There’s been a lot of noise recently about gait modification as a way of reducing pain and delaying the need for knee surgery. So what is gait modification and is it a realistic option? YKC’s Jim Newman takes a look.

“A small adjustment to one’s walking style can ease osteoarthritis pain as effectively as medication and delay the need for knee surgery by years, according to a new study.” That was the quote from the Independent recently which echoed lots of other publications which picked up on the study by the University of Utah.

The theory is sound. For most people, the knee first starts to wear on the inner side of the joint. That’s why partial knee resurfacing (replacing just the worn part rather than the entire knee) has become so commonplace.

The gradual wearing changes the way you walk – patients often start to develop bow legs as they try to shift the pain and pressure from the worn part of the knee.

If, however, you can change the alignment, you can alleviate the wear and its symptoms. We explored a similar issue a couple of years ago with shoes that helped to spread the load a little more evenly and alleviate osteoarthritis pain.

The idea of altering the gait (that is, the way you walk) to take the weight off worn parts of the knee also makes sense. While its benefit would be limited in patients with well-established osteoarthritis, it makes sense for mild sufferers.

Managing knee pain in practice

At least, it would make sense if practical reality didn’t throw up real issues. The study notes the effect of gait modification after training. It also stresses that training plans are individualised. To change the way someone walks takes time and repetition. That would require resource, something the NHS doesn’t have.

The attention an NHS physio can give any patient is, at best, minimal. So the alternative is a physio class (which, by definition, is hard to individualise). Or a leaflet with exercises to do yourself at home.

I would suggest that, if a patient with osteoarthritis had an individualised plan delivered by a physiotherapist using current techniques, they too would notice an improvement in pain and function.

In fact, we know this to be the case – physiotherapy is commonly recommended as a non-surgical way of alleviating osteoarthritis pain and delaying surgery.

So, while the theory behind gait modification may be sound, I’d suggest delivering the personalised, intensive service that it would require isn’t going to be realistic for most patients, or pretty much any NHS trust.