Gait retraining and incidence of medial tibial stress syndrome in army recruits.
OBJECTIVE
Gait retraining, comprising biofeedback 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-wk 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 (three sessions per week) and biofeedback enabling internalization of the foot balance variable (one session per week). Both groups continued with the usual military training regimen. Diagnoses of medial tibial stress syndrome over the 26-wk regimen were made by physicians blinded to the group assignment. Data were modeled 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 HR of 0.25 (95% confidence interval, 0.05-0.53). The number needed to treat to observe one additional injury-free recruit in intervention versus control at 20 wk was 14 (11 to 23) participants. Baseline foot balance was a nonspecific predictor of injury, with an HR 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.
1Infantry Training Centre, Catterick Garrison, England, UNITED KINGDOM; 2School of Social Sciences and Law, Teesside University, Middlesbrough, England, UNITED KINGDOM; and 3Health and Social Care Institute, Teesside University, Middlesbrough, England, UNITED KINGDOM.
Jagannath
J
Sharma
Matthew
M
Weston
Alan M
AM
Batterham
Iain R
IR
Spears
D000293:Adolescent; D001676:Biofeedback, Psychology; D005081:Exercise Therapy; D005528:Foot; D005684:Gait / Q000502:physiology*; D006801:Humans; D015994:Incidence; D008297:Male; D058923:Medial Tibial Stress Syndrome / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D008889:Military Personnel; D061366:Numbers Needed To Treat; D064797:Physical Conditioning, Human / Q000009:adverse effects; D004856:Postural Balance / Q000502:physiology; D011446:Prospective Studies; D012044:Regression Analysis; D016037:Single-Blind Method; D006113:United Kingdom; D055815:Young Adult