Gait retraining to reduce lower extremity loading in runners

NewsBot · Mar 2, 2020

Effect of neuromuscular training augmented with knee valgus control instructions on lower limb biomechanics of male runners
AmirLetafatkaraPouyaRabieibMinaAfsharia
Physical Therapy in Sport; 26 February 2020

Highlights
•Runners employ adaptive biomechanical strategies related to RRIs.
•This study compared the effect of NMT plus VCIs on biomechanics and injury incidence in short and long term.
•Adding instruction to NMT is superior to a NMT alone on variables of biomechanics and injury incidence.
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Objective
To examine if combining neuromuscular training (NMT) with knee valgus control instructions (VCIs) can affect lower limb biomechanics and injury incidence in male novice runners and assess over 1-year follow-up.

Design
Controlled laboratory Study.

Setting
University research laboratory.

Participants
60 male novice runners randomly assigned into NMT (n = 20), NMT plus VCIs (n = 20), and sham (n = 20).

Main outcome measures
Kinematic and kinetic were measured at pre- and post-test and 1-year follow-up. Injury incidence assessed at pre-test and 1-year follow up.

Results
There were significant between-group differences in kinetics after 6 weeks in NMT plus VCIs group. No significant differences were observed between NMT and NMT plus VCIs in kinematic variables. No significant change was seen in the sham in all variables. At 1-year follow-up, the minimal changes were seen in kinetic variables. Reduction reported running-related injuries were 31.58% in the NMT alone group, 65.52% in NMT plus VCIs group. In sham, it increased to 13.46%.

Conclusions
NMT plus VCIs was effective to reduce kinetics and improve kinematics in novice runners. Also, it could reduce injury incidence. This protocol may be an option for both athletic trainers and coaches for preventing of lower limbs’ injury in male runners.
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NewsBot · Mar 7, 2020

The effect of changing foot progression angle using real-time visual feedback on rearfoot eversion during running
Seyed Hamed Mousavi et al
British Journal of Sports Medicine 2020;54:A137https://bjsm.bmj.com/content/54/Suppl_1/A137.1

Background Abnormal rearfoot in/eversion is an important risk factor for running-related injuries. A modification derived from gait retraining to correct abnormal rearfoot in/eversion is lacking.

Objective To investigate changes in rearfoot in/eversion, subtalar pronation, and medial longitudinal arch angle (MLAA) while performing toe-in/toe-out running using real-time visual feedback.

Design Cross-sectional pilot study.

Setting Motion Lab of the Center for Rehabilitation.

Patients (or Participants) Fifteen female runners participated in this study.

Interventions (or assessment of risk factors) Subjects performed toe-in and toe-out running on treadmill using real-time visual feedback (Gait Real-time Analysis Interactive Lab; GRAIL) on foot progression angle (FPA), which was set ±5° from normal FPA. Real-time visual feedback was provided based on FPA in midstance. Ground reaction force (GRF) data were used to identify the stance phase. A repeated-measures ANOVA followed by pairwise comparisons was used to analyze changes in outcome between three conditions.

Main outcome measurements 3D kinematics of rearfoot in/eversion, subtalar supination/pronation, MLAA, FPA, and GRF were analyzed.

Results Toe-in running compared to normal and toe-out running reduced peak rearfoot eversion (mean difference (MD) with normal=–2.1°; p<0.001, MD with toe-out=–3.5°; p<0.001), peak pronation (MD with normal=–2.0°; p<0.001, MD with toe-out=–3.4; p≤0.001), and peak MLAA (MD with normal=–0.7°; p=0.022, MD with toe-out=–0.9; p=0.005). Toe-out running significantly increased these kinematic factors compared to normal and toe-in running.

Conclusions Runners were able to easily change their FPA when receiving real-time visual feedback for FPA. Toe-in/toe-out running altered rearfoot kinematics and MLAA, therefore supporting the potential value of gait retraining focused on FPA using real-time visual feedback when atypical rearfoot in/eversion needs to be modified.
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NewsBot · Mar 14, 2020

The effectiveness of real-time haptic feedback gait retraining for reducing resultant tibial acceleration with runners
Kelly R.Sheerin et al
Physical Therapy in Sport; 14 March 2020

Highlights
•Haptic feedback based on tibial acceleration appears to be as effective, but less invasive and expensive, compared to other more established modalities for retraining runners.
•Retention of initial changes and transfer to overground running was achieved in some, but not all runners.
•Runners have differing responses to a gait retraining intervention, and it is therefore important to assess the effectiveness of the intervention for each individual.
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Objectives
To examine the effectiveness of real-time haptic feedback gait retraining for reducing resultant tibial acceleration (TA-R) with runners, the retention of changes over four weeks, and the transfer of learning to overground running.

Design
Case control.

Setting
Biomechanical laboratory treadmill, and track-based overground, running.

Participants
18 experienced uninjured high tibial acceleration runners.

Main outcome measures
TA-R measured while treadmill and overground running assessed at pre-, post- and 4-weeks post-intervention.

Results
Across the group, a 50% reduction in TA-R was measured post-intervention (ES: 0.9, z = −18.2, p < .001), and 41% reduction at 4-weeks (ES: 0.8, z = −12.9, p < .001) with treadmill running. A 28% reduction (ES: 0.7, z = −13.2, p < .001), and a 17% reduction in TA-R were measured at these same time points when runners ran overground (ES: 0.7, z = −11.2, p < .001). All but two runners responded positively to the intervention at the post-intervention assessment. Eleven runners were categorised as positive responders to the intervention at the 4-week post-intervention.

Conclusions
Haptic feedback based on TA-R appears to be as effective, but less invasive and expensive, compared to other more established modalities, such as visual feedback. This new approach to movement retraining has the potential to revolutionise the way runners engage in gait retraining
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NewsBot · May 13, 2020

Change-Point Detection of Peak Tibial Acceleration in Overground Running Retraining
Pieter Van den Berghe et al
Sensors 2020, 20(6), 1720;

A method is presented for detecting changes in the axial peak tibial acceleration while adapting to self-discovered lower-impact running. Ten runners with high peak tibial acceleration were equipped with a wearable auditory biofeedback system. They ran on an athletic track without and with real-time auditory biofeedback at the instructed speed of 3.2 m·s−1. Because inter-subject variation may underline the importance of individualized retraining, a change-point analysis was used for each subject. The tuned change-point application detected major and subtle changes in the time series. No changes were found in the no-biofeedback condition. In the biofeedback condition, a first change in the axial peak tibial acceleration occurred on average after 309 running gait cycles (3′40″). The major change was a mean reduction of 2.45 g which occurred after 699 running gait cycles (8′04″) in this group. The time needed to achieve the major reduction varied considerably between subjects. Because of the individualized approach to gait retraining and its relatively quick response due to a strong sensorimotor coupling, we want to highlight the potential of a stand-alone biofeedback system that provides real-time, continuous, and auditory feedback in response to the axial peak tibial acceleration for lower-impact running.
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NewsBot · Jun 6, 2020

Predicting vertical ground reaction force during running using novel piezoresponsive sensors and accelerometry
Matthew K. Seeley et al
Journal of Sports Sciences : 25 May 2020

Running is a common exercise with numerous health benefits. Vertical ground reaction force (vGRF) influences running injury risk and running performance. Measurement of vGRF during running is now primarily constrained to a laboratory setting. The purpose of this study was to evaluate a new approach to measuring vGRF during running. This approach can be used outside of the laboratory and involves running shoes instrumented with novel piezoresponsive sensors and a standard accelerometer. Thirty-one individuals ran at three different speeds on a force-instrumented treadmill while wearing the instrumented running shoes. vGRF was predicted using data collected from the instrumented shoes, and predicted vGRF were compared to vGRF measured via the treadmill. Per cent error of the resulting predictions varied depending upon the predicted vGRF characteristic. Per cent error was relatively low for predicted vGRF impulse (2–7%), active peak vGRF (3–7%), and ground contact time (3–6%), but relatively high for predicted vGRF load rates (22–29%). These errors should decrease with future iterations of the instrumented shoes and collection of additional data from a more diverse sample. The novel technology described herein might become a feasible way to collect large amounts of vGRF data outside of the traditional biomechanics laboratory.
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NewsBot · Jun 9, 2020

Efficacy of an audio-based biofeedback intervention to modify running gait in female runners
Rothstein, Sarah(2020).
Master's Theses. 70.

Introduction: Gait retraining interventions are used to modify foot strike parameters associated with musculoskeletal injuries. Such interventions may prove beneficial if gait modifications are maintained long-term and provide a physiological performance benefit. Purpose: The primary purpose of this study was to determine whether female recreational runners can use a smartphone decibel app to self-modify gait mechanics associated with injury. The secondary purpose was to determine if such gait modifications are retained beyond the initial training session. The tertiary purpose was to determine if such gait modifications were associated with improved running economy. Methods: The peak vertical ground reaction force (vGRF), impact transient (IT), maximal instantaneous vertical loading rate (VILR), average vertical instantaneous vertical loading rate (VALR), ground contact time (GCT), and running economy (RE) were collected from subjects during overground and treadmill data collection sessions held Pre-training, Training, and at a 1- week Follow-Up. The gait retraining intervention used a smartphone decibel app to provide biofeedback on the sound intensity of the subject’s footfall. Results: Fifteen female recreational runners were included. There was a significant decrease in vGRF at the Follow-Up Session versus Pre-Training (2.39 vs. 2.34 BW, p = .023) and versus Training Session (2.34 vs. 2.30, p = .047). There was a significant decrease in VILR between Pre-Training versus Training Sessions (69.70 vs. 62.24 BW. s -1 , p = .02) and Pre-Training versus Follow- Up Sessions (69.70 vs. 60.35 BW. s -1 , p = .031). There was not a significant decrease in VO2 among Sessions (p = .308). Conclusions: Results from this study suggest a gait retraining intervention using a Decibel X app may enable recreational runners to benefit from self-modification of gait biomechanics iv associated with musculoskeletal injury long-term without an adverse effect on metabolic performance.
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NewsBot · Jul 10, 2020

A Real-Time Feedback Method to Reduce Loading Rate During Running: Effect of Combining Direct and Indirect Feedback
Alessandro Garofolini et al
J Sports Sci. 2020 Jul 4;1-8

Impact loading plays a key role in the pathophysiology of running-related injuries. Providing real-time feedback may be an effective strategy to reduce impact loading; however, it is currently unclear what an effective training method to help runners achieve a habitual low loading rate is. We subjected 20 healthy non-runners to a structured sequence of direct and indirect biofeedback designed to facilitate broader exploration of neuro-mechanical workspace for potential movement solutions (indirect feedback on cadence and foot-strike angle) and to refine and converge upon an optimal sub-set of that space to match the task goal (direct feedback on loading rate). While indirect biofeedback on foot-strike angle yielded a lower impact load than providing direct biofeedback on loading rate, compared to indirect biofeedback on foot-strike angle, providing direct feedback on loading rate statistically increased (+58%, p = 0.007) the range of goal-relevant solutions participants used to lower their impact loading. Results showed that structured feedback was effective in increasing the range of input parameters that match the task goal, hence expanding the size of goal-relevant solutions, which may benefit running performance under changing environmental constraints.
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NewsBot · Sep 14, 2020

Impact-Related Ground Reaction Forces Are More Strongly Associated With Some Running Injuries Than Others
Caleb D. Johnson, PhD, Adam S. Tenforde, MD, PhD, Jereme Outerleys, MASc, ...
The American Journal of Sports Medicine September 11, 2020

Background:
Inconsistent associations have been reported for impact-related ground reaction force variables and running injuries when grouping all injuries together. However, previous work has shown more consistent associations when focusing on specific injuries.

Purpose:
To compare ground reaction force variables between healthy and injured runners as a group and within specific common injuries.

Study Design:
Controlled laboratory study.

Methods:
A total of 125 runners presenting with patellofemoral pain, tibial bone stress injury, plantar fasciitis, Achilles tendinopathy, or iliotibial band syndrome and 65 healthy controls completed an instrumented treadmill assessment at a self-selected speed. Impact-related ground reaction force variables included vertical average (VALR) and instantaneous (VILR) load rates, posterior and medial/lateral instantaneous load rates, and vertical stiffness at initial loading (VSIL). Mean comparisons were made between the general and specific injury and control groups (α = .05). Cutoff thresholds were established and evaluated using several criteria.

Results:
VALR (+17.5%; P < .01), VILR (+15.8%; P < .01), and VSIL (+19.7%; P < .01) were significantly higher in the overall injured versus control groups. For individual injuries, VALR, VILR, and VSIL were significantly higher for patellofemoral pain (+23.4%-26.4%; P < .01) and plantar fasciitis (+17.5%-29.0%; P < .01), as well as VSIL for Achilles tendinopathy (+29.4%; P < .01). Cutoff thresholds showed better diagnostic criteria for individual versus grouped injuries.

Conclusion:
Impact variables (VALR, VILR, and VSIL) were significantly higher when assessing the injured group as a whole. However, these findings were driven by specific injury groups, highlighting the importance of taking an injury-specific approach to biomechanical risk factors for running injury.

Clinical Relevance:
These results suggest that practitioners may want to address impact loading in their treatment of injured runners, especially in those with patellofemoral pain and plantar fasciitis.
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NewsBot · Sep 21, 2020

Changes in the Plantar Flexion Torque of the Ankle and in the Morphological Characteristics and Mechanical Properties of the Achilles Tendon after 12-Week Gait Retraining
Liqin Deng et al
Life 2020, 10(9), 159

Purpose: Although the Achilles tendon (AT) is the largest and strongest tendon, it remains one of the most vulnerable tendons among elite and recreational runners. The present study aims to explore the effects of 12-week gait retraining (GR) on the plantar flexion torque of the ankle and the morphological and mechanical properties of the AT. Methods: Thirty-four healthy male recreational runners (habitual rearfoot strikers) who never tried to run in minimal shoes were recruited, and the intervention was completed (20 in the GR group vs. 14 in the control (CON) group). The participants in the GR group were asked to run in minimal shoes (INOV-8 BARE-XF 210) provided by the investigators with forefoot strike patterns during the progressive 12-week GR. Meanwhile, the participants in the CON group were instructed to run in their own running shoes, which they were familiar with, with original foot strike patterns and intensities. The morphological properties of the AT, namely, length and cross-sectional area (CSA), were obtained by using an ultrasound device. A dynamometer was utilized simultaneously to measure and calculate the plantar flexion torque of the ankle, the rate of torque development, the peak force of the AT, and the stress and strain of the AT. Results: After 12-week GR, the following results were obtained: (1) A significant time effect in the peak ankle plantarflexion torque was observed (p = 0.005), showing a 27.5% increase in the GR group; (2) A significant group effect in the CSA was observed (p = 0.027), specifically, the increase in CSA was significantly larger in the GR group than the CON group; (3) A significant time effect in the peak AT force was observed (p = 0.005), showing a 27.5% increase in the GR group. Conclusion: The effect of 12 weeks of GR is an increase in AT CSA, plantar flexor muscle strength of the ankle, and peak AT force during a maximal voluntary isometric contraction test. These changes in AT morphology and function could be positive for tendon health and could prevent future AT injury
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NewsBot · Sep 29, 2020

Effects of a 10-week running-retraining programme on the foot strike pattern of adolescents: A longitudinal intervention study
Pedro JoséConsuegra GonzálezaFelipe GarcíaPinillosbDavid J.Mora LópezcAntonio JoséCardona LinaresdJuan A.Párraga MontillaePedro ÁngelLatorre Románe
Gait & Posture; 28 September 2020

Highlights
•Intervention: pretest-postest-retest.
•Longitudinal training.
•Foot strike pattern analysis.
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Background
The purpose of this study was to analyse the effects of ten weeks of different running-retraining programmes on rearfoot strike (RFS) prevalence in adolescents.

Research question
it is possible to change foot strike pattern in adolescents?

Methods
A total of 180 children (45.3% girls), aged 13–16 years, participated in this intervention study. The children were randomly assigned to one of three experimental groups (EGs) that each carried out a different retraining programme, based on running technique (n = 38), a 15% increased step frequency (SF) (n = 37) and barefoot training (n = 30), performed for three days each week. A control group (CG) (n = 43) did not perform any retraining. A 2D video-based analysis (240 Hz) was used to determine the RFS.

Results
At baseline, no significant differences in RFS prevalence were found between the EGs and the CG in either the left (χ2 = 2.048; p = 0.559) or the right foot (χ2 = 0.898; p = 0.825). In the post-test, no significant differences were found for the left foot (χ2 = 7.102; p = 0.069), but there were significant differences for the right foot (χ2 = 9.239; p = 0.025) were observed. In the re-test, no significant differences were found for either the left foot (χ2 = 2.665; p = 0.273) or the right foot (χ2 = 2.182; p = 0.325). In addition, no group displayed significant changes in RFS prevalence from the pre-test to the re-test. There was a trend towards a reduction in the RFS prevalence in both the increased SF group and the barefoot group.

Meaning
The main finding of this study was that certain running-retraining programmes performed three times per week for ten weeks are not enough to modify the runner’s foot strike pattern (FSP).
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NewsBot · May 18, 2021

Gait Biomechanics Improve in Collegiate Distance Runners Following an In-Season Intervention Based on Functional Movement Screen Scores
Monique Mokha et al
Vol. 1 No. 1 (2021): Research Directs in Health Sciences

Introduction: Gait retraining techniques vary with little known on how correcting underlying functional movement patterns may remediate the more specialized skill of running. Therefore, the purpose of this exploratory study was to determine if an in-season corrective exercise program aimed at improving Functional Movement ScreenTM (FMS) scores would alter running biomechanics in a group of healthy distance runners.

Methods: Nine healthy NCAA Division II male (n=2) and female (n=7) cross country runners (age, 18.9 + 1.1 yrs; height, 1.64 + 0.09 m; mass, 56.7 + 6.3 kg)

underwent a laboratory-based 3D gait evaluation and FMS as part of preparticipation physical examinations. Team-based corrective exercises were developed from the FMS pretest scores and administered 2-3x/week for 12 weeks. FMS total scores, bilateral pelvis, hip, knee and ankle stance kinematics during running were compared before and after the corrective exercise program using paired samples t-tests, p≤0.05.

Results: FMS (pre 14 ±1.5 vs post 16.4 ± 1.8, p=.001) and left KFLEX (pre 36.4o ± 11.3 vs post 42.2 ± 5.2, p=.024) significantly changed. Right and left HADD, HIR, and CPD decreased indicating a trend toward improvement.

Conclusions: Correcting underlying functional movement patterns shows promise in improving faulty running mechanics in healthy distance runners.
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NewsBot · Jun 24, 2021

Self-selected running gait modifications reduce acute impact loading, awkwardness, and effort
Haisheng Xia et al
Sports Biomechanics: 09 Jun 2021

Impact loading has been associated with running-related injuries, and gait retraining has been suggested as a means of reducing impact loading and lowering the risk of injury. However, gait retraining can lead to increased perceived awkwardness and effort. The influence of specifically trained and self-selected running gait modifications on acute impact loading, perceived awkwardness and effort is currently unclear. Sixteen habitual rearfoot/midfoot runners performed forefoot strike pattern, increased step rate, anterior trunk lean and self-selected running gait modifications on an instrumented treadmill based on real-time biofeedback. Impact loading, perceived awkwardness and effort scores were compared among the four gait retraining conditions. Self-selected gait modification reduced vertical average loading rate (VALR) by 25.3%, vertical instantaneous loading rate (VILR) by 27.0%, vertical impact peak (VIP) by 16.8% as compared with baseline. Forefoot strike pattern reduced VALR, VILR and peak tibial acceleration. Increased step rate reduced VALR. Anterior trunk lean did not reduce any impact loading. Self-selected gait modification was perceived as less awkward and require less effort than the specifically trained gait modification (p < 0.05). These findings suggest that self-selected gait modification could be a more natural and less effortful strategy than specifically trained gait modification to reduce acute impact loading, while the clinical significance remains unknown.
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NewsBot · Jul 20, 2021

Effects of biofeedback on whole lower limb joint kinematics and external kinetics
Franky Mulloy et al
Journal of Sports Sciences: 18 May 2021

Biofeedback (BFb) is a useful tool to accelerate the skill development process. Limited research has applied BFb to the whole lower-limb in a complex skill therefore the aim of this research was to assess the effectiveness of a biofeedback intervention targeting whole lower limb kinematics. Thirty-two healthy participants were randomized to a BFb (n = 16) and a Control group (n = 16). Participants visited a motion capture laboratory on three occasions during one week, and returned for retention testing at 4–6 weeks. Following introduction to a novel lunge-touch task, visual BFb on lower limb joint kinematic extension angular velocities (ω) and timing were provided following each lunge. BFb was effective in increasing Hipω (F = 3.746, p = 0.03) and Kneeω (F = 10.241, p = 0.01). Peak Ankleω remained unchanged (F = 1.537, p = 0.23, η2 = 0.05), however Peak Ankleθ (F = 10.915, p < 0.001, η2 = 0.27) and AnkleROM (F = 9.543, p < 0.001, η2 = 0.24) significantly increased. Despite kinematic changes, there were no significant changes in any external kinetics. No significant correlations were found between Hipω, Kneeω or Ankleω and horizontal impulse (ImpulseY: r = 0.20, p = 0.26; r = −0.11, p = 0.24; and r = 0.22, p = 0.28, respectively). Findings demonstrate that BFb can be used to alter multiple kinematic variables in a complex skill, but do not necessarily alter associated kinetic variables not directly targeted by BFb.
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NewsBot · Oct 30, 2021

Gait Retraining With Visual Biofeedback Reduces Rearfoot Pressure and Foot Pronation in Recreational Runners
Warlindo Carneiro da Silva Neto, Alexandre Dias Lopes, and Ana Paula Ribeiro
Journal of Sport Rehabilitation: 25 Oct 2021

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.
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NewsBot · Oct 31, 2021

The effect of two retraining programs, barefoot running versus increasing cadence: a randomised controlled trial
Alejandro Molina-Molina et al
Scand J Med Sci Sports. 2021 Oct 30

The aim of this study was to compare the effects of two 10-week non-laboratory based running retraining programs on foot kinematics and spatiotemporal parameters in recreational runners. One hundred and three recreational runners (30 ± 7.2 years old, 39% females) were randomly assigned to either: a barefoot retraining group (BAR) with 3 sessions/week over 10 weeks, a cadence retraining group (CAD) who increased cadence by 10% again with 3 sessions/week over 10 weeks and a control group (CON) who did not perform any retraining. The footstrike pattern, footstrike angle (FSA) and spatial-temporal variables at comfortable and high speeds were measured using 2D/3D photogrammetry and a floor-based photocell system. A 3x2 ANOVA was used to compare between the groups and 2 time points. The FSA significantly reduced at the comfortable speed by 5.81° for BAR (p < 0.001; Cohen's d = 0.749) and 4.81° for CAD (p = 0.002; Cohen's d = 0.638), and at high speed by 6.54° for BAR (p < 0.001; Cohen's d = 0.753) and by 4.71° for CAD (p = 0.001; Cohen's d = 0.623). The cadence significantly increased by 2% in the CAD group (p = 0.015; Cohen's d = 0.344) at comfortable speed and the BAR group showed a 1.7% increase at high speed. BAR and CAD retraining programs showed a moderate effect for reducing FSA and rearfoot prevalence, and a small effect for increasing cadence. Both offer low-cost and feasible tools for gait modification within recreational runners in clinical scenarios.
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NewsBot · Nov 9, 2021

The effects of running gait retraining on biomechanics, performance, pain and injury: a systematic review and meta-analysis
Eoin Doyle, Tim Doyle, Jason Bonacci, Joel Fuller
Source

INTRODUCTION
Running gait retraining is an emerging area of interest in the prevention [1] and treatment [2,3] of running-related injuries. There is increasing evidence that runners can successfully modify their running biomechanics using various gait retraining strategies [4,5]. This review aimed to synthesise evidence from randomised controlled trials (RCTs) that investigated the effectiveness of gait retraining on running biomechanics, performance, pain and injury in distance runners.
METHODS
Seven electronic databases (MEDLINE, EMBASE, CINAHL, Web of Science, SPORTDiscus, PEDro, and CENTRAL) were searched from inception to March 2021 to identify RCTs evaluating running gait retraining compared to no intervention, usual training, placebo, or standard care, and reporting biomechanical, performance, or pain and injury outcomes. Only studies with longitudinal follow-up were included. Gait retraining interventions were categorised into step-rate, non-rearfoot footstrike (NRFS), impact, and multi-parameter subgroups. Risk of bias was assessed using the Cochrane Risk of Bias tool [6]. We conducted meta-analysis with standardised mean differences (SMD) for outcomes with homogeneous data from at least two studies and classified evidence quality as very low, low, moderate or high according to Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. SMDs were described as trivial (<0.20), small (0.20–0.59), moderate (0.60–1.19), and large (>1.19).
RESULTS AND DISCUSSION
A total of 19 studies from 16 independent cohorts involving 673 participants met the inclusion criteria in our review. There was moderate evidence that gait retraining targeting an increase in step rate does moderately increase step rate (SMD 1.03 [95% Confidence Interval (CI): 0.63, 1.44]) and cause a small decrease in average vertical loading rate (AVLR) (SMD -0.57 [95% CI: -1.05, -0.09]) (Figure 1). There was low-quality evidence that NRFS retraining moderately increases knee flexion at initial contact (SMD 0.74 [95% CI: 0.11, 1.37]) and NRFS and multi-parameter gait retraining does not significantly alter measures of running performance (SMD ≤0.32, p ≥0.192). There was a lack of studies that report on pain and injury outcomes with conflicting findings. Individual study findings demonstrated reduced injury incidence (hazard ratio 0.38 [95% CI: 0.25, 0.59]; rate ratio 0.52 [95% CI: 0.31, 0.86]) following impact and multi-parameter gait retraining and conflicting findings regarding knee pain changes following step-rate and NRFS retraining.
CONCLUSIONSThe findings from our review indicate step rate interventions were effective at increasing step rate and reducing AVLR, and NRFS interventions cause an increase in knee angle at initial contact. The retraining interventions in this review did not have any negative or positive effects on measures of running performance. Notably, there is preliminary evidence that gait retraining targeting a reduction in landing impacts may be an effective injury prevention strategy for healthy runners, but further RCT evidence is required before recommending gait retraining for injury treatment. Clinicians and researchers can selectively use the gait retraining approaches described in this review to target specific running biomechanics, but not enhance running performance.The GRADE evidence quality was generally rated as low to moderate due to imprecision related to the small size of most studies and risk of bias concerns that were common to several included studies. There was also large heterogeneity between gait retraining interventions employed in studies that limited the pooling of data. Further research involving injured runners is required because they are the population considered to be in most need of retraining.
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NewsBot · Feb 6, 2022

The Effectiveness of Gait Retraining on Running Kinematics, Kinetics, Performance, Pain, and Injury in Distance Runners: A Systematic Review With Meta-analysis
Journal of Orthopaedic & Sports Physical Therapy February 5, 2022

Objective
To evaluate the effectiveness of running gait retraining on kinematics, kinetics, performance, pain, and injury in distance runners.

Design
Intervention systematic review with meta-analysis.

Literature Search
Seven electronic databases from inception to March 2021.

Study Selection Criteria
Randomised controlled trials that (i) evaluated running gait retraining compared to no intervention, usual training, placebo, or standard care, and (ii) reported biomechanical, physiological, performance, or clinical outcomes.

Data Synthesis
Random-effects meta-analyses were completed, and the certainty of evidence was judged using the GRADE criteria. We categorised interventions into step-rate, non-rearfoot footstrike, impact, ground contact time, and multi-parameter subgroups.

Results
We included 19 trials (673 participants). Moderate certainty evidence indicated step rate gait retraining increased step rate (SMD 1.03 [95% CI: 0.63, 1.44]; number of trials (N): 4; I2: 0%) and reduced average vertical loading rate (SMD -0.57 [95% CI: -1.05, -0.09], N: 3; I2: 0%). Low certainty evidence indicated non-rearfoot footstrike retraining increased knee flexion at initial contact (SMD 0.74 [95% CI: 0.11, 1.37]; N: 2; I2: 0%), but did not alter running economy (SMD 0.21 [95% CI: -1.11, 1.52]; N: 3; I2: 19%).). Low certainty evidence indicated multi-parameter retraining did not alter running economy (SMD 0.32 [-0.39, 1.02]; N: 3; I2: 19%) or performance (SMD 0.14 [95% CI: -4.87, 4.58]; N: 2; I2: 18%). Insufficient trials reported on pain outcomes. Two trials demonstrated reduced 1 year injury incidence following gait retraining.

Conclusions
Gait retraining interventions altered step rate and knee kinematics, lowered vertical loading rates, and did not affect running performance
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NewsBot · Apr 17, 2022

Biomechanical adaptations following a music-based biofeedback gait retraining program to reduce peak tibial accelerations
Rud Derie,Pieter Van den Berghe,Joeri Gerlo,Senne Bonnaerens,Ine Van Caekenberghe,Pieter Fiers,Dirk De Clercq,Veerle Segers
10 April 2022

Purpose
The present study aimed to determine if runners can reduce impact measures after a six-session in-the-field gait retraining program with real-time musical biofeedback on axial peak tibial acceleration (PTAa) and identify the associated biomechanical adaptations.

Methods
Twenty trained high-impact runners were assigned to either the biofeedback or the music-only condition. The biofeedback group received real-time feedback on the PTAa during the gait retraining program, whereas the music-only condition received a sham treatment. Three-dimensional gait analysis was conducted in the lab before (PRE) and within one week after completing the gait retraining program (POST). Subjects were instructed to replicate the running style from the last gait retraining session without receiving feedback while running overground at a constant speed of 2.9 m⸳s-1.

Results
Only the biofeedback group showed significant reductions in both PTAa (∆x̅ = -26.9%, p = 0.006) and vertical instantaneous loading rate (∆x̅ = -29.2%, p = 0.003) from PRE to POST. In terms of biomechanical adaptations, two strategies were identified. Two subjects transitioned towards a more forefoot strike. The remaining eight subjects used a pronounced rearfoot strike and posteriorly inclined shank at initial contact combined with less knee extension at toe-off while reducing vertical excursion of the center of mass.

Conclusions
After completing a music-based biofeedback gait retraining program, runners can reduce impact while running overground in a lab. We identified two distinct self-selected strategies used by the participants to achieve reductions in impact.
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NewsBot · Apr 21, 2022

The Effectiveness of Gait Retraining on Running Kinematics, Kinetics, Performance, Pain, and Injury in Distance Runners: A Systematic Review With Meta-analysis
Journal of Orthopaedic & Sports Physical Therapy April 20, 2022

Objective
To evaluate the effectiveness of running gait retraining on kinematics, kinetics, performance, pain, and injury in distance runners.

Design
Intervention systematic review with meta-analysis.

Literature Search
Seven electronic databases from inception to March 2021.

Trial Selection Criteria
Randomized controlled trials that (1) evaluated running gait retraining compared to no intervention, usual training, placebo, or standard care and (2) reported biomechanical, physiological, performance, or clinical outcomes.

Data Synthesis
Random-effects metaanalyses were completed, and the certainty of evidence was judged using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. We categorized interventions into step rate, non-rearfoot footstrike, impact, ground contact time, and multiparameter subgroups.

Results
We included 19 trials (673 participants). Moderate-certainty evidence indicated step rate gait retraining increased step rate (SMD 1.03 [95% confidence interval {CI}: 0.63, 1.44]; number of trials (N): 4; I2: 0%) and reduced average vertical loading rate (SMD −0.57 [95% CI, −1.05 to −0.09], N: 3; I2: 0%). Low-certainty evidence indicated non-rearfoot footstrike retraining increased knee flexion at initial contact (SMD 0.74 [95% CI, 0.11 to 1.37]; N: 2; I2: 0%), but did not alter running economy (SMD 0.21 [95% CI, −1.11 to 1.52]; N: 3; I2: 19%).). Low-certainty evidence indicated multiparameter retraining did not alter running economy (SMD 0.32 [−0.39, 1.02]; N: 3; I2: 19%) or performance (SMD 0.14 [95% CI, −4.87 to 4.58]; N: 2; I2: 18%). Insufficient trials reported on pain outcomes. Two trials demonstrated reduced 1-year injury incidence following gait retraining.

Conclusions
Gait retraining interventions altered step rate and knee kinematics, lowered vertical loading rates, and did not affect running performance.
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NewsBot · Apr 24, 2022

Biomechanical adaptations following a music-based biofeedback gait retraining program to reduce peak tibial accelerations
Rud Derie,Pieter Van den Berghe,Joeri Gerlo,Senne Bonnaerens,Ine Van Caekenberghe,Pieter Fiers,Dirk De Clercq,Veerle Segers
10 April 2022

Purpose
The present study aimed to determine whether runners can reduce impact measures after a six-session in-the-field gait retraining program with real-time musical biofeedback on axial peak tibial acceleration (PTAa) and identify the associated biomechanical adaptations.

Methods
Twenty trained high-impact runners were assigned to either the biofeedback or the music-only condition. The biofeedback group received real-time feedback on the PTAa during the gait retraining program, whereas the music-only condition received a sham treatment. Three-dimensional gait analysis was conducted in the laboratory before (PRE) and within one week after completing the gait retraining program (POST). Subjects were instructed to replicate the running style from the last gait retraining session without receiving feedback while running overground at a constant speed of 2.9 m∙s−1.

Results
Only the biofeedback group showed significant reductions in both PTAa (∆x̅ = −26.9%, p = 0.006) and vertical instantaneous loading rate (∆x̅ = −29.2%, p = 0.003) from PRE to POST. In terms of biomechanical adaptations, two strategies were identified. Two subjects transitioned toward a more forefoot strike. The remaining eight subjects used a pronounced rearfoot strike and posteriorly inclined shank at initial contact combined with less knee extension at toe-off while reducing vertical excursion of the center of mass.

Conclusions
After completing a music-based biofeedback gait retraining program, runners can reduce impact while running overground in a laboratory. We identified two distinct self-selected strategies used by the participants to achieve reductions in impact.
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NewsBot · May 16, 2022

Running Gait Retraining: A Sports Medicine Training Gap in Family Medicine
Alexander C Knobloch
Fam Med. 2022 May;54(5):384-388

Background and objectives: Emerging evidence suggests that running gait retraining plays an important role in the treatment and prevention of running-related injury, yet it remains unclear how gait retraining is being utilized by family physicians with their patients. By surveying family physicians and residents, this study is the first to investigate the frequency of gait retraining discussions with patients with running-related injuries, barriers to these discussions, and physician confidence and perceived value in engaging in these discussions, so as to better inform family physician training on this subject.

Methods: This study investigated family physician attitudes toward gait retraining though a cross-sectional survey administered to 532 military family physicians and residents at the 2019 Uniformed Services Academy of Family Physicians Annual Meeting. Main outcome measures included frequency of, confidence in, and value of discussions of running gait retraining with patients with running-related injuries. Obstacles to discussing gait retraining, knowledge on the topic, and previous training on the topic were also assessed.

Results: With a 72.2% response rate, the majority of respondents (82%) felt discussions on the topic are at least somewhat valuable. However, 63% of respondents infrequently discuss the topic with patients, while 71% lack confidence in engaging in these discussions. The most frequently reported obstacles were lack of knowledge (55%) and time (24%).

Conclusions: Family physicians find value in discussions of running gait retraining with their patients, but discussion frequency and physician confidence are low. Educational interventions increasing physician knowledge and the development of non-time-intensive approaches would be best suited for improving confidence and discussion frequency for this valued skill.
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NewsBot · May 16, 2022

Knowledge, interest, and preference for gait retraining programs in street runners: a cross-sectional study
José Roberto de Souza JúniorPedro Henrique Reis RabeloThiago Vilela LemosGlauber Marques Paraizo BarbosaJoão Paulo Chieregato Matheus
Source

Some treatment modalities have been used to prevent or treat running-related musculoskeletal injuries, among them, gait retraining. This study aimed to evaluate street runners’ knowledge, interest, and preference for gait retraining programs and assess if these aspects differ between runners with and without history of injury. This is a cross-sectional study with 100 runners. Initially, a text showing what gait retraining was about was presented to participants. Then, they answered questions about their knowledge (yes x no) and interest (yes x no) on the programs. Subsequently, a text showing how fully and partially supervised programs would be conducted was offered to participants. Then, they reported their preference for one of them (fully x partially supervised). We found that most athletes were unaware of gait retraining programs (69.8%), though they showed great interest in performing them after explanation (87.1%). We observed no preference for a fully (48.2%) or partially supervised (51.8%) protocol. We also found a statistical difference in knowledge (p=0.029) in favor of participants with history of injury. Despite the growing evidence available, we observed that most runners lack any prior knowledge of this modality. Due to the great interest and lack of preference for different protocols shown, we suggest that healthcare providers who treat this population offer the programs described to patients.
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NewsBot · Jun 17, 2022

Acute Effects of Gait Interventions on Tibial Loads During Running: A Systematic Review and Meta-analysis
Meghan Keast , Jason Bonacci, Aaron Fox
Sports Med. 2022 Jun 16

Introduction: Changing running technique or equipment can alter tibial loads. The efficacy of interventions to modify tibial loads during running is yet to be synthesised and evaluated. This article reviewed the effect of running technique and footwear interventions on tibial loading during running.

Methods: Electronic databases were searched using terms relevant to tibial load and running. Interventions were categorised according to their approach (i.e., footwear; barefoot running; speed; surface; overground versus treadmill; orthotics, insoles and taping; and technique); if necessary, further subgrouping was applied to these categories. Standardised mean differences (SMDs) with 95% confidence intervals (CIs) for changes in tibial loading were calculated and meta-analyses performed where possible.

Results: Database searches yielded 1617 articles, with 36 meeting the inclusion criteria. Tibial loading increased with (1) barefoot running (SMD 1.16; 95% CI 0.50, 1.82); (2) minimalist shoe use by non-habitual users (SMD 0.89; 95% CI 0.40, 1.39); (3) motion control shoe use (SMD 0.46; 95% CI 0.07, 0.84); (4) increased stride length (SMD 0.86; 95% CI 0.18, 1.55); and (5) increased running speed (SMD 1.03; 95% CI 0.74, 1.32). Tibial loading decreased when (1) individuals ran on a treadmill versus overground (SMD - 0.83; 95% CI - 1.53, - 0.12); and (2) targeted biofeedback was used (SMD - 0.93; 95% CI - 1.46, - 0.41).

Conclusions: Running barefoot, in motion control shoes or in unfamiliar minimalist shoes, and with an increased stride length increases tibial loads and may increase the risk of a tibial stress injury during periods of high training load. Adopting interventions such as running on a treadmill versus overground, and using targeted biofeedback during periods of high loads could reduce tibial stress injury.
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NewsBot · Jun 27, 2022

Peak Muscle and Joint Contact Forces of Running with Increased Duty Factors
Bonnaerens, Senne et al
Medicine & Science in Sports & Exercise: June 23, 2022 - Volume - Issue - 10.1249

Purpose
Running with increased duty factors (DF) has been shown to effectively reduce external forces during running. In this study, we investigated whether running with increased DFs (INCR) also reduces internal musculoskeletal loading measures, defined as peak muscle forces, muscle force impulses and peak joint contact forces compared to a runners’ preferred running pattern (PREF).

Methods
Ten subjects were instructed to run with increased DFs at 2.1 m•s-1. Ground reaction forces and three-dimensional kinematics were simultaneously measured. A musculoskeletal model was used to estimate muscle forces based on a dynamic optimization approach, which in turn were used to calculate muscle force impulses and (resultant and three-dimensional) joint contact forces of the ankle, knee and hip joint during stance.

Results
Runners successfully increased their DF from 40.6% to 49.2% on average. This reduced peak muscle forces of muscles that contribute to support during running, i.e. the ankle plantar flexors (-19%), knee extensors (-18%) and hip extensors (-15%). As a consequence, peak joint contact forces of the ankle, knee and hip joint reduced in the INCR condition. However, several hip flexors generated higher peak muscle forces near the end of stance.

Conclusions
Running with increased DFs lowers internal loading measures related to support during stance. Although some swing-related muscles generated higher forces near the end of stance, running with increased DFs can be considered as a preventive strategy to reduce the occurrence of running-related injuries, especially in running populations that are prone to overuse injuries.
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NewsBot · Jul 12, 2022

Bespoke fuzzy logic design to automate a better understanding of running gait analysis
Fraser Young, Samuel Stuart, Robert McNicol, Rosie Morris, Craig Downs, Martin Coleman, Alan Godfrey
IEEE J Biomed Health Inform. 2022 Jul 11;

Running gait assessment and running shoe recommendation is important for the injury prevention of runners who exhibit different skill-levels and running styles. Traditionally, running gait assessment for shoe recommendation relies upon a combination of trained professionals (e.g., sports-therapists, physiotherapists) and complex equipment such as motion or pressure sensors, often incurring a high-cost to the consumer. Despite this, assessments are still prone to subjectivity, and may differ between assessors. Alternatively, methods to provide low-cost, reproduceable gait assessment has become a necessity, especially within a habitual (low-resource) context, with many traditional methods generally unavailable due to the need of professional assistance and more recently the COVID-19 pandemic. Fuzzy logic has shown to be an effective tool in the assessment and identification of gait by providing the potential for a high-accuracy methodology, while retaining a low computational cost; ideal for applications within embedded systems. Here, we present a novel shoe recommendation fuzzy inference system from the classification of two key running gait parameters, foot strike and pronation from a single foot mounted internet of thing (IoT) enabled wearable inertial measurement unit. The fuzzy approach provides excellent (ICC > 0.9) accuracy, while significantly increasing the resolution of the gait assessment technique, providing a more detailed running gait analysis.
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NewsBot · Sep 8, 2022

Correspondence Between Values of Vertical Loading Rate and Oxygen Consumption During Inclined Running
Marcel Lemire, Mathieu Falbriard, Kamiar Aminian, Eloïse Pavlik, Grégoire P. Millet & Frédéric Meyer
Sports Medicine - Open volume 8, Article number: 114 (2022)

Purpose
The aim of this study was to provide a theoretical model to predict the vertical loading rate (VLR) at different slopes and speeds during incline running.

Methods
Twenty-nine healthy subjects running at least once a week performed in a randomized order 4-min running trials on an instrumented treadmill at various speeds (8, 10, 12, and 14 km h−1) and slopes (− 20%, − 10%, − 5%, 0%, + 5%, + 10%, + 15%, + 20%). Heart rate, gas exchanges and ground reaction forces were recorded. The VLR was then calculated as the slope of the vertical force between 20 and 80% of the duration from initial foot contact to the impact peak.

Results
There was no difference in VLR between the four different uphill conditions at given running speeds, but it was reduced by 27% at 5% slope and by 54% at 10% slope for the same metabolic demand (similar V˙O2), when compared to level running. The average VLR measured at maximal aerobic intensity during level running would be decreased by 52.7% at + 5%, by 63.0% at + 10%, and by 73.3% at + 15% slope. Moreover, VLR was dependent on the slope in downhill conditions.

Conclusion
This study highlights the possibility to use uphill running to minimize rate of mechanical load (i.e., osteoarticular load) from foot impact on the ground and as a time-efficient exercise routine (i.e., same energy expenditure than in level running in less time).
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NewsBot · Nov 26, 2022

Efficacy of an Audio-Based Biofeedback Intervention to Modify Running Gait in Female Runners
Jacqueline A Augustine et al
J Sport Rehabil. 2022 Nov 24;1-5.

Context: A variety of gait retraining interventions are available to modify running mechanics associated with musculoskeletal injuries. These often require specialized equipment and/or personnel to prompt the runner toward specific strategies.

Objective: To determine whether instructing female recreational runners to "run quietly" could decrease impact force characteristics.

Design: Cohort.

Setting: Research laboratory.

Participants: Fifteen healthy female recreational runners (24 [7] y) volunteered.

Interventions: Baseline testing occurred on day 1 (baseline), a posttraining assessment occurred on day 2 (training), and a final assessment occurred 1 week after training on day 3 (follow-up). A smartphone decibel measuring app was used to provide biofeedback on the decibel level of foot strike on day 2 (training).

Main outcomes: Peak vertical force, impact transient, peak and average vertical loading rate, ground contact time, and running economy were collected on each day and compared via repeated-measures analyses of variance.

Results: Vertical ground reaction force was lower at follow-up (2.30 bodyweights [BW]) versus baseline (2.39 BW, P = .023) and training (2.34 BW, P = .047). Maximal loading rate decreased from baseline (69.70 BW·s-1) to training (62.24 BW·s-1, P = .021) and follow-up (60.35 BW·s-1, P = .031). There was no change in running economy.

Conclusions: Our findings demonstrate that simple instructions to "run quietly" can yield immediate and sustained reductions in impact force profiles, which do not influence the running economy.
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NewsBot · Jan 30, 2023

Effectiveness of Lower-Cost Strategies for Running Gait Retraining: A Systematic Review
Lissandro M. Dorst et al
Appl. Sci. 2023, 13(3), 1376; https://doi.org/10.3390/app13031376

The effectiveness of lower-cost equipment used for running gait retraining is still unclear. The objective of this systematic review was to evaluate the effectiveness of lower-cost equipment used in running gait retraining in altering biomechanical outcomes that may be associated with injuries. The literature search included all documents from MEDLINE, Web of Science, CINAHL, SPORTDiscus, and Scopus. The studies were assessed for risk of bias using an evaluation tool for cross-sectional studies. After screening 2167 initial articles, full-text screening was performed in 42 studies, and 22 were included in the systematic review. Strong evidence suggested that metronomes, smartwatches, and digital cameras are effective in running gait retraining programs as tools for intervention and/or evaluation of results when altering step cadence and foot strike patterns. Strong evidence was found on the effectiveness of accelerometers in interventions with feedback to reduce the peak positive acceleration (PPA) of the lower leg and/or footwear while running. Finally, we found a lack of studies that exclusively used lower-cost equipment to perform the intervention/assessment of running retraining.
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NewsBot · Feb 20, 2023

The Effect of Real-Time Tibial Acceleration Feedback on Running Biomechanics During Gait Retraining: A Systematic Review and Meta-Analysis
Xiaohan Li et al
Journal of Sport Rehabilitation

Objectives: To explore the immediate and retention effect of real-time tibial acceleration feedback on running biomechanics during gait retraining. Methods: Five electronic databases were searched to identify relevant studies published before May 2022. The included studies were evaluated for methodological quality and bias risk, and data were extracted. A meta-analysis was conducted on the primary outcomes, including peak tibial acceleration (PTA) and vertical ground reaction force. Subgroup analysis was performed by gender, feedback criterion, mode, dosage, fading, retention period, and running environment to evaluate the source of heterogeneity. Qualitative analysis was performed to describe other variables. Results: Fourteen studies (174 participants) were eligible. Meta-analysis showed that real-time tibial acceleration feedback reduced PTA (P < .01, P < .01), vertical impact peak (P = .004, P < .01), vertical average loading rate (P < .01, P < .01), and vertical instantaneous loading rate (P < .01, P < .01) after feedback and during retention period (5 min–12 mo). Subgroup analysis showed that the immediate effect of vertical impact peak was more noticeable with mixed gender (P = .005) and fading feedback (P = .005) conditions, and the retention effect of PTA was more noticeable with high feedback dosage (P < .01) and fading feedback (P < .01) conditions. Conclusions: Real-time tibial acceleration feedback can reduce PTA and vertical ground reaction force during gait retraining, and for periods of 5 minutes to 12 months when the feedback is removed.
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NewsBot · Apr 16, 2023

Instructions Promoting an External Focus Are More Effective for Altering Impact Forces in Female Runners
Jacy Zajac et al
Journal of Sport Rehabilitation 12 Apr 2023

Context: Previous studies have found that instructions promoting an external focus (EF) tend to be more effective for movement pattern retraining compared to instructions promoting an internal focus (IF), for a variety of movement tasks. However, few studies have examined how different types of instructions affect running mechanics associated with running-related injury risk. Therefore, the purpose of this study was to compare the effects of instructions promoting different attentional foci on impact forces during running. Design: Cross-sectional study. Methods: Twenty uninjured female recreational runners ran at a self-selected speed with their typical pattern (no instructions condition) on an instrumented treadmill that measured ground reaction forces. Next, they were given 2 sets of instructions intended to alter their running pattern; one promoted an IF and the other promoted an EF. Repeated-measures analysis of variance was used to compare impact peaks and loading rates across the conditions (no instructions, IF, and EF), with post hoc tests conducted in the case of a significant omnibus test. Results: There were differences among the conditions in the impact peaks (P < .001) and loading rates (P < .001). Impact peaks were lower for the IF (P = .002) and EF (P < .001) conditions compared to the no instructions condition. Loading rates were lower for the EF condition compared to the no instructions (P < .001) and IF (P < .001) conditions; there was no difference between the IF and no instructions conditions (P = .24). Conclusions: Our findings indicate that instructions promoting an EF may be more effective at reducing loading rates during running compared to instructions promoting an IF. Clinicians should consider these findings when attempting to retrain a runner’s running pattern.
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NewsBot · May 29, 2023

Foot Pronation Prediction with Inertial Sensors during Running: A Preliminary Application of Data-Driven Approaches
Liangliang Xiang et al
Source

Abnormal foot postures may affect foot movement and joint loading during locomotion. Investigating foot posture alternation during running could contribute to injury prevention and foot mechanism study. This study aimed to develop feature-based and deep learning algorithms to predict foot pronation during prolonged running. Thirty-two recreational runners have been recruited for this study. Nine-axial inertial sensors were attached to the right dorsum of the foot and the vertical axis of the distal anteromedial tibia. This study employed feature-based machine learning algorithms, including support vector machine (SVM), extreme gradient boosting (XGBoost), random forest, and deep learning, i.e., one-dimensional convolutional neural networks (CNN1D), to predict foot pronation. A custom nested k-fold cross-validation was designed for hyper-parameter tuning and validating the model’s performance. The XGBoot classifier achieved the best accuracy using acceleration and angular velocity data from the foot dorsum as input. Accuracy and the area under curve (AUC) were 74.7 ± 5.2% and 0.82 ± 0.07 for the subject-independent model and 98 ± 0.4% and 0.99 ± 0 for the record-wise method. The test accuracy of the CNN1D model with sensor data at the foot dorsum was 74 ± 3.8% for the subject-wise approach with an AUC of 0.8 ± 0.05. This study found that these algorithms, specifically for the CNN1D and XGBoost model with inertial sensor data collected from the foot dorsum, could be implemented into wearable devices, such as a smartwatch, for monitoring a runner’s foot pronation during long-distance running. It has the potential for running shoe matching and reducing or preventing foot posture-induced injuries.
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NewsBot · Dec 28, 2023

Effect of three different running gait cues on vertical tibial acceleration
Laura M Anderson, Daniel R Bonanno, Prasanna Sritharan, Hylton B Menz
Gait Posture. 2023 Nov 25

Background: Repetitive impacts during running are associated with some running injuries. Tibial acceleration is a proxy for tibial loading, and interventions that can decrease it are likely to be of interest to the running community.

Research question: What effect do running gait cues have on peak vertical tibial acceleration at a comfortable and moderate running pace, and how will these cues be executed?

Methods: Twenty-seven participants ran on a treadmill according to the following cues in random order: run softly and lightly, run with shorter steps, and increase preferred step rate by 7.5 %. Participants maintained each condition for one minute before returning to their 'preferred' running pattern for two minutes. Two tibia-mounted inertial measurement unit sensors were used to collect tibial acceleration data at a 'comfortable' and 'moderate' run pace. A repeated measures analysis of variance test was used to compare the means between running conditions.

Results: Compared to preferred running, the decrease step length (-8 %, p = 0.002, Cohen's d=0.33) and run softly and lightly (-9 %, p = 0.040, Cohen's d=0.38) cues provided a significant reduction in peak vertical tibial acceleration during a comfortable run pace. No significant difference was observed with an increase in step rate. Compared to preferred running, there was no significant difference in peak vertical tibial acceleration with any of the running gait cues during a moderate run pace.

Significance: Instructing runners to decrease step length or run softly and lightly can result in small reductions in peak vertical tibial acceleration during a comfortable run pace, but running gait cues during a moderate run pace provide no effects. Differences in the execution of each cue are likely to influence overall tibial loading throughout the stride cycle. These findings provide novel biomechanical evidence for the potential effects of running retraining strategies for reducing tibial accelerations at different running paces.
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NewsBot · Mar 2, 2024

Gait retraining targeting foot pronation: A systematic review and meta-analysis
Seyed Hamed Mousavi ,Fateme Khorramroo ,Amirali Jafarnezhadgero
March 1, 2024

Foot pronation is a prevalent condition known to contribute to a range of lower extremity injuries. Numerous interventions have been employed to address this issue, many of which are expensive and necessitate specific facilities. Gait retraining has been suggested as a promising intervention for modifying foot pronation, offering the advantage of being accessible and independent of additional materials or specific time. We aimed to systematically review the literature on the effect of gait retraining on foot pronation. We searched four databases including PubMed, Web of Science, Scopus and Embase from their inception through 20 June 2023. The Downs and Black appraisal scale was applied to assess quality of included studies. Two reviewers screened studies to identify studies reporting the effect of different methods of gait-retraining on foot pronation. Outcomes of interest were rearfoot eversion, foot pronation, and foot arch. Two authors separately extracted data from included studies. Data of interest were study design, intervention, variable, sample size and sex, tools, age, height, weight, body mass index, running experience, and weekly distance of running. Mean differences and 95% confidence intervals (CI) were calculated with random effects model in RevMan version 5.4. Fifteen studies with a total of 295 participants were included. The results of the meta-analysis showed that changing step width does not have a significant effect on peak rearfoot eversion. The results of the meta-analysis showed that changing step width does not have a significant effect on peak rearfoot eversion. Results of single studies indicated that reducing foot progression angle (MD 2.1, 95% CI 0.62, 3.58), lateralizing COP (MD -3.3, 95% CI -4.88, -1.72) can effectively reduce foot pronation. Overall, this study suggests that gait retraining may be a promising intervention for reducing foot pronation; Most of the included studies demonstrated significant improvements in foot pronation following gait retraining. Changing center of pressure, foot progression angle and forefoot strike training appeared to yield more favorable outcomes. However, further research is needed to fully understand its effectiveness and long-term benefits.
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NewsBot · Apr 24, 2024

Effects of 12-week gait retraining on plantar flexion torque, architecture, and behavior of the medial gastrocnemius in vivo
Chuyi Zhang et al
Front Bioeng Biotechnol. 2024 Mar 20:12:1352334

Objective: This study aims to explore the effects of 12-week gait retraining (GR) on plantar flexion torque, architecture, and behavior of the medial gastrocnemius (MG) during maximal voluntary isometric contraction (MVIC).

Methods: Thirty healthy male rearfoot strikers were randomly assigned to the GR group (n = 15) and the control (CON) group (n = 15). The GR group was instructed to wear minimalist shoes and run with a forefoot strike pattern for the 12-week GR (3 times per week), whereas the CON group wore their own running shoes and ran with their original foot strike pattern. Participants were required to share screenshots of running tracks each time to ensure training supervision. The architecture and behavior of MG, as well as ankle torque data, were collected before and after the intervention. The architecture of MG, including fascicle length (FL), pennation angle, and muscle thickness, was obtained by measuring muscle morphology at rest using an ultrasound device. Ankle torque data during plantar flexion MVIC were obtained using a dynamometer, from which peak torque and early rate of torque development (RTD50) were calculated. The fascicle behavior of MG was simultaneously captured using an ultrasound device to calculate fascicle shortening, fascicle rotation, and maximal fascicle shortening velocity (Vmax).

Results: After 12-week GR, 1) the RTD50 increased significantly in the GR group (p = 0.038), 2) normalized FL increased significantly in the GR group (p = 0.003), and 3) Vmax increased significantly in the GR group (p = 0.018).

Conclusion: Compared to running training, GR significantly enhanced the rapid strength development capacity and contraction velocity of the MG. This indicates the potential of GR as a strategy to improve muscle function and mechanical efficiency, particularly in enhancing the ability of MG to generate and transmit force as well as the rapid contraction capability. Further research is necessary to explore the effects of GR on MG behavior during running in vivo.
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NewsBot · May 22, 2024

Viability of Structured Gait Retraining for Improving Clinical Outcomes Following Running-related Injury in Active Duty Service Members
Kelly Leugers et al
Mil Med. 2024 May 21

Introduction: All branches of the U.S. Military have a running component of their physical readiness testing battery. Running-related musculoskeletal injuries affect 20 to 40% of DoD Service Members each year. Running form has not historically been addressed with military running-related injuries. To assess the utility of a structured gait retaining protocol designed to treat the onset of running-related pain and/or injury by correcting identified biomechanical risk factors for injury and improve clinical outcomes.

Study design: Case series.

Materials and methods: A total of 160 Active Duty Service Members (ADSMs) with running-related lower-body musculoskeletal injuries were referred by a physical therapist for a multisession gait retraining program termed "Run with CLASS" (Cadence, Lean, Alignment, Soft-landing, Strike). Run with CLASS utilized various drills to emphasize impact progression, proximal strengthening, and proprioception and spatial awareness.

Results: Results revealed that the implemented gait retraining protocol significantly improved running parameters following lower-body injury as evidenced by increased cadence, improved functional assessment scores, and a marked transition from predominantly heel strike to forefoot strike patterns during running.

Conclusions: A 3-week supervised gait retraining program focused on the gait retraining program termed "Run with CLASS" (Cadence, Lean, Alignment, Soft-landing, Strike) was successful in altering biomechanics of self-selected running gait by increasing cadence and transitioning ADSMs to a forefoot foot strike. Additionally, ADSMs reported significant improvements on the self-reported functional scores on the University of Wisconsin Running Injury and Recovery Index and Single Assessment Numerical Evaluation.
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NewsBot · Jul 3, 2024

Transference of outdoor gait-training to treadmill running biomechanics and strength measures: A randomized controlled trial
Alexandra F. DeJong Lempke et al
Journal of BiomechanicsVolume 168, May 2024, 112095

Outdoor gait-training has been successful in improving pain and reducing contact time during outdoor running for runners with exercise-related lower leg pain (ERLLP). However, it is unclear if these adaptations translate to gold standard treadmill running and clinical strength assessments. The study purpose was to assess the influence of a 4-week outdoor gait-training intervention with home exercises (FBHE) on treadmill running biomechanics and lower extremity strength compared to home exercises alone (HE) among runners with ERLLP. Seventeen runners with ERLLP were randomly allocated to FBHE and HE groups (FBHE: 3 M, 6F, 23 ± 4 years, 22.0 ± 4.6 kg/m2; HE: 3 M, 5F, 25 ± 5 years, 24.0 ± 4.0 kg/m2). Both groups completed eight sessions of home exercises over 4 weeks. The FBHE group received gait-training through wearable sensors to reduce contact time. Treadmill running gait and clinical strength assessments were conducted at baseline and 4-weeks. Multivariate repeated measures analyses of variance were used to assess the influence of group and timepoint for all outcomes. The FBHE group demonstrated significantly decreased contact time at 4-weeks compared to baseline and the HE group (Mean Difference [MD] range: −42 ms – −39 ms; p-range: <0.001–0.02). The FBHE group had significantly increased cadence (MD: +21 steps/min; p = 0.003) and decreased loading impulse (MD: −51, p < 0.001) during treadmill running at 4-weeks compared to the HE group. Strength did not significantly differ adjusting for multiple comparisons (p > 0.007). The outdoor FBHE intervention transferred to favorable changes in treadmill running biomechanics. Clinicians treating runners with ERLLP patients should implement data-driven outdoor gait-training to maximize patient benefits across running locations.
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NewsBot · Jul 3, 2024

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Transference of outdoor gait-training to treadmill running biomechanics and strength measures: A randomized controlled trial
Alexandra F. DeJong Lempke et al
Journal of BiomechanicsVolume 168, May 2024, 112095
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Press Release:
Too much treadmill? This could help your shin splints
Peer-Reviewed Publication

Good news for all the treadmill runners who suffer from stubborn and painful shin splints: A little outdoor gait training may help, new research suggests.

A randomized controlled trial found that four weeks of gait training outdoors, in addition to home exercises often prescribed for shin splints, led to improved running biomechanics even when the runners were using a treadmill. These improvements included decreasing the time the runners’ feet were in contact with the ground or treadmill, a recently identified contributor to shin splints.

Based on the trial results, the researchers, including UVA Health sports medicine expert David J. Hryvniak, DO, are recommending that clinicians begin including outdoor gait training as part of rehabilitation programs for patients struggling with chronic shin splints.

“This is an important finding for clinicians, as this gives us a tool to use to help these runners,” said Hryvniak, a running medicine specialist who is part of UVA Health’s Runner’s Clinic. “These gait-training cues can be an easy thing to add into a rehab program to help patients improve running mechanics that can underlie many common running injuries.”

Soothing Shin Splints

Affecting approximately 40% of all runners, shin splints typically begin as tenderness in the lower leg that goes away after exercising. But for regular runners, this pain can worsen and become persistent. In severe cases, shin splints can even lead to stress fractures.

Prior research has found that short courses of outdoor gait training can significantly reduce shin-splint pain for outdoor runners. But experts had been uncertain if these benefits would transfer to the flat, regular surface of treadmill running. That prompted an interdisciplinary team of researchers – from UVA’s College of Arts & Sciences, School of Education and School of Medicine, as well as Virginia Commonwealth University, Plymouth State University and the University of North Carolina at Chapel Hill – to launch a randomized trial to find out if outdoor gait training would benefit treadmill users.

The researchers enrolled 17 treadmill runners between ages 18 and 45 who ran at least three times a week and who had been suffering lower leg pain during or after running for at least a month. The volunteers were randomly divided into two groups: One group received four weeks of outdoor gait training and performed commonly prescribed home strengthening exercises, while the other group only performed the home exercises.

During the gait training, participants were provided with “vibrotactile feedback” –meaning they felt a little vibration – when special sensors in their shoes detected their feet were in contact with the ground for too long. This helped them improve their stride and gait to reduce this potential contributor to shin splints.

At the end of the study period, both groups saw strength improvements in their legs. But the gait trainers also had improved running technique, or what the researchers call “favorable adjustments in running gait mechanics.” And, sure enough, these gait improvements were seen during both outdoor runs and treadmill runs.

That suggests outdoor gait training could be an important new tool to help treadmill users work up a sweat pain-free, the researchers say.

“Shin splints are a very common running injury, especially with those who are new to the sport,” Hryvniak said. “These gait cues are something that have been shown to be an effective tool that patients can use literally ‘on the run.’”

NewsBot · Jul 8, 2024

Enhancing running injury prevention strategies with real-time biofeedback: A systematic review and meta-analysis
Wei Shen,Yifan Yu,Jose Frias Bocanegra,Patrick C. Wheeler &Daniel T. P. Fong
Journal of Sports Sciences: 05 Jul 2024

The number of runners and the incidence of running-related injuries (RRIs) are on the rise. Real-time biofeedback gait retraining offers a promising approach to RRIs prevention. However, due to the diversity in study designs and reported outcomes, there remains uncertainty regarding the efficacy of different forms of feedback on running gait biomechanics. Three databases: MEDLINE, PUBMED, and SPORTDiscus were searched to identify relevant studies published up to March 2024, yielding 4646 articles for review. The quality of the included studies was assessed using the Downs and Black Quality checklist. Primary outcomes, including Peak Tibial Acceleration (PTA), Vertical Average Loading Rate (VALR), and Vertical Instantaneous Loading Rate (VILR), were analysed through meta-analysis. 24 studies met the inclusion criteria and were analysed in this review.17 used visual biofeedback (VB) while 14 chose auditory biofeedback (AB). The meta-analysis revealed a reduction in loading variables both immediately following the intervention and after extended training, with both visual and auditory feedback. Notably, the decrease in loading variables was more pronounced post-training and VB proved to be more effective than AB. Real-time biofeedback interventions are effective in lowering loading variables associated with RRIs. The impact is more substantial with sustained training, and VB outperforms AB in terms of effectiveness.
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NewsBot · Jul 30, 2024

Step width modification to change rearfoot eversion and medial longitudinal arch angle during walking and running in individuals with pronated feet
Fateme Khorramroo et al
Gait Posture. 2024 Jul 26

Background: Individuals with pronated feet often experience altered foot biomechanics, leading to increased risk of lower limb injuries. Step width modification has been proposed as a potential intervention to improve foot alignment during gait.

Research question: Does modifying step width influence rearfoot eversion and medial longitudinal arch angle (MLAA) in individuals with pronated feet during walking and running?

Methods: Twenty individuals with pronated feet underwent analysis during walking and running on treadmill, maintaining increased or decreased step width using real-time visual feedback. Three-dimensional motion analysis measured rearfoot eversion and MLAA during the stance phase of gait.

Results: Wide step width significantly reduced peak rearfoot eversion during waking (mean difference - with normal step width - (MD) = 3.6°, p < 0.001) and running (MD = 4.4°, p < 0.001), time to peak rearfoot eversion during walking (MD = 16.6 p < 0.001) and running (MD = 13.8°, p = 0.014), rearfoot eversion at touch down (TD) during walking (MD = 1.3°, p = 0.004), rearfoot eversion excursion during running (MD = 4.3°, p < 0.001), and peak MLAA during walking (MD = 2.9°, p = 0.006) and MLAA excursion during running (MD = 4.8°, p = 0.004). By contrast, during running, narrow condition significantly increased peak rearfoot eversion (MD = 3.4°, p < 0.001). During walking, time to peak rearfoot eversion (MD = 16.1, p < 0.001), rearfoot eversion at TD (MD = 1.4°, p = 0.008), rearfoot eversion excursion (MD = 5.9°, p < 0.001), and peak MLAA (MD = 3.4°, p < 0.001) were significantly increased.

Significance: This study highlights the potential of step width modification as a simple yet effective intervention to improve foot biomechanics in pronated feet individuals during walking and running. Further research could lead to the development of personalized strategies for pronated feet individuals.
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Gait retraining to reduce lower extremity loading in runners

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