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Dr. Debby Givens, PT, PhD, DPT, director of the Division of Physical Therapy, recently received a $50,000 grant from the NC TraCS Institute to conduct a pilot study of research rehabilitation and knee osteoarthritis. Knee osteoarthritis (OA), is prevalent, and knee replacement surgeries are on the rise.

Quadriceps weakness is one of the most modifiable risk factors and treatment for OA, but strengthening efforts are limited by neural mechanisms that contribute to persistent quadriceps inhibition and pain. Previous research has found that interventions that affect neural mechanisms may serve as valuable adjuncts to exercise for quadriceps weakness. However, there is a considerable gap in understanding as to how to effectively treat knee OA-related quadriceps inhibition. As well, little is known as to how  critical factors such as pain sensitization and catastrophizing thoughts interact with motor inhibition to influence quadriceps voluntary activation, strength, and function in knee OA.

A critical first step of this pilot program is to establish a comprehensive infrastructure to explore factors that contribute to persistent quadriceps weakness with knee OA. The goal is to overcome natural barriers to strengthening quadriceps muscles weakened with knee OA and to provide laboratory and clinical methods to evaluate deficits and treatment efficacy. Dr. Givens’ innovative intervention approach is grounded in knowledge that repetitive transcranial magnetic stimulation (rTMS) can increase motor excitability in neurological conditions such as stroke and can relieve chronic pain. However, TMS has not been applied to rehabilitate knee OA. Givens and her team hypothesize that rTMS over the primary motor cortex will increase motor excitability and will interfere with the knee OA-related inhibition of maximal quadriceps contraction to ultimately reduce pain. The study will initiate this research program and develop pilot statistics to facilitate the design of a large-scale, prospective, randomized controlled trial of treatments that replace or delay invasive, irreversible interventions for knee OA.

Co-Investigators for this pilot program include: Dr. Brian Pietrosimone (Exercise and Sport Science); Dr. Rick Gracely (Center for Pain Research and Innovation); Dr. Lauren Porras (Orthopaedics and Family Medicine); Dr. David Berkoff (Orthopaedics and Emergency Medicine); and Dr. Young Truong (Biostatistics)