Running Gait Retraining
Original Editor - Mariam Hashem
Top Contributors - Mariam Hashem, Jess Bell, Tarina van der Stockt, Ewa Jaraczewska and Kim Jackson
Introduction[edit | edit source]
Gait retraining is a movement specific intervention that aims to facilitate a new learning technique used to abnormal running mechanics that are contributing to an injury.
Strength training was found to be effective in improving muscle strength but not sufficient to improve running mechanics[1]. The use of gait retraining rose from the need for a specific approach to the motor pattern that is likely contributing to the occurance and perisstance of symptpms.
It aims to reduce the tisue stress by either correcting the movement pattern thatt is causing the stress or changing the distribution of the stress from one joint to another[1].
Considerations[edit | edit source]
- Be specific to the movement pattern that you wish to address to make sure that the intervention will improve the gait pattern
- Consider the individual's capacity to change and their compliance with the intervention
- Bear in mid that there might be some adverse effects of the intervention that you are using and can be associated with different risks and possibly reducing running economy. This also depends on the individual, for instance for an elite runner this might hinder their performace but a recreational runner with chronic pain may not be affected as much with reducing the economy.
- Similar to any other intervention, gait retraining should be a shared decision. Discuss both negatives and positives of the intervention with the individual.
- the level of intervention depens on the individual's ability to learn new skills so the intervention needs to be tailored to the individual.
- Faded feedback design can be used to teach running techniques utilizing internal and external cues. First, use cues and ensure that the movement pattern is done correctly then aim to increae the duration spent running with this new movement pattern and occasionally droppping cueing when neccassary to help ensure they can still maintain this movment pattern.Once desired movement pattern is attained, withdraw the cues slowly to help the runner practicing it independently[1].
Methods[edit | edit source]
- Visual Feedback of running technique
- changing cadence or step rate
- Altering or changing foot strike pattern
Visual Feedback[edit | edit source]
Real time feedback is an effective method in changing mechanical patterns around hip and pelvis and was found to have an effect on correcting contralteral pelvic drop (hip dip), reduction of hip adduction and internal rotation angles.
Method: using a mirror and giving verbal cues.
This technique was used with runners with PFP and demonestrated good outcomes. It is also cheap and applicable in clinical practice.
Another method: encouraging wider steps by using a piece of tape on the treadmill and encourage the runner to run with their feet on either sides of the tepe. Increased step width has been shown to reduce hip adduction and peak rearfoot eversion in runners[2]. there are also some suggestions that it can reduce ITB strain[3] and bending forces acting on the tibia[4].
This technique may be most effective with runners who are demonestrating a narrow step width or a crossover gait but with people who don't have a narrow step, it may not be effective.
Step rate manipiulation[edit | edit source]
Method: using a metronome by increasing steps per minute combined with verbal cues by encouraging runner to shorten the strides and increase the steps and match their steps to the beat.
A study[5] of a single session of gait retraining investigated the effect of a 10% increase in the running step rate on the frontal-plane kinematics of the hip and pelvis as well as clinical outcomes in runners with PFP. Number of steps per minute were counted and per one foot and runners were asked to incerase that by 10% and match their feet to the beat of a metronome. once runners were able to attain this in clincial practice they were asked to use a metronome app on the phone and run using it for 2 weeks, maintinang the same cadence. For the second two weeks, they were asked to mnitor their cadence on their GPS watches The study found that runners were able to learn the step rate at the initial assessment and 4 weeks later and they were able to maintian it and implement in independently. This technique is effective and time-saving.
Bramah et al[5] found that Step retraining can result in reductions in peak contralateral pelvic drop, hip adduction and hip internal rotation. In the sagittal plane, step retraining can reduce the foot inclincation and increases knee flexion at intial contact possibly reducing the overstride mechanics and reduceing the breaking and impact forces on the joints.
The evidence suggests minimal changes in knee rotation abduction and adduction mechanics resulting frm gait retraining[1].
Foot strike manipulation:[edit | edit source]
Aim: to switch from rearfoot to forefoot strike pattern.
Method: using verbal cues such as: land on the ball of your foot, make a lighter foot contact or sound softer when you land.
Changing the overstride In current evidence, changing foot strike doesn't reflect on biomechanical parameters of contralateral pelvic drop, hip adduction and hip internal rotation.
Changing the overstride mechanics by bringing the foot closer to the body encourages more plantar flexion and knee fleioxion at intial contact may increase the breaking forces or the impact forces in the joints. This happens by shifting all the forces and all loads from the knee to the ankle effectively. Studies showed 21% reduction in quadriceps and hamstrings forces and significant increase in both gastrocnemiues and soleus forces of around 14- 28%. This may have an impact on the future of injuriy development particularily around calf and achilies foot complex
Changing from rear to forefoot strike reduces pain levels in PFP and increases the funciton[6]. The limitations of using this technique is that you cannot use it with a runner with PFP and already runs on forefoot and also there are the consequences of the injuries associated with it. The studies that used this technique with runners reported a number of patients experiencing achillies tendon pain, calf strain injuries and foot and plantar fascia type of pain as a result of switching to forefoot running.
The chose of this intervention might be limited and not recommended unless there aren't other options or when you have exhaused other clinical possibilites.
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 Bramah, C.Running Gait Retraining: What, why and how? Course, Physioplus 2020.
- ↑ Brindle RA, Milner CE, Zhang S, Fitzhugh EC. Changing step width alters lower extremity biomechanics during running. Gait & posture. 2014 Jan 1;39(1):124-8.
- ↑ Meardon SA, Campbell S, Derrick TR. Step width alters iliotibial band strain during running. Sports biomechanics. 2012 Nov 1;11(4):464-72.
- ↑ Meardon SA, Derrick TR. Effect of step width manipulation on tibial stress during running. Journal of Biomechanics. 2014 Aug 22;47(11):2738-44.
- ↑ 5.0 5.1 Bramah C, Preece SJ, Gill N, Herrington L. 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. 2019 Dec;47(14):3406-13.
- ↑ Roper JL, Harding EM, Doerfler D, Dexter JG, Kravitz L, Dufek JS, Mermier CM. The effects of gait retraining in runners with patellofemoral pain: A randomized trial. Clinical biomechanics. 2016 Jun 1;35:14-22.
