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Original research
Clinical application of foot strike run retraining for military service members with chronic knee pain
  1. Brittney Mazzone1,2,
  2. A Yoder1,
  3. R Condon2 and
  4. S Farrokhi1
  1. 1 Research and Surveillance Division, Extremity Trauma and Amputation Center of Excellence, San Diego, California, USA
  2. 2 Department of Physical and Occupational Therapy, Naval Medical Center San Diego, San Diego, California, USA
  1. Correspondence to Dr Brittney Mazzone, Extremity Trauma and Amputation Center of Excellence, San Diego, California, USA; bmazzon1{at}mail.naz.edu

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.

  • knee
  • musculoskeletal disorders
  • rehabilitation medicine

Data availability statement

Data are available upon reasonable request from the corresponding author.

https://doi.org/10.1136/bmjmilitary-2021-001789

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    Data availability statement

    Data are available upon reasonable request from the corresponding author.

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    Footnotes

    • Contributors SF, BM and AY contributed to the study and protocol design. BM and AY collected and processed data, as well as completed data analysis. All authors contributed to interpretation, manuscript edits and review of the final manuscript.

    • Funding Support was provided by the DoD-VA Extremity Trauma and Amputation Center of Excellence.

    • Disclaimer The views expressed herein are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense or the US government.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.