Can runners maintain a newly learned gait pattern outside a laboratory environment following gait retraining?

Background: Previous peak tibial shock gait retraining programs, which were usually conducted on a treadmill, were reported to be effective on impact loading reduction in runners. However, whether the trained runners can translate the training effect at different running modes (treadmill/overground), or running slopes (uphill/downhill), remains unknown. Research question: Is the training effect from a treadmill-based gait retraining translatable to unconstrained running conditions, including overground and uphill/downhill running? Methods: The peak tibial shock was measured during treadmill/overground running, as well as level/uphill/downhill running before and after a course of treadmill-based gait retraining. The 8-session training aimed to soften footfalls using real-time biofeedback of tibial shock data. Repeated measures ANOVA was used to examine the effect of training, running mode, and running slope, on a group level. Reliable change index of each participant was used to assess the individual response to the training protocol used in this study. Results: Eighty percent of the participants were responsive to the gait retraining and managed to reduce their peak tibial shock following training. They managed to translate the training effect to treadmill slope running (Level: p < 0.05, Cohen's d = 1.65; Uphill: p = 0.001, Cohen's d = 0.91; Downhill: p < 0.05; Cohen's d = 1.29) and overground level running (p = 0.014, Cohen's d = 0.85). However, their peak tibial shock were not reduced during overground slope running (Uphill: p = 0.054; Cohen's d = 0.62; Downhill p = 0.12; Cohen's d = 0.48). Significance: Our findings indicated that a newly learned gait pattern may not fully translate to running outside of the laboratory environment.