This summer KIMA will launch a new service called AposTherapy: a unique bio-mechanical device individually calibrated by a specially trained physical therapist to reduce compressive load and improve control of painful joints.This technology is not only reducing but eliminating pain in patients across the globe with chronic degenerative conditions.
What you need to know:
- It uses a biomechanical device that looks a lot like a regular shoe
- It’s used to alter compressive forces sent upward from the ground through painful or dysfunctional joints
- It helps to retrain the muscles surrounding the joint to improve their timing and coordination of contraction
- It’s one of the few treatment approaches that combines changes in joint loading and retraining of the neuromuscular system in a single device
- There’s no extra time or supervision required to train with the Apos device
- It’s an investment!
AposTherapy has been around, formally, since 2004 when co-founders, orthopedic and sports medicine physicians, Avi Elbaz and Amit Mor opened their flagship center in Israel. Since then, Apos has spread to the UK, Singapore, and, more recently, the United States. This therapy has been so successful in its initial locations, that it’s even gained coverage by Israeli and UK insurance companies.
Here in Manhattan, we’re lucky enough to be situated next door to the AposTherapy US Headquarters and Training Center. I recently completed the AposTherapist training course and am able to provide this innovative therapy to our patients here at KIMA. In case you’re unfamiliar with AposTherapy, I want to share a bit of what I learned about the science behind the biomechanical device and how it’s applied.
How does it work?
Before my formal introduction to AposTherapy, I’d heard the device described as an orthotic you wear on the outside of your shoe. Although this is a simple way to describe the concept, it really doesn’t hit on exactly what the device is all about. An orthotic repositions the foot to realign the bony framework, normalize tissue loading, and facilitate efficient mechanics and stability during standing and walking. Clearly, these are all positive effects. Perhaps the only downside is that, once the orthotic comes off, you’re left with the original problematic malalignment, preventing you from wearing certain types of shoes, doing barefoot activities, etc.
Unlike an orthotic, the Apos device doesn’t realign the foot itself. Instead, it uses proprietary “Pertupods” to change your foot’s center of pressure and, thus, the ground reaction forces traveling up from the ground compressing painful joints. Not only is your pain reduced by altering these compressive forces, but the Pertupods are also convex to varying degrees, which requires that the wearer control a very small degree of instability. If this sounds scary, let me explain how our bodies respond to a slight instability like the one Apos uses. In the presence of pain, the muscles surrounding a joint tend to “brace”. For purposes of discussion, you can think of bracing as almost a splinting of the joint caused by co-contraction of the opposing muscles surrounding it. For example, if the quads and hamstrings contract simultaneously, the result is a braced knee that’s difficult to bend or straighten. Imagine controlling for an instability with a braced joint. You can’t! In order to control for the instability introduced by the Pertupods, the body must normalize tone in the relevant muscles and produce coordinated contractions of flexors and extensors, resulting in improved joint motion and lubrication, less pain, and more effective training.
If you’re a visual learner, like me, take a look at this video by Apos on “How it Works”:
What do I do with it?
Now that you know how the device works, let’s talk about how you’d go about using it. Again, for purposes of comparison, I’ll use the orthotic (simply because it’s the tool I hear most commonly compared to AposTherapy). Unlike an orthotic, the Apos device doesn’t have to be worn every time you’re on your feet to see the benefit. You’ll begin with a treatment time of about one hour per day and you’ll train in the every-day scenarios where you typically experience pain; for example, standing up from your desk chair to walk to the printer. AposTherapy creates a proprioceptively rich environment (like walking on grassy terrain) even when you’re in the office, helping to re-educate your muscles to support the bony framework in the way they naturally should.
We keep initial treatment times low because our goal is to improve motor control. Let me clarify this a bit. Training to improve motor control is a bit different from training to improve pure strength. I consider strength training a privilege earned from developing good motor control in a given pattern. For example, you’d better have good motor control in a body-weight squat pattern before you load on additional weight for a barbell back squat. I want you to imagine the circumstances under which you’d try to learn and execute this perfect body-weight squat. Obviously, performing rep after rep will lead to fatigue and, eventually, crummy form. Much like training for motor control of this perfect body-weight squat, in the Apos device we’re looking for fewer, more pristine reps which aren’t clouded by pain or fatigue. To this end, your AposTherapist will ask you specifically to NOT wear the device beyond the time laid out in the treatment plan.
To see a great example of how AposTherapy can be used as part of a wellness program to develop optimal health, have a look at these former NFL players and Navy Seals being introduced to the device:
How successful has it been?
According to an independent telephone survey conducted by Network Research in November of 2009 including 150 AposTherapy patients in the UK, over 95% of patients are satisfied with AposTherapy, the majority say it exceeded their expectations.
The concept behind the device’s methodology as well as the application of the device itself have been significantly researched in the short time this type of therapy has been available. Currently, AposTherapy’s greatest body of evidence is in it’s treatment of knee osteoarthritis although it’s application in the treatment of chronic nonspecific low back pain and hip osteoarthritis have been thoroughly researched as well. See the evidence here: http://apostherapy.co.uk/en/healthcare-professionals/medical-research
If you’d like to hear it from the patients themselves, have a listen!:
So how much am I going to have to invest?
Beginning with your in-depth 1.5 hour initial evaluation, AposTherapy lasts for one full year and includes five follow-up sessions with your AposTherapist as well as the Apos device itself. The follow-up sessions will each involve an updated computerized gait analysis, re-evaluation, an updated treatment plan and, if necessary, re-calibration of the device. This full year of treatment costs less than a year of physical therapy treatment and can be broken into smaller installments if desired.
If you’d like to know more about AposTherapy, give us a call at KIMA Center for Physiotherapy & Wellness at 212-686-3101.