Gait modifications to change lower extremity gait biomechanics in runners: a systematic review.

BACKGROUND Abnormal biomechanics have been cited as a potential risk factor for running-related injury. Many modifiable biomechanical risk factors have also been proposed in the literature as interventions via gait retraining. AIM To determine which interventions have successfully modified biomechanical variables linked to running-related injury. STUDY DESIGN Systematic literature review. METHODS MEDLINE, EMBASE, CINAHL, SportDiscus and PSYCINFO were searched using key terms related to running biomechanics and gait retraining. Quality of included studies was assessed using the modified Downs and Black Quality Index and a best evidence synthesis was performed. RESULTS 27 studies investigating the effect of biomechanical interventions on kinetic, kinematic and spatiotemporal variables were included in this review. Foot strike manipulation had the greatest effect on kinematic measures (conflicting evidence for proximal joint angles; strong evidence for distal joint angles), real-time feedback had the greatest effect on kinetic measures (ranging from conflicting to strong evidence), and combined training protocols had the greatest effect on spatiotemporal measures (limited to moderate evidence). CONCLUSIONS Overall, this systematic review shows that many biomechanical parameters can be altered by running modification training programmes. These interventions result in short term small to large effects on kinetic, kinematic and spatiotemporal outcomes during running. In general, runners tend to employ a distal strategy of gait modification unless given specific cues. The most effective strategy for reducing high-risk factors for running-related injury-such as impact loading-was through real-time feedback of kinetics and/or kinematics.