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

Christopher Bramah, Stephen J Preece, Niamh Gill, Lee Herrington, Christopher Bramah, Stephen J Preece, Niamh Gill, Lee Herrington

Abstract

Background: Aberrant frontal-plane hip and pelvis kinematics have been frequently observed in runners with patellofemoral pain (PFP). Gait retaining interventions have been shown to improve running kinematics and may therefore be beneficial in runners with PFP.

Purpose: To investigate whether a 10% increase in the running step rate influences frontal-plane kinematics of the hip and pelvis as well as clinical outcomes in runners with PFP.

Study design: Case series; Level of evidence, 4.

Methods: Runners with PFP underwent a 3-dimensional gait analysis to confirm the presence of aberrant frontal-plane hip and/or pelvis kinematics at baseline. A total of 12 participants with frontal-plane hip and/or pelvis kinematics 1 standard deviation above a reference database were invited to undergo the gait retraining intervention. Running kinematics along with clinical outcomes of pain and functional outcomes were recorded at baseline, 4 weeks after retraining, and 3 months. Gait retraining consisted of a single session where step rate was increased by 10% using an audible metronome. Participants were asked to continue their normal running while self-monitoring their step rate using a global positioning system smartwatch and audible metronome.

Results: After gait retraining, significant improvements in running kinematics and clinical outcomes were observed at 4-week and 3-month follow-up. Repeated-measures analysis of variance with post hoc Bonferroni correction (P < .016) showed significant reductions in peak contralateral pelvic drop (mean difference [MD], 3.12° [95% CI, 1.88°-4.37°]), hip adduction (MD, 3.99° [95% CI, 2.01°-5.96°]), and knee flexion (MD, 4.09° [95% CI, 0.04°-8.15°]) as well as significant increases in self-reported weekly running volume (MD, 13.78 km [95% CI, 4.62-22.93 km]) and longest run pain-free (MD, 6.84 km [95% CI, 3.05-10.62 km]). Friedman test with a post hoc Wilcoxon signed-rank test showed significant improvements on a numerical rating scale for worst pain in the past week and the Lower Extremity Functional Scale.

Conclusion: A single session of gait retraining using a 10% increase in step rate resulted in significant improvements in running kinematics, pain, and function in runners with PFP. These improvements were maintained at 3-month follow-up. It is important to assess for aberrant running kinematics at baseline to ensure that gait interventions are targeted appropriately.

Registration: NCT03067545 (ClinicalTrials.gov identifier).

Keywords: gait retraining; kinematics; patellofemoral pain; running; step rate.

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: This project was internally funded by the University of Salford. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Clinical outcomes at baseline, 4 weeks, and 3 months. *Statistically significant difference when compared with baseline at P< .016. Error bars represent ±1 standard deviation.

References

    1. Almonroeder T, Willson JD, Kernozek TW. The effect of foot strike pattern on Achilles tendon load during running. Ann Biomed Eng. 2013;41(8):1758-1766.
    1. Besier TF, Gold GE, Delp SL, Fredericson M, Beaupre GS. The influence of femoral internal and external rotation on cartilage stresses within the patellofemoral joint. J Orthop Res. 2008;26(12):1627-1635.
    1. Binkley JM, Stratford PW, Lott SA, Riddle DL. The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network. Phys Ther. 1999;79(4):371-383.
    1. Bramah C, Preece SJ, Gill N, Herrington L. Is there a pathological gait associated with common soft tissue running injuries? Am J Sports Med. 2018;46(12):3023-3031.
    1. Chumanov ES, Wille CM, Michalski MP, Heiderscheit BC. Changes in muscle activation patterns when running step rate is increased. Gait Posture. 2012;36(2):231-235.
    1. Cohen J. Statistical Power Analysis for the Behavioral Sciences: Revised Edition. New York: Academic Press; 1977.
    1. Collins NJ, Bierma-Zeinstra SM, Crossley KM, van Linschoten RL, Vicenzino B, van Middelkoop M. Prognostic factors for patellofemoral pain: a multicentre observational analysis. Br J Sports Med. 2013;47(4):227-233.
    1. Cook C, Hegedus E, Hawkins R, Scovell F, Wyland D. Diagnostic accuracy and association to disability of clinical test findings associated with patellofemoral pain syndrome. Physiother Can. 2010;62(1):17-24.
    1. Crossley KM, Stefanik JJ, Selfe J, et al. 2016 patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester, part 1: terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. Br J Sports Med. 2016;50(14):839-843.
    1. Dingenen B, Staes FF, Santermans L, et al. Are two-dimensional measured frontal plane angles related to three-dimensional measured kinematic profiles during running? Phys Ther Sport. 2018;29:84-92.
    1. Dos Santos AF, Nakagawa TH, Lessi GC, et al. Effects of three gait retraining techniques in runners with patellofemoral pain. Phys Ther Sport. 2019;36:92-100.
    1. Esculier JF, Bouyer LJ, Dubois B, et al. Is combining gait retraining or an exercise programme with education better than education alone in treating runners with patellofemoral pain? A randomised clinical trial. Br J Sports Med. 2018;52(10):659-666.
    1. Foch E, Milner CE. Frontal plane running biomechanics in female runners with previous iliotibial band syndrome. J Appl Biomech. 2014;30(1):58-65.
    1. Handsaker JC, Forrester SE, Folland JP, Black MI, Allen SJ. A kinematic algorithm to identify gait events during running at different speeds and with different footstrike types. J Biomech. 2016;49(16):4128-4133.
    1. Herrington L, Law J. The effect of hip adduction angle on patellar position measured using real time ultrasound scanning. Knee. 2012;19(5):709-712.
    1. Lenhart RL, Thelen DG, Wille CM, Chumanov ES, Heiderscheit BC. Increasing running step rate reduces patellofemoral joint forces. Med Sci Sports Exerc. 2014;46(3):557-564.
    1. Mason DL, Preece SJ, Bramah CA, Herrington LC. Reproducibility of kinematic measures of the thoracic spine, lumbar spine and pelvis during fast running. Gait Posture. 2016;43:96-100.
    1. Merican AM, Amis AA. Iliotibial band tension affects patellofemoral and tibiofemoral kinematics. J Biomech. 2009;42(10):1539-1546.
    1. Napier C, Esculier JF, Hunt MA. Gait retraining: out of the lab and onto the streets with the benefit of wearables. Br J Sports Med. 2017;51(23):1642-1643.
    1. Neal BS, Barton CJ, Birn-Jeffrey A, Daley M, Morrissey D. The effects & mechanisms of increasing running step rate: a feasibility study in a mixed-sex group of runners with patellofemoral pain. Phys Ther Sport. 2018;32:244-251.
    1. Neal BS, Barton CJ, Gallie R, O’Halloran P, Morrissey D. Runners with patellofemoral pain have altered biomechanics which targeted interventions can modify: a systematic review and meta-analysis. Gait Posture. 2016;45:69-82.
    1. Neal BS, Lack SD, Lankhorst NE, Raye A, Morrissey D, van Middelkoop M. Risk factors for patellofemoral pain: a systematic review and meta-analysis. Br J Sports Med. 2019;53(5):270-281.
    1. Nielsen RO, Parner ET, Nohr EA, Sorensen H, Lind M, Rasmussen S. Excessive progression in weekly running distance and risk of running-related injuries: an association which varies according to type of injury. J Orthop Sports Phys Ther. 2014;44(10):739-747.
    1. Noehren B, Hamill J, Davis I. Prospective evidence for a hip etiology in patellofemoral pain. Med Sci Sports Exerc. 2013;45(6):1120-1124.
    1. Noehren B, Pohl MB, Sanchez Z, Cunningham T, Lattermann C. Proximal and distal kinematics in female runners with patellofemoral pain. Clin Biomech. 2012;27(4):366-371.
    1. Noehren B, Scholz J, Davis I. The effect of real-time gait retraining on hip kinematics, pain and function in subjects with patellofemoral pain syndrome. Br J Sports Med. 2011;45(9):691-696.
    1. Nunes GS, Stapait EL, Kirsten MH, de Noronha M, Santos GM. Clinical test for diagnosis of patellofemoral pain syndrome: systematic review with meta-analysis. Phys Ther Sport. 2013;14(1):54-59.
    1. Piva SR, Gil AB, Moore CG, Fitzgerald GK. Responsiveness of the activities of daily living scale of the knee outcome survey and numeric pain rating scale in patients with patellofemoral pain. J Rehabil Med. 2009;41(3):129-135.
    1. Powers CM, Ward SR, Fredericson M, Guillet M, Shellock FG. Patellofemoral kinematics during weight-bearing and non-weight-bearing knee extension in persons with lateral subluxation of the patella: a preliminary study. J Orthop Sports Phys Ther. 2003;33(11):677-685.
    1. Powers CM, Witvrouw E, Davis IS, Crossley KM. Evidence-based framework for a pathomechanical model of patellofemoral pain: 2017 patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester, UK, part 3. Br J Sports Med. 2017;51(24):1713-1723.
    1. Preece SJ, Mason D, Bramah C. The coordinated movement of the spine and pelvis during running. Hum Mov Sci. 2016;45:110-118.
    1. Roper JL, Harding EM, Doerfler D, et al. The effects of gait retraining in runners with patellofemoral pain: a randomized trial. Clin Biomech (Bristol, Avon). 2016;35:14-22.
    1. Sinclair JK. Effects of a 10 week footstrike transition in habitual rearfoot runners with patellofemoral pain. Comp Exerc Physiol. 2016;12(3):141-150.
    1. Smith BE, Selfe J, Thacker D, et al. Incidence and prevalence of patellofemoral pain: a systematic review and meta-analysis. PLoS One. 2018;13(1):e0190892.
    1. Streiner D, Geddes J. Intention to treat analysis in clinical trials when there are missing data. Evid Based Ment Health. 2001;4(3):70-71.
    1. Taunton JE, Ryan MB, Clement D, McKenzie DC, Lloyd-Smith D, Zumbo B. A retrospective case-control analysis of 2002 running injuries. Br J Sports Med. 2002;36(2):95-101.
    1. van Gent RN, Siem D, van Middelkoop M, et al. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med. 2007;41(8):469-480.
    1. van Mechelen W. Running injuries: a review of the epidemiological literature. Sports Med. 1992;14(5):320-335.
    1. Willson JD, Kernozek TW, Arndt RL, Reznichek DA, Scott Straker J. Gluteal muscle activation during running in females with and without patellofemoral pain syndrome. Clin Biomech (Bristol, Avon). 2011;26(7):735-740.
    1. Willy RW, Buchenic L, Rogacki K, Ackerman J, Schmidt A, Willson JD. In-field gait retraining and mobile monitoring to address running biomechanics associated with tibial stress fracture. Scand J Med Sci Sports. 2016;26(2):197-205.
    1. Willy RW, Manal KT, Witvrouw EE, Davis IS. Are mechanics different between male and female runners with patellofemoral pain? Med Sci Sports Exerc. 2012;44(11):2165-2171.
    1. Willy RW, Scholz JP, Davis IS. Mirror gait retraining for the treatment of patellofemoral pain in female runners. Clin Biomech. 2012;27(10):1045-1051.
    1. Yamato TP, Saragiotto BT, Lopes AD. A consensus definition of running-related injury in recreational runners: a modified Delphi approach. J Orthop Sports Phys Ther. 2015;45(5):375-380.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner