; 3 relevant studies utilizing gait retraining with visual feedback, pain level as an outcome measure, and follow-up measures of at least 1 month after the intervention were included. All the included studies reported a decrease in short- and long-term pain for participants following visual feedback gait retraining. In addition, biomechanical measures related to PFP, including peak hip adduction angle and the angle of contralateral pelvic drop, improved after the completion of the intervention. Clinical Bottom Line: There is level 2 evidence supporting the implementation of 8 sessions over 2 weeks of visual feedback gait retraining as a means of treating patients diagnosed with PFP. Based on current available evidence, clinicians should identify faulty mechanics of patients and implement a protocol of increasing real-time visual feedback over the first 4 sessions and decreasing visual feedback over the final 4 sessions. Strength of Recommendation: Level 2.

scholarly journals Twelve-Week Gait Retraining Reduced Patellofemoral Joint Stress during Running in Male Recreational Runners

2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
Author(s):  
Baofeng Wang ◽  
Yang Yang ◽  
Xini Zhang ◽  
Junqing Wang ◽  
Liqin Deng ◽  
...  
Keyword(s):  
Patellofemoral Joint ◽  
Pain Syndrome ◽  
Control Group ◽  
Biomechanical Property ◽  
Force Model ◽  
Gait Retraining ◽  
Joint Stress ◽  
Joint Force ◽  
Peak Knee ◽  
Recreational Runners

Purpose. To explore the changes in knee sagittal angle and moment and patellofemoral joint (PFJ) force and stress before and after 12-week gait retraining. Methods. A total of 30 healthy male recreational runners were randomized into a control group (n=15) who ran in their original strike pattern using minimalist shoes or experimental group (n=15) who ran in a forefoot strike pattern using minimalist shoes during the 12-week gait retraining. The kinematic and kinetic data of the dominant leg of the participants during the 12 km/h running were collected by 3D motion capture systems and 3D force platforms. Besides, the biomechanical property of the PFJ was calculated on the basis of the joint force model and the regression equation of the contact area. Results. After the 12-week gait retraining, 78% of the rearfoot strikers turned into forefoot strikers. Peak knee extension moment and peak PFJ stress decreased by 13.8% and 13.3% without altering the running speed, respectively. Meanwhile, no changes in maximum knee flexion angle/extension moment and PFJ force/stress were observed for the control group. Conclusion. The 12-week gait retraining effectively reduced the PFJ stress, thereby providing a potential means of reducing the risk of patellofemoral pain syndrome while running.

Improved running economy in elite runners after 20 days of simulated moderate-altitude exposure

2004 ◽  
Vol 96 (3) ◽  
pp. 931-937 ◽  
Author(s):  
P. U. Saunders ◽  
R. D. Telford ◽  
D. B. Pyne ◽  
R. B. Cunningham ◽  
C. J. Gore ◽  
...  
Keyword(s):  
Heart Rate ◽  
Respiratory Exchange Ratio ◽  
Minute Ventilation ◽  
Lactate Concentration ◽  
Blood Lactate Concentration ◽  
Running Economy ◽  
Moderate Altitude ◽  
Simulated Altitude ◽  
Distance Runners ◽  
Altitude Exposure

To investigate the effect of altitude exposure on running economy (RE), 22 elite distance runners [maximal O2 consumption (V̇o2) 72.8 ± 4.4 ml·kg-1·min-1; training volume 128 ± 27 km/wk], who were homogenous for maximal V̇o2 and training, were assigned to one of three groups: live high (simulated altitude of 2,000–3,100 m)-train low (LHTL; natural altitude of 600 m), live moderate-train moderate (LMTM; natural altitude of 1,500–2,000 m), or live low-train low (LLTL; natural altitude of 600 m) for a period of 20 days. RE was assessed during three submaximal treadmill runs at 14, 16, and 18 km/h before and at the completion of each intervention. V̇o2, minute ventilation (V̇e), respiratory exchange ratio, heart rate, and blood lactate concentration were determined during the final 60 s of each run, whereas hemoglobin mass (Hbmass) was measured on a separate occasion. All testing was performed under normoxic conditions at ∼600 m. V̇o2 (l/min) averaged across the three submaximal running speeds was 3.3% lower ( P = 0.005) after LHTL compared with either LMTM or LLTL. V̇e, respiratory exchange ratio, heart rate, and Hbmass were not significantly different after the three interventions. There was no evidence of an increase in lactate concentration after the LHTL intervention, suggesting that the lower aerobic cost of running was not attributable to an increased anaerobic energy contribution. Furthermore, the improved RE could not be explained by a decrease in V̇e or by preferential use of carbohydrate as a metabolic substrate, nor was it related to any change in Hbmass. We conclude that 20 days of LHTL at simulated altitude improved the RE of elite distance runners.

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