The Effectiveness of Gait Retraining on Running Kinematics, Kinetics, Performance, Pain, and Injury in Distance Runners: A Systematic Review With Meta-analysis

Objective To evaluate the effectiveness of running gait retraining on kinematics, kinetics, performance, pain, and injury in distance runners. Design Intervention systematic review with meta-analysis. Literature Search Seven electronic databases from inception to March 2021. Trial Selection Criteria Randomized controlled trials that (1) evaluated running gait retraining compared to no intervention, usual training, placebo, or standard care and (2) reported biomechanical, physiological, performance, or clinical outcomes. Data Synthesis Random-effects metaanalyses were completed, and the certainty of evidence was judged using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. We categorized interventions into step rate, non-rearfoot footstrike, impact, ground contact time, and multiparameter subgroups. Results We included 19 trials (673 participants). Moderate-certainty evidence indicated step rate gait retraining increased step rate (SMD 1.03 [95% confidence interval {CI}: 0.63, 1.44]; number of trials (N): 4; I 2 : 0%) and reduced average vertical loading rate (SMD −0.57 [95% CI, −1.05 to −0.09], N: 3; I 2 : 0%). Low-certainty evidence indicated non-rearfoot footstrike retraining increased knee flexion at initial contact (SMD 0.74 [95% CI, 0.11 to 1.37]; N: 2; I 2 : 0%), but did not alter running economy (SMD 0.21 [95% CI, −1.11 to 1.52]; N: 3; I 2 : 19%).). Low-certainty evidence indicated multiparameter retraining did not alter running economy (SMD 0.32 [−0.39, 1.02]; N: 3; I 2 : 19%) or performance (SMD 0.14 [95% CI, −4.87 to 4.58]; N: 2; I 2 : 18%). Insufficient trials reported on pain outcomes. Two trials demonstrated reduced 1-year injury incidence following gait retraining. Conclusions Gait retraining interventions altered step rate and knee kinematics, lowered vertical loading rates, and did not affect running performance. J Orthop Sports Phys Ther 2022;52(4):192–206. Epub 05 Feb 2022. doi:10.2519/jospt.2022.10585