Gait retraining and incidence of medial tibial stress syndrome in army recruits

Jagannath Sharma, Matthew Weston, Alan Batterham, Iain Spears

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Purpose: Gait retraining, comprising bio-feedback and/or an exercise intervention, might reduce the risk of musculoskeletal conditions. The purpose was to examine the effect of a gait retraining program on medial tibial stress syndrome incidence during a 26 week basic military training regimen.

Methods: A total of 450 British Army recruits volunteered. On the basis of a baseline plantar pressure variable (mean foot balance during the first 10% of stance), participants classified as at-risk of developing medial tibial stress syndrome (n = 166) were randomly allocated to an intervention (n = 83) or control (n = 83) group. The intervention involved supervised gait retraining, including exercises to increase neuromuscular control and flexibility (3 sessions per week) and bio-feedback enabling internalization of the foot balance variable (1 session per week). Both groups continued with the usual military training regimen. Diagnoses of medial tibial stress syndrome over the 26 week regimen were made by physicians blinded to group assignment. Data were modelled in a survival analysis using Cox regression, adjusting for baseline foot balance and time to peak heel rotation.

Results: The intervention was associated with a substantially reduced instantaneous relative risk of medial tibial stress syndrome versus control, with an adjusted hazard ratio of 0.25 (95% confidence interval, 0.05 to 0.53). The number needed to treat to observe one additional injury-free recruit in intervention versus control at 20 weeks was 14 (11 to 23) participants. Baseline foot balance was a nonspecific predictor of injury, with a hazard ratio per 2-SD increment of 5.2 (1.6 to 53.6). Conclusions: The intervention was effective in reducing incidence of medial tibial stress syndrome in an at-risk military sample
Original languageEnglish
Pages (from-to)1684-1692
JournalMedicine & Science in Sports & Exercise
Issue number9
Publication statusPublished - 2014


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