Effects of gait retraining with focus on impact versus gait retraining with focus on cadence on pain, function and lower limb kinematics in runners with patellofemoral pain: Protocol of a randomized, blinded, parallel group trial with 6-month follow-up.

José Roberto De Souza Júnior,João Paulo Chieregato Matheus,Pedro Henrique Reis Rabelo,João Pedro Da Silva Carto,Thiago Vilela Lemos,Jean-Francois Esculier,Walid Kamal Abdelbasset

doi:10.1371/journal.pone.0250965

José Roberto De Souza Júnior, João Paulo Chieregato Matheus + Show 5 more

Open Access

https://doi.org/10.1371/journal.pone.0250965

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Journal: PloS one	Publication Date: May 12, 2021
Citations: 4	License type: CC BY 4.0

Affiliation: Universidade de Brasília

Abstract

Patellofemoral pain (PFP) is one of the most prevalent injuries in runners. Unfortunately, a substantial part of injured athletes do not recover fully from PFP in the long-term. Although previous studies have shown positive effects of gait retraining in this condition, retraining protocols often lack clinical applicability because they are time-consuming, costly for patients and require a treadmill. The primary objective of this study will be to compare the effects of two different two-week partially supervised gait retraining programs, with a control intervention; on pain, function and lower limb kinematics of runners with PFP. It will be a single-blind randomized clinical trial with six-month follow-up. The study will be composed of three groups: a group focusing on impact (group A), a group focusing on cadence (group B), and a control group that will not perform any intervention (group C). The primary outcome measure will be pain assessed using the Visual Analog Pain scale during running. Secondary outcomes will include pain during daily activities (usual), symptoms assessed using the Patellofemoral Disorders Scale and lower limb running kinematics in the frontal (contralateral pelvic drop; hip adduction) and sagittal planes (foot inclination; tibia inclination; ankle dorsiflexion; knee flexion) assessed using the MyoResearch 3.14—MyoVideo (Noraxon U.S.A. Inc.). The study outcomes will be evaluated before (t0), immediately after (t2), and six months (t24) after starting the protocol. Our hypothesis is that both partially supervised gait retraining programs will be more effective in reducing pain, improving symptoms, and modifying lower limb kinematics during running compared with the control group, and that the positive effects from these programs will persist for six months. Also, we believe that one gait retraining group will not be superior to the other. Results from this study will help improve care in runners with PFP, while maximizing clinical applicability as well as time and cost-effectiveness.

Highlights

Millions of people practice running, an activity that requires minimal equipment and benefits cardiac, metabolic, and mental health
Various interventions are recommended for the treatment of individuals with patellofemoral pain (PFP), among which gait retraining can be highlighted [9]
A systematic review by Agresta and Brown [10], demonstrated immediate and short-term effects (1 and 3 months) on pain, function, and biomechanics of individuals with PFP, results corroborated by Barton and colleagues [11], who associated current evidence with expert opinions

Summary

Introduction

Millions of people practice running, an activity that requires minimal equipment and benefits cardiac, metabolic, and mental health. The primary objective of the study will be to compare the effects of two different two-week partially supervised gait retraining programs, one focusing on impact and the other focusing on cadence, with a control intervention; on pain, function and lower limb kinematics of runners with PFP. Our hypothesis is that the two partially supervised gait retraining programs will be more effective in reducing pain, improving symptoms, and modifying lower limb kinematics during running compared with the control group, and that the positive effects from these programs will persist for six months It is expected a reduction in contralateral pelvic drop, hip adduction, knee flexion, ankle dorsiflexion, tibia and foot inclination in both retraining groups.

Study design

Participants

Findings

Discussion