The Intervention components

Cognitive Muscular TherapyTM 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:

Making sense of 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 and movement initiation: 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. Using guided movement, the patient is taught to initiate movements without triggering inappropriate muscular activity.

Functional muscle retraining: Muscle biofeedback software is used to visualise knee muscle activation during walking. This software contrasts the patient’s muscle patterns with those collected from a healthy group. The biofeedback software is then used to teach the patient to reduce muscle overactivity and improve muscle coordination during walking.