Do Simple Running Technique Changes Reduce Pain and Change Injury Causing Mechanics
Condition: Patellofemoral Pain Syndrome; Medial Tibial Stress Syndrome; Iliotibial Band Syndrome; Achilles Tendinopathy
MeSH terms: Tendinopathy; Patellofemoral Pain Syndrome; Medial Tibial Stress Syndrome; Syndrome; Iliotibial Band Syndrome
Study type: Interventional

Summary: 
      This project aims to investigate whether an increase in step rate can be used to reduce pain
      and injury causing movement patterns in runners who are currently experiencing achilles
      tendonopathy, iliotibial band syndrome, patellofemoral pain syndrome and medial tibial stress
      syndrome.

      Many injuries have been reported to share similar injury causing movement patterns. For
      example iliotibial band syndrome and patellofemoral pain syndrome have been reported to be
      caused by increased side to side drop of the pelvis and inward movement of the hip.

      Gait retraining is a method of changing the way people run in order to change movement
      patterns.Increasing step rate may present a gait retraining method that does not pose further
      injury risks and can be used across multiple different injury populations. Studies have shown
      increasing step rate can reduce frontal plane movement patterns at the pelvis, hip and foot
      as well as reducing sagittal plane joint angles such as ankle dorsiflexion. Based on the
      changes in movement patterns increasing step rate has been recommended as an intervention for
      the treatment of patellofemoral pain syndrome, medial tibial stress syndrome, iliotibial band
      syndrome and achilles tendonopathy. Therefore this study aims to investigate whether an
      increase in step rate can reduce pain and change injury causing mechanics in runners
      currently running with patellofemoral pain syndrome, iliotibial band syndrome, medial tibial
      stress syndrome or achilles tendinopathy.

      The aim of the project is to use a simple gait intervention, increasing step rate to
      investigate if this technique change can reduce pain immediately, at short term follow up and
      long term follow up. The project will also look at whether an increased step rate can be
      maintained at follow up and whether this changes movement patterns proposed to be the cause
      of injury.

      Runners will be recruited from local running clubs and competitions using poster
      advertisement at running clubs and emailed to running clubs
    

Detailed description: 
      All data will be collected at the university of Salford podiatry clinic gait laboratory.
      Participants will be recruited from running clubs and races via poster advertisement sent via
      email to the running club and on advertisement at the club. Also participants presenting at
      the running performance clinic with patellofemoral pain syndrome, iliotibial band syndrome,
      medial tibial stress syndrome and achilles tendonopathy will be invited to take part in the
      research study investigating the effects of gait retraining on injury. Participants who agree
      to take part will be sent an email confirming their appointment along with an information
      sheet detailing the study which they are encouraged to read before attending the appointment.
      They will have contact details of the lead researcher should they wish to ask any further
      questions

      The objectives above will be addressed via the following data collection procedure:

      On arriving at the running clinic participants will be informed that the gait retraining
      intervention aims to reduce pain when running and that there is a risk that the retraining
      protocol will not affect their pain. If there are no improvements to symptoms following gait
      retraining they will be then directed to the appropriate medical service for further
      management. Participants will be informed as to the procedures and given the chance to read
      through an information sheet again detailing the procedures involve. If on reading the
      information sheet participants do not wish to take part they can terminate the appointment at
      any time. Before data collection begins participants will sign a consent form, a running
      history form and a health screening questionnaire will be completed by a qualified
      physiotherapist in order to assess the patients suitability to complete the assessment with
      no further risk to their health.

      Procedures:

      Participants will attend two visits 4 weeks apart. The first visit will consist of an initial
      assessment data collection and a retraining session. Detailed below. The second visit will
      consist of the same procedures in the initial assessment.

      Initial Assessment data collection:

      Participants will complete the appropriate self reported outcome measure: if iliotibial band
      syndrome or patellofemoral pain syndrome they will complete the Lower extremity Functional
      Index and the Anterior Knee Pain Scale. If they present with medial tibial stress syndrome
      they will complete the medial tibial stress syndrome score and the Lower Extremity Functional
      Index. If they present with achilles tendonopathy they will complete the VISA - A score and
      the Lower Extremity Functional Index.

      Before running retroreflective markers will be attached to the subject on specific points of
      their body: shoe, ankle joint, knee joint, greater trochanter of the hip, thigh, lower leg,
      pelvis (anterior superior iliac spine, posterior superior iliac spine, iliac crest), lumbar
      spine, thoracic spine, sternum and acromion process off the shoulders. This marker placement
      is according to a protocol previously established and validated in a project undertaken at
      the University of Salford. A qualysis motion capture system will then be used to track the
      movement of these markers as the participant runs on a treadmill. Once the marker data has
      been collected then we will use custom software to calculate the kinematic (joint movement)
      patterns for each person.

      Participants are required to run on a treadmill at two different speeds (3.2, 3.8m/s). These
      speeds have been chosen based on running speeds used in previous research to allow
      comparability between studies. If participants feel they are unable to run at these speeds
      they can run at a self selected running speed.

      They will be given a 6 minute accommodation period running on the treadmill at 3.2m/s. At
      this point data will then be collected for 1 minute of running in order to gain data for ten
      steps of running for the right and left feet. Speed will then be increased to 3.8m/s where
      they will be given a 1 minute accommodation period with data collected for a further minute
      of running.

      A qualified physiotherapists will monitor the patients feels ok to continue at each 2 minute
      interval. At the end of data collection for each running speed the participant will be asked
      to rate their current level of pain on a scale of 0 = no pain to 10 = sever pain. If at any
      point the participants pain exceeds 8 out of 10 or the participant feels they can no longer
      continue running the data collection will be terminated.

      Steps will be identified when the foot markers are in contact with the treadmill, once ten
      steps have been collected the data will be averaged across all trials for right and left
      feet. During the data collection injured participants will be asked to rate their current
      level of pain while running using a numerical rating scale 0 = no pain and 10 = sever pain.

      Retraining Session:

      Once data has been collected participants will then be asked to run for a further 5 minutes
      at each speed under an increased step rate condition with data collected for the final 1
      minute of the trial. Step rate will be calculated as number of steps per minute. Step rate
      will then be increased by 10% and participants instructed to run to an audible metronome to
      ensure the step rate increase is achieved. Again at the end of each running speed
      participants will be asked to rate their current level of pain using a numerical rating
      scale.

      Following data collection participants will be permitted up to a further 15 minute practise
      session running to maintain the increase in step rate without the metronome present to allow
      participants to adjust to the new running technique.

      Participants will then be instructed to continue their current level of running using the new
      running technique. Participants will have contact details to the lead researcher (email and
      phone number) and will be requested to provide weekly updates regarding their running and if
      any pain is experienced. This will ensure patients are continuing to improve, not running
      with an increase in pain and are able to ask any questions they may have. If patient's
      symptoms are increasing they will be informed to stop running and terminated from the
      assessment and directed to the appropriate medical professional for further assessment.

      Participants will be reassessed between 3 weeks and 5 weeks later following the same
      procedures outlined in the initial assessment data collection as well as at a 3 month follow
      up following the same procedures to investigate long term improvement.
    

Intervention name(s): Step rate increase
Intervention type(s): Other
Intervention description(s): increase the step rate during running by 10% steps per minute
Intervention model: Single Group Assignment
Intervention model description: single subject repeated measures design
Masking: None (Open Label)
Primary purpose: Treatment