Can Gait Retraining Decrease Running-Related Injuries?

Real-Time Biofeedback May Help Decrease Running Injuries

Can a gait retraining program reduce braking forces and decrease running-related injuries (RRIs)? This 15-week explorative study was designed to investigate (1) whether peak braking forces (PBFs) could be reduced following an 8-session gait retraining program for female recreational runners and (2) which self-selected movement strategies could generate this reduction in PBFs.

In this study, 12 female recreational runners with high PBFs (greater than 0.27 body weight) completed an 8-session gait retraining program with real-time biofeedback of braking forces shown on a monitor. These runners ran on a treadmill inside a lab with their usual running shoes at a self-selected speed representing a moderate-intensity run (Borg rating of perceived exertion of 13). The only cue the runners received was to attempt to remain below a 0.245 body weight (BW) PBF on the monitor with the encouragement that lower was better. This was considered the “modified gait.”

The primary kinetic outcome was PBF. Secondary kinetic outcomes included vertical loading rates such as average loading rate (AVLR) and instantaneous vertical loading rate (IVLR). Kinematic outcomes included step length, step frequency, horizontal distance from heel to sacrum, shank angle at initial contact, and foot-strike angle. Outcome measures were recorded at baseline for natural gait and at 15-week follow up for both natural gait and modified gait.

Here’s what the researchers found:

1. On average, a 15% reduction in PBF

a. A significant decrease from 0.28 BW at baseline to 0.24 BW at 15-week follow-up

This was clinically significant, since it corresponded to a 5-fold (400%) decrease in RRI risk, based on a previous study by Napier et al. in 2018.

2. AVLR reduced by 18% and IVLR reduced by 19%

a. Neither were statistically significant

It appears that movement strategies incorporated to decrease PBF might have additional, indirect benefits of decreasing vertical loading rates, which are associated with RRIs such as tibial stress fractures.

3. Movement strategies that were used to decrease PBF:

a. Shortening step length

b. Increasing step frequency (average 7% increase)

c. No change in running speed

d. No difference in horizontal distance from heel to sacrum (heel to center of mass)

e. No difference in shank angle

f. No difference in foot-strike angle

This is mostly consistent with previous studies that decreased loading parameters. The average cadence increased from 171 to 182-186 simply by shortening step length and increasing step frequency. By changing two simple variables alone, the runners were able to decrease PBFs without changing other aspects of their running biomechanics such as foot strike pattern or shank angle. Increasing cadence appears to be an effective way to decrease running forces that are associated with running injuries such as runner’s knee and iliotibial band friction syndrome. 

4. The gait retraining program was successful in improving natural running gait

a. Significant decrease in PBF at 15-week follow-up even when participants ran with their new “natural gait”

It appears that running biomechanics can change in as little as 8 sessions with minimal cueing, potentially decreasing risks for RRIs.

Limitations of the study:

1. Did not assess RRI risk reduction directly

Although it may seem reasonable to infer a RRI risk reduction as a result of decreased PBF, decreased vertical loading rates, and increased cadence, we cannot assume that a gait retraining program reduces injury rates based on this preliminary study alone.

2. Small sample size of 12 participants

So the statistical power is decreased.

3. No control group

Therefore, these results cannot support that a gait retraining program and a simultaneous half-marathon training program is superior to a half-marathon training program alone.

4. All participants were female recreational runners.

However, it’s reasonable that male or elite runners may benefit from a similar gait retraining program.

5. The follow-up period lasted only 15 weeks.

It is unknown whether the modified gait pattern was retained after the 15-week period.

6. All participants had a high PBF at baseline.

While there may have been a selection bias and ceiling effect, these individuals would likely benefit the most from altering their running gait for injury prevention since runners with a high PBF have a higher RRI risk, according to earlier studies.

7. Gait modifications were only observed in the lab

It is unclear whether these gait modifications would transfer to running in the community.

Takeaway:

1. Real-time biofeedback of braking force may be used clinically to decrease high PBF, which is correlated with increased risk for running injuries.

2. Reductions in PBF may be achieved by decreasing step length or increasing step frequency, without altering foot-strike or shank angle.

If you are looking for a running analysis to potentially reduce injury risks, please contact us below to schedule an appointment.

Disclaimer: This is not intended to be formal medical advice. Your individual needs should be met by the appropriate health care practitioners. Please consult with a trusted provider.

Dr. Vincent Liu, PT, DPT

Doctor of Physical Therapy

The Game Plan Physical Therapy