Current physiotherapy treatments for knee osteoarthritis focus on muscle strengthening and provide only small-moderate improvements in pain. Therefore, this project aimed to develop a new treatment to reduce the pain associated with knee osteoarthritis. The new treatment is designed to teach patients to reduce knee muscle co-contraction (simultaneous activation of the hamstrings and quadriceps), a muscle pattern which is associated with both structural and clinical progression of the disease.
The intervention uses EMG (electromyography) biofeedback, animated instructional videos and tailored muscle awareness procedures to teach patients to move with less co-contraction. Using these digital tools, the physiotherapist guides the patient through a gradual relearning process, in which they first learn to stand and then perform daily tasks, such as walking, with less co-contraction.
Preliminary clinical testing on 11 people has shown a mean improvement in pain of 69%. This is significantly higher than the 25% pain reductions, associated with conventional physiotherapy. We are now seeking further funding to perform a large clinical trial of this new treatment so that it can be adopted more widely across the NHS and in private physiotherapy practice.
This work is part of a larger portfolio of projects which seeks to understand the biomechanical drivers of altered muscle coordination in people with knee osteoarthritis. We want to use this understanding to develop new tools to enable physiotherapist to teach patients to improve their muscle patterns.
User testimonial: Yvonne Jackson (patient). After completing six sessions of the treatment, Yvonne, who had suffered with knee osteoarthritis for 15 years, said that the new treatment had “…eliminated almost all of her pain and enabled her to enjoy full physical activity once again….”
Funder: NIHR RfPB
Team: Dr Steve Preece, Mr Nathan Brookes (Salford Royal), Dr Chelsea Starbuck