Good day, good day.

Welcome back to the sports medicine project.

I am your host Blake, and thankfully we have a new series.

We I have a a new series that I am doing me something that I do a bit more on on on social media, but I just want a longer format to talk about it.

And guess what, because it's my podcast, I can just do whatever I want.

So welcome to this new series and I am titling running for a PhD.

So I think I mentioned this on on previous episodes, but I've started my my PhD, you know, on the very broad and interesting topic of running loaded injuries.

And as I've always done, but now more increasingly, I'm just reading a lot of running related research, which I share on socials and on Instagram and in reels.

But I thought each, each, you know, every few weeks or if we don't have a guest lined up for a couple of weeks, I just want to talk about something interesting that I'm that I'm reading.

And we're still going to do the the longer format podcast, which we'll have coming out next week.

But going to speak around the study.

Keep it short, keep it sweet.

Some of the problem, if it's a good study, what's the clinical relevance for people that that work with runners?

So yeah, I'm going to get cracking into it.

So this this paper that we're talking about, published in 2023, running gate modifications can lead to immediate reductions in matellofemoral pain.

Jean Francios Escula is the lead author, Laurent J Beuler and Jean Sebastian Roy, 2 jeans on the paper, pretty good.

So imagine this, you have matellofemoral pain, anterior knee pain.

We know pretty clearly from the research, it is one of, if not the most common running or later injury that is going to happen to someone and it is incredibly common in your runners.

So for the for the sake of this, just depending on who you are.

So we had a podcast with bolonia recently.

Patella thermal pain is, is a vague diagnosis.

You know, it's kind of a diagnosis of exclusion.

Rule out the the nasty stuff like, you know, bone stress as the other things going on internally and you kind of come to this pain around the Patella femoral joint.

It's not always just the joint.

So in this case, these people are clinically diagnosed with PFP.

You take 68 runners, you have a mix of non heel strikers and heel strikers and basically what you're trying to see is these people that are running with pain.

If we test a variety of of different gait modifications and gate retraining techniques, can we see some immediate change?

Now you hear the word immediate.

They didn't only test people for for 30 seconds, but it's still pretty interesting because you get to test all these different ones like changing strike pattern and and changing cadence.

So essentially what they do is they're going to test 6, a 10% increase in step rate, fixing people to 180 steps per minute regardless, whatever the cadence currently was at less 10% step rate, 4 foot strike and heel strike and run softer.

So, you know, if you rear foot strike, I can transition 4 foot and four foot to to heel strike.

Now this is pretty interesting.

Out of 68 people, 42% of symptomatic runners had immediate pain relief with just one modification, which is which is pretty awesome.

So overall, you know, you're probably thinking and I'll give you 5 seconds, but I'll countdown.

What do you think would have had the biggest change to pain?

543214 foot strong and a 10% increase in step rate with the most effective out of 35% and 28% improve with with more than three.

So what you're expecting to to see with an increase in step rate, we're going to see things like hopefully less knee flexion.

And of course, if you change from rear rear foot to the four foot, you're going to shift the load from knee and above the knee to below and you're going to make the ankle worker whole harder and the knee worker a lot less.

So 10% increase step rate and four foot strike reduced patellofromal joint force by approximate 12%, which is a whole lot and then runs off reduced PFJ force by 11%.

And they've done some some cool studies on giving someone the sorry, giving people the same queue and seeing what, seeing how they take on that queue and then modify decade.

So that for me in the clinic, I always have a couple of a different cues where I'm trying to get the same outcome.

Because, you know, the information is only as good as the people that do interpret it.

And everyone can interpret it different based off a whole lot of things.

You want to ask someone to, to run soft and they might spend more time in the air and the cadence come way down and they kind of bound up and down, up and down.

Other people might just change to to going from a real foot to a four foot so they can bring their, their foot leading a little bit closer to the centre of mass.

So he'll strike, increase PFJ force and pain in in most runners.

And that was in 72%.

You know which, which which makes sense, but interesting enough, and I'll speak about this in a in a second, that some runners had pain relief even when PFJ forces increase, which, you know, could suggest, you know, something central, something psychological expectation, whatever it may be.

But I found that really interesting.

So rear foot strike gained more benefit from 4 foot strike and and run softer.

Non rear foot strike is mostly benefit from a 10% increase in in separate.

So, you know, kind of based off that already, we think, well, what's going to have the the best influence?

It makes sense changing strike pattern and 10% increase step rate.

But we know whenever we're working with with someone and whether we're working with them at the start or, or during, you know, they're running maybe 50, a hundred, maybe even 150 KS a week, You know, there's always risk involved with changing how someone moves because we can't take force away.

We're only very likely moving it around and we're trying to evenly distribute it as as much as we can.

So what happens if we change someone's rear foot strike?

You know, we have some studies, up to 35% change, you know, when work at the arm of the joint, If we're changing someone from rear to A to a four foot, it's going to really make the foot in the ankle work quite hard.

The Achilles tendon, the, the four foot.

And if someone hasn't spent a lot of time running that way, it's not that running that way is inherently bad.

It's just the person that's not going to have their, their capacity to do that.

So when we're looking at overall safety, without a doubt, we're going to have to have somewhat of a gradual transition.

I think changing strike pattern is something that I do really, really hold a lot at all.

So separate, it's going to be a lot safer with not that much downside other than than just implementation.

And that's the one thing that this study doesn't follow up with, where you're changing someone for 30 seconds to see some immediate pain relief.

But it's pretty cool.

And you think of someone who's been in pain for a while or maybe a little bit scared of running to be able to change their pain while they're doing something that's meaningful to them.

That's, that's pretty awesome.

So it's, you know, you're much more likely to get some buying, maybe a lot more likely to become a bit more compliant.

So out of all those six, and I'll just say them again.

So 10% increase the step rate, fixing someone to 180 steps per minute less -10% step rate, 4 foot strike, heel strike and run softer.

So strike pattern and and 10% increase in step rate are going to move the needle the most, but without a doubt a 10% increase in step rate is going to be the the safest.

So one thing that was was quite good around the the the study was a pretty decent sample size 68 not too bad.

Good mix of rear foot and and non rear foot.

No, no measurement that I could find of kind of running history, you know, whether they were more experienced or recreational and nice to see, you know, a measurement of something that we really care about, you know, and, and sorry, patients care about is, is pain because that's what they're coming to see is for.

And then obviously for us trying to understand the bio mechanics and, and what might change.

And a lot of what they think is just less, less knee flexion and less of a a breaking force as they change their their cadence.

So it said 32nd follow up pain respond to threshold with less than one less than one out of 10, which was small and the non refill strike they had 23.

So potentially could have had more there as well.

So pretty interesting to know and and good for us as as a clinician, because we know it's a low risk, effective way to to help someone.

As we said, 4 foot strike can be helpful, but at risk to Achilles and other kind of conditions below the naive chins and example.

Running softer is another viable option, particularly for someone with a rare foot.

But usually what we say when you when you tell someone to do that is they usually are increased their cadence.

We just need to be careful though, when we ask someone to increase they're they're catered.

This is what I like to do on a treadmill.

They don't just run faster because it can be quite foreign.

Some people do it really well.

Other people it's not so much.

We have an awesome study.

I told me ITB, I'm pretty sure in collegiate young females and they, you know, separate these two groups for 8 or 12 weeks.

Now it, it escapes me how long they do it for anyway, they asked people to, to just change their step rate and they change implemented things go OK, a part of the group end up reverting back to how they always were, but their pain improved and they were OK.

And the other group, you know, kept the, the mechanics that they were taught at the start of the study.

So again, for, for us and, and for myself and, and clinicians working with, with runners, we may be trying to get someone to adapt for the long term.

Maybe they've really had a long history of injuries and they've looked, asked for everything else and you know what they're they just can't settle down the knee.

Maybe it's patellar femoral pain with some associated knee osteoarthritis and running means everything to them.

And it's like, well, what can I really do for the long term?

I'm happy to do anything.

Is there anything that can really unload my knee?

Because it's a, it gets a bit cranky and always, you know, when I get to 20 kilometers a week, you get sore.

You know, changing someone to a four foot strike is going to move the needle quite a lot.

And it might be an option, but of course we need to now we need to convey the risk.

We need to convey that we're, we're shifting quite a lot of low, probably the most low that we can.

And we don't have any research on how, how quickly, sorry, how long that will take for someone to adapt.

And you just have to go a lot.

So a little bit like a bone interest injuries where you know, when someone's asymptomatic, you know, coming out of the booty, how quickly can you progress them?

If we're not being guided by pain, we're just being guided by what we kind of understand around bone Physiology.

And you see some people that, that take a lot of risks and get back fine.

Other people that go really slow and, and don't go go too well.

So immediate response isn't universal, however.

So there was only 4040%.

Let me go back and have a look at that.

Yeah, it was around around 40% that found that there was like meaningful immediate relief.

So it's a tool, just something that we can use, but not a blanket fix.

So it's nice to see even with these people, they're testing in the lab and they're doing every sorry, they're they're measuring the right variables.

But everyone had immediate relief and that's when I'm sorry.

That's why we want to have more options out there for people.

And you know, when I'm seeing people in the clinic running modification, gate modification is certainly an option, but it's usually in combination with a good loading program, looking at their actual running program, how often they're running, how much they're running, you know, whether they're doing heels, not doing heels, what footwear they're wearing, whether we're using the auto mechanical stuff like, you know, footwear on hill leaves and all those and stuff like that.

But interestingly enough, some people had relief even when their patellofemoral loads increased.

So that just speaks to, you know, we're looking at loading as a big factor for sure.

But just because we're dealing with a runner doesn't mean there could be something else more centrally going on.

So enjoy.

Hope that gives you some clinical insight.

I'll see you guys next week.