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The treatment is called Cognitive Muscular Therapy and was developed with the support of patient experience groups and colleagues at the �������� at �������� Royal. NHS physiotherapists at 6-10 different trusts will be trained to deliver the treatment and together will treat 126 patients, while a further 126 patients will be in a control group. The research team will then follow all patients for one year to understand whether treatment can bring about long-term reductions in knee pain and disability.

Cognitive Muscular Therapy™ (CMT) is a completely new physiotherapy treatment for knee osteoarthritis. In contrast to existing physiotherapy which aims to strengthen muscles, CMT teaches patients to stand and move with less overactivity of the knee muscles. This is important because overactivity of the knee muscles leads to increased pressure on the joint and increased pain. With CMT, overactivity of the knee muscles is seen to result from either pain-related bracing or viewed as a compensatory pattern for abnormal postural control. Therefore, CMT integrates psychological principles to enable patients to recognise and change habitual responses to pain and to reduce inappropriate bracing of the knee muscles.

It also incorporates postural retraining, with a specific aim of reducing tension in the neck, back, stomach and hip muscles. Once postural control improves then overactivity of the knee muscles reduces. To aid muscle retraining, CMT incorporates EMG biofeedback. This uses small sensors on the knee muscles to allow patients to see, on a screen, when the muscles are tense or relaxed.

CMT is delivered through five sequential components, which guide people through a learning journey. As they progress through the treatment, patients learn to think differently about their condition and learn to change habitual responses to pain and by integrating new patterns of muscle coordination into everyday activities, patients learn the skills to self-manage their condition.

The trial started in November, and the first group of physiotherapists have begun training. If all goes to plan the treatments will begin in May. The �������� team for this study included Jen Parker (trial manager), Nathan Brookes (lead physiotherapist) and Rebecca Wright (intervention coordinator).

Steve said of the trial, “We are incredibly excited to have NIHR funding to run a large trial to investigate if CMT should be offered on the NHS.

“Although the physiotherapists are really enthusiastic about the study, there is a lot for them to learn because CMT is very different from current physiotherapy practice.

“Nevertheless, they are doing well, and we hope that the first patients will begin treatment around May this year. If all goes to plan, the last patient will finish treatment in October 2026. We will then follow the patients for one year with the final paper published in November 2027.

“If we see the same level of pain reduction in this trial that we have seen before, then this could revolutionise the way that knee osteoarthritis is managed on the NHS!”

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