Gait Retraining for Knee Osteoarthritis

Introduction to gait retraining for knee osteoarthritis

Gait retraining is a form of physical therapy that is used to address improper running mechanics that may be the cause of pain and/or injuries. A recent study found that gait retraining can help relieve knee osteoarthritis pain without surgery or drugs _1,2. These findings are significant because they highlight a low-cost non-invasive approach that can directly improve quality of life for patients with knee osteoarthritis.

Recent research from our group at Rothman Orthopaedics analyzed more than 3,500 patients with either knee or back pain using a smartphone-based gait analysis tool. This large-scale study currently under peer review has provided one of the clearest demonstrations that how people walk is directly linked to how much pain they feel.

Understanding the simple changes in how patients walk, such as improving walking speed or restoring step length, can reduce pain, as well as underscores the functional importance of gait (a clinical “vital sign”). Using data from observing and recording gait patterns can help draw conclusions to create easily implemented, low-risk intervention strategies, that can be an immediate first line treatment option for a wide variety of patients.

How does gait affect knee osteoarthritis symptoms, and why might gait retraining reduce pain?

Walking speed is one of the clearest indicators of symptom severity, i.e. patients who walk slower tend to report more pain. In knee osteoarthritis, people often shorten their step length or reduce cadence (step rate) to protect the affected joint, but these compensations can sometimes worsen pain. By retraining gait to encourage more efficient movement patterns, patients can reduce joint loading and potentially experience less discomfort.

What kinds of gait retraining strategies or exercises are typically used to help patients with arthritic knee pain?

Common gait retraining strategies include exercises to improve walking speed, controlled step length adjustments, and strength or balance training that encourages even weight distribution. Technology, such as smartphone-based gait monitoring and footwear that allows gait retraining, can guide patients and clinicians in tailoring these strategies. Strategies aimed at improving balance and proprioception, aka the mind-body-connection, can lead to improvements in gait resulting in reduced pain.

How realistic is it for doctors to integrate gait retraining into their standard treatment plans for patients with knee osteoarthritis? And how can this help doctors treat patients with arthritic knee pain?

Technological advancements with AI and smartphone can allow physicians to conduct quick, objective gait assessments in both clinic and home settings. For physicians, having access to gait metrics such as walking speed or step length provides a functional measure in possible reduced pain severity and progress over time. This can help tailor care plans more precisely and offer patients a sense of measurable improvement.

What are the potential benefits of recommending gait retraining compared to relying solely on medication or surgery?

Gait retraining addresses the mechanics of movement directly, helping to reduce pain without side effects from medication or the risks of surgery. Improving parameters like velocity or cadence can empower patients to play an active role in their recovery, and in some cases may delay the need for surgical intervention.

Are there any limitations or challenges that physicians should be aware of before suggesting gait retraining?

When a physician is considering recommending gait retraining, they should be aware that patients may struggle with consistency, especially if progress is gradual, and that not all patients have access to guided retraining or digital tools. Nonetheless, evidence shows that even modest gains in metrics such as walking speed can correlate with meaningful reductions in pain, which can encourage adherence when tracked over time. Patients with balance issues that may be prone to falls should be carefully considered when it comes to the risks and benefits of gait retraining.

What should doctors or patients know about using gait retraining as part of knee osteoarthritis care?

Gait retraining should be viewed as part of a broader care plan, complementing physical therapy, lifestyle changes, and when needed, medical or surgical interventions. Tracking gait velocity, step length, cadence, and single limb support provides doctors with objective measures of how pain is affecting function. For patients, seeing improvements in these metrics over time can reinforce progress and engagement. Additional upcoming data continues to support the idea that gait is both a marker and a modifiable factor in musculoskeletal pain care. To schedule a consultation at Rothman Orthopaedics, visit our appointments page today.

This article was co-written by Stephen A. Stache,  Jr., MD, FAMSSM and Gabriel Furey BA, Non-Operative Sports Medicine Research Coordinator at Rothman Orthopaedics.

References

1. Smith JA, Stabbert H, Bagwell JJ, Teng HL, Wade V, Lee SP. Do people with low back pain walk differently? A systematic review and meta-analysis. J Sport Health Sci. 2022;11(4):450–65.
2. Elbaz A, Mor A, Segal G, Debi R, Shazar N, Herman A. Novel classification of knee osteoarthritis severity based on spatiotemporal gait analysis. Osteoarthritis Cartilage. 2014;22(3):457–63.