1. 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

2. 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)

3. 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)

4. 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

5. 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)

6. 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

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

8. 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)

9. 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%

10. >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)

11. 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)

12. 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)

13. 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

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

15. Thanks for Listening …
@Brad_Neal_07