The notion of changing how somebody walks or runs in order to alter lower-limb loading is not new, and the earliest reference dates back to 1978 where it was used to equalise load distribution between the right and left legs in patients with pathological gait. More recently, research has shown that directly changing how a person runs can alter lower-limb loading and can be an effective treatment protocol for patients with running related injuries (Barton et al., 2016).

What is gait retraining?

Running injures are complicated, multifactorial, and the root-causes are poorly established (Barton et al., 2016; Warrener et al., 2021). We know that the way a person runs (his/her biomechanics) is a risk-factor for common musculoskeletal injuries and that identifying any biomechanical abnormalities helps clinicians understand why an injury happened in the first place, which is the first step to a long-term and successful treatment plan.

Given the evidence that links running biomechanics with injury, there is justification in directly altering these mechanics when treating the injured runner. This is referred to as gait retraining.

The process of gait retraining can be defined as "‘the implementation of any cue or strategy to alter an individual's running technique"  (Barton et al., 2016). The desired outcome of a gait retraining protocol is to adapt lower-limb loading for the long-term treatment of a musculoskeletal overuse injury.

However, altering movement patterns that have been reinforced over millions of cycles takes both guidance and practice. In a review on motor-control principles, Winstein (1991) suggested that learning a new motor program should be enhanced with feedback in two phases. During the first phase, referred to as the Acquisition Phase, extrinsic feedback should be provided to develop the connection between the extrinsic feedback and the internal sensory cues (proprioception) associated with the desired movement pattern. During the second phase, referred to as the Transfer Phase, the extrinsic feedback is removed in a controlled way in order to prevent reliance on it and to enhance the learning of the new motor pattern. The extrinsic feedback is usually a visual or audio cue presented to the the patient that indicates how he/she 'should' be running compared to how he/she is 'actually' running. This might be as simple as a metronome set to a specific cadence or a complete gait analysis to visualise exactly how the joints and bones are moving in real-time.

Based on Winstein's principles, the majority of clinicians and academics advocate a faded-feedback gait retraining protocol, which comprises a package of supervised gait retraining sessions using reducing amounts of feedback until the 'new' gait becomes a learned behaviour. For example in the first gait retraining session, a patient might run for 20-minutes with feedback provided for the entire time, whereas at the last session he/she might be given just 1-minute of feedback at the beginning and nothing for the remainder of the run.

It is important to note that whilst altering a movement pattern can reduce loading in one area, it might might increase it in another. For example retraining a runner to  become of mid-foot striker in order to reduce vertical impact, and decrease loading at the knee will increase loading at the lower-leg and ankle. It is therefore important to include a specific strengthening programme in any gait retraining intervention to anticipate the altered loading patterns and to minimise the risk of developing a new, different injury.

Gait retraining principles can be applied to any gait abnormality believed to be related to a musculoskeletal injury.

RUN3D Gait Retraining

The first step in any Run3D assessment is to take a history and to measure your 'baseline' run so that we can accurately identify any gait parameters that are associated with your injury. Depending on your results, gait retraining might be recommended as part of your treatment plan.

During a gait retraining session, we use our advanced 3D gait analysis in real-time to measure exactly what is happening at your pelvis, hip, knee and ankles as you are running on the treadmill. We cue you to change a specific feature of your running style, and use our real-time analysis to provide you with visual feedback of this parameter as you are running. At the same time, we also monitor the impact that this change is having on all the joints of your lower-limbs. For example, if the gait change is having a detrimental impact on other joints, we can identify this and manage this appropriately.

The gait retraining cues that you could be asked to implement depend on what we are trying to change, but they are usually quite simple from your perspective. Examples include taking shorter, faster steps, keeping your knees pointing forwards or tucking your bottom under. As clinicians, we have the more challenging job of assessing the impact that this change is having on the rest of your gait to ensure that you will not develop an injury elsewhere as a direct result of the gait modification.

Individuals respond differently to gait retraining and so the exact nature of the gait retraining protocol (session duration/amount of feedback/total number of sessions) is patient-specific. It is likely that you will be recommended a minimum of three gait retraining sessions, as well as given recommendations and exercises to carry-out between your sessions. Training progression must allow for tissue adaptation to the new loading, and we will be able to advise on this important consideration also.

Remember that gait retraining should represent only part of the treatment protocol for an injured runner and it is equally important to address muscle function, motor control, strength and flexibility deficits in any rehabilitation programme, which can also help to facilitate the desired movement patterns.  For example, gait retraining to increase hip extension at toe-off and reduce anterior pelvic tilt is quite simply impossible if a patient is unable achieve the required range of motion due to tight hip flexors.

Run3D is the only 3D gait retraining service that is not within a University research environment.

‍

The ability to provide our patients with a scientific way of altering faulty movement patterns, enabling them to reduce injury risk and treat existing injuries, is a very powerful rehabilitation tool.

‍

References

Barton, C., Bonanno, D., Carr, J., Neal, B., Malliaras, P., Franklyn-Miller, A., and Menz, H. (2016) Running retraining to treat lower limb injuries: A mixed – methods study of current evidence synthesised with expert opinion, British Journal of Sports Medicine, pp. 1-16

Cheung, R., An, W., Au, I., Zhang, J., Chan, Z., & Macphail, A. (2018) Control of impact loading during distracted running before and after gait retraining in runners, Journal of Sports Sciences, Vol. 36, No.13, p. 1497.

Davis, I., & Futrell, E. (2016) Gait retraining: Altering the fingerprint of gait, Physical medicine and rehabilitation clinics of north America ,Vol 27, No. 1, pp. 339-355.

Warrener, A., Tamai, R., and Lieberman, D. (2021) The effect of trunk flexion angle on lower limb mechanics during running, Human Movement Science, Vol 78. Pp. 1-10.

‍