Gait retraining as part of the treatment programme for soldiers with exercise-related leg pain: preliminary clinical experiences and retention

Abstract

Background: Gait retraining as part of a treatment programme for exercise-related leg pain (ERLP) was introduced in the sports medicine department of the Royal Netherlands Army in 2013.Objectives: To describe clinical experiences and retention of gait retraining in a military setting.Methods: Sixty-one cases from the year 2015 were available for analysis of gait and gait retraining. In 2016, 32 of these patients were available for a follow-up survey, 28 of them also for the follow-up measurement of running biomechanics in running shoes.Results: Soldiers received an outpatient treatment programme that lasted on average 129 days (SD 76). On average they received 2.4 gait retraining sessions, leading to significant and lasting changes in running biomechanics; in particular, reduction in maximal force (N) and maximal pressure (N/cm2) on the heels at 317 days follow-up (average, SD 108). Most soldiers were satisfied with gait retraining. At follow-up, 27 soldiers (84%) contributed some, the majority or all reduction of symptoms to it. Seventy percent reported that they had mastered the new running technique within two months. The Single Assessment Numeric Evaluation score increased from 55% to 78% for males and from 44% to 75% for females.Discussion: This is the first study to report on gait retraining for Medial Tibial Stress Syndrome. In future, prospective studies in the military running in shoes and running in boots respectively should be investigated.Conclusion: Soldiers with exercise-related leg pain (ERLP), among them patients with Medial Tibial Stress Syndrome, respond well to a treatment programme that included gait retraining. Ten months post-gait retraining, their running biomechanics still showed these positive changes from their time of intake.

Gait retraining reduces vertical ground reaction forces in running shoes and military boots

“…Comparing measurements after gait retraining to the literature, this study reconfirmed that biomechanical parameters can be altered by running modification training programs, even in military boots . Changes in stride length and cadence achieved by gait retraining in military boots were similar to the changes in running shoes . However, changes in vertical ground reaction forces in the mid foot were elevated for boots compared to shoes.…”

“…A possible explanation is that our cases were chronic ERLP patients and his cases were healthy. Encouragingly, in our study only one of the 41 patients who completed the treatment program was still categorized as a heel striker (2.4%) at post‐testing; in our previous study 25% of ERLP patients were still heel strikers postintervention . One possible explanation for the increased percentage of strike change is an increase in the number of training sessions offered, from average 2.4 to average 5.0 sessions per patient.…”

“…Patients’ running strike technique (heel, mid foot, or forefoot striker) was determined based on visual evaluation of slow‐motion camera images and treadmill vertical force measurement. A heel striker was defined as a visual heel striker at initial contact, plus a maximal force on the heels >400 N . Objective outcome measurements were stride length (centimeter); stride length was defined as the distance covered from initial contact to initial contact of the same foot and equal to the sum of the lengths of two steps, cadence (steps/min), maximum force (N), and maximum pressure (N/cm 2 ) per segment of the foot.…”

“…Information from this study can be useful for medical professionals treating soldiers with ERLP and also for those treating civilian athletes, who have constrained types of footwear (ie, hikers, climbers, wrestlers). Our previous studies have shown that gait retraining can reduce vertical ground reaction forces in running shoes and can contribute to the treatment program of service members with chronic ERLP . The same gait retraining cues can be used to achieve reductions in vertical ground reaction forces while running in military boots and perhaps in other types of shod running.…”

“…Two military studies have shown that service members with MTSS can benefit from gait retraining when given as part of a comprehensive treatment program . These studies have been performed in running shoes.…”