Gait retraining for runners with patellofemoral pain

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.

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The Persistence of Gait Changes in Runners with Patellofemoral Pain Syndrome 3-Months Post Gait Retraining

Medicine & Science in Sports & Exercise ◽

10.1249/01.mss.0000402714.59849.39 ◽

2011 ◽

Vol 43 (Suppl 1) ◽

pp. 16

Author(s):

Richard Willy ◽

Irene S. Davis

Keyword(s):

Pain Syndrome ◽

Patellofemoral Pain Syndrome ◽

Patellofemoral Pain ◽

Gait Retraining

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Can Gait Retraining Change Hip Kinematics And Reduce Symptoms In Runners With Patellofemoral Pain Syndrome?

Medicine & Science in Sports & Exercise ◽

10.1249/01.mss.0000353338.16292.98 ◽

2009 ◽

Vol 41 ◽

pp. 26 ◽

Cited By ~ 1

Author(s):

Brian W. Noehren ◽

Irene Davis

Keyword(s):

Pain Syndrome ◽

Patellofemoral Pain Syndrome ◽

Patellofemoral Pain ◽

Gait Retraining ◽

Hip Kinematics

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Is combining gait retraining or an exercise programme with education better than education alone in treating runners with patellofemoral pain?A randomised clinical trial

British Journal of Sports Medicine ◽

10.1136/bjsports-2016-096988 ◽

2017 ◽

Vol 52 (10) ◽

pp. 659-666 ◽

Cited By ~ 39

Author(s):

Jean-Francois Esculier ◽

Laurent Julien Bouyer ◽

Blaise Dubois ◽

Pierre Fremont ◽

Lynne Moore ◽

...

Keyword(s):

Clinical Trial ◽

Functional Limitations ◽

Randomised Clinical Trial ◽

Exercise Programme ◽

Patellofemoral Pain ◽

Primary Component ◽

Gait Retraining ◽

Significant Group ◽

Vertical Loading ◽

Group Time

DesignSingle-blind randomised clinical trial.ObjectiveTo compare the effects of three 8-week rehabilitation programmes on symptoms and functional limitations of runners with patellofemoral pain (PFP).MethodsSixty-nine runners with PFP were randomly assigned to one of three intervention groups: (1) education on symptoms management and training modifications (education); (2) exercise programme in addition to education (exercises); (3) gait retraining in addition to education (gait retraining). Symptoms and functional limitations were assessed at baseline (T0), and after 4, 8 and 20 weeks (T4, T8 and T20) using the Knee Outcome Survey of the Activities of Daily Living Scale (KOS-ADLS) and visual analogue scales (VASs) for usual pain, worst pain and pain during running. Lower limb kinematics and kinetics during running, and isometric strength were also evaluated at T0 and T8. The effects of rehabilitation programmes were assessed using two-way analysis of variance.ResultsNo significant group × time interactions (p<0.447) were found for KOS-ADLS and VASs. All three groups showed similar improvements at T4, T8 and T20 compared with T0 (p<0.05). Only the exercises group increased knee extension strength following rehabilitation (group × time: p<0.001) and only the gait retraining group (group × time: p<0.001) increased step rate (+7.0%) and decreased average vertical loading rate (−25.4%).ConclusionEven though gait retraining and exercises improved their targeted mechanisms, their addition to education did not provide additional benefits on symptoms and functional limitations. Appropriate education on symptoms and management of training loads should be included as a primary component of treatment in runners with PFP.Trial registration numberClinicalTrials.gov (NCT02352909).

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The effects and mechanisms of running gait retraining in the management of patellofemoral pain: A feasibility trial

Manual Therapy ◽

10.1016/j.math.2016.05.191 ◽

2016 ◽

Vol 25 ◽

pp. e107-e108

Author(s):

D. Morrissey ◽

B. Neal ◽

C. Barton

Keyword(s):

Patellofemoral Pain ◽

Feasibility Trial ◽

Gait Retraining

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

International Journal of Sports Medicine ◽

10.1055/s-0043-110225 ◽

2017 ◽

Vol 38 (14) ◽

pp. 1076-1082 ◽

Cited By ~ 9

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.

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Gait Retraining as an Intervention for Patellofemoral Pain

Current Reviews in Musculoskeletal Medicine ◽

10.1007/s12178-020-09605-3 ◽

2020 ◽

Vol 13 (1) ◽

pp. 103-114 ◽

Cited By ~ 6

Author(s):

Irene S. Davis ◽

Adam S. Tenforde ◽

Bradley S. Neal ◽

Jenevieve L. Roper ◽

Richard W. Willy

Keyword(s):

Patellofemoral Pain ◽

Gait Retraining

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A 10% Increase in Step Rate Improves Running Kinematics and Clinical Outcomes in Runners With Patellofemoral Pain at 4 Weeks and 3 Months

The American Journal of Sports Medicine ◽

10.1177/0363546519879693 ◽

2019 ◽

Vol 47 (14) ◽

pp. 3406-3413 ◽

Cited By ~ 8

Author(s):

Christopher Bramah ◽

Stephen J. Preece ◽

Niamh Gill ◽

Lee Herrington

Keyword(s):

Clinical Outcomes ◽

Rating Scale ◽

Frontal Plane ◽

Patellofemoral Pain ◽

Reference Database ◽

Single Session ◽

Gait Retraining ◽

Step Rate ◽

Post Hoc

Background: Aberrant frontal-plane hip and pelvis kinematics have been frequently observed in runners with patellofemoral pain (PFP). Gait retaining interventions have been shown to improve running kinematics and may therefore be beneficial in runners with PFP. Purpose: To investigate whether a 10% increase in the running step rate influences frontal-plane kinematics of the hip and pelvis as well as clinical outcomes in runners with PFP. Study Design: Case series; Level of evidence, 4. Methods: Runners with PFP underwent a 3-dimensional gait analysis to confirm the presence of aberrant frontal-plane hip and/or pelvis kinematics at baseline. A total of 12 participants with frontal-plane hip and/or pelvis kinematics 1 standard deviation above a reference database were invited to undergo the gait retraining intervention. Running kinematics along with clinical outcomes of pain and functional outcomes were recorded at baseline, 4 weeks after retraining, and 3 months. Gait retraining consisted of a single session where step rate was increased by 10% using an audible metronome. Participants were asked to continue their normal running while self-monitoring their step rate using a global positioning system smartwatch and audible metronome. Results: After gait retraining, significant improvements in running kinematics and clinical outcomes were observed at 4-week and 3-month follow-up. Repeated-measures analysis of variance with post hoc Bonferroni correction ( P < .016) showed significant reductions in peak contralateral pelvic drop (mean difference [MD], 3.12° [95% CI, 1.88°-4.37°]), hip adduction (MD, 3.99° [95% CI, 2.01°-5.96°]), and knee flexion (MD, 4.09° [95% CI, 0.04°-8.15°]) as well as significant increases in self-reported weekly running volume (MD, 13.78 km [95% CI, 4.62-22.93 km]) and longest run pain-free (MD, 6.84 km [95% CI, 3.05-10.62 km]). Friedman test with a post hoc Wilcoxon signed-rank test showed significant improvements on a numerical rating scale for worst pain in the past week and the Lower Extremity Functional Scale. Conclusion: A single session of gait retraining using a 10% increase in step rate resulted in significant improvements in running kinematics, pain, and function in runners with PFP. These improvements were maintained at 3-month follow-up. It is important to assess for aberrant running kinematics at baseline to ensure that gait interventions are targeted appropriately. Registration: NCT03067545 (ClinicalTrials.gov identifier)

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