Blog by Rehamed Therapy Team
(This article was written by Rehamed Therapy Team and featured as a guest article on LILA site.)
For this blog post, we decided to change the tune a little bit by looking into the technological advancements in physiotherapy treatment. As our Vision goes, “To establish REHAMED as THE standard of physiotherapy and rehabilitation, throughout the region first, and then, country” we are always keen on providing a World Class treatment with the State-of-the-Art facilities. We will be covering 3 of the technological improvements such as Wearable Resistance, Blood Flow Restriction (BFR), and Proxomed’s latest update which is the Individual Curve. Adding on, we will be concluding this post with a glimpse into the future of how technological advancement in physiotherapy treatment can make a huge impact, via Omni Virtuix, a multidirectional treadmill that can enhance 3D motion treatment.
Exogen (“exoskeleton generation”) by LILA is the world’s leading wearable resistance technology designed by sports scientists to improve people’s movement. Exogen is a compression-based high-performance sport garment under layer which applies weights/loads to any part of the body. These micro-loads range from as little as 50grams up to 10% body weight and can be applied in any sport or exercise without disturbing the movement patterns.
To understand wearable resistance, it is resistance training that incorporates the 4 laws of training:
- Progressive overload; and,
For rehabilitation, Exogen works ideally in the early strengthening and return-to-sports (RTS) stages, when the injury is healed but the body is still unbalanced as the person now looks to return to full function. The focus lies primarily on the following:
- Forced weight shift/rebalancing of movement;
- Rebuilding unilateral specific strength;
- Power and range of motion deficits; and,
- Regaining competition/work relevant specific movement.
Why is it beneficial to patients/injuries during rehab?
The use of wearable resistance in the early injury process is not well explored in sports medical and physiotherapy practices. However, it is being used now in the RTS stages of rehabilitation whereby the athlete is no longer injured but they are extremely vulnerable in terms of confidence level and susceptibility to re-injury. General dysfunction at the RTS stage is also psychological, where the athlete may not be supervised by the rehab-team and therefore perceives a loss of direct support. In addition, there is a physiological loss in RTS stages to sport-play seen as bilateral muscle imbalances, reduced specific strength, power, agility, coordination, proprioception, reaction, balance and lastly, loss of skill (performance attributes).
A real-life example highlighting the benefits of wearable resistance is from the Captain of NZ Women’s All Blacks. She had a compound surgical repair on her left fibula and while she was medically cleared for RTS in 2019, the coach reported significant on field deficiencies.
Applying the wearable resistance, running analysis was performed using a non-Motorised Treadmill, bilateral force plates and sprints on an indoor running track with 3D motion analysis. The analysis was done while running with the added load and running immediately after the added load was removed. Directly after the wearable resistance load has been removed, it was reported that the athlete felt running was faster with improved contact time, improved balance between left and right side (27% improvement in only 4 weeks), decreased flight time and increased propulsive impulse on the injured leg (Sports Physiotherapy Bulletin, 2015)
In order to create a better recovery in the RTS stage, with no on field deficiencies, wearable resistance is reported and proven to help significantly improve performance.
“I thought it was going to be very complicated to be honest, but nothing could be further from the truth. It was so easy to use and integrate into all our in-season and post-season rehab and injury programs, because the athlete can feel it working. Just one session and they understand how and where this is helping. And I don’t have to coach, that I simply let them feel it. And a feeling is worth a million words” (Mark Uyeyama, Director of Performance, Minnesota Vikings)
Blood Flow Restriction (BFR) Rehabilitation
Blood flow restriction (BFR) therapy is a training and rehabilitation strategy involving the use of cuffs or bands placed around a limb which partially restrict blood flow to the muscle and occlude venous outflow (Patterson et al, 2019). It is a new, unconventional way to rehabilitate muscle injuries & weakness particularly those occurring in the arm or leg. The application is normally paired with low intensity resistance exercises. This allows the individual to train their muscles without placing excessive weight on the limb, while still reaping similar benefits to conventional strength training.
From a physiological perspective, blood flow restriction to the muscles creates an ischaemic and hypoxic muscular environment which induces increased levels of metabolic stress. When paired with exercise, both the mechanical tension from exercise and the increased metabolic stress activate mechanisms that elicit muscle growth.
A proper BFR application uses a surgical tourniquet cuff that looks similar to a blood pressure cuff. Typically, cuff application would be succeeded by measurement of limb occlusion pressure (LOP – minimum pressure required to stop arterial blood flow away from the cuff) before the restriction pressure is set. There are devices that rely on manually determining the LOP to set the restriction pressure, such as the 2nd generation smart cuffs. However, there are also intelligent BFR systems that can automatically calculate LOP, and set & regulate restriction pressure specific to each individual, such as the Delfi- Personalised Tourniquet System. The personalized automated systems are often the preferred choice in clinical practice due to their multiple safety features and clinical research programs that support their use.
Why is it beneficial to patients/injuries during rehab?
Unlike conventional strength training, BFR allows patients to begin strength training at a much earlier phase of rehabilitation hence prompting a much earlier recovery. Almost anyone with a muscular weakness or injury can benefit from BFR rehab may it be upper or lower limb related, e.g., ACL injury, rotator cuff or other shoulder injuries, muscle atrophy. In addition, the reduced pressure on the musculoskeletal system (due to lower weights) provides a safer means of training.
Comparison to status quo
In order to produce a noticeable increase in muscle size and strength through conventional strength training, a person should be looking to lift loads of approximately 65% or more of the individual’s one-repetition-maximum (1RM). This approach however may not be suitable for those who cannot tolerate the mechanical stress of heavy loads; for example, due to injury. On the other hand, BFR application only requires minimal loads, approximately 20-40% of an individual’s 1RM, to elicit similar improvement in strength & muscle size.
In general, most BFR cuffs are uniquely designed to make cuff application easy. Additionally, the modern automated personalized BFR systems are straightforward despite their cutting edge technology. Typically, less than 10 minutes are required for set up, contributing to its usefulness in rehabilitation.
Biofeedback – Individual Curve
Rehamed Therapy’s primary equipment provider is Proxomed, in particular regarding our Leg Press and Trunk Flexion and Trunk Extension machines. These provide Biofeedback to users during training, making the exercises safer and more traceable.
With is latest update, the newly added Individual Curve adds a significant amount of advantages and benefits not only for the therapists but also the patients using it. It provides much clearer and real-time feedback of the exercises done to the physical body. With this addition, therapists are now able to get a better understanding on their patient’s capability and body limits. Furthermore, it enhances the patient’s understanding of the injury and how to best engage with the treatment programme. Due to the constant development of the extensive product range the Biofeedback curves can now be individualised for each patient and allow the therapist to focus the exercises further.
The individual curve is the implementation of a brand new default curve next to the already existing sinus curve. The state-of-the-art technology works by means of intelligent pattern recognition: the software analyses the individual movement of the patient and uses an algorithm to match the specific movement patterns with one of the six geometric default shapes.
Below is the selection of possible examples:
In comparison to similar features of the competition the individual curve of Proxomed is created by a time specification. The given time for the movement is always maintained by means of a stored algorithm despite, e.g., different ranges of motion of the patients. Thus, the default curve will be automatically customized to the individual needs of the patient.
Why is it beneficial to patients / injuries during rehab?
There is a long list of benefits on why the Proxomed individual curve is considered as one of the best in the market currently. There is an almost unlimited number of design options for the default curve which can be adapted according to the clinical picture or training objective. This includes intuitive operation and improved usability for both physios as well as the patient. With optimal control of the movement quality by considering different movement phases, it provides the maximum comfort while complying with highest standard medical quality requirements. The newly updated and uncomplicated programmability of the curve allows for adjustments of the default curve in very small steps (0.1 second for eccentric/concentric, 0.5 second for isometric phases). This provides a higher neuromuscular control and understanding of the patients and focus can be set on concentric, eccentric, or isometric phases as desired.
Requirements for the individual curve
Every patient has their own strengths and weaknesses. We at Rehamed Therapy always believe that the training and treatment for each patient need to be personalised to their body capability in order to achieve the fastest and best results for our patient. With these state-of-the-art training devices, each therapist’s work station and the optional info point are interconnected to a data management system. This is an essential part of data-based rehabilitation.
Looking into the future – Omni Virtuix
In this blog post, we have already presented three more recent or new technologies and techniques that are being used in the field of physiotherapy and sports rehabilitation. As a final section, we would now like to take a look into the future.
As we have seen, technology plays an important role in sports and rehabilitation. Specifically in physiotherapy, biomechanists use 3D motion analysis to assess movement, in sports therapy and rehabilitation we rely on technologies such as cryo- and hydro-therapy to speed up the process of recovery, and we have already discussed two other new techniques above.
However, an important aspect of sport rehabilitation that is often overlooked is the ability to overcome kinesiophobia. Kinesiophobia is the fear of movement, particularly in a direction that causes pain. Many injuries are non-contact injuries (link to Rehamed), be it sport injuries, work injuries or day-to-day life injuries. Therefore, it is not surprising that people develop a fear of moving if it causes pain. When it comes to those who want to return to sport after injury, it is therefore understandable that they find are fearful to go all out in their sport. For this reason, it is crucial to help these individuals overcome this fear by starting them off in a safe and controllable sporting environment.
There are many known multidirectional treadmills but the following concept will be based off the Omni Virtuix. It’s a multidirectional treadmill that’s mainly used for VR gaming It boasts a harness around the waist allowing the user to move freely without falling. What if we could do that for sports? Imagine playing FIFA on a multidirectional treadmill – dribbling defenders like Lionel Messi, scoring a penalty as Cristiano Ronaldo. The Omni Virtuix multidirectional treadmill allows changing of direction fluidly (mimicking similar movements on the ground) on top of allowing the hands to be free to do anything (due to the harness, ensures the safety of the user and in turn warrants confidence to the user).
Why could it be beneficial to patients / injuries during rehab?
To take this concept into sports rehabilitation, what if it were possible to play a sport virtually, in a controlled environment, prior to returning to the sport? Imagine someone has just torn their ACL by running into a pothole in the field. This requires surgery, and the attendance of months of physiotherapy and rehabilitation. Now getting ready to return to play football, for some reason they are lacking the confidence to push themselves to their top level as they used to. What if they’re not strong enough? What if they fall again or if someone pushes them? Wouldn’t it be nice to mimic a football game safely without having to go on a field to play actual football and fall into a pothole again?
The idea of an omnidirectional treadmill is to:
- Enable running in any direction and
- Change direction safely
without having to actively pivot or change the position of the body to fit direction of the standard treadmill, potentially creating unwanted torsion or rotation onto the leg. The user could be instructed to run on the omnidirectional treadmill while, for example, having to catch/pass a ball from/to any direction. This would force the user to turn and change the direction of running, but can be done without compromising or increasing the risk of injury.
Additionally, if VR were to be incorporated, the sport and atmosphere could be mimicked. Alternatively, aside from mimicking a sport, the environment or obstacles within a sport could be changed according to preference. For example, adding potholes or other players onto a field so the user has to run around them.
It is imperative that upon return to sport, the individual is confident both mentally and physically. With the advancement of technology, anything is possible.