Real-time Gait Retraining to Reduce Loading in Runners

描述（由申请人提供）：2010年健康人倡议鼓励人们在一生中定期锻炼。跑步是美国人最喜欢的健身活动之一。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承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，应力性骨折部分与跑步者经历的胫骨电击量有关。这表明，减少胫骨冲击将降低这些严重骨损伤的风险。因此，本研究的目的是：1.以确定胫骨冲击（以及因此的垂直载荷）是否可以通过在表现出高冲击的跑步者中的实时反馈来减少; 2.确定使用哪些运动学策略来减少下肢负荷; 3.确定在跑步机上重新训练期间所做的改变是否转移到地上跑步;以及4.确定这些步态变化是否持续超过6个月。将招募40名没有当前受伤的男性和女性跑步者，年龄在18-45岁之间，每周至少跑10英里。通过预筛选评估确定，他们将表现出胫骨冲击增加。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名受试者将接受为期2周、每周4次的再培训计划。他们将在一个装有仪器的跑步机上跑步，加速度计紧紧地固定在他们的胫骨远端内侧。每次足部撞击时，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，并在12个会话中逐渐删除反馈。第二组将作为对照组，并进行类似的跑步机协议，没有反馈。在治疗后和6个月随访时，将对两组进行训练后地上步态分析。相关性;本研究的结果将提供有关改变和维持步态力学以降低下肢应力性骨折风险的能力的信息。这些结果可以应用于预防医学和康复，并计划开发一种简单的便携式工具来识别和重新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.