A 10% increase in step rate improves running kinematics and clinical outcomes in runners with patellofemoral pain at 4 weeks and 3 months

Bramah, CA; Preece, SJ; Gill, NM; Herrington, LC

Abstract

Background: Aberrant frontal plane hip and pelvis kinematics have been frequently observed in runners with patellofemoral pain (PFP). Gait retaining interventions have been shown to improve running kinematics and may therefore be beneficial in runners with PFP.
Purpose: the aim of this study was to investigate whether a 10% increase in running step rate influences frontal plane kinematics of the hip and pelvis, as well as clinical outcomes in runners with PFP.
Study Design: Case Series
Methods: Runners with PFP underwent a 3D gait analysis to confirm the presence of aberrant frontal plane hip and pelvis kinematics at baseline. Twelve participants with frontal plane hip and pelvis kinematics one standard deviation above a reference database, were invited to participate in the gait retraining intervention. Running kinematics along with clinical outcomes of pain and functional measures were recorded at baseline, 4 weeks following retraining and 3-months. Gait retraining consisted of a single session where step rate was increased by 10% using an audible metronome. Participants were asked to continue their normal running while self-monitoring their step rate using a global positioning system watch and audible metronome. Results: Following gait retraining significant improvements in running kinematics and clinical outcomes were observed at 4 week and 3-month follow up. Repeated measures ANOVA with post hoc Bonferroni (p <0.016) showed significant reductions in peak contralateral pelvic drop (Mean Difference [MD], 3.12⁰; 95% Confidence Interval [CI], 1.88⁰, 4.37⁰), hip adduction (MD, 3.99⁰; 95% CI, 2.01⁰, 5.96⁰) and knee flexion (MD, 4.09⁰; 95% CI, 0.04⁰, 8.15⁰), as well as significant increases in self-reported weekly running volume (MD, -13.78km; 95% CI, -22.93km, -4.62km) and longest run pain free (MD, -6.84km; 95% CI, -10.62km, -3.05km). Friedman test with post hoc Wilcoxon signed-rank showed significant improvements in Numerical Rating Scale for worst pain in the past week and Lower Extremity Functional Scale.
Conclusion: A single session of gait retraining using a 10% increase in step rate results in significant improvements in running kinematics, pain and function in runners with PFP. These improvements were maintained at 3-month follow up. It is important to assess for aberrant running kinematics at baseline to ensure gait interventions are targeted appropriately.
Clinical Relevance: Step rate modification is a simple method of gait retraining that can be easily integrated into clinical practice and running outside of a laboratory setting.

• Journal Article Type: Article
• Online Publication Date: Oct 28, 2019
• Publication Date: Oct 28, 2019
• Deposit Date: Sep 30, 2019
• Publicly Available Date: Nov 6, 2019
• Journal: The American Journal of Sports Medicine
• Print ISSN: 0363-5465
• Electronic ISSN: 1552-3365
• Publisher: SAGE Publications
• Volume: 47
• Issue: 14
• Pages: 3406-3413
• DOI: https://doi.org/10.1177/0363546519879693
• Publisher URL: https://doi.org/10.1177/0363546519879693
• Related Public URLs: https://uk.sagepub.com/en-gb/eur/journal/american-journal-sports-medicine