Neil Segal’s Multi-Faceted Career Focuses on Arthritis 

Neil Segal, MD, MS, supervises the Kansas City site for the Knee Arthroplasty Activity Trial (KArAT), an Arthritis Foundation-funded study. Research has shown that people who have total knee replacement surgery often don’t increase their physical activity after the surgery, even though they have much less arthritis-related pain or none at all. The KArAT study is testing whether personal coaching and financial incentives can help people increase their activity levels after a knee replacement.   

Tell us about your background.   

I grew up in Rochester, New York. As a child, I was interested in how the body works. I also began martial arts training. When I entered Brown University, I wanted to learn more about both areas and selected a dual concentration in engineering and Japanese history. Once I started studying Japanese history, I realized that I wanted to know so much more, and I changed to a concentration in East Asian Studies with a focus on Japan, while also completing my pre-medical studies. I pursued my medical training at Vanderbilt University Medical School and completed Physical Medicine & Rehabilitation training at Mayo Clinic. I developed an interest in arthritis in medical school and received research distinction for completing a clinical trial for patients with rheumatoid arthritis affecting the knee. That led me to study osteoarthritis (OA), and I have been conducting OA clinical trials ever since. 

What drew you to the field of science and research, and arthritis research in particular? What do you hope to accomplish professionally?   

I was drawn to biomechanics and imaging of osteoarthritis because I was interested in the relationship between body structure and function. Since medical school, I have wanted to focus on patients’ physical function and quality of life to help them achieve their goals. Professionally, I am a rehabilitation physician with a focus on musculoskeletal care. I hope to improve diagnosis and treatment of problems with the musculoskeletal and nervous systems to help people be as independent as possible. 

Could you describe what you do with KArAT?  

I have been very fortunate to work with Dr. Elena Losina on the development of the KArAT project since the initial grant application in 2015. I have been involved with patient recruitment as well as elements of the trial protocols. I supervise the University of Kansas site for KArAT, including oversight of scientific, budgetary and regulatory compliance and other administrative activities. This includes training research assistants and certifying them in trial protocols. 

Do you expect KArAT to affect patients either directly or indirectly?  

I do. Translation of research results is why we conduct clinical trials. In this case, I hope the results of the trial will guide health care payors make decisions that keep people with knee osteoarthritis more active. Ultimately, that’s better for their health and quality of life and better for society, too. 

What are you excited about in OA? What should patients be excited about?   

We have better ways to reduce pain than we used to have and that is exciting both for me as a provider and, of course, for patients. 

What else would you like to share about your involvement with arthritis research? 

I have been fortunate to be involved with arthritis research for almost 30 years. While a usual research career focuses on a specific scientific area to develop expertise, my path has been challenging and exciting by pursuing several areas. I started as a body composition researcher. I wanted to understand how muscle and fat might contribute to osteoarthritis in people with excess body mass. This led me to then pursue biomechanical studies of gait and contact stress within the knee joint. These discoveries led me to conduct clinical trials for strengthening muscle on land and in a pool and the use of braces to reduce knee pain. Since we used imaging for the biomechanics studies and clinical trials, I became interested in how we could better image joints to improve the pace of research as well as improve diagnosis and evaluation of how well treatments work for patients. I also conducted several years of studies of how pregnancy affects each part of the musculoskeletal system and might contribute to elevated risk for knee, hip and foot problems later in life. While mine has been a less traveled path, it has been a rewarding one. 

Why is it important for those patients who have lived with osteoarthritis through a total knee replacement to remain physically active? 

Physical activity is essential for health of all our organ systems. People who have undergone arthroplasty have already had years of challenges, such as pain, muscle weakness, lost range of motion, functional limitations and restrictions in their participation in activities. To recover these, physical activity is key. Insufficient physical activity can worsen pain and prevent recovery of strength and joint range of motion. Of course, physical activity also improves quality of life, so we want to advocate for it for our patients’ health and quality of life. 

What are your favorite land- or pool-based programs to strengthen knee muscle and reduce pain for those with knee OA? 

I don’t have one favorite program for strengthening knee muscle and reducing pain for all patients. I think that my favorite program would be the one that each person will do. The Arthritis Foundation has a great Aquatic program. For those who don’t have access to or want to be in a pool, quarter-squats and leg lifts will help keep the knee extensors and hip abductors strong to protect the knee.