Abstract

Background
Excessive vertical impacts at landing are associated with common running injuries. Two primary gait-retraining interventions aimed at reducing impact forces are transition to forefoot strike (FFS) and increasing cadence (CAD). The objective of this study was to compare the short- and long-term effects of 2 gait-retraining interventions aimed at reducing landing impacts.

Methods
A total of 39 healthy recreational runners using a rearfoot strike and a CAD of ≤170 steps/min were randomized into CAD or FFS groups. All participants performed 4 weeks of strengthening followed by 8 sessions of gait-retraining using auditory feedback. Vertical average load rates (VALR) and vertical instantaneous load rates were calculated from the vertical ground reaction force curve. Both CAD and foot strike angle were measured using 3-dimensional motion analysis and an instrumented treadmill at baseline and at 1 week, 1 month, and 6 months after retraining.

Results
Analysis of variance revealed that the FFS group had significant reductions in VALR (49.7%) and vertical instantaneous load rates (41.7%), and changes were maintained long term. Foot strike angle in the FFS group changed from 14.2° dorsiflexion at baseline to 3.4° plantarflexion, with changes maintained long term. The CAD group exhibited significant reduction only in VALR (16%) and only at 6 months. Both groups had significant and similar increases in CAD at all follow-ups (CAD, +7.2% to 173 steps/min; and FFS, +6.1% to 172 steps/min).

Conclusion
FFS gait-retraining resulted in significantly greater reductions in VALR and similar increases in CAD compared to CAD gait-retraining in the short and long term. CAD gait-retraining resulted in small reductions in VALR at only the 6-month follow-up.