Steve Preece, Nathan Brookes

Study seeks new way to tackle knee osteoarthritis

A ground breaking study is aiming to find a new way to help people with painful knee osteoarthritis.

About 10 per cent of people aged more than 55 have troubling knee osteoarthritis, of whom around a quarter are severely disabled.

The condition happens when cartilage around the knee joint becomes worn – as well as age, being overweight is a major risk factor. Those affected tend to walk in a way in which they over-tense the muscles of their knees. Scientists now believe that treatments that tackle this stiff gait, which increases loading on the knee, could hold the key to reducing pain.

Dr Steve Preece, Research Centre Director in the School of Health Sciences at the University of Salford is leading the research. He is working with Salford Royal Senior Physiotherapist Nathan Brookes on a project which is funded by the National Institute for Health Research (NIHR) Research for Patient Benefit programme. Together, they are working alongside physiotherapists and patients at the Northern Care Alliance NHS Group’s Salford Royal and Fairfield General, as well as Stockport NHS Foundation Trust and Manchester University NHS Foundation Trust.

Dr Preece said: “The aim of this research is to develop a novel biofeedback approach to help people with knee arthritis better manage their pain. With this technique, small sensors placed on the knee muscles are used to provide information to patients on how they are coordinating their leg movements during everyday tasks, such as walking. With this feedback, patients learn to improve their muscle control and consciously reduce muscle tension. Previous research has shown that people with knee osteoarthritis tend to over-tense the muscles at the front and back of the thigh, which we call co-contraction.  This gives them a stiff style of walking and increases the stress on the knee joint. People don’t realise they’re doing this and are amazed when they see how different their muscle coordination is from a healthy person. At present scientist are not sure why people with knee osteoarthritis over-tense their muscles. It is possibly a natural response to pain or something that may be part of the cause of osteoarthritis.

“Currently physiotherapists give these patients exercises to strengthen their muscles but we are exploring whether it would be better to find ways of helping them coordinate their muscles instead.

“During the 18 months of the study we will be gradually refining our biofeedback approach by working with 30 to 40 patients, some recently diagnosed and others with advanced osteoarthritis. We’ll ask for their feedback on whether they feel the treatments help and also consult with physiotherapists on how they view the new treatment.

“People with severe knee osteoarthritis can end up having knee replacement surgery if their mobility is severely reduced and they have a lot of pain, affecting their quality of life. This is major surgery and so, if we can improve their muscle coordination, and reduce their pain through less invasive treatments, that would be a major improvement on current practice as well as much cheaper for the NHS.”