Real-time Gait Retraining to Reduce Loading in Runners

描述（由申请人提供）：“健康人2010”倡议鼓励人们在一生中进行有规律的锻炼。跑步是美国人参与的最受欢迎的健身活动之一。然而，由于其重复性，过度使用损伤是常见的。应力性骨折是跑步者遭受的最严重的过度使用损伤之一。回顾性和前瞻性研究表明，应力性骨折在一定程度上与跑步者所经历的胫骨冲击有关。这表明减少胫骨冲击可以降低这些严重骨损伤的风险。因此，本调查的目的是：1。为了确定是否可以通过实时反馈来减少高冲击跑步者的胫骨冲击（以及由此产生的垂直负荷）；2. 确定使用哪些运动学策略来减少下肢负荷；3. 确定在跑步机上再训练期间所做的改变是否可以转移到地上跑；和4。确定这些步态变化是否持续6个月。将招募40名目前没有受伤的男性和女性跑步者，年龄在18-45岁之间，每周跑步至少10英里。他们将表现出增加的胫骨休克，由预筛选评估确定。受试者将被随机分配到两组中的一组，并对其下肢运动学和动力学进行基线仪器步态分析。20名受试者将被安排参加为期两周，每周四次的再培训计划。他们将在带器械的跑步机上跑步，加速计紧紧固定在胫骨内侧远端。每次脚着地，他们将获得胫骨震动的实时视觉反馈。他们将被要求将电击减少到正常范围内（由监视器上的目标指示）。运行时间将逐渐增加，反馈将在12个会话中逐渐删除。第二组作为对照组，在没有反馈的情况下进行同样的跑步机训练。训练后的地面步态分析将在治疗后进行，并对两组进行6个月的随访。相关性;这项研究的结果将提供有关改变和维持步态力学的能力的信息，以降低下肢应力性骨折的风险。这些结果既可以应用于预防医学，也可以应用于康复，计划开发一种简单的便携式工具，以识别和再培训那些有风险的人。

DESCRIPTION (provided by applicant): The Healthy People 2010 initiative encourages people to engage in regular exercise throughout their lives. Running is one of the most popular fitness activities that Americans engage in. However, due to its repetitive nature, overuse injuries are common. Stress fractures are among the most serious overuse injuries a runner sustains. Retrospective and prospective studies have shown stress fractures are related, in part, to the amount of tibial shock a runner experiences. This suggests that reducing tibial shock would reduce the risk of these serious bony injuries. Therefore, the purposes of this investigation are: 1. to establish whether tibial shock (and consequently vertical loads) can be reduced through realtime feedback in runners exhibiting high shock; 2. determine which kinematic strategies are used to reduce lower extremity loading; 3. determine whether the changes made during the retraining on the treadmill transfer to overground running; and 4. determine whether these gait changes persist over a 6 month period. 40 male and female runners free of current injuries, aged 18-45 yrs and running at least 10 miles/week will be recruited. They will exhibit increased tibial shock, determined by a prescreening assessment. Subjects will be randomly assigned to one of two groups and undergo a baseline instrumented gait analysis of their lower extremity kinematics and kinetics. 20 subjects will be placed into a 2-week, four times a week retraining program. They will run on an instrumented treadmill with an accelerometer tightly fixed to their distal-medial tibia. With each foot strike, they will be provided with real-time visual feedback of their tibial shock. They will be asked to reduce their shock to within normal limits (indicated by a target on the monitor). Run time will be gradually increased and feedback gradually removed over the 12 sessions. The second group will serve as a control group and undergo a similarly progressed treadmill protocol with no feedback. A post-training overground gait analysis will be conducted following the treatment, and at a 6-month follow-up for both groups. RELEVANCE; Results from this investigation will provide information regarding the ability to alter and maintain gait mechanics to reduce the risk for lower extremity stress fractures. These results can be applied to both preventative medicine as well as rehabilitation with the planned development of a simple portable tool to identify and retrain those at risk.