Background to 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 into chronic musculoskeletal pain suggests a link between such negative pain-related beliefs and muscle overactivity.
The aim of Cognitive Muscular Therapy (CMT) is to raise awareness of the muscular control of posture and movement and to reduce muscle overactivity. It is based on a theoretical framework in which knee muscle overactivity is viewed as a biomechanical compensation for increased passive stiffness (or muscle shortening) in the hip/trunk muscles. This can result from sedentary behaviours. The framework also integrates the idea that pain-related beliefs will shape the pain experience and may influence muscle overactivity. Through a set of five sequential components, 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.
CMT is a new type of psychologically informed physiotherapy. While psychological techniques are becoming part of standard practice, CMT is novel because it uses biofeedback to raise consciousness of muscle overactivity related to pain expectations. CMT is also novel because of the holistic framework in which overactivity of the knee muscles is linked to alterations in postural muscle activity. While there are some parallels between CMT and muscle imbalance physiotherapy, CMT does not incorporate any muscle strengthening. Instead, patients are provided with experiential learning of how to stand and move with less muscle overactivity and to integrate these new motor patterns into everyday life.