Gait retraining programs for cadence, impact may relieve patellofemoral pain
Key takeaways:
- A gait retraining program improved pain, knee function and lower limb kinematics in runners with patellofemoral pain.
- The programs focused on step cadence and impact.
According to published results, a 2-week partially supervised gait retraining program, which focused on cadence and impact, relieved pain and improved knee function and lower limb kinematics in runners with patellofemoral pain.
Researchers performed a randomized controlled trial of 30 runners (aged 18 to 45 years) who presented with patellofemoral pain symptoms between August 2020 and July 2022. Researchers randomly assigned 10 patients to participate in a gait retraining program focused on cadence, 10 patients to participate in a gait retraining program focused on impact and a control group of 10 patients who did not receive any intervention.
According to the study, the interventions were partially supervised and lasted for 2 weeks. The cadence group trained to increase step cadence by 7.5% to 10%, while the impact group trained to reduce tibial acceleration by 50%.
Outcomes were assessed before the intervention, immediately after the intervention and at 6 months after the intervention. Outcomes included VAS pain scores, knee functional scores and lower limb kinematics, such as contralateral pelvic drop, hip adduction, knee flexion, ankle dorsiflexion, tibia inclination and foot inclination.
Overall, researchers found both intervention groups had greater improvements in running pain at 6-month follow-up compared with the control group. Researchers noted the impact group had greater improvements in knee functional scores immediately after the intervention compared with the control group. No differences were found between the groups for usual pain or lower limb kinematics.
Researchers concluded by highlighting the differences between the supervised vs. unsupervised portions of the programs.
“Participants in a supervised protocol focusing on tibial acceleration were unable to transfer the results outside the clinic,” the researchers wrote in the study. “These results show the relevance of partially supervised protocols, which allow exposure to outdoor training during retraining,” they added.
Perspective
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Patellofemoral pain plagues athletes and outdoor enthusiasts of all levels due to complex biomechanical, neuromuscular and psychosocial factors. One important piece of this holistic puzzle is a dominant biomechanical theory which postulates that higher forces contribute to chronic pain and subsequent osteoarthritis.
The manuscript by José de Souza Júnior, PT, PhD, and colleagues describes their randomized controlled study that analyzes the effects of gait retraining in runners with patellofemoral pain, utilizing two strategies for reducing forces at the knee.
The investigators found that decreasing tibial acceleration and increasing cadence may help assist in the management of patellofemoral pain. Tibial acceleration was reduced by training with an accelerometer, as well as instructions to “make the footfalls quieter.” Cadence was increased by training using a metronome with an increase of 7.5% to 10% from baseline step rate. Essentially, “running softer” and finding the slightly faster “happy pace” are simple strategies for load management to accelerate knee rehabilitation.
It would be interesting to investigate a larger sample with high-density electromyography, advanced motion and force capture to provide more comprehensive kinetic and kinematic analysis of the effect of the training program on biomechanics. Identifying the source of patellofemoral pain and influences of neuromuscular training requires a holistic, evidence-based and multidisciplinary approach to improve outcomes and guide runners to truly achieve their high.
Reference:
Zazulak, BT. Master your core: A science-based guide to achieve peak performance and resilience to injury. TCK Publishing; 2021.
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