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Moore IS, Ashford KJ, Mullen R, Jones HSR, McCarthy-Ryan M. The effect of attentional cues on mechanical efficiency and movement smoothness in running gait: An interdisciplinary investigation. J Sports Sci 2024; 42:589-598. [PMID: 38743402 DOI: 10.1080/02640414.2024.2353402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 05/02/2024] [Indexed: 05/16/2024]
Abstract
The aim was to examine the effect of focus of attention cues on foot angle for retraining movement purposes. Twenty (females: 8) rearfoot-striking recreational runners (mass: 72.5 ± 11.8 kg; height: 1.73 ± 0.09 m; age: 32.9 ± 11.3 years) were randomly assigned to an internal focus (IF) (n = 10) or external focus (EF) (n = 10) verbal cue group. Participants performed 5 × 6 minute blocks of treadmill running (control run, 3 × cued running, retention run) at a self-selected running velocity (9.4 ± 1.1 km∙h-1) during a single laboratory visit. Touchdown foot angle, mechanical efficiency, internal and external work were calculated and, centre of mass (COM) and foot movement smoothness was quantified. Linear-mixed effect models showed an interaction for foot angle (p < 0.001, ηp2 = 0.35) and mechanical efficiency (p < 0.001, ηp2 = 0.40) when comparing the control to the cued running. Only the IF group reduced foot angle and mechanical efficiency during cued running, but not during the retention run. The IF group produced less external work during the 1st cued run than the control run. COM and foot smoothness were unaffected by cueing. Only an IF produced desired technique changes but at the cost of reduced mechanical efficiency. Movement smoothness was unaffected by cue provision. Changes to foot angle can be achieved within 6 minutes of gait retraining.
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Affiliation(s)
- Isabel S Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Kelly J Ashford
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Richard Mullen
- Department of Life Sciences, Brunel University London, London, UK
| | - Holly S R Jones
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Molly McCarthy-Ryan
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
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Sara LK, Gaudette LW, Souza Júnior JRD, Tenforde AS, Wasserman L, Johnson CD. Cues to land softly and quietly result in acute reductions in ground reaction force loading rates in runners. Gait Posture 2024; 109:220-225. [PMID: 38364508 PMCID: PMC10939780 DOI: 10.1016/j.gaitpost.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/26/2024] [Accepted: 02/08/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND A common gait retraining goal for runners is reducing vertical ground reaction force (GRF) loading rates (LRs), which have been associated with injury. Many gait retraining programs prioritize an internal focus of attention, despite evidence supporting an external focus of attention when a specific outcome is desired (e.g., LR reduction). RESEARCH QUESTION Does an external focus of attention (using cues for quiet, soft landings) result in comparable reductions in LRs to those achieved using a common internal focus (forefoot striking while barefoot)? METHODS This observational study included 37 injured runners (18 male; mean age 36 (14) years) at the OMITTED Running Center. Runners wore inertial measurement units over the distal-medial tibia while running on an instrumented treadmill at a self-selected speed. Data were collected for three conditions: 1) Shod-Control (wearing shoes, without cues); 2) Shod-Quiet (wearing shoes, cues for quiet, soft landings); and 3) Barefoot-FFS (barefoot, cues for forefoot strike (FFS)). Within-subject variables were compared across conditions: vertical instantaneous loading rate (LR, primary outcome); vertical stiffness during initial loading; peak vertical GRF; peak vertical tibial acceleration (TA); and cadence. RESULTS Vertical LR, stiffness, and TA were lower in the Shod-Quiet compared to Shod-Control p < 0.001). Peak vertical GRF and cadence were not different between Shod-Quiet and Shod-Control. Reductions in stiffness and LR were similar between Shod-Quiet and Barefoot-FFS, and GRF in Barefoot-FFS remained similar to both shod conditions. However, runners demonstrated additional reductions in TA and increased cadence when transitioning from Shod-Quiet to the Barefoot-FFS condition (p < 0.05). SIGNIFICANCE These results suggests that a focus on quiet, soft landings may be an effective gait retraining method for future research.
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Affiliation(s)
- Lauren K Sara
- Spaulding National Running Center, Spaulding Rehabilitation Hospital, Cambridge, MA 02138, USA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA 02138, USA; Department of Rheumatology, Boston University, Boston, MA 02215, USA.
| | - Logan W Gaudette
- Spaulding National Running Center, Spaulding Rehabilitation Hospital, Cambridge, MA 02138, USA
| | - José Roberto de Souza Júnior
- Spaulding National Running Center, Spaulding Rehabilitation Hospital, Cambridge, MA 02138, USA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA 02138, USA; Graduate Program of Sciences and Technologies in Health, University of Brasília, Brasília, Federal District 72220-275, Brazil
| | - Adam S Tenforde
- Spaulding National Running Center, Spaulding Rehabilitation Hospital, Cambridge, MA 02138, USA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA 02138, USA
| | - Lindsay Wasserman
- Spaulding National Running Center, Spaulding Rehabilitation Hospital, Cambridge, MA 02138, USA
| | - Caleb D Johnson
- Spaulding National Running Center, Spaulding Rehabilitation Hospital, Cambridge, MA 02138, USA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA 02138, USA; United States Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
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Crowell MS, Brindle RA, Miller EM, Reilly N, Ford KR, Goss DL. The effectiveness of telehealth gait retraining in addition to standard physical therapy treatment for overuse knee injuries in soldiers: a protocol for a randomized clinical trial. Trials 2023; 24:672. [PMID: 37845752 PMCID: PMC10580615 DOI: 10.1186/s13063-023-07502-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/07/2023] [Indexed: 10/18/2023] Open
Abstract
INTRODUCTION Running is the most common cardiovascular exercise in the military. However, there is a high incidence of running-related overuse injuries that reduces military readiness. Gait retraining is a common intervention to treat running-related injuries, but the high cost of equipment and lack of clinician expertise and availability reduces utilization. Gait retraining intervention in a telehealth format might improve feasibility. The purpose of this randomized clinical trial is to determine the effectiveness of a telehealth gait retraining intervention on pain, self-reported function, and biomechanical risk factors for injury in service members who present to a Military Health System physical therapy clinic with an overuse knee injury. METHODS This is a parallel, two-arm, single-blind randomized clinical trial. The two independent variables are intervention (2 levels: telehealth gait retraining intervention with standard of care or only standard of care) and time (3 levels: baseline, 10 weeks or post-intervention, 14 weeks). Participants between the ages of 18 to 60 years will be included if they report knee pain during and/or after running to be anywhere from a 3 to a 7 on the numerical pain rating scale and demonstrate a rearfoot strike pattern. The primary dependent variables are as follows: (1) pain (worst pain during and/or after running) and (2) foot strike pattern (conversion rate from rearfoot to non-rearfoot foot strike pattern during running). Secondary outcomes include patient self-reported function and running biomechanics. DISCUSSION The effectiveness of a telehealth gait retraining intervention to reduce pain and modify foot strike pattern is not known. The results of this study may help determine the effectiveness and feasibility of a telehealth gait retraining intervention to reduce pain, change foot strike, improve function, and improve running gait biomechanics. TRIAL REGISTRATION ClinicalTrials.gov, NCT04269473 . Registered 05 February 2020.
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Affiliation(s)
- Michael S Crowell
- Baylor University - Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, 900 Washington Road, West Point, NY, 10966, USA.
| | | | - Erin M Miller
- Baylor University - Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, 900 Washington Road, West Point, NY, 10966, USA
| | - Nicholas Reilly
- Department of Physical Therapy, High Point University, High Point, NC, USA
| | - Kevin R Ford
- Department of Physical Therapy, High Point University, High Point, NC, USA
| | - Donald L Goss
- Department of Physical Therapy, High Point University, High Point, NC, USA
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Gottwald V, Davies M, Owen R. Every story has two sides: evaluating information processing and ecological dynamics perspectives of focus of attention in skill acquisition. Front Sports Act Living 2023; 5:1176635. [PMID: 37293436 PMCID: PMC10244639 DOI: 10.3389/fspor.2023.1176635] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/02/2023] [Indexed: 06/10/2023] Open
Abstract
Directing our focus of attention appropriately during task execution can benefit outcome performance, cognitive efficiency, and physiological efficiency. For instance, individuals may benefit from adopting an external focus of attention (i.e., by focusing attention on the effects of one's movements on the environment) over an internal focus of attention (e.g., focusing on one's body movements). However, accounts concerning the theoretical functioning of such effects have primarily relied on hierarchical information processing perspectives; far less consideration has been given to potentially alternative explanations based on ecological dynamics, instances where an internal focus may be desirable over an external focus, and the associated applied implications. Within the present review, we: (a) outline the most recent developments in attentional focus research; (b) evaluate similarities and differences between information processing and ecological dynamics explanations of the focus of attention effect; (c) provide practical recommendations; and (d) discuss future research avenues. In doing so, a case is made for an "Ecological Dynamics Account of Attentional Focus" to act as an alternative to information processing-based hypotheses.
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Affiliation(s)
- Victoria Gottwald
- Department of Sport and Exercise Sciences, Bangor University, Bangor, United Kingdom
| | - Marianne Davies
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, United Kingdom
| | - Robin Owen
- School of Health and Sport Sciences, Liverpool Hope University, Liverpool, United Kingdom
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Zajac J, Redman K, Watkins E, Gus Almonroeder T. Instructions Promoting an External Focus Are More Effective for Altering Impact Forces in Female Runners. J Sport Rehabil 2023:1-6. [PMID: 37044378 DOI: 10.1123/jsr.2022-0380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/03/2023] [Accepted: 02/17/2023] [Indexed: 04/14/2023]
Abstract
CONTEXT Previous studies have found that instructions promoting an external focus (EF) tend to be more effective for movement pattern retraining compared to instructions promoting an internal focus (IF), for a variety of movement tasks. However, few studies have examined how different types of instructions affect running mechanics associated with running-related injury risk. Therefore, the purpose of this study was to compare the effects of instructions promoting different attentional foci on impact forces during running. DESIGN Cross-sectional study. METHODS Twenty uninjured female recreational runners ran at a self-selected speed with their typical pattern (no instructions condition) on an instrumented treadmill that measured ground reaction forces. Next, they were given 2 sets of instructions intended to alter their running pattern; one promoted an IF and the other promoted an EF. Repeated-measures analysis of variance was used to compare impact peaks and loading rates across the conditions (no instructions, IF, and EF), with post hoc tests conducted in the case of a significant omnibus test. RESULTS There were differences among the conditions in the impact peaks (P < .001) and loading rates (P < .001). Impact peaks were lower for the IF (P = .002) and EF (P < .001) conditions compared to the no instructions condition. Loading rates were lower for the EF condition compared to the no instructions (P < .001) and IF (P < .001) conditions; there was no difference between the IF and no instructions conditions (P = .24). CONCLUSIONS Our findings indicate that instructions promoting an EF may be more effective at reducing loading rates during running compared to instructions promoting an IF. Clinicians should consider these findings when attempting to retrain a runner's running pattern.
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Affiliation(s)
- Jacy Zajac
- College of Science & Health, University of Wisconsin-La Crosse, La Crosse, WI,USA
| | - Kelsey Redman
- College of Science & Health, University of Wisconsin-La Crosse, La Crosse, WI,USA
| | - Emily Watkins
- Rinker-Ross School of Health Sciences, Trine University, Angola, IN,USA
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Efficacy of an Audio-Based Biofeedback Intervention to Modify Running Gait in Female Runners. J Sport Rehabil 2023; 32:272-276. [PMID: 36423619 DOI: 10.1123/jsr.2022-0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/13/2022] [Accepted: 09/19/2022] [Indexed: 11/26/2022]
Abstract
CONTEXT A variety of gait retraining interventions are available to modify running mechanics associated with musculoskeletal injuries. These often require specialized equipment and/or personnel to prompt the runner toward specific strategies. OBJECTIVE To determine whether instructing female recreational runners to "run quietly" could decrease impact force characteristics. DESIGN Cohort. SETTING Research laboratory. PARTICIPANTS Fifteen healthy female recreational runners (24 [7] y) volunteered. INTERVENTIONS Baseline testing occurred on day 1 (baseline), a posttraining assessment occurred on day 2 (training), and a final assessment occurred 1 week after training on day 3 (follow-up). A smartphone decibel measuring app was used to provide biofeedback on the decibel level of foot strike on day 2 (training). MAIN OUTCOMES Peak vertical force, impact transient, peak and average vertical loading rate, ground contact time, and running economy were collected on each day and compared via repeated-measures analyses of variance. RESULTS Vertical ground reaction force was lower at follow-up (2.30 bodyweights [BW]) versus baseline (2.39 BW, P = .023) and training (2.34 BW, P = .047). Maximal loading rate decreased from baseline (69.70 BW·s-1) to training (62.24 BW·s-1, P = .021) and follow-up (60.35 BW·s-1, P = .031). There was no change in running economy. CONCLUSIONS Our findings demonstrate that simple instructions to "run quietly" can yield immediate and sustained reductions in impact force profiles, which do not influence running economy.
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Dalvandpour N, Zareei M, Abbasi H, Abdoli B, Mohammadian MA, Rommers N, Rössler R. Focus of Attention During ACL Injury Prevention Exercises Affects Improvements in Jump-Landing Kinematics in Soccer Players: A Randomized Controlled Trial. J Strength Cond Res 2023; 37:337-342. [PMID: 36696258 DOI: 10.1519/jsc.0000000000004201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
ABSTRACT Dalvandpour, N, Zareei, M, Abbasi, H, Abdoli, B, Mohammadian, MA, Rommers, N, and Rössler, R. Focus of attention during ACL injury prevention exercises affects improvements in jump-landing kinematics in soccer players: a randomized controlled trial. J Strength Cond Res 37(2): 337-342, 2023-Anterior cruciate ligament tears are severe and complex knee injuries that commonly occur in soccer. Prevent injuries enhance performance (PEP) is an exercise-based prevention program to effectively reduce anterior cruciate ligament injuries. It is, however, unclear how the delivery of the program contributes to its effectiveness. Therefore, we aimed to investigate the effect of the focus of attention that was emphasized during the delivery of the PEP program on jump-landing kinematics in male, elite-level, U21 soccer players. Forty-two players participated in this randomized controlled trial and were allocated to (a) the internal focus of attention (IF) group, receiving instructions focusing on the execution of the exercise (b), the external focus of attention (EF) group, receiving instructions focusing on the outcome of the exercise, or (c) the control group. Before and after the 8-week intervention, players performed a jump-landing task during which we measured hip and knee angles at the initial contact, peak knee flexion, and peak vertical ground reaction force using a 3-dimensional motion analyzer. A repeated-measures analysis of variance was used to compare groups over time. Significant time-by-group interaction effects with large effect sizes were found for hip flexion at all moments (p < 0.032; η2 > 0.15) and for the knee flexion angle at initial contact and maximum knee flexion (p < 0.001; η2 > 0.35), all in favor of the EF group. This shows that EF during PEP improves hip and knee joint kinematics in the sagittal plane more than IF. Therefore, EF during PEP instructions is preferred to increase the effectiveness of this injury prevention program.
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Affiliation(s)
- Nazanin Dalvandpour
- Department of Sport Rehabilitation and Health, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Mostafa Zareei
- Department of Sport Rehabilitation and Health, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Hamed Abbasi
- Department of Sport Injuries and Corrective Exercises, Sport Sciences Research Institute, Tehran, Iran
| | - Behrouz Abdoli
- Department of Behavioral and Cognitive Sciences in Sport, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | | | - Nikki Rommers
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Clinical Research, Clinical Trial Unit, University Hospital Basel, Basel, Switzerland; and
| | - Roland Rössler
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Skammer S, Halvorson J, Becker J. Using an external focus of attention for gait retraining in runners: A case report. Physiother Theory Pract 2022; 39:1083-1094. [PMID: 35129062 DOI: 10.1080/09593985.2022.2035032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Many gait retraining studies use cues that promote internal focus of attention. However, the motor control literature clearly shows the beneficial effects of using cues that promote an external focus of attention (EFOA) when teaching new movements. This case report seeks to illustrate the outcomes of using an EFOA for running gait retraining. It also examines whether retrained mechanics transfer across different running speeds. CASE DESCRIPTIONS A 22-year-old female competitive runner with a history of tibial stress injuries was the participant. PATIENT MANAGEMENT Baseline assessments of flexibility, strength, and running biomechanics were performed after which an eight-session gait retraining protocol was implemented. Visual (mirror) and verbal feedback (EFOA) cues were provided during the retraining protocol. Outcomes showed improved hip, knee, and ankle kinematics, reduced ground reaction forces, and earlier onset and longer durations of muscle activity following retraining. These improvements transferred across running speeds. DISCUSSION AND CONCLUSION In this participant, EFOA cues were effective for the gait retraining protocol and the benefits were transferable across running speeds. Clinicians should consider how EFOA cues may be incorporated to improve gait retraining outcomes.
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Affiliation(s)
- Sara Skammer
- Department of Health and Human Development, Montana State University, Bozeman, MT, USA
| | - Justin Halvorson
- Department of Athletics, Montana State University, Bozeman, MT, USA
| | - James Becker
- Department of Health and Human Development, Montana State University, Bozeman, MT, USA
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Mazzone B, Yoder A, Condon R, Farrokhi S. Clinical application of foot strike run retraining for military service members with chronic knee pain. BMJ Mil Health 2021; 168:303-307. [PMID: 34035158 DOI: 10.1136/bmjmilitary-2021-001789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/14/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Military training is associated with a high incidence of knee pain. Conversion from a rearfoot to non-rearfoot strike during running is effective at reducing knee pain in research environments. The purpose of this report was to demonstrate run retraining as a clinical intervention for service members with knee pain. METHODS Sixteen service members with running-related chronic knee pain underwent run retraining that converted foot strike from a rearfoot to a non-rearfoot strike using real-time visual feedback. The Lower Extremity Functional Scale (LEFS) and Numerical Pain Rating Scale (NPRS) for knee pain during running were assessed pretraining, at the final training session and at a 1-month follow-up. During running, foot inclination angle and vertical ground reaction force (VGRF) average loading rate were measured pretraining and at 1 month of follow-up. RESULTS Service members underwent 7.4±1.0 training sessions over the course of 15.8±4.6 days. LEFS improved by 8±6 points immediately after retraining, with an overall improvement of 10±6 points from pretraining to 1-month follow-up (p<0.01). NPRS improved by 2.0±0.4 points immediately after retraining, with an overall improvement of 2.0±0.4 points from pretraining to 1-month follow-up (p<0.01). Conversion to a non-rearfoot strike pattern was apparent at follow-up for all but two patients. VGRF average loading rate decreased by 56%±17% (p<0.01) from pretraining to 1-month follow-up. CONCLUSIONS Knee pain and function improved as a result of non-rearfoot strike run retraining, which supports the clinical use of this evidence-based intervention.
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Affiliation(s)
- Brittney Mazzone
- Research and Surveillance Division, Extremity Trauma and Amputation Center of Excellence, San Diego, California, USA .,Department of Physical and Occupational Therapy, Naval Medical Center San Diego, San Diego, California, USA
| | - A Yoder
- Research and Surveillance Division, Extremity Trauma and Amputation Center of Excellence, San Diego, California, USA
| | - R Condon
- Department of Physical and Occupational Therapy, Naval Medical Center San Diego, San Diego, California, USA
| | - S Farrokhi
- Research and Surveillance Division, Extremity Trauma and Amputation Center of Excellence, San Diego, California, USA
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Goss DL, Watson DJ, Miller EM, Weart AN, Szymanek EB, Freisinger GM. Wearable Technology May Assist in Retraining Foot Strike Patterns in Previously Injured Military Service Members: A Prospective Case Series. Front Sports Act Living 2021; 3:630937. [PMID: 33718868 PMCID: PMC7952986 DOI: 10.3389/fspor.2021.630937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/27/2021] [Indexed: 12/13/2022] Open
Abstract
A rearfoot strike (RFS) pattern with increased average vertical loading rates (AVLR) while running has been associated with injury. This study evaluated the ability of an instrumented sock, which provides real-time foot strike and cadence audio biofeedback, to transition previously injured military service members from a RFS to a non-rearfoot strike (NRFS) running pattern. Nineteen RFS runners (10 males, 9 females) were instructed to wear the instrumented socks to facilitate a change in foot strike while completing an independent walk-to-run progression and lower extremity exercise program. Kinetic data were collected during treadmill running while foot strike was determined using video analysis at initial (T1), post-intervention (T2), and follow-up (T3) data collections. Nearly all runners (18/19) transitioned to a NRFS pattern following intervention (8 ± 2.4 weeks after the initial visit). Most participants (16/18) maintained the transition at follow-up (5 ± 0.8 weeks after the post-intervention visit). AVLR of the involved and uninvolved limb decreased 29% from initial [54.7 ± 13.2 bodyweights per sec (BW/s) and 55.1 ± 12.7 BW/s] to post-intervention (38.7 ± 10.1 BW/s and 38.9 ± 10.0 BW/s), respectively. This effect persisted 5-weeks later at follow-up, representing an overall 30% reduction on the involved limb and 24% reduction on the uninvolved limb. Cadence increased from the initial to the post-intervention time-point (p = 0.045); however, this effect did not persist at follow-up (p = 0.08). With technology provided feedback from instrumented socks, approximately 90% of participants transitioned to a NRFS pattern, decreased AVLR, reduced stance time and maintained these running adaptations 5-weeks later.
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Affiliation(s)
- Donald L Goss
- Department of Physical Therapy, High Point University, High Point, NC, United States
| | - Daniel J Watson
- 15th Medical Group, Joint Base Pearl Harbor-Hickam, Honolulu, HI, United States
| | - Erin M Miller
- Baylor University-Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, West Point, NY, United States
| | - Amy N Weart
- Department of Physical Therapy, Keller Army Community Hospital, West Point, NY, United States
| | | | - Gregory M Freisinger
- Department of Civil and Mechanical Engineering, United States Military Academy, West Point, NY, United States
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Charlton JM, Eng JJ, Li LC, Hunt MA. Learning Gait Modifications for Musculoskeletal Rehabilitation: Applying Motor Learning Principles to Improve Research and Clinical Implementation. Phys Ther 2021; 101:pzaa207. [PMID: 33351940 PMCID: PMC7899063 DOI: 10.1093/ptj/pzaa207] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 10/04/2020] [Indexed: 12/11/2022]
Abstract
Gait modifications are used in the rehabilitation of musculoskeletal conditions like osteoarthritis and patellofemoral pain syndrome. While most of the research has focused on the biomechanical and clinical outcomes affected by gait modification, the process of learning these new gait patterns has received little attention. Without adequate learning, it is unlikely that the modification will be performed in daily life, limiting the likelihood of long-term benefit. There is a vast body of literature examining motor learning, though little has involved gait modifications, especially in populations with musculoskeletal conditions. The studies that have examined gait modifications in these populations are often limited due to incomplete reporting and study design decisions that prohibit strong conclusions about motor learning. This perspective draws on evidence from the broader motor learning literature for application in the context of modifying gait. Where possible, specific gait modification examples are included to highlight the current literature and what can be improved on going forward. A brief theoretical overview of motor learning is outlined, followed by strategies that are known to improve motor learning, and finally, how assessments of learning need to be conducted to make meaningful conclusions.
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Affiliation(s)
- Jesse M Charlton
- Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Janice J Eng
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- Arthritis Research Canada, Richmond, BC, Canada
| | - Michael A Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
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12
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Moran MF, Wager JC. Influence of Gait Retraining on Running Economy: A Review and Potential Applications. Strength Cond J 2020. [DOI: 10.1519/ssc.0000000000000511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Van Hooren B, Goudsmit J, Restrepo J, Vos S. Real-time feedback by wearables in running: Current approaches, challenges and suggestions for improvements. J Sports Sci 2019; 38:214-230. [PMID: 31795815 DOI: 10.1080/02640414.2019.1690960] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Injuries and lack of motivation are common reasons for discontinuation of running. Real-time feedback from wearables can reduce discontinuation by reducing injury risk and improving performance and motivation. There are however several limitations and challenges with current real-time feedback approaches. We discuss these limitations and challenges and provide a framework to optimise real-time feedback for reducing injury risk and improving performance and motivation. We first discuss the reasons why individuals run and propose that feedback targeted to these reasons can improve motivation and compliance. Secondly, we review the association of running technique and running workload with injuries and performance and we elaborate how real-time feedback on running technique and workload can be applied to reduce injury risk and improve performance and motivation. We also review different feedback modalities and motor learning feedback strategies and their application to real-time feedback. Briefly, the most effective feedback modality and frequency differ between variables and individuals, but a combination of modalities and mixture of real-time and delayed feedback is most effective. Moreover, feedback promoting perceived competence, autonomy and an external focus can improve motivation, learning and performance. Although the focus is on wearables, the challenges and practical applications are also relevant for laboratory-based gait retraining.
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Affiliation(s)
- Bas Van Hooren
- School of Sport Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands.,Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jos Goudsmit
- School of Sport Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands.,Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Juan Restrepo
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Steven Vos
- School of Sport Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands.,Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
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Moore IS, Ashford KJ, Cross C, Hope J, Jones HSR, McCarthy-Ryan M. Humans Optimize Ground Contact Time and Leg Stiffness to Minimize the Metabolic Cost of Running. Front Sports Act Living 2019; 1:53. [PMID: 33344976 PMCID: PMC7739683 DOI: 10.3389/fspor.2019.00053] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 10/14/2019] [Indexed: 12/15/2022] Open
Abstract
Trained endurance runners appear to fine-tune running mechanics to minimize metabolic cost. Referred to as self-optimization, the support for this concept has primarily been collated from only a few gait (e.g., stride frequency, length) and physiological (e.g., oxygen consumption, heart rate) characteristics. To extend our understanding, the aim of this study was to examine the effect of manipulating ground contact time on the metabolic cost of running in trained endurance runners. Additionally, the relationships between metabolic cost, and leg stiffness and perceived effort were examined. Ten participants completed 5 × 6-min treadmill running conditions. Self-selected ground contact time and step frequency were determined during habitual running, which was followed by ground contact times being increased or decreased in four subsequent conditions whilst maintaining step frequency (2.67 ± 0.15 Hz). The same self-selected running velocity was used across all conditions for each participant (12.7 ± 1.6 km · h-1). Oxygen consumption was used to compute the metabolic cost of running and ratings of perceived exertion (RPE) were recorded for each run. Ground contact time and step frequency were used to estimate leg stiffness. Identifiable minimums and a curvilinear relationship between ground contact time and metabolic cost was found for all runners (r 2 = 0.84). A similar relationship was observed between leg stiffness and metabolic cost (r 2 = 0.83). Most (90%) runners self-selected a ground contact time and leg stiffness that produced metabolic costs within 5% of their mathematical optimal. The majority (n = 6) of self-selected ground contact times were shorter than mathematical optimals, whilst the majority (n = 7) of self-selected leg stiffness' were higher than mathematical optimals. Metabolic cost and RPE were moderately associated (r s = 0.358 p = 0.011), but controlling for condition (habitual/manipulated) weakened this relationship (r s = 0.302, p = 0.035). Both ground contact time and leg stiffness appear to be self-optimized characteristics, as trained runners were operating at or close to their mathematical optimal. The majority of runners favored a self-selected gait that may rely on elastic energy storage and release due to shorter ground contact times and higher leg stiffness's than optimal. Using RPE as a surrogate measure of metabolic cost during manipulated running gait is not recommended.
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Affiliation(s)
- Isabel S Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Kelly J Ashford
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Charlotte Cross
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Jack Hope
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Holly S R Jones
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Molly McCarthy-Ryan
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
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