Beyond Strength and Flexibility: How Technology Is Advancing Physical Therapy

By Alex Barrow, PT

Technology has transformed healthcare, allowing clinicians to better understand how the body functions and develop new approaches to treatment. Physical therapy is no exception.

While strengthening, flexibility, and joint mobility remain essential components of rehabilitation, advances in movement science have expanded our understanding of another important factor: how the brain and nervous system coordinate the way we move.

Understanding How Our Bodies Learn to Move

Think about learning to ride a bicycle. Initially, balancing, pedaling, and steering require conscious effort. With practice, these movements become more coordinated and automatic.

This process is known as motor learning. Through repetition and experience, the nervous system adapts, allowing us to perform familiar movements with greater efficiency and less conscious attention.

Walking is a complex example of this coordination. Our muscles, joints, sensory systems, and nervous system work together to maintain balance and propel us forward.

But what happens when pain begins to influence these movement patterns?

How Pain Can Change the Way We Walk

When someone experiences knee, hip, or back pain, they may naturally adjust their walking pattern to reduce discomfort.

For example, a person with knee pain may begin limping or spending less time bearing weight on the affected leg. This is known as an antalgic gait, a common adaptation intended to reduce pain during movement.

Although these adjustments may provide temporary relief, persistent changes in walking mechanics can alter how forces are distributed across the joints and how muscles are recruited during movement.

Importantly, altered gait is not always the result of muscle weakness. Pain, joint stiffness, reduced mobility, balance deficits, and changes in motor control may all contribute.

These adaptations are not necessarily harmful, but understanding why they occur can help clinicians identify appropriate treatment strategies.

Why Movement Retraining Matters

Physical therapy has long addressed movement limitations through strengthening, flexibility exercises, balance training, gait training, and neuromuscular re-education.

These approaches are supported by research and remain important components of managing musculoskeletal conditions, including knee osteoarthritis.

Neuromuscular re-education focuses on improving the coordination, control, and timing of movement. Depending on the individual’s needs, treatment may involve balance exercises, functional movement practice, and repeated task-specific activities.

Research on motor learning demonstrates that the nervous system can adapt through practice and experience, a capacity known as neuroplasticity.

As technology advances, clinicians have additional opportunities to incorporate these therapeutic principles into activities performed outside the traditional clinical setting.

How Technology Is Expanding Treatment Options

One example is personalized biomechanical therapy, which uses adjustments to the forces acting on the body during movement.

Apos® is an FDA-cleared, foot-worn medical device that uses individually calibrated elements beneath the feet to influence lower-limb biomechanics during walking.

The positioning of these elements can modify the center of pressure beneath the foot and influence the forces acting on the lower extremities. Their convex design also introduces controlled movement challenges that may stimulate neuromuscular responses.

By incorporating these principles into walking, Apos® provides a personalized treatment approach for appropriate patients.

What Does the Research Show?

A randomized clinical trial published in JAMA in 2020 evaluated individualized biomechanical footwear therapy in 220 participants with knee osteoarthritis.

After 24 weeks, participants receiving the biomechanical intervention reported statistically greater improvements in knee pain and physical function compared with those using control footwear.

The study also identified favorable changes in certain walking parameters, including walking speed and step length.

While these findings are encouraging, the researchers noted that the clinical importance of the pain difference was uncertain and that additional research is needed to establish long-term effectiveness and safety.

These findings support the potential role of personalized biomechanical therapy in managing knee osteoarthritis, while highlighting the importance of continued research.

The Future of Physical Therapy

Movement is influenced by much more than muscle strength or flexibility. Pain, joint mobility, balance, coordination, and the nervous system all contribute to how we walk and perform everyday activities.

As physical therapy continues to evolve, technology offers additional ways to assess movement and support individualized treatment.

The goal remains the same: helping people move more comfortably, improve their function, and maintain their independence.