Strategies for Injury Prevention Through Gait Retraining in Runners

Dr. Rachel Selina // #FitnessAthleteFriday // www.ptonice.com

In today's episode of the PT on ICE Daily Show, Endurance Athlete faculty member Rachel Selina discusses research supporting the use of gait retraining for preventative rehab. She shares practical advice for coaching & cues to use with runners to improve their gait in a manner that has been shown to reduce likelihood of future injury.

Take a listen to the episode or check out the full show notes on our blog at www.ptonice.com/blog

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EPISODE TRANSCRIPTION

RACHEL SELINAAlright, good morning everyone and welcome back to the PT on Ice daily show. My name is Rachel Salina and I am a TA within our Endurance Athlete Division. So I help teach our Rehabilitation of the Injured Runner live and online courses. So hopefully today you are ready for a running topic because that's what we're going into. I will apologize now if it gets a tiny bit loud in a few minutes. I'm currently at our CrossFit gym, so we've got a group that's going to start doing 24.3 here in just a moment. So if you hear the music kick up a little bit in the background, that is what's going on. But otherwise, we'll keep this a bit brief into the point today. So we're going to talk about gait retraining and really addressing a question that comes up in our courses a lot. And that question is, do I address running mechanics if a runner isn't injured? So kind of asking that question, like, is there an ideal gait form, gait mechanics that we're trying to get to? Um, like if it's don't broke, don't fix it kind of thing. What do we do when someone is not injured? Should we still intervene? WHAT IS THE GOAL OF GAIT RETRAINING DURING INJURY? And I think first we need to break down a little bit what we're trying to do with gait retraining when someone is injured. So really what we're doing with most of our drills is we're taking a load that's overloading a particular structure, right? Say it's the knee. The knee is aggravated. running aggravates it. And we're going to use a drill to try and shift that load to a different structure, allowing the knee to have less load and therefore kind of recover and be able to tolerate the running. So all we're doing is shifting load from one structure to another. So we're not necessarily trying to make it perfect. We're just allowing that person to still be able to run because we've changed how their body has to absorb the forces of running. So for example, That same patient who's having maybe patellofemoral pain, we see that they land with an overstride, their foot is landing far in front of their center of mass. We might give that patient a forward leaning drill to try and bring the center of mass closer to where the foot is. By doing that, by getting that patient to lean forward more so than their preferred or kind of typical pattern, we decrease the stress at the patellofemoral joint, which is good. It decreases their pain. They're able to still run. But what we've done is we've shifted that load to the glutes and to the gastroxoleus. We've just moved the load. So that's the case where we'll use gait retraining. kind of in addressing injury shifting load. WHAT ABOUT GAIT RETRAINING FOR SOMEONE WITHOUT AN INJURY? But what about, like I said, if that runner's not injured, can we still use gait retraining in any form to either help that person run better, right? So we can talk about it from performance. That might be one time where we would use gait retraining in a non-injured runner. Or can we, do we have any evidence to show that we could use gait retraining to actually reduce the risk of injury. So that's where we're gonna talk a little bit more today. There's a really cool study that came out by Chan in 2018 and we dive into this some in our live course, but I really wanted to kind of deep dive today. So this study was looking at a group of non-injured runners and giving them a gait retraining drill. and then they followed these runners out over a year, which is a pretty long time to follow these runners, to see if there was any difference in the injury rates. So their only intervention, right, they were looking at addressing vertical loading to be able to reduce the vertical loading. So they had runners come in, okay, for eight sessions over two weeks, so four sessions each week. They increased their running time in that two week period from 15 minutes a session to 30 minutes a session. They gave the patients feedback, like they gave them visual feedback, which there's some systems we can use in a clinic to show like peak forces and rates. And we'll get into kind of how we can do this without having that visual. Anyways, they gave them lots of feedback initially. and then reduce that feedback over the eight sessions, which this is very typical of how you would see gait retraining carried out in a clinical setting or how we would like to prescribe it. So lots of feedback initially, kind of tapering that feedback off. And they actually didn't give them feedback in the last few sessions. And then they sent those runners off, right? That was just the first two weeks. And then followed them over a year. And they found, that the group that did the gait retraining had a 62% lower injury occurrence, which that's a huge deal to be able to, like that was the only intervention they did. They let the runners keep, you know, like their normal shoes, their normal running pace, speed, all that kind of thing. They just did the feedback. So given this is one study, but it's pretty hopeful or pretty helpful in thinking that if we can intervene and do some things to reduce the loading rate, we might be able to prevent some injuries. So like I said, in this study, they used like the, like they got visual feedback of their forces, but they also told the runners to run softer. And that's something that's very applicable to our runners that we can tell them to focus on, right? We can have them go, and spend those four or um sorry eight sessions on a treadmill inside like in a controlled setting trying to focus on making their gait um or their foot strikes softer and then send them out like they don't have to continue every single run to focus on that um but i think we can actually have an impact there um in how their body is having to accept load and hopefully be able to prevent some injuries. So like I said, I'll reference this study in the show notes if you want to read it all the way through. But again, a very promising way to start to look at still being able to provide something helpful to our runners when they're coming in, maybe from a performance or just a non-injury standpoint, we don't have to say like oh well you're not injured now so we don't do anything um but we also don't have to like pick apart every single tiny thing of their gait if not all of it um is something that we want to address so can we make them maybe run softer and then another instance where we can think of gait retraining from an injury perspective there was another study looking more at high school runners and again this was prospective as well so a bunch of runners that weren't injured, they measured their cadence and then followed them out. And the runners who had a cadence less than 164 steps per minute had a higher incidence that was associated with injury. Right, so that's another way where if someone comes in, they're not currently injured, maybe they don't have any complaints, they just want their gait looked at, they're curious what their gait looks at, they want to be able to do, like to run better or feel better running, we might be able to manipulate their cadence as well as a preventative type of intervention. So can they run softer? And can we make their cadence faster? So as I say, if you want to focus on two things for your non-injured runners that can be beneficial in the long term, that's where I would focus our attention. That's it. And some of these things are cues that you can very easily pick up when your runner is in the clinic for a gait analysis. If your runner is very loud, like you hear every foot strike really, really heavy, they might be someone that's good to give the cue to run softer and have them focus on that. If you measure their cadence and it's really low, like below that 164, have them start working on cadence retraining at 10% above that. These are some really simple, actionable ways to start helping your non-injured runners hopefully stay non-injured. All right, that's it today. Like I said, just want to keep it short and sweet. SUMMARY If you are interested in learning more about gait retraining, gait mechanics, gait analysis, we have two live courses scheduled for this year so far for Rehabilitation of the Injured Runner Live. Our first one is coming up in June, so that's June 1 and 2 in Milwaukee. And then we have September 7 and 8 out in Maryland. So we'd love to see you at one of those. If you can't make it live, Our next online cohort starts the beginning of June as well. So sweet. I hope you all have a great Friday. Get after 24.3 if that's your jam. Otherwise, get outside, go for a run, and we will see you soon. Bye.

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