Overview of Cognitive Muscular Therapy

Current physiotherapy approaches for managing knee osteoarthritis pain focus on muscle strengthening exercises. However, there is a large amount of research showing that people with knee osteoarthritis over activate their knee muscles during daily activities. This muscle overactivity will increase the pressure on the joint, accelerate cartilage degeneration and is likely to increase knee pain. In addition, people with knee osteoarthritis often have pain-related beliefs, such as pain catastrophising, which may make their pain worse. Importantly, research now shows a link between these pain-related beliefs and muscle overactivity.

With Cognitive Muscular Therapy^TM (CMT), patients are guided through an individualised programme in which they learn to improve muscle coordination and to change the way they think about and react to pain. Muscle sensors are used to provide a visualisation of the activity of the quadriceps, and this helps patients to understand what is going in their muscles and how this could be influencing their pain. Patients begin by learning to fully relax their knee muscles and learn to become aware of how they might be bracing their knee when they feel pain or anticipate pain. The focus then shifts to postural control.

CMT views overactivity of the knee muscles within a whole-body framework of postural control. In contrast to other type of postural retraining which teach active contraction of the ‘core’ muscles, CMT specifically teaches patients to reduce low-level activity in the abdominal and neck muscles, which is often related to prolonged sitting and/or sedentary behaviours. With the CMT framework, overactivity of the knee muscles is seen as a compensation for stiffness/overactivity in the flexor system. As this stiffness reduces, there is a corresponding reduction in the overactivity in the knee muscles, and this reduces mechanical loading through the knee.

Alongside the muscular and postural focus of CMT, techniques from pyschologically informed physiotherapy are used to help patients reconceptualise their condition and to change how they think about and respond to pain. They also learn to become aware of the link between their beliefs about pain and overactivity of their knee muscles. The CMT treatment runs across seven individual one hour physiotherapy sessions and is structured following five intervention components. To facilitate learning and guide practice outside of clinical sessions, patients are given access to an online platform which includes a range of animated videos which explain concepts related to the treatment.