The Effectiveness of Telehealth Gait Retraining in Soldiers and Cadets with Overuse Knee Injuries - APTA CSM 2026

m crowell, e florkiewicz, a weart, n reilly, j morris, p mchenry, k rochester, k ford

Abstract accepted for platform presentation at the 2026 American Physical Therapy Association Combined Sections Meeting

Running-related overuse injuries, particularly of the knee, are common in military personnel and impair readiness. While gait retraining is a common intervention, broad implementation is limited by costs, expertise, and time. The purpose of this study was to determine the effectiveness of telehealth gait retraining (THGR) on pain, self-reported function, and footstrike pattern in service members with running-related knee pain.

One hundred eighty active-duty soldiers and cadets aged 18–60 were enrolled. Inclusion criteria included running-related knee pain rated 3–7/10 during or after running and a rearfoot strike pattern.

This single-blind, randomized clinical trial used concealed allocation to assign participants to standard physical therapy (PT) or standard PT plus THGR. Standard PT included interventions aligned with clinical practice guidelines and a return-to-run program without gait retraining cues. THGR participants received auditory and visual feedback via commercially available video coaching software to increase cadence and transition to a non-rearfoot strike (NRFS) pattern. Feedback was delivered weekly during weeks 1–4, and at weeks 6 and 8. Outcomes, including pain via Visual Analog Scale and function via the Single Assessment Numeric Evaluation (SANE), Anterior Knee Pain Scale (AKPS), and University of Wisconsin Running Injury and Recovery Index (UWRI), were assessed at baseline, post-intervention (8 weeks), and a retention follow-up (12 weeks). Footstrike was assessed with 2D sagittal video analysis. Group-by-time interactions were evaluated using 2×3 mixed-model ANOVA for continuous outcomes and chi-square tests for footstrike pattern. Alpha was set at 0.05.

Of the 180 participants, 38 were excluded during baseline screening, and 42 withdrew, leaving 100 in the final analysis (44 THGR, 56 PT). Mean age was 29.9 (8.5) years; 22% were female. Mean symptom duration was 29.8 (28.4) months and weekly running volume was 14.1 (12.9) km. No significant group-by-time interactions were observed for overall pain (F=0.47, p=.61), pain during (F=0.57, p=.54) or after running (F=0.44, p=.61), SANE (F=0.94, p=.38), AKPS (F=0.18, p=.80), or UWRI (F=0.30, p=.70). There were significant time main effects for all variables (p<.001). A group main effect was observed only for pain during running (F=4.19, p=.04). Clinically meaningful improvements were seen in pain and UWRI scores, but not in the AKPS. A significantly greater proportion of THGR participants transitioned to NRFS (65%) compared to standard PT (16%) (χ²=24.12, p<.001).

Telehealth gait retraining combined with standard PT produced similar improvements in pain and function compared to standard PT alone, with both groups showing meaningful clinical improvements in pain and function.