The Effectiveness of Gait Retraining on Running Kinematics, Kinetics, Performance, Pain, and Injury in Distance Runners: A Systematic Review With Meta-analysis.

This systematic review with meta-analysis examined whether gait retraining, changing how runners move while running, affects running mechanics, performance, pain, and injury in distance runners. The authors pooled data from 19 randomized controlled trials involving 673 participants, grouping interventions by type: step rate changes, non-rearfoot footstrike training, impact reduction, ground contact time, and multiparameter approaches. Moderate-certainty evidence showed step rate retraining increased step rate and reduced average vertical loading rate (a measure related to impact forces), based on 3 to 4 trials with low inconsistency between them. Low-certainty evidence showed non-rearfoot footstrike retraining increased knee flexion at initial contact but did not change running economy.

Multiparameter retraining did not alter running economy or performance, also based on low-certainty evidence. Too few trials reported pain outcomes to draw conclusions, and only two trials reported reduced injury incidence over one year.

This review looked at studies testing whether changing how runners move, such as taking quicker steps or landing differently, helps with running performance, pain, or injury. Researchers combined findings from 19 clinical trials with a total of 673 runners. The strongest evidence, described as moderate certainty, found that training runners to take more steps per minute (step rate retraining) did increase their step rate and reduced a measure of impact force on the legs, based on 3 to 4 trials.

Evidence on changing foot-strike pattern (landing on the middle or front of the foot instead of the heel) was low certainty and showed a change in knee position at landing but no change in running economy (how efficiently the body uses energy while running). Combining multiple gait changes together did not show changes in running economy or performance, again with low certainty evidence. Too few studies looked at pain to draw conclusions, and only two trials followed injury rates, showing fewer injuries over one year with gait retraining.

Overall, the evidence remains limited and mostly low to moderate certainty.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This review pooled 19 RCTs (n=673) evaluating gait retraining interventions in distance runners, categorizing them by step rate, non-rearfoot footstrike, impact, ground contact time, and multiparameter approaches, then applying GRADE to rate certainty. Moderate-certainty pooled evidence (3 to 4 trials, I2 0%) supported step rate retraining increasing step rate and reducing average vertical loading rate, suggesting reasonably consistent findings across a small number of trials. In contrast, low-certainty evidence for non-rearfoot footstrike retraining showed increased knee flexion at initial contact without a corresponding change in running economy, and multiparameter interventions showed no change in running economy or performance, both based on only 2 to 3 trials with some heterogeneity (I2 up to 19%). Clinically relevant outcomes were sparse: insufficient trials reported pain, and only two trials assessed one-year injury incidence, limiting conclusions about protective effects.

The small number of trials per subgroup, low certainty ratings for most outcomes, and limited outcome reporting on pain and injury constrain confidence in these findings and highlight the need for larger, more consistent trials before firmer conclusions can be drawn.