Gait Retraining for Patellofemoral Pain in Runners: An Umbrella Review of Clinical and Biomechanical Evidence.

Background

Gait retraining has been proposed as a strategy to modify running biomechanics and reduce symptoms in runners with patellofemoral pain (PFP). However, review-level evidence remains heterogeneous regarding clinical effects, biomechanical mechanisms, and preventive applicability.

Objectives

To critically evaluate the methodological quality and synthesise review-level evidence on gait retraining for the management of patellofemoral pain (PFP) in runners while secondarily summarising preventive findings when available.

Methods

Umbrella review conducted in accordance with Joanna Briggs Institute guidelines and reported according to PRISMA 2020. PubMed/MEDLINE and Scopus were searched from inception to March 2026, complemented by manual searches. Systematic reviews (with or without meta-analysis) and structured narrative reviews investigating gait retraining in runners were included. Clinical conclusions were prioritised from reviews focused on symptomatic runners with patellofemoral pain, whereas broader biomechanical or preventive evidence was interpreted contextually. Methodological quality was assessed using AMSTAR-2 for systematic reviews and SANRA for narrative reviews.

Results

Eight reviews were included: five systematic reviews and three narrative or mixed-methods reviews. AMSTAR-2 rated four systematic reviews as high quality and one as low quality, while SANRA rated two narrative or mixed-methods as high quality and one as good quality. Gait retraining strategies primarily involved increasing cadence by 5-10%, reducing vertical impact through soft-landing cues, modifying foot-strike pattern, and auditory or visual biofeedback, usually delivered progressively with gradual feedback withdrawal. The most consistent findings related to short-term improvements in pain and function and reductions in selected loading-related biomechanical variables, particularly with cadence-based and soft-landing strategies. Findings for injury prevention, foot-strike modification, and longer-term outcomes were less consistent.

Conclusions

Gait retraining may be a feasible adjunctive intervention for runners with patellofemoral pain, particularly when focused on modest cadence increases and/or softer-landing cues within supervised, progressively faded-feedback protocols. However, heterogeneity across protocols and the predominance of short-term outcomes limit stronger conclusions. Preventive effects remain uncertain, and high-quality controlled longitudinal studies are needed to clarify long-term clinical relevance and identify runners most likely to benefit.

Registration

PROSPERO (CRD420251145069).