Reductions in co-contraction following neuromuscular re-education in people with knee osteoarthritis

BMC Musculoskeletal Disorders 2016;17:372.

Preece SJ, Jones RK, Brown CA, Cacciatore TW, Jones AKP.

BRIEF SUMMARY

Background: Knee osteoarthritis is a common condition affecting more than one in ten people in the UK, and causing considerable pain and disability. It has become clear that people with this condition have an abnormal pattern of leg muscle function when walking and moving in general. Instead of the normal pattern in which one set of leg muscles relaxes as another set contracts, in people with knee osteoarthritis, opposing sets of muscles contract at the same time and this puts a lot of stress on the joint. 

Aims: The aims of the study were to find out whether learning the Alexander Technique could help reduce the pain and disability associated with knee osteoarthritis, and whether a more normal pattern of leg muscle function could be restored. 

Methods: 21 people with diagnosed osteoarthritis in their knees were recruited to the study and attended 20 one-to-one Alexander lessons with a STAT-registered teacher. Knee pain, as well as stiffness and functioning, were assessed by the well-established self-report measure called WOMAC. The researchers also studied the pattern of leg muscle activation in these 21 individuals and compared this with a control group of healthy individuals of similar age and weight.

Results: On average, knee pain decreased by half (56% reduction) following the lessons, and this benefit was maintained longer term, as shown at the 15 month follow-up. A similar reduction was observed in the overall score of pain, stiffness and functioning. An interesting additional observation was that most people who were taking painkillers at the beginning of the study, were able to stop or reduce this following the Alexander lessons (10 out of the 15 taking painkillers at the start). The study also showed an abnormal pattern of leg muscle function, in which both sets of muscles contracted at the same time when these individuals began to walk. This abnormal pattern improved following the Alexander lessons, and became more similar to the pattern seen in the healthy control group. Furthermore, greater improvements in the pattern of muscle function were found to be associated with larger reductions in pain. Interestingly, leg muscle strength did not change as a result of the lessons, instead the improvement was associated with a reduction in excessive muscle activation.

Conclusions: The study demonstrates the potential of Alexander lessons to enable people with knee osteoarthritis to reduce inappropriate muscle activation and therefore reduce their pain and disability. These results need to be followed up with a larger, controlled clinical trial but suggest that Alexander lessons may be an appropriate alternative approach for knee osteoarthritis to the usual one of muscle strengthening exercises.

I have been doing the Alexander Technique for ~2 years now... and am a lighter and faster runner than I was 10 years ago!

Jason Pufahl, Chief Information Security Officer

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