Gait retraining is helpful!

Gait analysis is an important part of running rehabilitation. A clinician who is trained in running gait analysis can help a patient recover from an injury and even help to minimize future injury risk. 

Gait analysis is used to assess how a runner loads certain joints and tissue while going through the running gait cycle. Gait retraining strategies can then be prescribed to shift that load around the body, away from painful areas. 

Managing loads includes decreasing overall loading rates to the knee and hip, and decreasing tibial shock. There are a few simple cues a trained physical therapist (hi!) can help you work on to achieve this. 

Essentially, gait retraining introduces new ways to move into a runner’s existing movement patterns. I like to explain to patients that they have a “movement library” to choose from. Gait retraining will help expand the options in the library, not replace the current collection.

Last week, I learned something new about gait retraining. 

For athletes (including runners!) who have had ACL reconstruction (ACLR), gait analysis and retraining is a vital tool for long-term knee joint health. 

Dr. Daniel Cobian from the University of Wisconsin presented research virtually about gait retraining post-ACL reconstruction. The findings of the research surprised me: after ACLR, an athlete’s running gait cycle will change significantly. Regardless of gender, foot strike pattern, gait speed, and sport, most athletes post-ACLR ran a “stiff” knee on their surgical side. From a football player to soccer player to track runner, the stiff knee landing persisted. Why does this matter? Landing with a stiff knee shifts stress away from the knee up to the hip, which could result in hip pain and tissue injury. It can also promote knee osteoarthritis over time, which could lead to knee pain and poor joint health.

This stiff knee landing is due to lack of quadriceps (thigh) power and muscle control. Even with normal levels of thigh muscle strength, abnormal movement patterns persist. Because gait retraining helps to improve movement control, this is where motor control and gait retraining can make a difference in knee function, especially in the long term. 

Most athletes after ACLR will return to some form of running between 3-4 months. But these asymmetries continued even when measured at 13 months post-surgery, so time won’t just improve this issue. Interestingly, bone mineral density in the thigh bone also decreases up to 15% after ACLR, which may be a consequence of abnormal knee mechanics, evidence that all tissue is affected after this serious surgery and lengthy rehabilitation process.

As for the stiff knee issue, there are specific cues to give a runner after ACLR to increase knee bending while running, which will help with quadriceps activation and control. These could include short bouts of walking in a squat position and running with a long stride. Gait retraining is individualized and prescriptive, so the gait retraining cues and frequency will be unique to each runner.

As a physical therapist with a passion for treating runners, this information is very exciting to me. What can runners be excited about? It’s exciting that there are ways for a runner to return to sport, even after a serious surgery like ACLR. If you’ve had an ACLR or are struggling with recurring injury, find a clinician who is trained in gait retraining to ensure you’re reaching your running potential.

Katie Noble is a Doctor of Physical Therapy, a journalist, and a runner. She enjoys empowering and supporting female runners with evidenced-based education.