Gait Modification to Reduce Lower Extremity Joint Load: a Review and Investigation into Unintended Consequences



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Gait modification using real-time biofeedback may positively alter mechanical load at the knee. Currently, there is no consensus regarding the most effective gait-modification strategy, magnitude of modification, or mode of biofeedback. The effects on the biomechanical parameters of the non-modified limb also remain unclear. Additionally, trunk modifications are associated with frontal plane knee moment reductions ranging from 9% to 65%, and involve a shift of the center of mass to the implicated side. Increased trunk dynamics are associated with increased spinal load, and implicated in the pathomechanics of lower back pain. Three studies were conducted to achieve the objective of this dissertation. Their purposes were to (1) systematically assess the efficacy of gait modification using real-time biofeedback for reducing frontal plane knee moment; (2) investigate the acute changes in the biomechanical parameters of the non-modified side in individuals undergoing unilaterally implemented medial knee thrust, lateral trunk lean, and toe-in foot progression gait modification; and (3) to investigate the effects of subject-specific trunk lean gait modification on trunk kinetics. Overall, the findings of this dissertation inform gait-retraining-related research. Gait modification produced frontal plane knee moment reductions, although available evidence was of low quality. During the medial knee thrust gait modification, the loading environment of the non-modified knee for our healthy cohort appeared compromised. We further found increased spinal load throughout the gait cycle during the lateral trunk lean gait condition. Future experimental studies using experimental designs should investigate acute and chronic adaptations to gait modification within both healthy and pathological populations.