The Intervention components
Cognitive Muscular TherapyTM is delivered through five intervention components, each of which is supported through the use of animated instructional videos. A brief description of each component is provided below:
Understanding knee pain: This component focuses on patient education, challenging the idea that knee osteoarthritis pain is the inevitable result of ‘wear and tear’. Patients are introduced to the concept that muscle overactivity can increase pain, and that brain processing, beliefs about osteoarthritis and psychosocial factors can shape the pain experience. Through this learning, patients learn to reconceptualise their condition.
General relaxation: Patients are taught to become aware of the feeling of contracting and relaxing their quadriceps muscles in lying, sitting and supported standing. They also learn to use diaphragmatic breathing to reduce low-level contraction of the abdominal muscles. This component initiates the process of muscular re-education.
Postural deconstruction: Patients are taught about the idea of a ‘tug-of-war’ between the flexor system and the extensor system. They also learn to appreciate that overactivity of the knee muscles can be a biomechanical compensation for increased activity and/or stiffness in the flexor system. A set of clinical procedures are used which enable the physiotherapist to unpick (deconstruct) interconnected patterns of postural muscle activity across the abdominal, neck, back, shoulder, hip and knee muscles. As this progresses, the patient is provided with experiential learning of how to stand with reduced postural muscle activity and to full relax their knee muscles.
Contextual triggers: This component aims to raise awareness of inappropriate muscular contraction which can be triggered by pain expectations, or which has been conditioned/associated with specific contexts or activities. For example, patients with knee osteoarthritis often tense their knee muscles as they initiate stair ascent/descent because they associate these activities with pain. As their awareness improves, patients learn to initiate functional tasks with less inappropriate muscular contraction.
Functional integration: The focus of this final component is to take learning from the previous four components and to put it into practice during activities which the patient identifies as causing pain. This includes activities such as walking, ascending/descending stairs, standing up from a chair and performing household tasks. The patient is then guided to create an action plan to ensure they continue to embed new habits into daily life and can manage any future pain flare ups.