Gait Retraining Program Research Articles

Gait retraining versus foot orthoses for patellofemoral pain: a pilot randomised clinical trial

ObjectivesTo determine the feasibility of a clinical trial that compares a 6-week, physiotherapist-guided gait retraining program with a foot orthoses intervention in runners with patellofemoral pain. DesignPilot randomised controlled trial. MethodsRunners aged 18–40 years with clinically diagnosed patellofemoral pain were randomly allocated to either a 6-week gait retraining intervention of increasing cadence and use of a minimalist shoe or prefabricated foot orthoses. Outcomes at baseline and 12-weeks included recruitment, retention, adherence, adverse events, global improvement, anterior knee pain scale, worst and average pain on a 100mm visual analogue scale. ResultsOf the 16 randomised participants, two withdrew prior to commencing treatment due to non-trial related matters (n=1 from each group) and 14 completed the pilot trial. Minor calf muscle soreness was reported by 3 participants in the gait retraining group while no adverse events were reported in the foot orthoses group. There were no deviations from the treatment protocols. There was a large between-group difference favouring gait retraining at 12-weeks in the anterior knee pain scale and the worst pain in the past week, which was reflected in the number needed-to-treat of 2. ConclusionsThis study supports the feasibility of a trial comparing gait retraining with foot orthoses and provides point estimates of effect that informs the design and planning of a larger clinical trial. It appears that a 6-week gait retraining program has a clinically meaningful effect on runners with patellofemoral pain when compared to an evidence-based treatment of foot orthoses.

Backward compared to forward over ground gait retraining have additional benefits for gait in individuals with mild to moderate Parkinson’s disease: A randomized controlled trial

Over ground gait retraining in the reverse direction has shown to be beneficial for neurological rehabilitation, but has not yet been investigated in Parkinson’s disease (PD). Backwards walking (BW) might be a useful training alternative to improve PD gait and possibly reduce fall risk during complex multi-directional daily activities. The primary aim was to compare the effect of an eight-week forward (FWG) and backwards (BWG) gait retraining program on gait parameters in PD individuals. Twenty-nine participants (aged 71.0±8.8years; UPDRS-III 38.1±12.3; H&Y 2.7±0.5) were randomly assigned to either the control (FWG; n=14) or experimental group (BWG; n=15). Baseline measures included disease severity (UPDRS III), global cognition (MoCA) and depression (PHQ-9). Outcome measures were selected gait variables on the 10m-instrumented-walk-test (i10mWT) assessed before and after the interventions. Both groups improved usual gait speed (FWG: p=0.03, d=0.35; BWG: p<0.01, d=0.35) and height-normalized gait speed (FWG: p=0.04, d=0.35; BWG: p<0.01, d=0.57). Additionally, the BWG demonstrated improved cadence (p<0.01, d=0.67) and stride length (SL; p=0.02, d=0.39). Both interventions were effective to improved gait speed sufficiently to independently navigate in the community.

Short and long-term effects of gait retraining using real-time biofeedback to reduce knee hyperextension pattern in young women

The use of real-time biofeedback has been shown to enable individuals to make changes to their gait patterns. It remains unknown whether the short-term improvements reported in previous studies are retained in the longer term. In this study, the paradigm used to investigate the short and long-term effects of real-time biofeedback was modifying knee range of motion during gait to prevent knee hyperextension in women. The purpose of this study was to investigate the short-term (1-month follow up) and long-term (8-month follow up) effects of a gait retraining program using real-time biofeedback to correct knee hyperextension in young women. Seventeen healthy women, ages 18–35 years, with asymptomatic knee hyperextension underwent a three-week (6 sessions) treadmill gait retraining program. Real-time feedback of kinematic data (Visual 3D) was provided during treadmill training. Knee extension range of motion was monitored during overground gait evaluations and training sessions. Gait evaluations were performed pretraining, posttraining (2days after), and 1-month, and 8-month after the last training session. This study showed significant reduction in knee hyperextension patterns immediately following training (mean±SD, 10.9°±4°), and at 1-month (7.5°±5°) and 8-month (6.3°±3.5°) follow ups. There was an increase in knee extension between posttraining and 1-month follow up (3.4°±5°). Reduction in knee hyperextension range of motion was retained at 8-month follow up evaluation. The present study shows the effects of real-time biofeedback in facilitating the acquisition and retention of proficiency in reducing knee hyperextension gait patterns, documenting that the retention is sustained for up to 8 months.

Contribution of Paretic and Nonparetic Limb Peak Propulsive Forces to Changes in Walking Speed in Individuals Poststroke

Background. Recent rehabilitation efforts after stroke often focus on increasing walking speed because it is associated with quality of life. For individuals poststroke, propulsive force generated from the paretic limb has been shown to be correlated to walking speed. However, little is known about the relative contribution of the paretic versus the nonparetic propulsive forces to changes in walking speed. Objective. The primary purpose of this study was to determine the contribution of propulsive force generated from each limb to changes in walking speed during speed modulation within a session and as a result of a 12-week training program. Methods. Gait analysis was performed as participants (N = 38) with chronic poststroke hemiparesis walked at their self-selected and faster walking speeds on a treadmill before and after a 12-week gait retraining program. Results. Prior to training, stroke survivors increased nonparetic propulsive forces as the primary mechanism to change walking speed during speed modulation within a session. Following gait training, the paretic limb played a larger role during speed modulation within a session. In addition, the increases in paretic propulsive forces observed following gait training contributed to the increases in the self-selected walking speeds seen following training. Conclusions. Gait retraining in the chronic phase of stroke recovery facilitates paretic limb neuromotor recovery and reduces the reliance on the nonparetic limb’s generation of propulsive force to increase walking speed. These findings support gait rehabilitation efforts directed toward improving the paretic limb’s ability to generate propulsive force.

General scheme to reduce the knee adduction moment by modifying a combination of gait variables.

Reducing the knee adduction moment (KAM) is a promising treatment for medial compartment knee osteoarthritis (OA). Although several gait modifications to lower the KAM have been identified, the potential to combine modifications and individual dose-responses remain unknown. This study hypothesized that: (i) there is a general scheme consisting of modifications in trunk sway, step width, walking speed, and foot progression angle that reduces the KAM; (ii) gait modifications can be combined; and (iii) dose-responses differ among individuals. Walking trials with simultaneous modifications in step width, walking speed, progression angle, and trunk sway were analyzed for 10 healthy subjects. Wider step width, slower speed, toeing-in, and increased trunk sway resulted in reduced first KAM peak, whereas wider step width, faster speed, and increased trunk sway reduced the KAM angular impulse. Individual regressions accurately modeled the amplitude of the KAM variables relative to the amplitude of the gait modification variables, while the dose-responses varied strongly among participants. In conclusion, increasing trunk sway, increasing step width, and toeing-in are three gait modifications that could be combined to reduce KAM variables related to knee OA. Results also indicated that some gait modifications reducing the KAM induced changes in the knee flexion moment possibly indicative of an increase in knee loading. Taken together with the different dose-responses among subjects, this study suggested that gait retraining programs should consider this general scheme of modifications with individualization of the modification amplitudes. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1547-1556, 2016.

Changes in tibiofemoral contact forces during running in response to in-field gait retraining

ABSTRACTWe evaluated the efficacy of an in-field gait retraining programme using mobile biofeedback to reduce cumulative and peak tibiofemoral loads during running. Thirty runners were randomised to either a retraining group or control group. Retrainers were asked to increase their step rate by 7.5% over preferred in response to real-time feedback provided by a wrist mounted running computer for 8 routine in-field runs. An inverse dynamics driven musculoskeletal model estimated total and medial tibiofemoral joint compartment contact forces. Peak and impulse per step total tibiofemoral contact forces were immediately reduced by 7.6% and 10.6%, respectively (P < 0.001). Similarly, medial tibiofemoral compartment peak and impulse per step tibiofemoral contact forces were reduced by 8.2% and 10.6%, respectively (P < 0.001). Interestingly, no changes were found in knee adduction moment measures. Post gait retraining, reductions in medial tibiofemoral compartment peak and impulse per step tibiofemoral contact force were still present (P < 0.01). At the 1-month post-retraining follow-up, these reductions remained (P < 0.05). With these per stance reductions in tibiofemoral contact forces in mind, cumulative tibiofemoral contact forces did not change due to the estimated increase in number of steps to run 1 km.

Day 1. Free Communications – Sport and Performance

Gait-retraining using real time visual feedback is an effective intervention for modifying factors associated with overuse injuries in runners (Noehren et al., 2011, Br J Sports Med, 45, 691-696). Decreased knee flexion at initial contact has been associated with increased vertical loading rates, an identified risk factor for tibial stress fracture (Milner et al., 2006, Med Sci Sports Exer, 38, 323-328). Therefore, the aim of this study was to evaluate the effectiveness of a gait retraining program designed to increase knee flexion angle at initial contact . Following institutional ethics approval, eight injury-free recreational runners (5 females and 3 males; mean ± SD: age 24 ± 6.5 years) with an initial knee contact angle lower than 12° at initial screening, were recruited. In a pre-test, participants completed five trials of overground running on a 16m runway at a self-selected speed (mean speed 2.8 m.s-1, SD = 0.5) while force plate data (1000Hz) and sagittal plane video (100Hz) were captured. Participants then completed six 15 minute treadmill-based gait-retraining sessions, over two weeks. Running at a self-selected speed, participants received real-time visual feedback on knee angle via a bespoke system comprising a Microsoft Kinect and custom-written software. The system encouraged participants to maintain an initial knee contact angle of greater than 16°, with feedback gradually removed over the last three sessions. Post-intervention, the overground testing protocol was repeated. The effect of the intervention on knee angle at initial contact, peak knee angle during stance, average and instantaneous vertical loading rates was assessed using paired t-tests and Cohen's d effect sizes (d). Knee flexion at initial contact increased from 8.0° ± 2.8° pre to 19.4° ± 2.0° post retraining (P < 0.001, d = 4.7), while maximum knee flexion increased from 39.2° ± 3.1° to 48.6° ± 4.7° following the intervention (P < 0.001, d = 2.3). Average vertical loading rate and instantaneous vertical loading were both reduced following the gait retraining programme with reductions of 30% (P < 0.001, d =1.2), and 25% (P < 0.001, d = 1.1), respectively. Results showed the six session intervention was successful in altering knee kinematics and reducing vertical ground reaction forces, suggesting gait-retraining to be an effective means of reducing injury risk. The real-time feedback system is low cost and portable offering scope for the use of gait-retraining outside of the laboratory in the clinic or home.

The influence of orthotic gait training with an isocentric reciprocating gait orthosis on the walking ability of paraplegic patients: a pilot study.

The aim of this study was to evaluate the influence of walking with an isocentric reciprocating gait orthosis (IRGO) by spinal cord injury (SCI) patients on walking speed, distance walked and energy consumption whilst participating in a 12-week gait re-training program. Six people with motor complete SCI (mean age 29 years, weight 63 kg and height 160 cm with injury levels ranging from T8 to T12) participated in this study. Gait evaluation was performed at baseline and after 4, 8 and 12 weeks. Walking speed and heart rate were measured to calculate the resulting physiological cost index (PCI). Reductions in energy consumption were observed after 4, 8 and 12 weeks compared with baseline but were not significant. However, walking distance increased significantly (P=0.010, P=0.003 and P=0.005, respectively) and also did so during the 8-12-week period (P=0.013). Walking speed also improved, but not significantly. Intensive gait training with the IRGO improved walking speed and the distance walked by paraplegics, as well as reducing the PCI of walking, as compared with baseline during the whole 12-week period. This indicates that further improvements in these parameters may be expected when utilizing gait training longer than 8 weeks.

In-field gait retraining and mobile monitoring to address running biomechanics associated with tibial stress fracture.

We sought to determine if an in-field gait retraining program can reduce excessive impact forces and peak hip adduction without adverse changes in knee joint work during running. Thirty healthy at-risk runners who exhibited high-impact forces were randomized to retraining [21.1 (± 1.9) years, 22.1 (± 10.8) km/week] or control groups [21.0 (± 1.3) years, 23.2 (± 8.7) km/week]. Retrainers were cued, via a wireless accelerometer, to increase preferred step rate by 7.5% during eight training sessions performed in-field. Adherence with the prescribed step rate was assessed via mobile monitoring. Three-dimensional gait analysis was performed at baseline, after retraining, and at 1-month post-retraining. Retrainers increased step rate by 8.6% (P < 0.0001), reducing instantaneous vertical load rate (-17.9%, P = 0.003), average vertical load rate (-18.9%, P < 0.0001), peak hip adduction (2.9° ± 4.2 reduction, P = 0.005), eccentric knee joint work per stance phase (-26.9%, P < 0.0001), and per kilometer of running (-21.1%, P < 0.0001). Alterations in gait were maintained at 30 days. In the absence of any feedback, controls maintained their baseline gait parameters. The majority of retrainers were adherent with the prescribed step rate during in-field runs. Thus, in-field gait retraining, cueing a modest increase in step rate, was effective at reducing impact forces, peak hip adduction and eccentric knee joint work.

A real-time topography of maximum contact pressure distribution at medial tibiofemoral knee implant during gait: Application to knee rehabilitation

Knee contact pressure is a crucial factor in the knee rehabilitation programs. Although contact pressure can be estimated using finite element analysis, this approach is generally time-consuming and does not satisfy the real-time requirements of a clinical set-up. Therefore, a real-time surrogate method to estimate the contact pressure would be advantageous.This study implemented a novel computational framework using wavelet time delay neural network (WTDNN) to provide a real-time estimation of contact pressure at the medial tibiofemoral interface of a knee implant. For a number of experimental gait trials, joint kinematics/kinetics and the resultant contact pressure were computed through multi-body dynamic and explicit finite element analyses to establish a training database for the proposed WTDNN. The trained network was then tested by predicting the maximum contact pressure at the medial tibiofemoral knee implant for two different knee rehabilitation patterns; “medial thrust” and “trunk sway”. WTDNN predictions were compared against the calculations from an explicit finite element analysis (gold standard).Results showed that the proposed WTDNN could accurately calculate the maximum contact pressure at the medial tibiofemoral knee implant for medial thrust (RMSE¯=1.7MPa, NRMSE¯=6.2% and ρ¯=0.98) and trunk sway (RMSE¯=2.6MPa, NRMSE¯=9.3%, ρ¯=0.96) much faster than the finite element method. The proposed methodology could therefore serve as a cost-effective surrogate model to provide real-time evaluation of the gait retraining programs in terms of the resultant maximum contact pressures.

Gait Retraining and Incidence of Medial Tibial Stress Syndrome in Army Recruits

Gait retraining, comprising biofeedback and/or an exercise intervention, might reduce the risk of musculoskeletal conditions. The purpose was to examine the effect of a gait-retraining program on medial tibial stress syndrome incidence during a 26-wk basic military training regimen. A total of 450 British Army recruits volunteered. On the basis of a baseline plantar pressure variable (mean foot balance during the first 10% of stance), participants classified as at risk of developing medial tibial stress syndrome (n = 166) were randomly allocated to an intervention (n = 83) or control (n = 83) group. The intervention involved supervised gait retraining, including exercises to increase neuromuscular control and flexibility (three sessions per week) and biofeedback enabling internalization of the foot balance variable (one session per week). Both groups continued with the usual military training regimen. Diagnoses of medial tibial stress syndrome over the 26-wk regimen were made by physicians blinded to the group assignment. Data were modeled in a survival analysis using Cox regression, adjusting for baseline foot balance and time to peak heel rotation. The intervention was associated with a substantially reduced instantaneous relative risk of medial tibial stress syndrome versus control, with an adjusted HR of 0.25 (95% confidence interval, 0.05-0.53). The number needed to treat to observe one additional injury-free recruit in intervention versus control at 20 wk was 14 (11 to 23) participants. Baseline foot balance was a nonspecific predictor of injury, with an HR per 2 SD increment of 5.2 (1.6 to 53.6). The intervention was effective in reducing incidence of medial tibial stress syndrome in an at-risk military sample.

Effect of exercise and gait retraining on knee adduction moment in people with knee osteoarthritis

The knee adduction moment represents the medial knee joint load, and greater value is associated with higher load. In people with knee osteoarthritis, it is important to apply proper treatment with the least side effects to reduce knee adduction moment and, consequently, reduce medial knee joint load. This reduction may slow the progression of knee osteoarthritis. The research team performed a literature search of electronic databases. The search keywords were as follows: knee osteoarthritis, knee adduction moment, exercise program, exercise therapy, gait retraining, gait modification and knee joint loading. In total, 12 studies were selected, according to the selection criteria. Findings from previous studies illustrated that exercise and gait retraining programs could alter knee adduction moment in people with knee osteoarthritis. These treatments are noninvasive and nonpharmacological which so far have no or few side effects, as well as being low cost. The results of this review revealed that gait retraining programs were helpful in reducing the knee adduction moment. In contrast, not all the exercise programs were beneficial in reducing knee adduction moment. Future studies are needed to indicate best clinical exercise and gait retraining programs, which are most effective in reducing knee adduction moment in people with knee osteoarthritis.

Six‐week gait retraining program reduces knee adduction moment, reduces pain, and improves function for individuals with medial compartment knee osteoarthritis

Six‐week gait retraining program reduces knee adduction moment, reduces pain, and improves function for individuals with medial compartment knee osteoarthritis

Validity of the Microsoft Kinect for providing lateral trunk lean feedback during gait retraining

Gait retraining programs are prescribed to assist in the rehabilitation process of many clinical conditions. Using lateral trunk lean modification as the model, the aim of this study was to assess the concurrent validity of kinematic data recorded using a marker-based 3D motion analysis (3DMA) system and a low-cost alternative, the Microsoft Kinect™ (Kinect), during a gait retraining session. Twenty healthy adults were trained to modify their gait to obtain a lateral trunk lean angle of 10°. Real-time biofeedback of the lateral trunk lean angle was provided on a computer screen in front of the subject using data extracted from the Kinect skeletal tracking algorithm. Marker coordinate data were concurrently recorded using the 3DMA system, and the similarity and equivalency of the trunk lean angle data from each system were compared. The lateral trunk lean angle data obtained from the Kinect system without any form of calibration resulted in errors of a high (>2°) magnitude (mean error=3.2±2.2°). Performing global and individualized calibration significantly (P<0.001) improved this error to 1.7±1.5° and 0.8±0.8° respectively. With the addition of a simple calibration the anatomical position coordinates of the Kinect can be used to create a real-time biofeedback system for gait retraining. Given that this system is low-cost, portable and does not require any sensors to be attached to the body, it could provide numerous advantages when compared to laboratory-based gait retraining systems.

Six‐week gait retraining program reduces knee adduction moment, reduces pain, and improves function for individuals with medial compartment knee osteoarthritis

This study examined the influence of a 6-week gait retraining program on the knee adduction moment (KAM) and knee pain and function. Ten subjects with medial compartment knee osteoarthritis and self-reported knee pain participated in weekly gait retraining sessions over 6 weeks. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and a 10-point visual-analog pain scale score were measured at baseline, post-training (end of 6 weeks), and 1 month after training ended. Gait retraining reduced the first peak KAM by 20% (p < 0.01) post-training as a result of a 7° decrease in foot progression angle (i.e., increased internal foot rotation), compared to baseline (p < 0.01). WOMAC pain and function scores were improved at post-training by 29% and 32%, respectively (p < 0.05) and visual-analog pain scale scores improved by two points (p < 0.05). Changes in WOMAC pain and function were approximately 75% larger than the expected placebo effect (p < 0.05). Changes in KAM, foot progression angle, WOMAC pain and function, and visual-analog pain score were retained 1 month after the end of the 6-week training period (p < 0.05). These results show that a 6-week gait retraining program can reduce the KAM and improve symptoms for individuals with medial compartment knee osteoarthritis and knee pain.

Recommended number of strides for automatic assessment of gait symmetry and regularity in above-knee amputees by means of accelerometry and autocorrelation analysis

BackgroundSymmetry and regularity of gait are essential outcomes of gait retraining programs, especially in lower-limb amputees. This study aims presenting an algorithm to automatically compute symmetry and regularity indices, and assessing the minimum number of strides for appropriate evaluation of gait symmetry and regularity through autocorrelation of acceleration signals.MethodsTen transfemoral amputees (AMP) and ten control subjects (CTRL) were studied. Subjects wore an accelerometer and were asked to walk for 70 m at their natural speed (twice). Reference values of step and stride regularity indices (Ad1 and Ad2) were obtained by autocorrelation analysis of the vertical and antero-posterior acceleration signals, excluding initial and final strides. The Ad1 and Ad2 coefficients were then computed at different stages by analyzing increasing portions of the signals (considering both the signals cleaned by initial and final strides, and the whole signals). At each stage, the difference between Ad1 and Ad2 values and the corresponding reference values were compared with the minimum detectable difference, MDD, of the index. If that difference was less than MDD, it was assumed that the portion of signal used in the analysis was of sufficient length to allow reliable estimation of the autocorrelation coefficient.ResultsAll Ad1 and Ad2 indices were lower in AMP than in CTRL (P < 0.0001). Excluding initial and final strides from the analysis, the minimum number of strides needed for reliable computation of step symmetry and stride regularity was about 2.2 and 3.5, respectively. Analyzing the whole signals, the minimum number of strides increased to about 15 and 20, respectively.ConclusionsWithout the need to identify and eliminate the phases of gait initiation and termination, twenty strides can provide a reasonable amount of information to reliably estimate gait regularity in transfemoral amputees.

Interventions for improving mobility after hip fracture surgery in adults

Hip fracture mainly occurs in older people. Strategies to improve mobility include gait retraining, various forms of exercise and muscle stimulation. To evaluate the effects of different interventions for improving mobility after hip fracture surgery in adults. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE and other databases, and reference lists of articles, up to April 2010. All randomised or quasi-randomised trials comparing different mobilisation strategies after hip fracture surgery. The authors independently selected trials, assessed risk of bias and extracted data. There was no data pooling. The 19 included trials (involving 1589 older adults) were small, often with methodological flaws. Just two pairs of trials tested similar interventions.Twelve trials evaluated mobilisation strategies started soon after hip fracture surgery. Single trials found improved mobility from, respectively, a two-week weight-bearing programme, a quadriceps muscle strengthening exercise programme and electrical stimulation aimed at alleviating pain. Single trials found no significant improvement in mobility from, respectively, a treadmill gait retraining programme, 12 weeks of resistance training, and 16 weeks of weight-bearing exercise. One trial testing ambulation started within 48 hours of surgery found contradictory results. One historic trial found no significant difference in unfavourable outcomes for weight bearing started at two versus 12 weeks. Of two trials evaluating more intensive physiotherapy regimens, one found no difference in recovery, the other reported a higher level of drop-out in the more intensive group. Two trials tested electrical stimulation of the quadriceps: one found no benefit and poor tolerance of the intervention; the other found improved mobility and good tolerance.Seven trials evaluated strategies started after hospital discharge. Started soon after discharge, two trials found improved outcome after 12 weeks of intensive physical training and a home-based physical therapy programme respectively. Begun after completion of standard physical therapy, one trial found improved outcome after six months of intensive physical training, one trial found increased activity levels from a one year exercise programme, and one trial found no significant effects of home-based resistance or aerobic training. One trial found improved outcome after home-based exercises started around 22 weeks from injury. One trial found home-based weight-bearing exercises starting at seven months produced no significant improvement in mobility. There is insufficient evidence from randomised trials to establish the best strategies for enhancing mobility after hip fracture surgery.

Gait retraining to reduce lower extremity loading in runners

Background Tibial stress fractures, which are among the most common running related injuries, have been associated with increased lower extremity loading (i.e., peak positive acceleration of the tibia, vertical force impact peak, and average and instantaneous vertical force loading rates) during initial contact. This study was conducted to evaluate the efficacy of a gait retraining program designed to reduce this loading during running and to assess the short-term persistence of these reductions. Methods Ten runners (six females and four males) with peak positive tibial acceleration greater than 8 g, measured in an initial screening, participated in the retraining program. During the retraining sessions, subjects ran on a treadmill and received real-time visual feedback from an accelerometer attached to their distal tibias. Tibial acceleration and vertical ground reaction force data were collected from subjects during overground data collection sessions held pre-training, post-training, and at a 1-month follow-up. Findings Peak positive acceleration of the tibia, vertical force impact peak, and average and instantaneous vertical force loading rates were all reduced immediately following the gait retraining. The decrease in tibial acceleration was nearly 50%. The reductions in vertical force loading rates and vertical force impact peak were approximately 30% and 20%, respectively. These reductions were maintained at the 1-month follow-up. Interpretation Subjects were able to run with reduced tibial acceleration and vertical force loading immediately following completion of the gait retraining program and at the 1-month follow-up evaluation. This may reduce their risk of stress fractures.

Effect of a Gait Retraining Program to Reduce Vertical Loading on the Contralateral, Untrained Limb

Effect of a Gait Retraining Program to Reduce Vertical Loading on the Contralateral, Untrained Limb

The Effect Of Gait Retraining On Medial Knee Loading

PURPOSE: Gait retraining to reduce knee loading in patients with knee OA has received recent attention. Individuals with genu varum are at increased risk of developing knee OA due to increased loading of the medial tibiofemoral compartment. Therefore, if joint loads can be altered prior to the development of OA, the risk of developing the disease may be reduced. METHODS: A single, asymptomatic male (age 31, BMI 23.1) with genu varum was recruited. He underwent an 8 session, gait-retraining program aimed at reducing medial knee loading. The subject walked at a self-selected speed on a treadmill while receiving visual feedback of his alignment in a mirror. He was instructed to rotate his knees inward to reduce varus mechanics as he walked. His walk time was gradually increased over the 8 sessions. The feedback was gradually removed during the last 4 sessions. An instrumented gait analysis was conducted following each session to monitor the subject's progress. The primary outcome variable was the peak knee external adduction moment (KEAM). Perceived effort associated with the modified gait was also recorded on a VAS during each session. RESULTS: Using the modified gait, the subject was able to reduce the peak KEAM across sessions by 31%, from 0.41 ± 0.04 to 0.28 ± 0.03 Nm/kg*m. This was accomplished in the modified gait primarily through hip internal rotation, which was increased across sessions from 8.4° ± 3.1° to 11.7° ± 3.1°. However, the subject initially exhibited increased knee flexion during midstance (16°). He was then provided verbal feedback regarding this maladaptation, and was able to correct the excessive midstance knee flexion (1°) by the third session. Perceived effort decreased from 4/10 to 1/10 on a VAS scale by the conclusion of the protocol. Based on these promising results, a larger scale study using real time kinematic feedback is planned. CONCLUSIONS: These results suggest that simple, visual feedback can result in a significant reduction in medial knee loading in patients at risk for knee OA. In addition, faded feedback appears to reduce the perceived effort required to execute the locomotor pattern. Care should be taken to monitor and correct abnormal mechanics with this gait modification, particularly sagittal plane knee motion.