Movement retraining

Movement pattern retraining for individuals with patellofemoral pain is receiving growing attention in research and clinical practice, and has been recommended by international experts.

In this section, you will find information about how to implement this technique in clinical practice.

Mirror gait retraining is an effective treatment to reduce abnormal mechanics during running. Interestingly, this new movement skill may be transferred to the untrained tasks as single leg squat and step down. Reflecting these changes in dynamic alignment, measures of pain and function also improve.

How to perform:

During the first training session, patients should be first shown their baseline assessment video so they can visualize the abnormal hip and knee alignment that they exhibit during running.
During gait retraining, visual feedback should be provided by a full length mirror placed directly in front of the treadmill.
Patients should receive verbal cueing at the beginning of each session, such as “run with your knees apart with your kneecaps pointing straight ahead” and “squeeze your buttocks.”
Patients should receive additional verbal feedback during each training session if they won’t be maintaining the desired gait modifications.
During all training sessions, each patient’s response to the cueing should be analyzed subjectively using a standard video camera and compared with their baseline video.

Feedback should be gradually removed during the final training sessions to shift dependence from external to internal cues and reinforce learning

This is accomplished by decremental reductions in verbal cueing in addition to reductions in visual feedback by turning the mirror around so that patients can not see themselves while running. During each period of feedback removal, running mechanics should be monitored via a standard video stream that is only visible to the therapist. Once feedback is resumed, patients should receive retrospective verbal cueing on their running mechanics during the preceding feedback removal period.