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What is it?
Gait Re-Education is changing the way you run or walk to reduce stress on injuries.
This is a long-term process that permanently changes the way the central nervous system reacts to sensory information.
Who benefits from it?
People struggling with long term issues have the most to gain. At Ayres Health we have had great success with:
1. Runners who are struggling with persistent injuries.
2. People struggling with arthritis.
3. People who are getting aches and pains 12 months or more after having had a joint replacement.
What does the science say?
There are a few key principles that science shows us:
1. Gait re-training is helpful for changing the way people move. This does reduce load on injured tissues. However, the laws of physics say that if we reduce force on one structure, we must increase force on another structure. This can lead to secondary injury. This risk can be reduced with targeted strength and conditioning.
2. Changing gait does not improve performance of an uninjured runner. It probably (but we cannot say with great certainty) does not hinder performance either.
3. Changing gait can lead to more consistent training of an injured runner. This can lead to improved performance.
4. We cannot predict injury by looking at the way someone walks or runs. In other words, we can not say that someone is more likely to get injured because of the way they move. Does alter kinematics and kinetics, therefore tissue loading.
5. Strength training alone is not enough to change gait. There must be a neuromuscular element, a conscious effort to change movement patterns.
6. Gait retraining is a long-term process that takes a minimum of 6 weeks, but the effect is long lasting.
Keeping these points in mind:
· We do not recommend gait re-training for people who do not have an injury as the risk of secondary injury far outweighs any benefit.
· Gait retraining is a long term treatment. It must be supported with short term and medium-term interventions and targeted rehabilitation.
· Gait re-training can not be used to reduce risk of injury for a non-injured runner.
How Do We Change Gait?
There are 2 stages to the gait re-training process which are very straightforward but is does require consistent practice.
Stage 1: Acquisition – Lots of extrinsic feedback is provided e.g., video or mirror. This develops a link between what the person feels and what they see.
Stage 2: Transfer – Extrinsic feedback is reduced. This prevents the person becoming reliant of external cues and develops their ability to feel how they are moving.
Are there any contraindications?
There are no direct contraindications for gait re-training. But we do need to keep in mind time scales for completing the process.
· Long term process, not a quick fix. Therefore, it is not a good idea to start the process close to an important event or mid-season. It is better to wait until after the even or the end of the season.
· Gait retraining works best for long term, persistent injuries rather than traumatic injury. However, if a traumatic injury has led to long term pains or nervousness then gait re-training would be of benefit.
What can we change?
There are many parameters that we can change. Which ones we change will depend on the presenting problem. We must keep in mind that changing one parameter will cause others to change too. This may or may not be beneficial.
1. Cadence (steps per minute)
2. Step width
3. Overstride
4. Hip adduction
5. Contralateral hip drop (Trendelenburg)
6. Foot contact angle
7. Vertical loading rate
8. Excessive trunk lean
9. Foot strike position (rear, mid, forefoot)
10. Knee angle at foot strike
11. Breaking at foot strike
12. Vertical oscillation.
At Ayres Health we usually start gait retraining by altering cadence, steps per minute. This is a very easy parameter to change with 1-2 running drills. By altering cadence we instantly change stride length, foot contact angle, vertical loading rate (impact), foot strike position, breaking and vertical oscillation, usually for the better.
Summary
Gait retaining can have huge benefits when used appropriately on people with persistent injuries. Due to it being a long term treatment it must be used alongside short and medium-term treatments, it is not a standalone treatment. It can lead to secondary injury but this risk can be reduced with targeted strength and conditioning.