Scientists are reporting that a simple adjustment to how people walk can relieve knee arthritis pain as effectively as prescription drugs, while also slowing the deterioration of cartilage. Nearly a quarter of people over the age of 40 experience painful osteoarthritis due to degrading joint-cushioning cartilage, and there is currently no way to reverse this damage. The only options have been to manage pain with medication or consider joint replacement.
Researchers from the University of Utah, New York University, and Stanford are demonstrating the potential for another option: gait retraining. By making a small adjustment to the angle of their foot while walking, participants in a year-long randomized control trial experienced pain relief equivalent to medication. Importantly, those participants also showed less knee cartilage degradation compared to a group that received a placebo treatment. This study, published on August 13 in The Lancet Rheumatology, is the first placebo-controlled research to show the effectiveness of a biomechanical intervention for osteoarthritis.
Scott Uhlrich, an assistant professor of mechanical engineering at Utah, explained that higher loads on the knee accelerate progression in people with osteoarthritis, and changing the foot angle can reduce knee load. However, previous studies had not been randomized or placebo-controlled to validate this approach. The researchers focused on patients with mild-to-moderate osteoarthritis in the medial compartment of the knee, which tends to bear more weight than the lateral compartment. The ideal foot angle for reducing load in the medial side of the knee differs from person to person, depending on their natural gait.
Past trials often prescribed the same intervention to all individuals, which resulted in some not reducing, or even increasing, their joint loading. The researchers used a personalized approach to select each individual’s new walking pattern, which improved how much individuals could offload their knee and likely contributed to the positive effects on pain and cartilage health.
During the study, participants received a baseline MRI and practiced walking on a pressure-sensitive treadmill while motion-capture cameras recorded their gait mechanics. This allowed researchers to determine the most effective foot angle adjustment for each participant. Half of the participants were assigned to a sham treatment group, which involved foot angles that were identical to their natural gait.
After a year, all participants self-reported their experience of knee pain and had a second MRI to assess the damage to their knee cartilage. The reported decrease in pain in the intervention group was comparable to what one might expect from over-the-counter medications. The MRIs also showed slower degradation of a marker of cartilage health in the intervention group.
Participants expressed enthusiasm for both the approach and the results, noting satisfaction with not having to rely on drugs or devices. The ability to adhere to the intervention over long periods could be a significant advantage, especially for younger individuals who may face decades of pain management before being recommended for joint replacement.
Both groups returned to the lab for six weekly training sessions, where they received biofeedback to help maintain the prescribed foot angle while walking. After the training, participants were encouraged to practice their new gait for at least 20 minutes a day until it felt natural. Check-ins showed that participants were able to maintain their prescribed foot angle closely.
Before this gait retraining can be widely adopted in clinical settings, researchers noted that the process needs to be streamlined for use in physical therapy and everyday walking. Those interested in participating in future studies can contact Scott Uhlrich’s Movement Bioengineering Lab.
Sources:
Source: Good News Network, by Good News Network