Patellofemoral Pain Syndrome Clinical Trial
Official title:
Do Simple Running Technique Changes Reduce Pain and Change Injury Causing Mechanics in Runners With Common Running Related Injuries?
This project aims to investigate whether an increase in step rate can be used to reduce pain
and injury causing movement patterns in runners who are currently experiencing achilles
tendonopathy, iliotibial band syndrome, patellofemoral pain syndrome and medial tibial stress
syndrome.
Many injuries have been reported to share similar injury causing movement patterns. For
example iliotibial band syndrome and patellofemoral pain syndrome have been reported to be
caused by increased side to side drop of the pelvis and inward movement of the hip.
Gait retraining is a method of changing the way people run in order to change movement
patterns.Increasing step rate may present a gait retraining method that does not pose further
injury risks and can be used across multiple different injury populations. Studies have shown
increasing step rate can reduce frontal plane movement patterns at the pelvis, hip and foot
as well as reducing sagittal plane joint angles such as ankle dorsiflexion. Based on the
changes in movement patterns increasing step rate has been recommended as an intervention for
the treatment of patellofemoral pain syndrome, medial tibial stress syndrome, iliotibial band
syndrome and achilles tendonopathy. Therefore this study aims to investigate whether an
increase in step rate can reduce pain and change injury causing mechanics in runners
currently running with patellofemoral pain syndrome, iliotibial band syndrome, medial tibial
stress syndrome or achilles tendinopathy.
The aim of the project is to use a simple gait intervention, increasing step rate to
investigate if this technique change can reduce pain immediately, at short term follow up and
long term follow up. The project will also look at whether an increased step rate can be
maintained at follow up and whether this changes movement patterns proposed to be the cause
of injury.
Runners will be recruited from local running clubs and competitions using poster
advertisement at running clubs and emailed to running clubs
All data will be collected at the university of Salford podiatry clinic gait laboratory.
Participants will be recruited from running clubs and races via poster advertisement sent via
email to the running club and on advertisement at the club. Also participants presenting at
the running performance clinic with patellofemoral pain syndrome, iliotibial band syndrome,
medial tibial stress syndrome and achilles tendonopathy will be invited to take part in the
research study investigating the effects of gait retraining on injury. Participants who agree
to take part will be sent an email confirming their appointment along with an information
sheet detailing the study which they are encouraged to read before attending the appointment.
They will have contact details of the lead researcher should they wish to ask any further
questions
The objectives above will be addressed via the following data collection procedure:
On arriving at the running clinic participants will be informed that the gait retraining
intervention aims to reduce pain when running and that there is a risk that the retraining
protocol will not affect their pain. If there are no improvements to symptoms following gait
retraining they will be then directed to the appropriate medical service for further
management. Participants will be informed as to the procedures and given the chance to read
through an information sheet again detailing the procedures involve. If on reading the
information sheet participants do not wish to take part they can terminate the appointment at
any time. Before data collection begins participants will sign a consent form, a running
history form and a health screening questionnaire will be completed by a qualified
physiotherapist in order to assess the patients suitability to complete the assessment with
no further risk to their health.
Procedures:
Participants will attend two visits 4 weeks apart. The first visit will consist of an initial
assessment data collection and a retraining session. Detailed below. The second visit will
consist of the same procedures in the initial assessment.
Initial Assessment data collection:
Participants will complete the appropriate self reported outcome measure: if iliotibial band
syndrome or patellofemoral pain syndrome they will complete the Lower extremity Functional
Index and the Anterior Knee Pain Scale. If they present with medial tibial stress syndrome
they will complete the medial tibial stress syndrome score and the Lower Extremity Functional
Index. If they present with achilles tendonopathy they will complete the VISA - A score and
the Lower Extremity Functional Index.
Before running retroreflective markers will be attached to the subject on specific points of
their body: shoe, ankle joint, knee joint, greater trochanter of the hip, thigh, lower leg,
pelvis (anterior superior iliac spine, posterior superior iliac spine, iliac crest), lumbar
spine, thoracic spine, sternum and acromion process off the shoulders. This marker placement
is according to a protocol previously established and validated in a project undertaken at
the University of Salford. A qualysis motion capture system will then be used to track the
movement of these markers as the participant runs on a treadmill. Once the marker data has
been collected then we will use custom software to calculate the kinematic (joint movement)
patterns for each person.
Participants are required to run on a treadmill at two different speeds (3.2, 3.8m/s). These
speeds have been chosen based on running speeds used in previous research to allow
comparability between studies. If participants feel they are unable to run at these speeds
they can run at a self selected running speed.
They will be given a 6 minute accommodation period running on the treadmill at 3.2m/s. At
this point data will then be collected for 1 minute of running in order to gain data for ten
steps of running for the right and left feet. Speed will then be increased to 3.8m/s where
they will be given a 1 minute accommodation period with data collected for a further minute
of running.
A qualified physiotherapists will monitor the patients feels ok to continue at each 2 minute
interval. At the end of data collection for each running speed the participant will be asked
to rate their current level of pain on a scale of 0 = no pain to 10 = sever pain. If at any
point the participants pain exceeds 8 out of 10 or the participant feels they can no longer
continue running the data collection will be terminated.
Steps will be identified when the foot markers are in contact with the treadmill, once ten
steps have been collected the data will be averaged across all trials for right and left
feet. During the data collection injured participants will be asked to rate their current
level of pain while running using a numerical rating scale 0 = no pain and 10 = sever pain.
Retraining Session:
Once data has been collected participants will then be asked to run for a further 5 minutes
at each speed under an increased step rate condition with data collected for the final 1
minute of the trial. Step rate will be calculated as number of steps per minute. Step rate
will then be increased by 10% and participants instructed to run to an audible metronome to
ensure the step rate increase is achieved. Again at the end of each running speed
participants will be asked to rate their current level of pain using a numerical rating
scale.
Following data collection participants will be permitted up to a further 15 minute practise
session running to maintain the increase in step rate without the metronome present to allow
participants to adjust to the new running technique.
Participants will then be instructed to continue their current level of running using the new
running technique. Participants will have contact details to the lead researcher (email and
phone number) and will be requested to provide weekly updates regarding their running and if
any pain is experienced. This will ensure patients are continuing to improve, not running
with an increase in pain and are able to ask any questions they may have. If patient's
symptoms are increasing they will be informed to stop running and terminated from the
assessment and directed to the appropriate medical professional for further assessment.
Participants will be reassessed between 3 weeks and 5 weeks later following the same
procedures outlined in the initial assessment data collection as well as at a 3 month follow
up following the same procedures to investigate long term improvement.
;
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