Running Gait Retraining

Original Editor - Mariam Hashem

Top Contributors - Mariam Hashem and Tarina van der Stockt

Introduction

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Gait retraining is a movement specific intervention that aims to facilitate a new learning technique used to correct 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 came from the need for a specific approach to the motor pattern that is likely contributing to the incidence and persistence of symptoms.

It aims to reduce the tissue stress by either correcting the movement pattern that is causing the stress or changing the distribution of the stress from one joint to another[1].

Considerations

  • 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 mind that there might be some adverse effects of the intervention that you are using and can be associated with different risks and possibly reducing the running economy. This also depends on the individual, for instance for an elite runner, changes in the running mechanics might hinder their performance 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 the intervention depends on the individual's ability to learn new skills so it 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 increase the duration spent running with this new movement pattern and occasionally dropping cues when necessary to help ensure they can still maintain this movement pattern.vOnce the desired movement pattern is attained, withdraw the cues slowly to help the runner practising it independently[1].
  • Gait retraining has shown a positive effect on addressing running injuries, however, running injuries are multifactorial. Strength deficits and training load errors can contribute to injuries and if not addressed well the intervention might not be effective.

Methods

  • Visual Feedback of running technique
  • Changing cadence or step rate
  • Altering or changing footstrike pattern

Visual Feedback

Real-time feedback is an effective method in changing mechanical patterns around hip and pelvis and was found to have an effect on correcting contralateral 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 patellofemoral pain and demonstrated good outcomes[2]. It is also cheap and applicable in clinical practice.

Another method: encouraging wider steps by using a piece of tape on the treadmill and encouraging the runner to run with their feet on either side of the tape. Increased step width has been shown to reduce hip adduction and peak rearfoot eversion in runners[3]. There are also some suggestions that it can reduce Iliotibial Band strain[4] and bending forces acting on the tibia[5].

This technique may be most effective with runners who are demonstrating 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 manipulation

Method: using a metronome by increasing steps per minute combined with verbal cues by encouraging the runner to shorten the strides, increase the steps and match their steps to the beat.

A study[6] 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 patellofemoral pain. The number of steps per one foot in a minute was counted and runners were asked to increase that by 10% and match their feet to the beat of a metronome. Once runners were able to attain this in clinical practice they were asked to use a metronome app on the phone and run using it for 2 weeks, maintaining the same cadence. For the second two weeks, they were asked to monitor 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 maintain it and implement it independently. This technique is effective and time-saving.

Bramah et al[6] found that step retraining can result in a reduction in peak contralateral pelvic drop, hip adduction and hip internal rotation. In the sagittal plane, step retraining can reduce the foot inclination and increases knee flexion at initial contact possibly reducing the overstride mechanics and reducing the breaking and impact forces on the joints. Over the four week period, there was a significant reduction in pain and improvement in function using the Lower Extremity Function Scale for those who had patellofemoral pain. There was also an increase in running volume and longer distance pain-free running.

The evidence suggests minimal changes in knee rotation, knee abduction and adduction, rear foot in- and eversion mechanics resulting from gait retraining, might not be clinically meaningful[1].

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Foot strike manipulation

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.

In current evidence, changing footstrike 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 flexion at initial contact and 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 a 21% reduction in quadriceps and hamstrings forces and a significant increase in both gastrocnemius and soleus forces of around 14- 28%. This may have an impact on the future of injury development particularly around the calf and Achilles foot complex[1]

Changing from rear to forefoot strike reduces pain levels in patellofemoral pain and increases the function[8]. The limitations of using this technique are that you cannot use it with a runner with patellofemoral pain who is already running on the forefoot and also there are the consequences of the associated injuries. The studies that used this technique with runners reported a number of patients experiencing Achilles tendon pain, calf strain injuries and foot and plantar fascia type of pain as a result of switching to forefoot running.

The selection of this intervention might be limited and not recommended unless there aren't other options or when you have exhausted other clinical possibilities.

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Resources

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References

  1. 1.0 1.1 1.2 1.3 1.4 Bramah, C.Running Gait Retraining: What, why and how? Course, Physioplus 2020.
  2. dos Santos AF, Nakagawa TH, Lessi GC, Luz BC, Matsuo HT, Nakashima GY, Maciel CD, Serrão FV. Effects of three gait retraining techniques in runners with patellofemoral pain. Physical Therapy in Sport. 2019 Mar 1;36:92-100.
  3. 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.
  4. Meardon SA, Campbell S, Derrick TR. Step width alters iliotibial band strain during running. Sports biomechanics. 2012 Nov 1;11(4):464-72.
  5. Meardon SA, Derrick TR. Effect of step width manipulation on tibial stress during running. Journal of Biomechanics. 2014 Aug 22;47(11):2738-44.
  6. 6.0 6.1 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.
  7. How to Increase Running Cadence (with a Metronome App) Available from: https://www.youtube.com/watch?v=08lmp5zQAmA [last access 9/2/2020]
  8. 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.
  9. Proper running forefoot strike. Available from: https://www.youtube.com/watch?v=--YU8YcWeUU [last access 9/2/2020]
  10. Running retraining for patellofemoral pain SMA symposium with Dr Christian Barton Available from: https://www.youtube.com/watch?v=88Dmh-1Ux9A [last access 9/2/2020]