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The effect of real-time gait retraining on hip kinematics, pain and function in subjects with patellofemoral pain syndrome.
Br J Sports Med 2011; 45(9):691-6BJ

Abstract

BACKGROUND

Patellofemoral pain syndrome (PFPS) is the most common overuse injury in runners. Recent research suggests that hip mechanics play a role in the development of this syndrome. Currently, there are no treatments that directly address the atypical mechanics associated with this injury.

OBJECTIVE

The purpose of this study was to determine whether gait retraining using real-time feedback improves hip mechanics and reduces pain in subjects with PFPS.

METHODS

Ten runners with PFPS participated in this study. Real-time kinematic feedback of hip adduction (HADD) during stance was provided to the subjects as they ran on a treadmill. Subjects completed a total of eight training sessions. Feedback was gradually removed over the last four sessions. Variables of interest included peak HADD, hip internal rotation (HIR), contralateral pelvic drop, as well as pain on a verbal analogue scale and the lower-extremity function index. We also assessed HADD, HIR and contralateral pelvic drop during a single leg squat. Comparisons of variables of interest were made between the initial, final and 1-month follow-up visit.

RESULTS

Following the gait retraining, there was a significant reduction in HADD and contralateral pelvic drop while running. Although not statistically significant, HIR decreased by 23% following gait retraining. The 18% reduction in HADD during a single leg squat was very close to significant. There were also significant improvements in pain and function. Subjects were able to maintain their improvements in running mechanics, pain and function at a 1-month follow-up. An unexpected benefit of the retraining was an 18% and 20% reduction in instantaneous and average vertical load rates, respectively.

CONCLUSIONS

Gait retraining in individuals with PFPS resulted in a significant improvement of hip mechanics that was associated with a reduction in pain and improvements in function. These results suggest that interventions for PFPS should focus on addressing the underlying mechanics associated with this injury. The reduction in vertical load rates may be protective for the knee and reduce the risk for other running-related injuries.

Authors+Show Affiliations

Division of Physical Therapy, University of Kentucky, Lexington, 40536-0200, USA. bwn51@yahoo.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

20584755

Citation

Noehren, B, et al. "The Effect of Real-time Gait Retraining On Hip Kinematics, Pain and Function in Subjects With Patellofemoral Pain Syndrome." British Journal of Sports Medicine, vol. 45, no. 9, 2011, pp. 691-6.
Noehren B, Scholz J, Davis I. The effect of real-time gait retraining on hip kinematics, pain and function in subjects with patellofemoral pain syndrome. Br J Sports Med. 2011;45(9):691-6.
Noehren, B., Scholz, J., & Davis, I. (2011). The effect of real-time gait retraining on hip kinematics, pain and function in subjects with patellofemoral pain syndrome. British Journal of Sports Medicine, 45(9), pp. 691-6. doi:10.1136/bjsm.2009.069112.
Noehren B, Scholz J, Davis I. The Effect of Real-time Gait Retraining On Hip Kinematics, Pain and Function in Subjects With Patellofemoral Pain Syndrome. Br J Sports Med. 2011;45(9):691-6. PubMed PMID: 20584755.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of real-time gait retraining on hip kinematics, pain and function in subjects with patellofemoral pain syndrome. AU - Noehren,B, AU - Scholz,J, AU - Davis,I, Y1 - 2010/06/28/ PY - 2010/6/30/entrez PY - 2010/6/30/pubmed PY - 2012/1/10/medline SP - 691 EP - 6 JF - British journal of sports medicine JO - Br J Sports Med VL - 45 IS - 9 N2 - BACKGROUND: Patellofemoral pain syndrome (PFPS) is the most common overuse injury in runners. Recent research suggests that hip mechanics play a role in the development of this syndrome. Currently, there are no treatments that directly address the atypical mechanics associated with this injury. OBJECTIVE: The purpose of this study was to determine whether gait retraining using real-time feedback improves hip mechanics and reduces pain in subjects with PFPS. METHODS: Ten runners with PFPS participated in this study. Real-time kinematic feedback of hip adduction (HADD) during stance was provided to the subjects as they ran on a treadmill. Subjects completed a total of eight training sessions. Feedback was gradually removed over the last four sessions. Variables of interest included peak HADD, hip internal rotation (HIR), contralateral pelvic drop, as well as pain on a verbal analogue scale and the lower-extremity function index. We also assessed HADD, HIR and contralateral pelvic drop during a single leg squat. Comparisons of variables of interest were made between the initial, final and 1-month follow-up visit. RESULTS: Following the gait retraining, there was a significant reduction in HADD and contralateral pelvic drop while running. Although not statistically significant, HIR decreased by 23% following gait retraining. The 18% reduction in HADD during a single leg squat was very close to significant. There were also significant improvements in pain and function. Subjects were able to maintain their improvements in running mechanics, pain and function at a 1-month follow-up. An unexpected benefit of the retraining was an 18% and 20% reduction in instantaneous and average vertical load rates, respectively. CONCLUSIONS: Gait retraining in individuals with PFPS resulted in a significant improvement of hip mechanics that was associated with a reduction in pain and improvements in function. These results suggest that interventions for PFPS should focus on addressing the underlying mechanics associated with this injury. The reduction in vertical load rates may be protective for the knee and reduce the risk for other running-related injuries. SN - 1473-0480 UR - https://www.unboundmedicine.com/medline/citation/20584755/The_effect_of_real_time_gait_retraining_on_hip_kinematics_pain_and_function_in_subjects_with_patellofemoral_pain_syndrome_ L2 - http://bjsm.bmj.com/cgi/pmidlookup?view=long&pmid=20584755 DB - PRIME DP - Unbound Medicine ER -