Walking retraining reduces pain and slows down knee damage in osteoarthritis

A quarter of people over the age of 40 experience painful osteoarthritis, a major cause of disabilities in adults. Osteoarthritis breaks down the cartilage cartilage in the joint. Currently there is no way to reverse this damage. The only option is to manage your pain with medication and ultimately manage your joint replacement.

Researchers at the University of Utah, New York University and Stanford University are now showing the possibility of another option: Gait Retrain.

By adjusting the angle of the foot during walking, participants in the 1-year randomized controlled trial experienced medication-equivalent pain relief. Seriously, these participants also showed less degradation of knee cartilage over that period compared to the placebo-treated group.

These findings published in Lancet Rheumatology and co-led by John and Scott Ulrich of Mercia Price Engineering in Utah, come from the first placebo-controlled study demonstrating the effectiveness of biomechanical interventions in lytic arthritis.

We know that People with osteoarthritishigher load on the knees will promote progression and changing the angle of the foot can reduce the load on the knees. Therefore, although the ideas of biomechanical interventions are not new, there are no randomized, placebo-controlled studies to demonstrate that they are effective. ”

Scott Ulrich, assistant professor of mechanical engineering at the University of Utah

A personalized approach to walking retraining

With support from the National Institutes of Health and other federal agencies, researchers specifically looked at patients with mild to moderate osteoarthritis in the medial medial content of the legs. Osteoarthritis of this form is most common, but the ideal foot angle to reduce the internal knee load will vary from person to person, depending on the changes that occur when adopting natural walking and new walking patterns.

“Previous trials stipulated the same intervention for all individuals, so some individuals did not reduce or increase joint loads,” Uhlrich said. “We used a personalized approach to select individual new walking patterns, which could have improved the amount of knees that an individual could turn off, which could have contributed to the positive effects on the pain and cartilage they saw.”

During the first two visits, participants received a baseline MRI and practiced walking on a pressure sensitive treadmill, while the motion capture camera recorded the walking mechanism. This allowed researchers to determine whether turning the patient's toes inward or outward increases the load and whether a 5- or 10-degree adjustment would be ideal.

This personalized analysis selected potential participants who were unable to benefit from intervention when foot angle changes were unable to reduce knee load. These participants were included in previous studies, but may have contributed to the conclusive pain outcomes of these studies.

Promising results, but more clinical trials are needed to improve the process

Furthermore, after the initial intake session, half of the 68 participants were assigned to the sham treatment group to control for placebo effects. These participants were actually prescribed foot angles identical to natural walking. Conversely, participants in the intervention group were prescribed changes in foot angles with maximum knee load.

Participants from both groups returned to the lab for six weekly training sessions. There, it helped me maintain the prescribed foot angle while walking on the lab treadmill. After a six-week training period, participants were encouraged to practice new walking for at least 20 minutes per day. Regular check-in visits showed participants on average adherence to prescribed foot angles within their magnitude.

One year later, all participants self-reported their experiences of knee pain and had a second MRI to quantitatively assess knee cartilage damage.

“The reports of pain in the placebo group have been reported somewhere in over-the-counter drugs like ibuprofen and narcotics like OxyContin,” Uhlrich said. “We also saw slow deterioration of markers of cartilage health in the intervention group, which was very exciting.”

Beyond quantitative measures of effectiveness, participants in this study expressed enthusiasm for both the approach and the outcome. One participant said, “I don't have to take my medicine or wear a device. It's just a part of my body, so I'm excited to be with me for the rest of the day.”

Participants' ability to adhere to interventions over a long period of time is one of their potential benefits.

“For people in their 30s, 40s, or 50s, osteoarthritis can mean decades of pain management before it is recommended for joint replacement,” Uhrlich said. “This intervention will help fill that big treatment gap.”

The gait retraining process must be streamlined before this intervention can be deployed clinically. The motion capture technique used to create the original foot angle formula is expensive and time-consuming. Researchers expect the intervention to be ultimately prescribed at a physical therapy clinic, and retraining can occur while people go for walks around the neighborhood.

“We and others have developed technologies that can be used to personalize and deliver this intervention in a clinical setting using mobile sensors such as smartphone video and 'smart shoes',” Uhlrich says. Future research on this approach is necessary before making interventions widely available to the public.