Gait Retraining: Altering the Fingerprint of Gait

Abstract

In terms of running, there is evidence that links mechanics with injury. This evidence provides the justification for altering these mechanics. Increased hip adduction and vertical impact loading have been most commonly associated with injury. More work is needed in order to understand the optimal way to retrain gait patterns in runners. The human body has a considerable ability to adapt. To provide individuals with the ability to alter faulty movement patterns in ways that can reduce injury risk is a powerful tool.

Keywords: Biofeedback; Faded feedback; Gait retraining; Running injuries.

Copyright © 2016 Elsevier Inc. All rights reserved.

Figures

Figure 1

Basic factors contributing to running injuries. Any one or combination of factors can cause a runner to reach their injury threshold.

Figure 2

Calculation of vertical load rates from the vertical ground reaction force during the stance phase of running. The average load rate (ALR) is calculated as the slope of the early impact transient over its most linear portion (between 20–80% of the vertical impact peak (VIP)). The instantaneous load rate (ILR) is calculated as the peak slope between any two successive points along the same region of interest.

Figure 3

Malalignments seen in runners. A. Excessive peak rearfoot pronation. B. Excessive ankle dorsiflexion at footstrike. C. Toe-in during stance. D. Genu valgum during stance. E. Excessive anterior tilt of the pelvis.

Figure 4

One of the most common malalignments seen in runners involving excessive contralateral pelvic drop, hip adduction and internal rotation.

Figure 5

Results of study by Willy and Davis.. A. Comparison of hip strength values. Note the significant change in the Trainer group. B. Comparison of pre- and post-strengthening hip kinematics in the Trainer group. Note the lack of change in hip movement patterns, despite the increase in strength noted in this group.

Figure 6

Real-time feedback of hip adduction angle during a retraining session. The shaded region represents +/− 1 standard deviation from the mean value of hip adduction based on a healthy population of runners. With each stance, the hip adduction angle is provided to the runner on a monitor in front of them. They are instructed to modulate their gluteal activation until they are able to keep their hip adduction angle within the targeted shaded region.

Figure 7

Faded feedback design used in many of the gait retraining studies. Run time is increased from 10 to 30 minutes over 8 sessions. Feedback is provided 100% of the time over the first 4 sessions and then is gradually removed over the last 4 sessions.

Figure 8

Results of the Noehren et al. Note the reduction in hip adduction, internal rotation and contralateral pelvic drop, both at 1 and 3 month follow-ups.

Figure 9

Measurement of tibial shock while running. A lightweight accelerometer is tightly affixed (and overwrapped) to the distal medial tibia.

Figure 10

Long term follow-up on a patient who underwent a supervised transition to running with a forefoot strike pattern using foot and ankle strengthening and gait retraining. A. Footstrike pattern and associated vertical ground reaction forces at left: Baseline with shoes (RFS), middle: Baseline, barefoot (FFS), and right: 1 yr followup, minimal shoes (FFS). B. Vertical instantaneous and average load rates at baseline (PRE) when patient was running with shoes (red), barefoot (white) and 1-year post when running in her minimal shoes (blue). Note reduction of her load rates when barefoot at baseline and in her minimal shoes at 1 yr post.

Figure 11

A. An example of an inertial measurement unit (IMU) and B. attached to the ankle. These devices facilitate the measurement of gait in runners in their natural environment.