A study found that retraining people to change their gait, adjusting their foot angle, provided as much pain relief for osteoarthritis as medication. The discovery can delay knee surgery for years according to the researchers from the Univ. of Utah.
Osteoarthritis is a degenerative joint disease that impacts almost a quarter of adults and is the leading cause of disability globally. The cartilage that cushions joints degenerates, causing pain, stiffness and lowered mobility. It’s irreversible, and the treatment is limited to pain management with meds and eventual joint replacement.
“We have known that for people with osteoarthritis, higher loads in their knee accelerate progression and that changing the foot angle can reduce knee load,” Scott Uhlrich, an author of the study, said. “So the idea of a biomechanical intervention is not new but there have not been randomised, placebo-controlled studies to show that they’re effective.”
Biomechanical means the way we move. It put it in layman’s terms, taking pressure off the knee joint and learning to redistribute weight helps people with osteoarthritis. However, while that is logical, no study had proved that before this one.
Every person’s gait is different. That means the stress that has worn on their knees has been different.
Using MRI and motion-capture cameras while people walked on treadmills, the scientists saw how the people walked to help them adjust it by turning their toe in or out by five or 10 degrees. Those changes could make a big difference. People were trained with devices that vibrated on their shins when they misstepped. They trained 20 minutes daily until it became natural.
A year later, MRI scans showed people who had received training had less cartilage degeneration than people in a control group. And they reported pain reductions that were better than taking an OTC painkiller and not quite as good as a narcotic. Knowing the dangers of narcotics, avoiding them and getting “better than ibuprofen” would possibly satisfy many patients.
Dr. Uhlrich said that the new approach could be a game-changer for people in their 30’s, 40’s and 50’s who live with osteoarthritis for decades before they need surgery. “This intervention could help fill that large treatment gap.”
The researchers are working to streamline their gait retraining method so it can become a clinical treatment. They are working with others to develop tech, like smart shoes, that interact with smartphones to help people in the real world.
However, Dr. David Kruse of Cedars-Sinai, who did not work on the project, urges us to keep our expectations. He first pointed out how complex and individualized our gaits are. “An individual’s gait, or walking pattern, is influenced by a unique chain of complex musculoskeletal structures. Understanding and examining normal gait patterns can be challenging. Consequently, making biomechanical changes to a person’s gait pattern can be very difficult.”
He also has doubts about the ease of retraining people, “The analysis and retraining require specialized insight and expensive equipment. Therefore, modifying gait patterns is not a simple process.”
