Reduce The Need For Knee Surgery With One Small Change

Walking is great! Except when it’s not.

Which in many cases, as you’ll have gathered from the title today, is about one’s knees.

See for example: Why 10,000 Steps Might Be Making Your Pain Worse (+ What To Do Instead)

That’s not to say that there aren’t solutions, and often the problem with our knees is not, in fact, a problem with our knees:

• Do This Before Walking To Suffer Less (It Takes 30 Seconds) ← when what feels like a problem in your knees is actually a lack of glute activation
• How To Make Downhill Walking Easier On The Knees ← famously more of a challenge than going uphill, in the case of dubious knees
• The Best Exercise to Stop Your Legs From Giving Out ← this one’s good if, like this writer, you have strong legs and/but also EDS or a similar connective tissue disorder that causes your joints to sometimes just fold like laundry for no obvious reason (it’s about the body’s misguided attempt to save you from something that’s not actually a problem but a tendon got confused so the muscle just dropped it)

But, what about walking and actual knee problems?

The small adjustment that makes a big difference

Researchers (Dr. Valentina Mazzoli et al.) did a randomized, placebo-controlled trial on gait retraining in patients with mild-to-moderate knee osteoarthritis.

How it worked: participants practiced walking with a slightly adjusted foot angle (toe in or out by 5–10°), tailored individually using motion capture and pressure-sensitive treadmills to reduce knee load. This wasn’t just “point and go”, however; to ensure proper use of the angle instructed, there were 6 weekly lab sessions with biofeedback (shin vibrations) to teach participants to maintain their new gait, followed by daily practice of at least 20 minutes.

How they did placebo: half of the participants were unknowingly given sham angles identical to their natural gait, controlling for placebo effects.

And the results: after one year, intervention participants reported pain relief similar to over-the-counter drugs and even some narcotics, plus slower cartilage deterioration* on MRI compared to the placebo group. And in case you’re wondering: yes, participants maintained their adjusted gait accurately (within 1° on average) upon testing after a year, and expressed enthusiasm since it required no devices or drugs.

*This is critical, and is what we were talking about in the title, as cartilage deterioration is the main driver of the need for knee surgery.

You can find the paper itself, here: Personalised gait retraining for medial compartment knee osteoarthritis: a randomised controlled trial

You may be thinking: that’s great, but how am I supposed to do that?

• In the medium-term, the researchers hope to streamline gait assessment and training with cheaper tools like smartphone video or wearables, for maximum accessibility.
• In the short-term, getting advice from a local physical therapist is recommended, as they may be able to identify the adjustments that would be best for you.

In a similar vein, small adjustments to squats can make them much more doable; see: Squat Variations for Painful Knees (No More Pain!)

Want to learn more?

We recommend:

52 Ways to Walk: The Surprising Science Of Walking For Wellness & Joy, One Week At A Time – by Annabel Streets

Enjoy!