IS RUNNING RETRAINING EFFECTIVE IN PEOPLE WITH PATELLOFEMORAL PAIN?
What is running retraining?
Running retraining is defined as internal or external feedback that we provide whilst someone is running. We do so in a faded fashion by gradually increasing run exposure, gradually reducing feedback, and this feedback should be targeted at atleast one or more biomechanical variables.
Where has this intervention come from?
Certain mechanical variables are associated with patellofemoral pain. For example if we are thinking about peak hip adduction, historically, we would have thought about trying to strengthen the hip abductors in an attempt to change that kinematic variable. But we now have a number of different papers, all of which conclude the same thing, and that is exercise protocols do not generally lead to significant alterations in running kinematics. So if we want to try and change kinematics, we need to try and do something different and move beyond exercise.
If you want to learn more about this topic, you can watch Simon Lack & Brad Neal's lecture here:
What does the research say?
So in the early 2010s, some colleagues in the US explored a variety of different techniques and cues to bring about changes in running kinematics. Brian Noehren initially explored this lovely high tech intervention where runners were tasked with maintaining their hip adduction within a number of standard deviations by following a tracking marker on a screen. The results showed that attempting to change
This variable in female runners, we see significant changes in pain and function, but also a significant reduction in peak hip adduction to the tune of five degrees.
Similar to this other cues were also explored. In a small randomized control trial, from the USA, forefoot strike cue was compared with a gradual progressive running programme and it was quite clear that a post follow up at four weeks, but also at three month follow up as well, the forefoot strike group demonstrated a significant reduction in pain in comparison to just the load management gradual exposure to running group.
In a very similar narrative, a randomized control trial from Australia looked at combining minimalist shoes with a step rate intervention compared to a prefabricated foot orthoses. The results showed a significance between group differences in terms of anterior knee pain scale, worst pain and average pain.
A randomized control trial from Brazil looked to see if any of these cues were superior to the other. The results showed that all of the groups were improving, but there was no superiority in any of the groups. So when we take these running retraining interventions and put them against a robust control of either exercise or good quality in education, we don't see a difference. So running retraining may not work for all.
How can running retraining be used?
To summarize, running retraining has a developing evidence base and we should be considering it in people with clear biomechanical targets.We can use the faded feedback design where we can slowly increase the run exposure with a gradual reduction in feedback to facilitate motor learning, and a step rate intervention targeted at the biomechanical deficit.
If you want to learn more about this topic, you can watch Simon Lack & Brad Neal's lecture here:
Sources:
1. 'Patellofemoral pain course’ by Brad Neal and Simon Lack
