Can Changing the Way You Walk Help Osteoarthritis Pain?

By Linda Rath | Updated Dec. 6, 2023

Walking may seem pretty simple; after all, you learned to do it as a baby. By about age 7, you developed the gait (way of walking) that carried you into adulthood. Yet experts on the biomechanics of gait say walking is complex, even though the fundamentals – planting one foot on the ground (stance phase) while the other is moving through the air (swing phase) – seem easy enough. Lots of things can interfere with this pattern, though, including injury and normal aging. And medical conditions like osteoarthritis (OA) can cause significant gait changes that hinder mobility, increase pain and create problems in parts of the body that try to compensate.

How does OA affect gait?

More than 20 years ago, researchers observed that people with OA walked less and more slowly than healthy controls. Newer lab studies using technology like wearable sensors help explain why.

• Knee OA limits the range of movement in both the stance and swing phases of your gait, leading to a shorter, slower stride. In one study, people who had knee OA walked 10.8 fewer steps per minute than healthy participants; those with hip OA walked 9.8 steps fewer steps. The same study found that people who had hip OA had an exaggerated motion in the lower back when walking, probably to compensate for pain and weak muscles.
• Knee OA can affect the hip and ankle joints, leading to decreased range of motion in all three. These joints work together when you walk, and what happens in one causes problems up and down the chain.
• Hip OA can affect muscles in the buttocks, especially the smaller gluteus minimus and medius, making them weaker than normal. The glute muscles stabilize the hips, so when they’re weak or atrophied, walking is harder, and the risk of falls is greater. One small randomized controlled trial found that a 12-week program of physical therapy and home exercises strengthened these muscles so they functioned more like those in healthy young adults.
• Uneven loading of the knee joint occurs naturally when you walk because the inner (medial) part of the knee joint bears two or three times the force of the outer (lateral) part. This uneven loading is the main reason medial OA is 10 times more common than other locations of knee arthritis. It is also associated with more severe symptoms and disease progression. 

Is gait retraining the answer?

Treatments for OA are limited. They include nondrug options like weight loss and acupuncture, anti-inflammatory drugs and hyaluronic acid (HA) injections. Acupuncture, while effective for pain, is rarely covered by insurance and truly skilled acupuncturists are hard to find. Anti-inflammatory drugs can have serious side effects and may even make OA worse because reducing pain often leads to more joint loading, which speeds up disease progression. In light of this, gait retraining, which aims to shift some of the medial compartment’s load to the healthier lateral side, seems like a simple, safe and inexpensive approach to easing OA.

Gait retraining may alter a person’s walking pattern in one of three main ways:

• Turning the toes more inward or outward
• Increasing the tilt of the upper body over the affected knee during the stance phase of the gait cycle (trunk lean) 
• Moving the knee slightly inward (medial thrust)

In at least one study, the trunk lean was the most effective approach, likely because people with OA tend to compensate for pain and muscle weakness in the knee by changing movement in the upper body. Although the trunk lean may be the best choice for reducing load on an arthritic knee, some studies suggest it takes more energy to perform, leading to fatigue – already a common complaint among people with OA. And in one study, healthy participants reported that the technique was fairly hard to learn and caused pain in other joints, including the low back. 

Gait retraining is causing some concern among experts for other reasons, too. For example, although gait has been studied extensively in runners, walking, especially in people with OA, is a relatively new area of research. In addition, most gait studies have used healthy volunteers, and it’s unclear if the findings translate well to people who have arthritis.

Another concern is that adjusting gait to take pressure off the knee may lead to problems in other joints, especially the hip and ankle. Experts say long-term studies are needed to determine the effects of gait retraining on different joints and overall function. Longer studies are also needed to determine whether people can actually learn new movement patterns and sustain them in daily life.  

Alternatives to gait retraining

One of the biggest problems with gait retraining is that it’s mainly available in specialized gait labs, not doctors’ offices. Some research groups are creating predictive models that are supposed to help health care providers assess a patient’s need for gait retraining. Whether these models will be widely used in clinical practice remains to be seen. 

In the meantime, if you have knee OA, consider losing excess weight. Each pound of weight you lose takes four pounds of pressure off your weight-bearing joints. You can also get movement retraining without all the bells and whistles by working with a physical therapist who can teach you how to walk more symmetrically and spend equal time on both legs. Experts say you can learn to move differently in about six weeks, but consistency is key. Without constant attention and practice, it’s easy to fall back into old habits.