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What is the Effect of Changing Running Step Rate on Injury, Performance and Biomechanics? A Systematic Review and Meta-analysis

Abstract

Background

Running-related injuries are prevalent among distance runners. Changing step rate is a commonly used running retraining strategy in the management and prevention of running-related injuries.

Objective

The aims of this review were to synthesise the evidence relating to the effects of changing running step rate on injury, performance and biomechanics.

Design

Systematic review and meta-analysis.

Data Sources

MEDLINE, EMBASE, CINAHL, and SPORTDiscus.

Results

Thirty-seven studies were included that related to injury (n = 2), performance (n = 5), and biomechanics (n = 36). Regarding injury, very limited evidence indicated that increasing running step rate is associated with improvements in pain (4 weeks: standard mean difference (SMD), 95% CI 2.68, 1.52 to 3.83; 12 weeks: 3.62, 2.24 to 4.99) and function (4 weeks: 2.31, 3.39 to 1.24); 12 weeks: 3.42, 4.75 to 2.09) in recreational runners with patellofemoral pain. Regarding performance, very limited evidence indicated that increasing step rate increases perceived exertion ( − 0.49,  − 0.91 to − 0.07) and awkwardness (− 0.72, − 1.38 to − 0.06) and effort (− 0.69, − 1.34, − 0.03); and very limited evidence that an increase in preferred step rate is associated with increased metabolic energy consumption (− 0.84, − 1.57 to − 0.11). Regarding biomechanics, increasing running step rate was associated with strong evidence of reduced peak knee flexion angle (0.66, 0.40 to 0.92); moderate evidence of reduced step length (0.93, 0.49 to 1.37), peak hip adduction (0.40, 0.11 to 0.69), and peak knee extensor moment (0.50, 0.18 to 0.81); moderate evidence of reduced foot strike angle (0.62, 034 to 0.90); limited evidence of reduced braking impulse (0.64, 0.29 to 1.00), peak hip flexion (0.42, 0.10 to 0.75), and peak patellofemoral joint stress (0.56, 0.07 to 1.05); and limited evidence of reduced negative hip (0.55, 0.20 to 0.91) and knee work (0.84, 0.48 to 1.20). Decreasing running step rate was associated with moderate evidence of increased step length (− 0.76, − 1.31 to − 0.21); limited evidence of increased contact time (− 0.95, − 1.49 to − 0.40), braking impulse (− 0.73, − 1.08 to − 0.37), and negative knee work (− 0.88, − 1.25 to − 0.52); and limited evidence of reduced negative ankle work (0.38, 0.03 to 0.73) and negative hip work (0.49, 0.07 to 0.91).

Conclusion

In general, increasing running step rate results in a reduction (or no change), and reducing step rate results in an increase (or no change), to kinetic, kinematic, and loading rate variables at the ankle, knee and hip. At present there is insufficient evidence to conclusively determine the effects of altering running step rate on injury and performance. As most studies included in this review investigated the immediate effects of changing running step rate, the longer-term effects remain largely unknown.

Prospero Registration

CRD42020167657.

Key Points

  • Increasing running step rate reduces step length, peak knee flexion angle, peak hip adduction, peak knee extensor moment and foot strike angle

  • There is insufficient evidence to determine the effects of changing running step rate on injury or performance

  • Increasing running step rate will broadly reduce kinematic and kinetic variables at the ankle, knee and hip

Background

Running participation provides many health and social benefits [1]. Yet, it is estimated that 50% of runners experience an injury that prevents them from running in a given year, and up to 25% of runners are injured at any given time [2]. Most running-related injuries affect the lower limb and are overuse in nature [2, 3]. The most common injury diagnoses include medial tibial stress syndrome, Achilles tendinopathy, and patellofemoral pain [4].

Many factors are proposed to contribute to running-related injuries including training load, biomechanical factors, and lifestyle and emotional stressors [5]. As running-related injuries often occur following changes to training load [5], it is likely that injuries develop in tissues that are exposed to load that exceeds their capacity [3, 6]. Given the high incidence of running-related injuries, interventions that can decrease tissue loads, assist in maintaining running load, and reduce injury risk without reducing running performance, are likely to be of considerable interest to the running community.

Running retraining (changing running technique) can be used to reduce, or shift tissue loads [7]. Common running retraining strategies include alterations to strike pattern, impact loading, and step rate [8]. A previous mixed-methods study, which synthesised clinical and biomechanical evidence with international expert opinion from coaches and clinicians related to running retraining, found that increasing step rate is the most used strategy in the management of running-related injuries [8]. In addition to considering effects on injury, understanding the relationship between running retraining and performance is needed. Changing a runner’s preferred running gait has been shown by some studies to immediately increase metabolic cost [9, 10], and is therefore proposed to potentially reduce running performance in the short-term. This may not be a major consideration among some recreational runners, but it is likely to be a very important concern among competitive runners. Therefore, it is important for clinicians, coaches, and runners to be aware of the evidence regarding the effects of changing running step rate on measures of performance, in the short- and long-term.

Understanding how changing running step rate affects biomechanics will provide a mechanistic insight into how this retraining strategy could be utilised in managing both injury and performance. A systematic review published in 2012 [11] summarised the immediate effects of changing step rate and stride length in runners from 10 studies, with the review identifying that an increase in step rate decreased centre of mass vertical excursion, ground reaction force, shock attenuation, and energy absorbed at the hip, knee, and ankle joints. Based on these findings, the authors concluded that increasing running step rate may help to reduce the risk of running-related injury [11]. However, the findings of this previous systematic review need to be considered with the knowledge that it did not use meta-analysis to synthesise data, and it focussed on kinematic and kinetic outcomes—performance and injury data were not considered. Additionally, this previous review did not include any studies evaluating step rate as a running retraining intervention over time. There has been a substantial increase in research evaluating the effects of changing running step rate over the past decade and synthesising all contemporary literature through meta-analysis would provide more accurate estimates of these effects.

Therefore, the primary aim of this systematic review and meta-analysis was to synthesise the evidence relating to the effects of altering running step rate on injury and performance. As changing running step rate can affect biomechanics, and therefore tissue loads, a secondary aim of this review was to synthesise the evidence relating to the effects of altering running step rate on spatiotemporal, kinetic, kinematic, muscle function, and impact-related parameters.

Methods

This systematic review and meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol was prospectively registered on the PROSPERO International Prospective Register for Systematic Reviews website in July 2020 (Registration number: CRD42020167657). The review adhered to the protocol without amendments or deviations.

Literature Search Strategy

Using guidelines provided by the Cochrane Collaboration, a comprehensive search strategy was devised and applied to the following electronic databases with no date restrictions; (i) CINAHL via EBSCO, (ii) EMBASE via OVID, (iii) MEDLINE via OVID and (iv) SPORTDiscus. The first search was performed in April 2020 and repeated in May 2021. The search strategy was deliberately simplified to ensure inclusion of all relevant papers, with all terms searched as free text and keywords (where applicable). Concept 1 covered ‘step rate’ (step frequency OR stride frequency OR step rate OR stride rate OR cadence OR step length OR stride length) AND Concept 2 covered ‘running’ (run* OR jog*). All potential references were imported into Endnote X7 (Thomson Reuters, Carlsbad, California, USA) and duplicates were removed. Two reviewers (LMA and JFM) reviewed all titles returned by the database searches and retrieved suitable abstracts. Where abstracts suggested that papers were potentially suitable, the full-text versions were screened and included in the review if they met the selection criteria. A third reviewer was consulted in case of disagreements (DRB). All studies that met the inclusion criteria had their reference list hand searched. In addition, citation tracking of included studies was performed using Google Scholar.

Selection Criteria

Studies comparing preferred (i.e. habitual) running step rate to an increase or decrease in step rate, while running were considered for inclusion. A change in running step rate was defined as runners being instructed to alter their preferred step rate by taking more or fewer steps, while running at the same speed. Studies were excluded if step length was manipulated without a corresponding change in step rate, or if participants ran at a set step rate without reporting their preferred step rate, as it was not possible to determine if preferred step rate was altered. Studies were also excluded if other running retraining strategies (e.g. changing foot strike) were used in addition to changing step rate. Case reports and non-English studies were excluded, along with studies with fewer than 10 participants in the cohort or each group [12]. The latter criterion was applied to minimise the risk of potentially false-positive or false-negative findings influencing the evidence synthesis [12].

Variable Classifications

Injury, performance and biomechanical variables were included in this review. Injury variables included participant-reported measures of pain and/or function. Performance variables were those relating to both physiological measures of performance (e.g. VO2) and participant-reported measures of effort (e.g. rate of perceived exertion (RPE)). Biomechanical variables included kinetic, kinematic, and spatiotemporal measures.

Reported Methodological Quality Assessment

Two independent reviewers (JFM and DRB) rated the quality of included studies using the Downs and Black Quality Index [13]. Any inter-rater discrepancies were resolved by consensus, with a third reviewer (CJB) available if needed. All items were scored as ‘Yes’ (score = 1), ‘No’ (score = 0) or ‘Unclear’ (score = 0), except item 5, which was scored as ‘Yes’ (score = 2), ‘Partial’ (score = 1), ‘No’ (score = 0) or ‘Unclear’ (score = 0). Based on assessment scores, studies were categorised as high quality (≥ 20 out of maximum possible score 28), moderate quality (17–19) or low quality (≤ 16) [12]. The Downs and Black Quality Index has been shown to have high internal consistency, test–retest and inter-rater reliability, and high criterion validity [13].

Data Management

All study data were extracted from included studies by the primary author (LMA) and double-checked by a second author (JFM). If sufficient data were not reported in the published article or related supplementary material, corresponding authors were contacted via email to request further data. If additional data were not provided, the best available data from the published article were still included in the review.

Statistical Analysis

Means and standard deviations were used to calculate the standardised mean difference (SMD) with 95% confidence intervals (CI) for variables of interest. Data were pooled where possible. Meta-analysis was performed using the Cochrane Collaboration Review Manager 5.4 software. A random-effects model was used for the meta-analyses due to differences between the study design, interventions, participants, and research settings.

Data Synthesis

Levels of evidence were determined using a modified version of the van Tulder criteria [14]: (i) strong evidence provided by consistent findings among multiple studies, including at least three high-quality studies; (ii) moderate evidence provided by consistent findings among multiple studies, including at least three moderate- or high-quality studies or two high-quality studies; (iii) limited evidence provided by consistent findings among multiple low- or moderate-quality studies, or one high-quality study; (iv) very limited evidence provided by findings from one low or moderate quality study; and, (v) conflicting evidence provided by inconsistent findings among multiple studies, regardless of quality.

Definition of consistent findings (i.e. statistical homogeneity) was based on an I2 of 50% or less. I2 values greater than 50% were classified as inconsistent (i.e. statistical heterogeneity), with level of evidence downgraded one level if pooled results were significant. Calculated SMD magnitudes were classified as small (≤ 0.59), medium (0.60–1.19), or large (≥ 1.20) [12].

Results

Search Strategy and Reported Quality

The initial search identified 4602 titles. Following removal of duplicate publications, titles of 2320 publications were evaluated. The full text of 54 articles were retrieved, and 37 studies were identified for inclusion (see Fig. 1). Thirty-three studies investigated the immediate effects of changing step rate on performance and biomechanics, and four studies evaluated the longer-term effects of changing step rate on injury and biomechanics. The primary reasons for exclusion of studies were combined running retraining strategies [15,16,17,18], and manipulation of step length with no change in step rate [19,20,21]. In addition to data being extracted directly from the 37 included studies where possible, additional data were provided by 5 authors upon request [22,23,24,25,26].

Fig. 1
figure 1

PRISMA flow diagram for the selection of studies.

Characteristics of the 37 included studies are given in Table 1. The results of the Downs and Black Quality Index scores for each study are shown in Table 2. Of the 37 included studies, 17 were high quality [22, 27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42], 19 were moderate quality [23, 25, 26, 43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58], and 1 was low quality [24].

Table 1 Characteristics of included studies
Table 2 Downs and Black Quality Index results for each study

Primary Outcomes

Injury

Two studies [23, 55] were identified evaluating pain and function with a change in running step rate over time periods of 4 weeks to 3 months. One study investigated the effects of a 10% increase in step rate on pain and function in recreational runners with patellofemoral pain (1MQ [23]), providing limited evidence of improvements in total running distance per week, longest run pain-free, numeric pain rating scale, and Lower Extremity Functional Scale at 4 weeks and 3 months. The remaining study investigated the effects of a 7.5% increase in step rate on pain and function in recreational runners with patellofemoral pain (1MQ [55]), providing limited evidence of improvements in average pain, worst pain, and the Kujala Scale at 6 weeks. No data pooling was possible for any injury variables. All SMDs and CI for the four variables and associated time periods are shown in Table 3.

Table 3 Single study results for injury variables

Performance

Five studies [26, 42, 49, 50, 53] were identified evaluating the immediate differences in surrogate measures of performance with a change in running step rate.

Subjective Measures of Performance

Two studies were identified evaluating subjective measures of performance [49, 50]. In recreational runners, compared to running with a preferred step rate: very limited evidence indicated an increase in rate of perceived exertion (RPE) with a 10% increase in step rate, but no differences were reported with a 5% increase in step rate, or with 5% or 10% reductions in step rate (1MQ [48]); and very limited evidence indicated an increase in self-reported awkwardness and effort with a 10% increase in step rate (1MQ [49]).

Physiological Measures of Performance

Three studies were identified evaluating physiological measures of running performance [26, 42, 53]. In recreational runners, compared to running with a preferred step rate, very limited evidence indicated an increase in VO2 consumption when running at 3.13 m/s and 3.58 m/s with a 15% decrease in step rate [53]. Very limited evidence indicated no difference in VO2 consumption when: running at 4.02 m/s with a 15% decrease in step rate [53]; running at 3.13 m/s, 3.58 m/s and 4.02 m/s with a 15% increase in step rate [53]; and, running at maximum speed for a 1-h run with a 4% and 8% increase or decrease in step rate [42]. Very limited evidence indicated an increase in metabolic energy consumption with an 8% decrease, 15% decrease and 15% increase in step rate, while no difference was observed with an 8% increase in step rate [26]. No data pooling was possible for any performance findings as no measure of performance was reported by multiple studies. All SMDs and CI from single studies are shown in Table 4.

Table 4 Single study results for performance variables

Secondary Outcome

In the main manuscript, only the pooled results from two or more studies are presented for biomechanical variables. All SMDs and CI, including those from single studies are shown in Tables 5, 6, 7, 8, 9,10, 11, with all significant biomechanical findings additionally shown in Fig. 2. Unless stated otherwise, all reported findings are immediate effects to a change in running step rate.

Table 5 Pooled and single study results for spatiotemporal gait parameters
Table 6 Pooled and single study results for ground reaction force and loading rate variables
Table 7 Pooled and single study results for kinetic, kinematic and muscle activation variables at the foot, ankle and lower leg
Table 8 Pooled and single study results for kinetic, kinematic and muscle activation variables at the knee
Table 9 Pooled and single study results for kinetic, kinematic and muscle activation variables at the hip
Table 10 Pooled and single study results for kinetic, kinematic and muscle activation variables at trunk and pelvis
Table 11 Segment coordination and coordination variability results from single studies
Fig. 2
figure 2

Significant biomechanical variables with changes in running step rate. Note: Changes in running step rate are provided in brackets next to each biomechanical variable (e.g. + 10% = 10% increase in habitual running step rate). Effect size of change is indicated by the colour of the text used to note the percentage change in running step rate (e.g. + 10% in red = small effect size with a 10% increase in habitual running step rate; orange = medium effect size; green = large effect size). AV average, AVLR average vertical loading rate, BF bicep femoris, COM centre of mass, DF dorsiflexion, GLUTE MAX gluteus maximus, GLUTE MED gluteus medius, GLUTE MIN gluteus minimus, IR internal rotation, IVLR instantaneous vertical loading rate, PFJ patellofemoral joint, PF plantarflexion, PROX proximal, RF rectus femoris, SAG sagittal, SEG segment, SMEM semimembranosus, TA tibialis anterior, TRANS transverse, VGRF verticl ground reaction orce, VL vasus lateralis

Biomechanics

Twenty-two studies [10, 12,13,14, 18,19,20,21,22,23,24,25, 28, 30, 32, 33, 35, 37,38,39, 42, 45] were identified evaluating biomechanical differences between running with a preferred step rate and an increased step rate, and 13 studies [12,13,14, 19, 20, 24, 25, 28, 32, 33, 37, 39, 42] were identified evaluating biomechanical differences between running with a preferred step rate and a reduced step rate. A total of 221 variables were evaluated (Tables 5, 6, 7, 8, 9,10, 11).

Spatiotemporal Gait Parameters

Nine studies [24, 26, 30, 33, 44, 45, 49, 54, 57] were identified evaluating running spatiotemporal gait parameters. Eight studies [26, 30, 33, 44, 45, 49, 54, 57] evaluated differences in gait parameters between running with a preferred step rate and an increased step rate, while seven studies [24, 26, 30, 44, 45, 49, 54] evaluated differences between running with a preferred step rate and a reduced step rate.

Step length: In recreational runners, compared to running with a preferred step rate: moderate evidence indicated a shorter step length with a 10% increase in step rate (2HQ [30, 33] and 2MQ [44, 49]; 0.93, 0.49 to 1.37; I2 = 52%); and moderate evidence indicated a longer step length with a 10% reduction in step rate (1HQ [30], 2MQ [44, 49] and 1LQ [24]; − 0.76, − 1.31 to − 0.21; I2 = 70%).

Contact time: In recreational runners, compared to running with a preferred step rate: limited evidence indicated no difference in contact time with a 10% increase in step rate (1HQ [30] and 1MQ [45]; 0.50, -0.02 to 1.03; I2 = 0%); and limited evidence indicated an increase in contact time with a 10% reduction in step rate (1HQ [30] and 1MQ [45]; − 0.95, − 1.49 to − 0.40; I2 = 0%).

Ground Reaction Forces, Loading Rates and Braking Impulse

Ten studies [25, 30, 31, 33, 38, 41, 44, 49, 50, 54] were identified evaluating ground reaction force and loading rate variables. All studies evaluated biomechanical differences between running with a preferred step rate and an increased step rate, while six studies [25, 30, 31, 44, 49, 54] evaluated biomechanical differences between running with a preferred step rate and a reduced step rate.

Ground reaction forces: In recreational runners, increasing step rate by 10% was associated with limited evidence of no difference in peak vertical ground reaction force (1HQ [33] and 1MQ [49]; 0.24, -0.11 to 0.59; I2 = 0%).

Loading rates: In recreational runners, increasing running step rate by 10% was associated with no difference in average vertical loading rate (1HQ [41] and 1MQ [50]; 0.24, − 0.23 to 0.70; I2 = 0%) and vertical instantaneous loading rate (1HQ [41] and 1MQ [50]; − 0.04, − 0.50 to 0.42; I2 = 0%).

Braking impulse: In recreational runners, reducing step rate by 10% was associated with limited evidence of increased braking impulse (1HQ [30] and 1MQ [49]; − 0.73, − 1.08 to − 0.37; I2 = 0%).

Foot, Ankle, and Lower Leg

Nineteen studies [22, 26, 30,31,32,33,34,35,36, 38, 39, 41, 44, 45, 47, 49, 50, 54, 57] evaluated 81 biomechanical variables at the foot, ankle, and lower leg. All studies evaluated biomechanical differences between running with a preferred step rate and an increased step rate, while ten studies [26, 30, 31, 35, 36, 39, 44, 45, 49, 54] also evaluated biomechanical differences between running with a preferred step rate and a reduced step rate.

Kinetics: In recreational runners, increasing step rate by 10% was associated with moderate evidence of no difference in peak tibial acceleration (2HQ [31, 41] and 2MQ [44, 50]; 0.06, − 0.29 to 0.42; I2 = 8%); and limited evidence of no difference in negative ankle work (2 MQ [44, 49]; − 0.01, − 0.36 to 0.33; I2 = 0%). Increasing step rate by 5% was associated with moderate evidence of no difference in rearfoot peak pressure (2HQ; 0.18, − 0.15 to 0.51; I2 = 0%) and rearfoot contact time (2HQ; − 0.07, − 0.41 to 0.26; I2 = 0%).

In recreational runners, reducing step rate by 10% was associated with limited evidence of increased negative ankle work (2 MQ [44, 49];−  0.38, − 0.73 to − 0.03; I2 = 0%) and no difference in peak tibial acceleration (1HQ [31] and 1 MQ [44]; − 0.42, − 0.93 to 0.08; I2 = 0%). Reducing step rate by 5% was associated with moderate evidence of no difference in rearfoot peak pressure (2HQ [35, 39]; − 0.14, − 0.48 to 0.19; I2 = 0%), rearfoot max force (2HQ; − 0.14, − 0.47 to 0.19; I2 = 0%), and rearfoot contact time (2HQ [35, 39]; − 0.23, − 0.56 to 0.10; I2 = 0%).

Kinematics: In recreational runners, increasing step rate by 10% was associated with moderate evidence of reduced foot strike angle (2HQ [22, 33] and 1MQ [49]; 0.62, 0.34 to 0.09; I2 = 0%); and limited evidence of no difference in average plantar/dorsiflexion at initial contact (1HQ [34] and 1MQ [45]; 0.23, − 0.20 to 0.67; I2 = 0%). Increasing step rate by 5% was associated with limited evidence of reduced foot strike angle (1HQ [22] and 1MQ [49]; 0.39, 0.09 to 0.69; I2 = 0%).

Knee

Fourteen studies [23, 26, 29, 30, 32,33,34, 36, 38, 44, 45, 47, 49, 51, 55] evaluated 64 biomechanical variables at the knee. All studies evaluated biomechanical differences between running with a preferred step rate and an increased step rate, while seven studies [26, 30, 36, 44, 45, 49, 51] also evaluated biomechanical differences between running with a preferred step rate and a reduced step rate.

Kinetics: In recreational runners, increasing step rate by 10% was associated with moderate evidence of reduced peak knee extensor moment (2HQ [29, 33] and 1MQ [49]; 0.50, 0.18 to 0.81; I2 = 0%); and limited evidence of reduced peak patellofemoral joint stress (2HQ [29, 33]; 0.56, 0.07 to 1.05; I2 = 0%) and reduced negative knee work (2 MQ [44, 49]; 0.84, 1.20 to 0.48; I2 = 0%). In recreational runners, reducing step rate by 10% was associated with limited evidence of reduced negative knee work (2 MQ [44, 49]; 0.88, 0.52 to 1.25; I2 = 0%).

Kinematics: In recreational runners, increasing step rate by 10% was associated with strong evidence of reduced peak knee flexion angle (3HQ [29, 33, 34] and 2MQ [47, 49]; 0.66, 0.40 to 0.92; I2 = 0%); and moderate evidence of no difference in average knee flexion at initial contact (1HQ [34] and 2MQ [45, 49]; − 0.23, − 0.53 to 0.07; I2 = 0%). Increasing step rate by 5% was associated with limited evidence of no difference in average knee flexion at initial contact (2 MQ [45, 49]; − 0.19, − 0.57 to 0.18; I2 = 0%).

In recreational runners, reducing step rate by 10% was associated with limited evidence of no difference in average knee flexion at initial contact (2 MQ [45, 49]; 0.18, − 0.20 to 0.55; I2 = 0%). Reducing step rate by 5% was associated with limited evidence of no difference in average knee flexion at initial contact (2 MQ [45, 49]; 0.15, − 0.22 to 0.53; I2 = 0%).

Hip

Thirteen studies [23, 24, 26, 32,33,34, 36, 38, 41, 44, 45, 49, 51, 55] evaluated 67 biomechanical variables at the hip. Twelve studies [23, 26, 32,33,34, 36, 38, 41, 44, 45, 49, 51, 55] evaluated biomechanical differences between running with a preferred step rate and an increased step rate, while seven studies [24, 26, 36, 44, 45, 49, 51] evaluated biomechanical differences between running with a preferred step rate and a reduced step rate.

Kinetics: In recreational runners, increasing step rate by 10% was associated with limited evidence of reduced negative hip work (2 MQ [44, 49]; 0.55, 0.91 to 0.20; I2 = 0%). In recreational runners, reducing step rate by 10% was associated with limited evidence of increased negative hip work (2 MQ [44, 49]; − 0.67, − 1.02 to − 0.31; I2 = 0%).

Kinematics: In recreational runners, increasing step rate by 10% was associated with moderate evidence of reduced peak hip adduction during stance phase (2HQ [34, 41] and 1MQ [49]; 0.40, 0.11 to 0.69; I2 = 0%); and limited evidence of reduced peak hip flexion during stance phase (1HQ [34] and 1MQ [49]; 0.42, 0.10 to 0.75; I2 = 0%), no difference in average hip flexion at initial contact (1HQ [34] and 1MQ [45]; 0.14, − 0.29 to 0.57; I2 = 0%) and no difference in peak hip internal rotation during stance phase (1HQ [34] and 1MQ [49]; 0.07, − 0.25 to 0.38; I2 = 0%).

Trunk and Pelvis

Five studies [23, 24, 33, 34, 44] evaluated five biomechanical variables at the trunk and pelvis (Table 10). Four studies [23, 33, 34, 44] evaluated biomechanical differences between running with a preferred step rate and an increased step rate, while two studies [24, 44] evaluated biomechanical differences between running with a preferred step rate and a reduced step rate.

Kinetics: No data pooling was possible for any trunk or pelvis kinetic findings.

Kinematics: In recreational runners, increasing step rate by 10% was associated with moderate evidence of no difference in average trunk flexion during stance phase (2 HQ [33, 34]; 0.00, − 0.39 to 0.39; I2 = 0%).

Discussion

This systematic review summarises the literature and provides a meta-analysis to estimate the effects of changing running step rate on injury, performance and biomechanics. Findings indicate there is insufficient evidence to conclusively determine the effects of altering running step rate on injury and performance. However, a large body of biomechanical research that can guide clinical practice and future research was identified. Our meta-analysis found that increasing running step rate generally results in a reduction (or no change) in kinetic, kinematic, and loading rate variables at the ankle, knee, and hip. In contrast, reducing running step rate generally resulted in an increase (or no change) in kinetic, kinematic, and loading rate variables.

Injury

Despite coaches and clinicians commonly increasing running step rate in the management of running injuries [8], only two studies [23, 55] have evaluated the effect of this practice on clinical outcomes in injured runners. These studies indicate that increasing preferred running step rate by 7.5% (mean baseline preferred step rate: 163 per minute) [55] and 10% (mean baseline preferred step rate: 166 per minute) [23] is associated with improved pain and function in runners with patellofemoral pain at 4 weeks [23], 6 weeks [55], and 3 months [23]. Although these findings are promising, neither study used a control or comparator group, limiting the ability to evaluate efficacy. With this in mind, it is worth noting that a clinical trial, not included in this review due to using a combined running retraining strategy, found that increasing step rate by 7.5% to 10% in conjunction with other retraining strategies (instruction to run softer and adopt a non-rearfoot strike pattern if deemed necessary) did not provide additional benefits in runners with patellofemoral symptoms compared to education about symptom management and training modification [15]. Considering these findings, and those from the two case-series studies included in this review, high-quality clinical trials are required to establish the efficacy of increasing running step rate for the management of patellofemoral pain, and other common running-related injuries.

Performance

This review found insufficient evidence to determine the effect of changing running step rate on performance. Five studies focussed on surrogate measures of performance inclusive of VO2 [42, 53], RPE [49], metabolic cost [26], awkwardness [50], and effort [50]. Although findings from these studies indicated that increasing step rate may have a detrimental effect on some subjective measures of performance (e.g. RPE, effort and a feeling of awkwardness), there was no evidence to indicate a detrimental effect on physiological measures of running performance (e.g. VO2). Of note, very limited evidence from a recent cross-sectional study found that changing a runner’s preferred step rate results in an increase in metabolic energy consumption, proposed to result from large increases in positive ankle power when decreasing step rate, and large increases in positive hip power when increasing step rate [26, 51]. The studies included in this review relate to the immediate effect of changing step rate on performance, and as such the long-term effect of a change in step rate after a period of habituation remains unknown.

Biomechanics

The findings from this review provide some biomechanical rationale for increasing running step rate to reduce numerous kinetic, kinematic, and loading rate variables at the ankle, knee and hip, while also resulting in changes to spatiotemporal measures.

As expected, pooled data provide moderate evidence that increasing and decreasing running step rate by 10% results in a shorter and longer step length, respectively. Additionally, limited evidence indicated an increase in contact time when step rate is reduced by 10%. However, limited evidence indicated that a 10% increase in step rate provides no effect on contact time. Single studies (not included in meta-analysis) provide very limited evidence that contact time decreased with a 15% and 30% increase in step rate, but this was not observed with smaller increases in step rate (5% and 8%). While shorter contact time is associated with faster running speeds, the effect on performance is not known [59, 60]. Further, very limited evidence indicated a reduction in COM to heel distance with a 10% increase in step rate, which is consistent with the finding that a shorter step length is associated with an increase in step rate. Although changing running step rate has been shown to provide effects on spatiotemporal measures, any clinical benefits from these changes remain unknown as there is a lack of evidence linking spatiotemporal gait parameters to running injuries [61].

The relationship between vertical ground reaction forces and running-related injury has been extensively researched, with vertical loading rate reported to have the most consistent association with injury [62,63,64]. Pooled data from this review provide limited evidence that increasing step rate does not change peak vertical ground reaction force, average vertical loading rate, and vertical instantaneous loading rate [1, 5, 10, 11]. These findings were consistent across multiple single studies and included step rate increases from 5 to 30%. In contrast, however, a single study found that in-field gait retraining (8 sessions in 4 weeks to increase running step rate by 7.5%) in runners with high impact forces reduced average vertical load rate and vertical instantaneous load rate [40]. A possible explanation for this finding, compared to other studies, is they included a targeted population of runners with high impact loads (≥ 85 body weights/second in either limb). Limited evidence from single studies indicates an increase in vertical ground reaction force, average vertical loading rate, and vertical instantaneous loading rate with a 30% reduction in step rate [25, 54]. However, this finding was not observed with smaller reductions in step rate (5% to 15%). We found limited evidence that a reduction in braking impulse is associated with a 10% increase in step rate [30, 49]. Peak braking force is an impact variable likely to be of interest to runners as it been identified as a predictor of running-related injuries [65]. It would therefore be beneficial if further studies could confirm if braking impulse can be reduced by increasing step rate, and ideally explore if this reduces injury risk in runners.

At the foot and ankle, limited evidence indicated a reduction in negative ankle work with a reduced step rate, and moderate evidence identified a reduction in foot strike angle with an increase in step rate. This latter finding is likely to be of interest to coaches and runners as reducing foot strike angle, or converting to a non-rearfoot strike pattern, are other commonly used running retraining strategies [8]. The findings of this review indicate that increasing running step rate may be a relatively safe running retraining strategy if attempting to reduce foot strike angle, as it achieves this goal while providing an overall reduction in kinetic, kinematic and loading rate variables. All other biomechanical variables included in this review indicate no effect at the foot and ankle with a change in step rate.

The biomechanical effects observed at the knee with an increase in step rate provide rationale for potential clinical benefits of running-related knee injuries, such as patellofemoral pain. An increase in running step rate was associated with strong evidence of a reduction in peak knee flexion angle [29, 33, 34, 47, 49], moderate evidence of a reduction in patellofemoral joint stress [29, 33] and peak knee extensor moment [29, 33, 49], and limited evidence of a decrease in negative knee work [44, 49]. Two studies that reported a reduction in patellofemoral joint stress and peak knee extensor moment with an increase in step rate made these observations in runners with patellofemoral pain [29, 33]. It is biologically plausible that reducing patellofemoral joint stress and peak knee extensor moments at the site of injured tissue is likely to provide benefits in pain and function. Combined with the clinical benefits reported in case-series studies of increasing step rate in runners with patellofemoral pain, these biomechanical findings justify the need for clinical trials to establish efficacy of increasing step rate in runners with patellofemoral pain.

At the hip, moderate evidence indicated a reduction in peak hip adduction during stance phase with a 10% increase in step rate. As greater peak hip adduction during running has previously been associated with common running injuries inclusive of patellofemoral pain, ITB friction syndrome and gluteal tendinopathy [66], it could be hypothesised that increasing step rate could be clinically beneficial in the management of these injuries. Of interest, a reduction in peak hip adduction was also observed at 4 weeks and 12 weeks post gait retraining to increase running step rate by 10% [23], indicating that changes can be maintained over time. Limited evidence indicated an increase in step rate reduces both hip flexion during stance and negative hip work, with the latter finding being of particularly interest given that reducing negative hip work has been theorised to be beneficial in the management of running injuries, due to its association with improved lower limb alignment at initial contact [49].

At the trunk and pelvis, no data were able to be pooled and most findings indicate that changing running step rate does not change biomechanical variables. The exceptions were very limited evidence from single studies indicating reduced pelvic tilt immediately, and reduced contralateral pelvic drop at 4 weeks and 12 weeks post, an increase in running step rate by 10% [23].

Our review found that many biomechanical variables can be altered by instructing a runner to increase or decrease their preferred step rate, but it is difficult to determine if the biomechanical variations occur to achieve the goal of a change in step rate or are a result of a change. Therefore, the biomechanical findings of this review reflect what occurs in clinical practice, whether a mechanism or outcome, when runners are instructed to change their step rate.

Clinical Implications

Insufficient evidence exists to determine the effects of increasing running step rate on injury and performance. Therefore, the rationale for its use largely relies on the knowledge that numerous biomechanical variables can be changed with each step, as found in this review. At present, there is no evidence to guide clinicians in identifying runners most likely to benefit from an increase in running step rate. Clinicians will therefore need to determine its appropriateness based on each runner’s clinical presentation, short- and long-term running goals, and a runner’s desire to change their running gait.

It is also noteworthy that the studies included in this systematic review predominantly included recreational runners, and consideration must therefore be given to the potential differences in response among elite athletes.

If an increase in running step rate is adopted by an injured runner, any reduction in biomechanical load at the site of injury could help to reduce pain, and potentially maintain running load. Increasing step rate may only be required in the short-term, allowing for a continuation of running while the injury is rehabilitated. The runner may then be able to return to their preferred step rate once the injury is resolved. A long-term change in a runner’s preferred step rate may be warranted where a chronic running-related injury is being managed, or where the runner’s preferred step rate is considered by the clinician as being a factor for ongoing injury risk [8]. It is worth noting that multiple single studies looking at increasing step rate as a running retraining intervention found that increases in step rate were maintained across time frames from 12 to 12 weeks [23, 27, 40].

Consideration must also be given to baseline step rate before determining the appropriateness of implementing a change in step rate. Mean baseline values for step rate reported in studies within this review range from 160 [56] to 172 steps per minute [33], with an increase in reported step rate values as high as 192 steps per minute with a 15% increase [19]. It is likely that the observed effects that occur when a runner changes their step rate are likely to be dependent on each runner’s preferred step rate, which was not explored by any study included in this review.

Clinicians, coaches, and runners need to be mindful that any observed reduction in kinetic, kinematic or loading rate variables per step may be off-set by the increased number of steps taken per minute of running (up to 30% in some studies)—possibly leading to an equal or greater accumulation of loading over a set distance or time. Such consideration is important, as most running-related injuries are proposed to result from an accumulation of tissue load, rather than just the magnitude of each application of load. Of interest, one study has investigated the effects of running with a shortened step length (i.e. increased step rate) on patellofemoral kinetics with each step and over a set distance, finding that patellofemoral kinetics decreased by 15 to 20% with each step and decreased by 9 to 12% per kilometre [18]. Despite these promising findings, given the uncertainty regarding other biomechanical variables, when runners are increasing their running step rate, a transition period may be necessary to allow adaption to any new tissue loads experienced with the change in running gait.

Limitations and Future Directions

The findings of this review need to be considered in the context of five key limitations. First, there is limited research on the effects of changes in step rate on injury and performance, which are likely to be the main motivators for changing running step rate among runners, clinicians and coaches. Second, as most studies included in this review investigated the immediate effects of changes in step rate, the longer-term effects remain largely unknown. Third, participants used in most studies were healthy (i.e. uninjured) and relatively young so it remains unclear if the biomechanical and performance effects may differ among injured and / or older runners. Fourth, we excluded studies that combined interventions with changes in running step rate. Importantly, changes in step rate may be accompanied by other running retraining strategies (e.g. change in footstrike) or interventions (e.g. change in footwear) in research and practice. Therefore, our findings may only apply in cases where changing step rate is the sole intervention. Fifth, data were not able to be extracted from some studies and were not provided upon request, which may have led to the omission of potentially relevant data in our results. Finally, we recognise that the association between injury and some of the biomechanical variables included in this review have not been fully established. In consideration of these shortcomings, it would be beneficial for future studies to investigate the immediate and longer-term effects of altered running step rate on biomechanical and performance variables known to, or proposed to be, associated with injury, or actual patient-focused outcomes and running performance.

Conclusion

This systematic review highlights that increasing running step rate will, in general, either provide no change or reduce kinetic, kinematic and loading rate variables at the ankle, knee and hip—all common injury sites in runners. In contrast, no change or an increase in kinetic, kinematic and loading rate variables were generally observed when running step rate was reduced. At present there is insufficient evidence to conclusively determine the effects of altering running step rate on injury or performance. While research relating to the effect of changing running step rate on injury and performance appears to be scarce, it does suggest that increasing running step rate could be effective in reducing load through targeted tissues and therefore appropriate in certain injury presentations, such as patellofemoral pain. It also suggests that while increasing running step rate may not improve performance, if utilised as an intervention in the management of an injury, it is unlikely to have a detrimental effect on performance.

Availability of Data and Materials

All data are provided within the main manuscript and supplementary files.

Code Availability

Not applicable.

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LMA, DRB and CJB developed the initial review protocol. LMA and DRB completed the literature search. LMA and JFM were responsible for acquisition of data and can take responsibility for the integrity of the data. LMA and DRB were involved in statistical analysis and interpretation of data. DRB and JFM performed quality assessment of included studies. LMA and DRB were responsible for the preparation of the manuscript with all other authors involved in its review prior to submission for publication. The material within has not been and will not be submitted for publication elsewhere. All authors read and approved the final manuscript.

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Correspondence to Laura M. Anderson.

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Laura M. Anderson, Daniel R. Bonanno, Joel F. Martin and Christian J. Barton declare that they have no competing interests.

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Anderson, L.M., Martin, J.F., Barton, C.J. et al. What is the Effect of Changing Running Step Rate on Injury, Performance and Biomechanics? A Systematic Review and Meta-analysis. Sports Med - Open 8, 112 (2022). https://doi.org/10.1186/s40798-022-00504-0

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Keywords

  • Gait retraining
  • Running retraining
  • Step rate
  • Cadence
  • Running-related injury
  • Biomechanics
  • Performance
  • Systematic review
  • Meta-analysis