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

Preece, SJ; Jones, R; Brown, CA; Cacciatore, TW; Jones, AKP

Abstract

Background
Both increased knee muscle co-contraction and alterations in central pain processing
have been suggested to play a role in knee osteoarthritis pain. However, current
interventions do not target either of these mechanisms. The Alexander Technique
provides neuromuscular re-education and may also influence anticipation of pain. This
study therefore sought to investigate the potential clinical effectiveness of the AT
intervention in the management of knee osteoarthritis and also to identify a possible
mechanism of action.
Methods
A cohort of 21 participants with confirmed knee osteoarthritis were given 20 lessons of
instruction in the Alexander Technique. In addition to clinical outcomes EMG data,
quantifying knee muscle co-contraction and EEG data, characterising brain activity
during anticipation of pain, were collected. All data were compared between baseline
and post-intervention time points with a further 15-month clinical follow up. In addition,
biomechanical data were collected from a healthy control group and compared with the
data from the osteoarthritis subjects.
Results:
Following AT instruction the mean WOMAC pain score reduced by 56% from 9.6 to 4.2
(P<0.01) and this reduction was maintained at 15 month follow up. There was a clear
decrease in medial co-contraction at the end of the intervention, towards the levels
observed in the healthy control group, both during a pre-contact phase of gait (p<0.05)
and during early stance (p<0.01). However, no changes in pain-anticipatory brain
activity were observed. Interestingly, decreases in WOMAC pain were associated with
reductions in medial co-contraction during the pre-contact phase of gait.
Conclusions:
This is the first study to investigate the potential effectiveness of an intervention aimed
at increasing awareness of muscle behaviour in the clinical management of knee
osteoarthritis. These data suggest a complex relationship between muscle contraction,
joint loading and pain and support the idea that excessive muscle co-contraction may
be a maladaptive response in this patient group. Furthermore, these data provide
evidence that, if the activation of certain muscles can be reduced during gait, this may
lead to positive long-term clinical outcomes. This finding challenges clinical
management models of knee osteoarthritis which focus primarily on muscle
strengthening.

Citation

Preece, S., Jones, R., Brown, C., Cacciatore, T., & Jones, A. (2016). Reductions in co-contraction following neuromuscular re-education in people with knee osteoarthritis. BMC Musculoskeletal Disorders, 17(372), https://doi.org/10.1186/s12891-016-1209-2

• Journal Article Type: Article
• Acceptance Date: Aug 10, 2016
• Publication Date: Aug 27, 2016
• Deposit Date: Sep 1, 2016
• Publicly Available Date: Sep 1, 2016
• Journal: BMC Musculoskeletal Disorders
• Publisher: Springer Verlag
• Volume: 17
• Issue: 372
• DOI: https://doi.org/10.1186/s12891-016-1209-2
• Publisher URL: http://dx.doi.org/10.1186/s12891-016-1209-2