Gait Retraining Shows Promise in Reducing Knee Pain for Osteoarthritis Sufferers

A recent study led by an engineering professor in Utah suggests that adjusting walking patterns might alleviate pain and lessen cartilage damage in individuals with knee osteoarthritis.

Osteoarthritis affects nearly one in four adults over 40 and is a significant cause of disability. This degenerative condition gradually erodes joint cartilage, and unfortunately, there aren’t existing methods to reverse this damage. Current treatments primarily focus on pain relief with medications, eventually leading to joint replacement.

Researchers from the University of Utah, along with colleagues from New York University and Stanford University, are advocating for an alternative treatment: gait retraining.

In a year-long trial, participants who modified their foot angle while walking experienced pain relief comparable to that offered by medications. Moreover, these participants showed a slower rate of cartilage deterioration compared to those receiving a placebo.

First Placebo-Controlled Evidence

The study, published in The Lancet Rheumatology and co-led by Scott Uhlrich from Utah’s John and Marcia Price College of Engineering, marks the first placebo-controlled trial demonstrating a biomechanical intervention’s effectiveness for osteoarthritis.

Uhlrich remarked, “We already know that increased pressure on the knee can worsen osteoarthritis, and adjusting foot angle can help reduce that load. But randomized, placebo-controlled studies proving their effectiveness had been lacking.”

Personalized Treatment Approaches

Supported by the National Institutes of Health and other agencies, the study focused on patients suffering from mild to moderate osteoarthritis, particularly in the inner compartment of the knee. The best way to reduce stress on this area can differ from person to person, based on their natural walking styles.

Uhlrich noted, “Many past trials offered a uniform approach to treatment, leaving some individuals without any benefits, or even worsening their condition. Our personalized technique aimed to find the best walking pattern for each participant, which likely contributed to the overall positive outcomes.”

To achieve this, researchers used motion capture technology to assess how much participants turned their feet during walking. This data helped determine the most effective adjustments for each individual’s knee stress levels.

Only those participants who could benefit from a foot angle adjustment were included in the study, addressing a limitation in previous studies that had returned ambiguous results on pain relief.

Understanding the Intervention versus Placebo

After the initial assessment, 68 participants were divided into two groups. One group experienced a sham treatment, maintaining their natural foot angle, while the other adjusted their foot angle for optimal knee stress reduction.

Both groups attended lab-based training sessions that provided biofeedback through gentle vibrations on their shins, helping them adapt to the prescribed walking style. They were encouraged to practice this new gait daily until it felt natural, with regular follow-ups ensuring adherence to the program.

After a year, participants reported their knee pain experiences and underwent follow-up MRIs to evaluate cartilage health quantitatively.

Uhlrich mentioned, “Participants in the intervention group experienced pain reduction between what you’d expect from an over-the-counter painkiller and a stronger narcotic. We also observed diminished cartilage degradation markers in their MRIs, which was quite promising.”

Notably, feedback from participants was positive. One remarked, “I love that I don’t need to rely on medication or devices anymore; this just feels like a part of how I move now.”

Potential for Long-Term Solutions

The study indicates that this method could offer sustained benefits, especially for younger individuals facing long-term osteoarthritis management before possibly needing joint replacements.

Uhlrich noted, “For those in their 30s, 40s, or 50s, this intervention could help bridge the gap in treatment options.”

However, before this intervention becomes widely accessible, the researchers aim to simplify the gait retraining process. The current motion capture setup is expensive and complex; they envision a scenario where it could be implemented during regular walks using mobile sensing technology.

“We’re developing tools that could personalize and implement this intervention in a clinical context, possibly using smartphone apps and innovative footwear,” Uhlrich said. Further studies will be critical to making this approach available to the broader public.

Reference: “Personalised gait retraining for medial compartment knee osteoarthritis: a randomised controlled trial” by Scott D Uhlrich et al., The Lancet Rheumatology, 12 August 2025.