The Association Between Functional Gait Recovery and Pain Reduction in Musculoskeletal Pain

Musculoskeletal pain (knee or lower back) significantly impairs physical function. Altered gait patterns are often associated with pain, creating a feedback loop. Understanding the relationship between gait and pain is crucial for optimising treatment and monitoring patient progress. The purpose of this study was to investigate the longitudinal association between functional gait improvement and pain reduction in patients with knee or lower back musculoskeletal pain.

Data were analysed from a retrospective cohort of patients attending a clinic between December 2023 and April 2025. Pain was assessed with the Numeric Pain Rating Scale (NPRS, 0-10) at initial evaluation and follow-up (60-150 days) for (a) walking-evoked pain (N = 503) and (b) overall pain at rest (N = 547). Five objective gait parameters (velocity, step length and single-support time) were assessed using a smartphone-based application. Multivariable regression models analysed the relationship between gait improvement and pain reduction, adjusting for demographics and clinical confounders.

Participants in both analysis sets demonstrated significant changes in pain and gait. Multivariable regression models, adjusted for confounders, showed that improvements in gait velocity (β = 0.503 NPRS points per 1-SD change) and affected step length (β = 0.409) were significantly associated with greater reductions in walking-evoked pain (p < 0.05). A similar, though weaker, pattern was observed for general pain. Sensitivity analysis of patients with moderate to severe baseline walking-evoked pain (≥ 4) revealed even stronger associations. These findings indicate a moderate-to-high association between functional gait recovery and reduced musculoskeletal pain. The more pronounced relationship for task-specific pain supports the validity of using gait analysis as a direct measure of functional improvement. Objective gait metrics, particularly using scalable technology such as smartphone applications, are valuable outcome measures for clinical practice.