Enhancing running injury prevention strategies with real-time biofeedback: A systematic review and meta-analysis.

Running injuries are common, and one idea for preventing them is gait retraining using real-time biofeedback, where runners get visual or auditory signals during running to help them change how their foot strikes the ground. This review pulled together 24 studies that tested this approach, comparing visual feedback against auditory feedback, and looked at changes in loading measures linked to injury risk, such as how hard and how fast force travels through the leg with each step. Across the pooled studies, both types of feedback reduced these loading measures, with a bigger drop seen after sustained training than right after a single session, and visual feedback outperforming auditory feedback. This is a useful signal for a prevention strategy that is still being worked out, but the finding is about biomechanical loading, not about confirmed reductions in actual injury rates, and the studies varied in design and quality, which limits how confidently these results translate into practice.

If you run regularly, you have probably heard about gait retraining, where a runner gets real-time feedback, either something to watch or something to listen to, aimed at helping change their running form to ease stress on the legs. This review combined evidence from 24 studies to see whether this kind of feedback actually changes the forces your body absorbs with each stride, since high loading is thought to play a role in running injuries. The combined results showed that both visual (watching a screen) and sound-based feedback reduced these loading forces, and the effect was larger after longer training rather than a single short session.

Visual feedback showed a bigger reduction than auditory feedback. It's encouraging that both approaches moved loading in a favorable direction, but this review measured changes in forces during running, not whether runners actually got injured less often, and the underlying studies differed quite a bit in how they were designed, so the certainty of these results is still limited.

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

This review addresses a practical question for anyone using gait retraining in running injury prevention programmes: does real-time biofeedback actually change the loading variables thought to contribute to running-related injuries, and does the type of feedback matter? The authors pooled data from 24 studies, 17 using visual biofeedback and 14 using auditory biofeedback, assessing outcomes including peak tibial acceleration, vertical average loading rate, and vertical instantaneous loading rate, with study quality rated using the Downs and Black checklist. The meta-analysis found reductions in these loading variables with both feedback modalities, with larger reductions evident after extended training compared to immediately post-intervention, and visual biofeedback showing greater effectiveness than auditory biofeedback. This offers some mechanistic support for visual feedback as a potentially more potent retraining signal, but the outcome measured is biomechanical loading, a surrogate linked to injury risk, not confirmed injury incidence, so this does not establish that gait retraining actually prevents running injuries in practice. The diversity in study designs and reported outcomes noted by the authors, along with variable study quality, means the pooled estimates should be interpreted cautiously, and the comparison across feedback types is based on indirect evidence from separate study groups rather than head-to-head trials in every case.

These findings inform the biomechanical rationale for biofeedback-based retraining rather than providing direct, high-certainty proof of injury reduction.