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Acute effects of gait interventions on tibial stress during running: A systematic review and meta-analysis

      Introduction: High running volumes are a risk factor for sustaining tibial stress injuries. Changing running technique and/or equipment can alter the load and stress placed on the tibia. The ability of interventions to modify tibial stress during running are yet to be synthesised and evaluated. We systematically reviewed the effect of technique and footwear interventions on tibial stress during running.
      Methods: Two searches of electronic databases were conducted using key terms relevant to tibial stress and running. Studies were included if: (1) participants were 18 – 45 years of age; (2) the immediate effect of a gait retraining or footwear intervention during running was evaluated; and (3) a measure of tibial stress was used. Interventions and corresponding data were categorised according to their approach (i.e. Footwear; barefoot running; running speed; surface; overground versus treadmill; orthotics, insoles and taping and technique). Methodological quality and risk of bias of included studies was assessed. Standardised mean differences (SMD) with 95% confidence intervals (95% CI) for changes in tibial stress following the intervention were calculated for all relevant studies and meta-analyses were performed where possible.
      Results: Database searches yielded 1530 articles, with 33 meeting the inclusion criteria. Tibial stress measures increased when individuals ran barefoot (SMD 1.16 [95% CI 0.50, 1.82]), in minimalist shoes (non-habitually) (SMD 0.89 [95% CI 0.40, 1.39]), in motion control shoes (SMD 0.46 [95% CI 0.07, 0.84]), increased stride length (SMD 0.86 [95% CI 0.18, 1.55]), and with increased running speed (SMD 1.03 [95% CI 0.74,1.32]). Tibial stress measures decreased when individuals ran on a treadmill versus overground (SMD -0.83 [95% CI -1.53, -0.12]), and when targeted biofeedback was used (SMD -0.93 [95% CI -1.46, -0.41]).
      Discussion: Reducing the stress and loading on the tibia may reduce the risk of tibial stress injuries. We found several gait alterations that increase tibial stress measures during running and suggest that these be minimised during training periods of high load or be avoided with runners at-risk or recovering from a tibial stress injury. We also found that running on a treadmill versus overground, and the use of biofeedback can reduce tibial stress measures. These interventions could be adopted to target tibial stress reductions in runners training or rehabilitation.
      Conflict of interest statement: The authors acknowledge that we have no conflict of interest to the submission of this abstract.