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Does gait retraining reduce knee (patellafemoral) pain?
Research reviewed: Gait retraining as an intervention for patellafemoral pain. Davis et al. Curr Rev Musculoskeletal Med Feb 2020.
Patellafemoral knee pain (aka PFP, think kneecap) is one of the most common injuries in athletes, with nearly 1/3 of runners having chronic knee pain. It can often be a nebulous injury that is multi-factorial in nature and thus becomes more difficult to treat.
Physiotherapy is a key part of treating PFP - including strengthening, taping, bracing, gradual activity progressions, and gait retraining.
The last item - gait retraining- means retraining of movement and improved motor control. This paper reviewed whether or not it helps to reduce PFP pain.
What the researchers found
The researchers reviewed a number of studies on using retraining for individuals suffering from PFP, with the majority of studies conducted on runners and focused on four changes:
1- Reducing hip adduction (the hip and leg dropping inwards)
2 - Increasing forward lean (think trunk leaning forward)
3 - Transitioning to a forefoot strike pattern (making impact closer to the front of the foot)
4 - Increasing cadence (think more steps per minute)
Additionally, a number of studies aimed to improve functional activities like squatting and stair navigation via motor control strategies.
What the researchers found is that those studies which adhered to key motor control principles - such as using a faded feedback design and adequate dosage (sessions) - had the greatest effect.
To the latter point, those studies which had between 3-4 sessions per week for a minimum of 2 weeks with sessions increasing to 30-45 minutes in the later periods showed the best results.
Retraining using faded feedback and proper dosage resulted in significantly improved outcomes in terms of less pain - in the short, medium, and long-term - along with reduction in tibial shock and vertical loading.
In sum - gait retraining using proper motor control principles and teaching methods in combination with the right amount of sessions have shown to change movement patterns and reduce PFP pain significantly.
Dr. Rajpal Brar, DPT, (@3cbperformance) is a physiotherapist, movement expert, strength and conditioning/fitness coach, sports scientist and mindfulness coach. He runs the LA and online based physiotherapy and athletic performance clinic 3CB Performance and you can subscribe to his Youtube channel (which posts a variety of sports injury, performance, and fitness related content).