Is combining gait
retraining or an exercise programme with education better than education alone
in treating runners with patellofemoral pain? A randomised clinical trial
JF, Bouyer LJ, Dubois B, Fremont P, Moore L, McFadyen B, Roy JS. Br J Sports
Med. 2018 May; 52(10):659-666. doi: 10.1136/bjsports-2016-096988.
Take Home
: Education, education
with home exercises, and education with gait retraining offered similar improvements
in pain and function among runners with patellofemoral pain. Adding home
exercises or gait retraining offered some added benefits, which were unique to
the intervention (e.g., improved strength or improved joint loading;
are multiple approaches to address patellofemoral pain in runners, including
education on best running practices to reduce stress to the knee,
rehabilitation focusing on hip and knee muscles, and gait retraining to change foot strike pattern or cadence
(steps/minute). However, it is unknown which combination of treatment with
education may be most effective. Therefore, the authors conducted a randomized
control trial to compare the effects of education, education with home
exercises, and education with gait retraining on changes in pain, function,
strength, and running outcomes among 69 runners with patellofemoral pain. Education
included instructions to decrease length and speed of runs, avoid downhill and
stair running, and to maintain low levels of pain, which should return to
normal shortly after exercise. The progression was to gradually increase
distance, and then incorporate speed and hill running. The home exercise group
received the education with home exercises to target strength and control of
the lower legs. The final group received the education along with gait
retraining to increase cadence by 7.5 to 10%, and if applicable, to “run
softer” or to not land on their heels. The interventions lasted for 8 weeks,
and outcomes were compared at baseline, and at 4-, 8- and 20-week follow-up (86%
attended the final follow-up).  All
groups improved pain and function at each follow-up visit; however, the authors
found no differences in pain or function over time between groups. The
education and exercise group alone had better improvements in quadriceps and
hip abductor strength compared with the exercise group. The gait retraining and
education group alone had increased cadence, decreased average vertical loading rates
at 8 weeks, and lower peak patellofemoral joint forces compared to the education
authors found that the benefits runners with patellofemoral pain received
corresponded specifically to what an intervention targeted. These benefits
lasted for another 12 weeks after the training ended. However, the addition of home
exercises or gait retraining to education failed to offer additional benefit
for improving pain or function compared to education alone. Therefore, the
authors concluded that each of these interventions may be beneficial for certain
outcomes; but, education should always be a key part of the treatment strategy.
It is important to consider what specific goals and running activities may be
important to an individual patient so we can tailor interventions accordingly (for
example, gait retraining for distance to reduce cumulative loading).
Additionally, it may be important to consider patient-specific limitations,
such as adding hip/quadriceps strengthening for patients that present with
weakness. In all, runners with patellofemoral pain responded well to running
education in terms of pain and functional outcomes, with no differences in
these outcomes among runners who also received additional interventions. Thus,
running education should be an integral component of treatment for runners with
patellofemoral pain.
for Discussion:
What interventions
have you tried for runners with patellofemoral pain that have been successful?
What advice do you give runners to improve their pain and function during
Written by: Alexandra F DeJong
Reviewed by: Jeffrey Driban
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