A new study led by researchers at Stanford University has found that personalized gait retraining may offer an effective treatment for knee osteoarthritis, a condition affecting nearly one in four adults over 40. The research, published in The Lancet Rheumatology, is the first placebo-controlled trial to show that biomechanical interventions can slow cartilage degradation and provide pain relief similar to medication.
The study focused on patients with mild-to-moderate osteoarthritis in the medial compartment of the knee. Researchers adjusted each participant’s walking pattern by prescribing a specific foot angle designed to reduce load on the affected area. This approach differed from previous studies by tailoring the intervention to each individual’s biomechanics.
“We’ve known that for people with osteoarthritis, higher loads in their knee accelerate progression, and that changing the foot angle can reduce knee load,” said Scott Uhlrich, who led the study while at Stanford and is now an assistant professor at the University of Utah. “So the idea of a biomechanical intervention is not new, but there have not been randomized, placebo-controlled studies to show that they’re effective.”
Earlier trials had used uniform interventions for all participants, which sometimes resulted in increased joint loading for some individuals. Uhlrich explained: “Previous trials prescribed the same intervention to all individuals, resulting in some individuals not reducing, or even increasing, their joint loading. We used a personalized approach to selecting each individual’s new walking pattern, which improved how much individuals could offload their knee and likely contributed to the positive effect on pain and cartilage that we saw.”
“This study not only demonstrates a promising approach to help individuals with osteoarthritis,” said Scott Delp, director of Stanford’s Wu Tsai Human Performance Alliance and James H. Clark Professor in Stanford’s School of Engineering. “It also showcases how powerful a more personalized approach can be.”
Participants underwent baseline MRI scans and walked on pressure-sensitive treadmills while motion-capture cameras recorded their gait mechanics. This process determined whether turning toes inward or outward would best reduce knee load for each person and identified if a 5- or 10-degree adjustment was optimal.
Half of the 68 participants were assigned randomly either to receive this tailored intervention or a sham treatment where no change was made from their natural gait. Both groups received six weekly training sessions using biofeedback devices before being encouraged to continue practicing daily.
After one year, participants reported changes in pain levels and underwent follow-up MRIs. According to Uhlrich: “The reported decrease in pain over the placebo group was somewhere between what you’d expect from an over-the-counter medication, like ibuprofen, and a narcotic, like OxyContin.” Delp added: “The MRIs also showed improved biomarkers of cartilage health in the intervention group. This is an exciting finding that gives hope to people with osteoarthritis.”
One participant noted satisfaction with adopting this method: “I don’t have to take a drug or wear a device … it’s just a part of my body now that will be with me for the rest of my days, so that I’m thrilled with.”
Researchers highlighted adherence as another advantage since participants maintained prescribed changes long-term through daily practice.
“Especially for people in their 30s, 40s or 50s,” Uhlrich said,“osteoarthritis could mean decades of pain management before they’re recommended for joint replacement.This intervention could help fill that large treatment gap.”
For broader clinical use,gait retraining methods must become less costly than current motion-capture-based approaches.The team hopes future technology,such as mobile sensors or smart shoes,could make personalized prescriptions feasible outside specialized labs.Uhlrich stated:“We and others have developed technology that could be used to both personalize and deliver this intervention in a clinical setting using mobile sensors like smartphone video and a ‘smart shoe.’ Future studies of this approach are needed before the intervention can be made widely available to the public.”
Other contributors included Amy Silder (former associate director,HPL),Andrea Finlay (Ladd Lab statistician),Feliks Kogan (assistant professor,research,radiology),Garry Gold (professor,radiology) at Stanford,and Gary S.Beaupre(Palo Alto VA).Funding came from agencies such as National Science Foundation,the United States Department of Veterans Affairs Rehabilitation Research Service,and National Institutes of Health.
