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Cited by 403Lower Extremity Biomechanics and PathologiesSports Performance and TrainingSports injuries and prevention

Gait retraining to reduce lower extremity loading in runners

Open access
Crowell, Harrison Philip, Davis, Irene S.·2011·Clinical Biomechanics
DOI 10.1016/j.clinbiomech.2010.09.003PMC PMC3014399
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Abstract

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 8g, 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.

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Crossref · 10.1016/j.clinbiomech.2010.09.003

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  • External perceptual control engages automatic and implicit motor strategies that are more efficient than deliberate conscious control, leading to fast, robust learning with high retention and transfer.

    “This mode of control engages automatic and implicit motor strategies that operate more efficiently and effectively than deliberate, explicitly conscious control of movement28–37, which yields fast, robust learning, leading to high retention and transfer38–43.”

    From Injury Risk Factors Integrated Into Self-Guided Real-Time Biofeedback Improves High-Risk Biomechanics (2019) · cites this paper as [33]

    The Discussion reports that reduced loading after gait retraining persisted at the one-month follow-up, supporting retention of the trained change. Neither the Discussion nor the Introduction establishes fast learning, transfer to other tasks, or that automatic and implicit control is more efficient than deliberate conscious control. The paper attributes the persistence to faded feedback only as a postulate. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Trials without feedback are necessary for developing a durable internal movement representation that can be recalled in retention when feedback is removed.

    “No-feedback trials are needed to develop a persistent internal movement representation, which can be recalled in retention tests when augmented feedback is withdrawn (Crowell & Davis, 2011;Kovacs & Shea, 2011;Winstein, 1991).”

    From Augmented visual, auditory, haptic, and multimodal feedback in motor learning: A review (2013) · cites this paper as Crowell & Davis, 2011

    The Introduction says gradually removing feedback helps runners rely on internal cues and may improve persistence of a motor pattern. The Discussion reports that reduced loading persisted at one month and proposes faded feedback as the reason. The paper does not establish that no-feedback trials are necessary or demonstrate the development and recall of an internal movement representation. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Fading feedback, meaning reduced feedback frequency over time, has been shown to be effective.

    “Fading feedback-that is, reduced feedback frequency over time-has been shown to be effective (Crowell & Davis, 2011;Kovacs & Shea, 2011).”

    From Augmented visual, auditory, haptic, and multimodal feedback in motor learning: A review (2013) · cites this paper as Crowell & Davis, 2011

  • Reduced or fading feedback frequency appears beneficial for both terminal and concurrent feedback.

    “Reduced feedback frequency-that is, fading feedbackseems beneficial for both terminal feedback and concurrent feedback, as was shown in studies on training running technique (Crowell & Davis, 2011) and interlimb out-ofphase coordination (Kovacs & Shea, 2011).”

    From Augmented visual, auditory, haptic, and multimodal feedback in motor learning: A review (2013) · cites this paper as Crowell & Davis, 2011

  • Acceleration-time plots taught runners to reduce excessive impact forces.

    “Accelerationtime plots taught runners how to reduce excessive impact forces (Crowell & Davis, 2011).”

    From Augmented visual, auditory, haptic, and multimodal feedback in motor learning: A review (2013) · cites this paper as Crowell & Davis, 2011

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1 of the 45 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. McClay IS Williams DS Laughton CA 1999 Can Gait be Retrained to Prevent Injury in Runners? Proceedings of the American Society of Biomechanics Pittsburgh, PA

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Authors
Crowell, H. P., & Davis, I. S.
Affiliations
University of Delaware (US)
Corresponding author
Crowell, Harrison Philip
ORCID
Venue
Clinical Biomechanics
Publisher
Elsevier BV
Published
2011-01
Volume
26
Issue
1
Pages
78-83
ISSN
0268-0033 (ISSN-L)
DOI
10.1016/j.clinbiomech.2010.09.003
PMC
PMC3014399
OpenAlex
W2129442430
Cited by
403
References
45
Citations by year
2026: 11 · 2025: 18 · 2024: 24 · 2023: 21 · 2022: 37 · 2021: 31 · 2020: 41 · 2019: 38 · 2018: 31 · 2017: 28 · 2016: 23 · 2015: 33 · 2014: 25 · 2013: 22 · 2012: 16
FWCI
7.93
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Clinical Biomechanics (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (1s10rr022396-01)
  • National Center for Research Resources (S10 RR-022396, 1S10 RR022396)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD050679)
Topics
  • Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
Keywords
gait retraining, tibial stress fracture, running injuries, lower limb loading, tibial acceleration, vertical ground reaction force, real-time visual feedback, accelerometer, treadmill running, overground running, injury prevention
MeSH terms
Acceleration, Adult, Biomechanical Phenomena, Female, Gait, Humans, Male, Retrospective Studies, Running, Stress, Mechanical, Tibia, Tibial Fractures, Time Factors, Fractures, Stress

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