One of the major risk factors for getting or worsening osteoarthritis in the knee is overloading the joint. Doctors may recommend weight loss or shoe inserts. Some even may suggest a surgical joint realignment called high tibial osteotomy. But now researchers at Stanford University and elsewhere are taking another tack: They’re teaching patients to move differently.

This approach is being studied in people with medial, or inner, compartment OA, which is 10 times more common than other forms of knee OA.

“The medial knee compartment bears a much higher load than the lateral [outside] compartment,” says Pete Shull, PhD, a post-doctoral researcher in the Bioengineering Department at Stanford. “That’s just the way our bodies are structured. The inside knee compartment sees loading [or force] that’s two to three times higher than the outside."

So researchers have set out to find ways to shift some of the medial compartment’s load to the lateral one. “The lateral compartment almost always has healthy cartilage,” says Shull. “The compartments are like brake pads on a bike, unevenly worn. So by changing the way someone walks, we can get the cartilage in the compartments to wear more evenly.”

In a 2011 study published in the Journal of Biomechanics, Shull and his colleagues retrained nine healthy people without osteoarthritis to shift their gait.

First, they had the participants walk on a treadmill equipped to measure the forces on the knee, a technology unavailable just five years ago.Then they asked the participants to walk again on the treadmill using something called haptic, or touch, feedback. The researchers placed small motor devices on the back of the participants’ legs and backs, then instructed them to walk differently, perhaps with their toes slightly in or out, or by shifting their upper body toward to aching knee.

“Whenever they took a step, they felt a buzz, like someone pressing on their back or legs,” explains Shull. “When they felt the buzz, they knew they were supposed to move in that direction.”

With the feedback, people walked in a new way within three to four minutes, as long as they still had the buzzes to remind them when they swerved back to their old style. And the pressure on the medial compartment lessened by 20 percent. Foot orthotics, or wedges, reduce knee pressure by 5 to 10 percent, and a knee brace by only 10 to 15 percent.

Participants repeated lab training for four weeks, once weekly. And they kept a training log at home, practicing the new movement 10 to 20 minutes a day. “We found that after four weeks, people were able to retain the new walking pattern,” says Shull. “After six weeks, people had less knee pain and more function and were still walking in the new way.”

Researchers at University of British Columbia and University of Melbourne have also been studying how changes in gait may lessen knee burden. In a 2012 study published in Arthritis Care and Research, researchers asked 22 participants with knee OA to shift the lean of their trunks sideways toward their damaged knee, guiding them to stick to the new walk through biofeedback

“The amount of trunk lean was measured and displayed in front of the participant as he walked toward a screen,” says study author Michael Hunt, PT, PhD, assistant professor in the Department of Physical Therapy, University of British Columbia in Vancouver. “A target area onscreen guided the amount of lean.”

Although the greater the lean, the less pressure on the inner joint, participants had a tough time learning the new walk and initially at least, found no pain reduction.