This is a paper that is in press at the moment in the AJSM. It is a very interesting study because if I’m not mistaken, this is the first study to investigate gait retraining and it’s effect in lowering injury risk.
We know from previous studies that gait retraining does help reduce the vertical loading rate, which is associated with a number of running injuries namely PFP. We also know that gait retraining is an effective intervention for patients with PFP.
So this paper is huge in that it does provide us with some first insights into the effectiveness of using gait retraining as a prevention tool for running injuries. Tom Goom has made an excellent video summary on this study, so please check it out below:
Of course we need to understand that this is quite a complex issue because running injuries comprise of so many different conditions and different mechanisms of injury. The 62% reduction in injury risk, which I would say is pretty impressive, considering that we know injury risk for runners can be pretty high, so the pre-test probabilities are already relatively high. So with a reduction of 62% in injury risk for a group of patients with relatively high injury risks I would say that is clinically relevant. Certainly we need to acknowledge the limitations of the study and be cautious of bias because we know that just having one study in any one field of study is highly prone to bias. But it does provide us with a glimmer of hope that there is some progress towards the prevention or more appropriately the reduction of running injuries by using gait-retraining. For far too long there just weren’t any evidence at all to support or disprove this claim.
Another thing to note from the study is the obvious reduction of plantar fasciitis and PFP incidence in the gait retraining group, BUT an INCREASE in achilles and calf injuries. Note that there were 0% of achilles and calf injuries in the control group. This we know is because with gait retraining, the focus is usually on increasing cadence or running softer, and this places more strain on the calf complex. This finding is consistent with a few other studies, which found similar increases in achilles and calf injuries with gait retraining programs.
Tom Goom mentioned that the training loads of the runners were not shown in this study, which could potentially have a huge effect on the results. If the training loads were not matched then what could have happen might be that the those in the gait-retraining group just had lower training loads, and consequently less injuries. Another point I saw mentioned on twitter by Derek Griffin was that there was a large drop-out rate in the study, if I’m not mistaken around 80 or so, and this was not addressed by the authors of the paper. So that again must be something to consider when we interpret the results of this study.
While recognising the limitations of the study, I still salute the researchers for leading the way in this area. Hopefully and I’m sure we will see more research being done to confirm or refute this finding, but what is certain is that we need to build the evidence base around this topic.
Please click here for access to the PDF version of the paper which is freely shared by the researchers. Again kudos to them.