The Effects & Mechanisms of Running Retraining in the Management of Patellofemoral Pain: a Feasibility Study Neal, BS 1-2 Domone, S 1,3 Griffiths, IB 2 Ohri, H 1 Barton CJ 1-2, 4-5 Morrissey, D 1,6 1 Centre for Sports and Exercise Medicine, Queen Mary University of London, UK. 2 Pure Sports Medicine, London, UK 3ukactive Research Institute, London, UK 4 Complete Sports Care, Melbourne, Australia 5 Lower Extremity and Gait Studies Program, Faculty of Health Sciences, La Trobe University, Melbourne, Australia 6 Physiotherapy Department, Bart’s Health NHS Trust, London, United Kingdom

Introduction Running retraining in females with PFP has been shown to: reduce pain & increase function (Noehren ‘11, Willy ’12, Neal ‘16) reduce peak hip adduction reduce patellofemoral joint stress (Willson ‘14)

Introduction Increasing running step rate (cadence) in normative cohorts has been shown to: reduce peak hip adduction & vertical/instantaneous loading rate (Willy ‘15, Hobara ‘12, Heiderschiet ’11) reduce stride length without altering efficiency (Hafer ‘14)

Introduction: Current Gaps Gait retraining using cadence feedback is yet to be tested in a symptomatic cohort Analysis of a symptomatic cohort is yet to take place outside of the USA Effects of gait retraining in PFP subjects has only been completed in females

Study Aims Feasibility Effects Mechanisms UK Population Male Subjects Clinically Viable Feedback Effects Symptoms (VAS) Function (Kujala) Mechanisms Lower Limb Kinematics EMG (Gluteal/Quads/Hamstring)

Methods: Data Collection 3KM Run 10s Data Collection 0.8 / 1.8 / 2.8 KM Instruction to cease if VAS >3/10 Self selected “steady state” speed

Intervention: 6/52 Gait Retraining Audio Metronome to Increase Running Cadence by 7.5%

Results: Baseline Variable Mean (SD) Sex (Male/Female) 3/4 Age (Years) 32.5 (5.6) Height (cm) 171.5 (5.8) Weight (kg) 69.4 (6.9) Symptom Duration (Months) 51.6 (36) Average Run Volume (KM) 20 (10.4) Cadence (SPM) 163.7 (4.9) Kujala Scale 86.1 (6.7) Average VAS 2.6 (1.7) Worst VAS 6.4 (1.7)

Results: Effects Variable Pre Mean (SD) Post Mean (SD) Percentage Change Kujala Scale 86.1 (6.7) 88.5 (4.2) 3% Cadence 163.7 (4.9) 177 (2.4) 7.5%

>MCID of Hip Adduction = 2.6˚ - 3.5˚ (Noehren, 2010) Results: Mechanisms Variable Pre Mean (SD) Post Mean (SD) Percentage Change Peak Hip ADD 16.8˚ (4.9˚) 15.0˚ (5.3˚) 11% Variable Pre Mean (SD) Post Mean (SD) Percentage Change Peak Hip ADD 16.8˚ (4.9˚) 12.9˚ (3.4˚) 23% >MCID of Hip Adduction = 2.6˚ - 3.5˚ (Noehren, 2010)

Discussion: Effects Intervention is feasible: no attrition to date male subjects recruited clinically viable (clinician and patient) Positive reduction in average & worst pain Modest improvement in function (ceiling effect of Kujala Scale)

Discussion: Mechanisms Possible Kinematic Mechanisms Level 1 evidence suggests a kinematic mechanism for running retraining in PFP in females (Neal ‘16) Our feasibility data appears to be aligning with this suggestion in a mixed-sex cohort N=10 is required for confirmation at 80% power (Noehren, 2011)

Final Steps 2 further subjects recruited (1 male, 1 female, n=9) One more male subject required for N=10 (50/50 male/female cohort) Increase number of kinematic outputs to those identified as factors from recent systematic review Normalise EMG and determine onset/offset

Acknowledgements Private Physiotherapy Educational Foundation: Novice Research Grant (EMRG1E8R) Dr. Steven Lindley from Delsys: System Loan/ Procurement and Data Analysis Assistance

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