The Intervention components

Cognitive Muscular Therapy^TM is delivered through five sequential intervention components, each of which is supported through the use of animated instructional videos. A brief description of each components 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 and psychosocial factors can shape the pain experience.

General relaxation: Patients are taught to become aware of inappropriate contraction of the quadriceps muscles and to learn a relaxed diaphragmatic breathing by minimising low-level contraction of the abdominal muscles. This component initiates the process of muscular re-education.

Postural deconstruction: A set of clinical procedures are used which enable the physiotherapist to unpick (deconstruct) patterns of postural muscle activity and associated patterns of hip/trunk muscle stiffness. Working through the procedures, the patient is provided with experiential learning of how to stand with reduced postural muscle activity and more relaxed 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. With improved awareness the patients learns to reduce inappropriate contraction.

Functional integration: The focus of this final componeent 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 walking, ascending/descending stairs and standing up from a chair