Trial reportBMC musculoskeletal disorders2016
Reductions in co-contraction following neuromuscular re-education in people with knee osteoarthritis.
Trial report in BMC musculoskeletal disorders, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it, 285 citations in OpenAlex.
- Pooled it
- Cognitive muscular therapy™ for knee osteoarthritis: A feasibility randomised controlled trial.Osteoarthritis and cartilage open · 2026Trial
- Comparison between movement pattern training and strengthening on muscle volume, muscle fat, and strength in patients with hip-related groin pain: An exploratory analysis.Journal of orthopaedic research : official publication of the Orthopaedic Research Society · 2022Trial
- Self-efficacy and embodiment associated with Alexander Technique lessons or with acupuncture sessions: A longitudinal qualitative sub-study within the ATLAS trial.Complementary therapies in clinical practice · 2018Trial
- Effects of Massage on Pain, Muscle Co-Contraction, and Knee Loading in Medial Knee Osteoarthritis: A Randomized Controlled Trial Protocol.Journal of pain research · 2026Article
- Interpretable Machine Learning on Simulation-Derived Biomechanical Features for Hamstrings-Quadriceps Imbalance Detection in Running.Sports (Basel, Switzerland) · 2025Article
- Article
- Relationship between Fear-Avoidance Beliefs and Muscle Co-Contraction in People with Knee Osteoarthritis.Sensors (Basel, Switzerland) · 2024Article
- An assessment of co-contraction in reinnervated muscle.Regenerative medicine · 2024Article
- Understanding muscle coordination during gait based on muscle synergy and its association with symptoms in patients with knee osteoarthritis.Clinical rheumatology · 2024Article
- Central mechanisms of muscle tone regulation: implications for pain and performance.Frontiers in neuroscience · 2024Article
- Altered coordination strategies during upright stance and gait in teachers of the Alexander Technique.Frontiers in aging · 2023Article
- Muscle activation patterns around knee following neuromuscular training in patients with knee osteoarthritis: secondary analysis of a randomized clinical trial.Archives of physiotherapy · 2022Article
- Muscle Co-Contraction Detection in the Time-Frequency Domain.Sensors (Basel, Switzerland) · 2022Article
- A new integrated behavioural intervention for knee osteoarthritis: development and pilot study.BMC musculoskeletal disorders · 2021Review
- Alexander Technique vs. Targeted Exercise for Neck Pain-A Preliminary Comparison.Applied sciences (Basel, Switzerland) · 2021Article
- Effects of age and knee osteoarthritis on the modular control of walking: A pilot study.PloS one · 2021Article
- Lighten Up! Postural Instructions Affect Static and Dynamic Balance in Healthy Older Adults.Innovation in aging · 2020Article
- Changes in Muscle Activity Patterns and Joint Kinematics During Gait in Hemophilic Arthropathy.Frontiers in physiology · 2019Article
- Training with Hybrid Assistive Limb for walking function after total knee arthroplasty.Journal of orthopaedic surgery and research · 2018Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundBoth 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.
methodsA 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.
resultsFollowing 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.
conclusionsThis 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.
trial registrationISRCTN74086288 , 4th January 2016, retrospectively registered.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.