APOS can get the disabled in step

An Israeli system that relieves the pain of osteoarthritis and rehabilitates victims of other disabling conditions has been scientifically proven effective for many patients.

By JUDY SIEGEL-ITZKOVICH
apos 311 (photo credit: Courtesy)
apos 311
(photo credit: Courtesy)
Anatomically, humans were apparently meant to climb hills and trek over sand and soil, rocks and mud while barefoot rather than walk comfortably in shoes on concrete, asphalt, tiles, parquet and carpets. The elderly, as well as sportsmen of all ages, are at risk for developing osteoarthritis (OA) from punishing their knees by walking on flat surfaces without challenging their leg muscles.
The chronic, incurable condition, caused by wear and tear on the cartilage in the joints with possible tears in the meniscus in the knee or ligaments in the leg, affects about seven percent of the Western world’s population, including 400,000 to 500,000 Israelis. Cartilage is the rubbery tissue that cushions the bones where they meet at the joints and enable bones to glide over one another. But it can break down and erode, causing the bones to rub together, resulting in pain, swelling and stiffness. As one ages, superfluous bone may form around the joints, and the ligaments and muscles become weaker and stiffer.
OSTEOARTHRITIS tends to run in families, but even without a family history, individuals who are overweight are at higher risk due to the extra burden on the joints. Trauma such as chronic overuse at work or in sports can lead to the disease.
The most frequent symptoms are pain and stiffness in the joints, which are often worse after exercise, when putting pressure or weight on the joints, or when you wake up in the morning. The condition may be recognizable by a crackling, rubbing or grating sound when the joints move.
Almost everyone has at least some minor symptoms by the age of 70, but in many sufferers, the condition can be so debilitating that victims can’t walk more than a few steps. For many, surgery to replace the knee joint was the only answer.
But in 2005, two Israeli physicians now in their mid 40s – Dr. Amit Mor and Dr. Avi Elbaz – unveiled their AposTherapy system for successfully treating the majority of OA cases, changing the lives of victims. After working on development for eight years, they presented it to Dr. Mati Nof, an orthopedic specialist at Tzrifin’s Assaf Harofe Medical Center who specializes in foot and ankle surgery and joint replacement. As Nof was enthusiastic about the idea, Mor and Elbaz established their company, Medical and Sports Technologies Ltd. (www.apos.co.il).
This is not another “magical cure” like those regularly advertised in the media – but a serious treatment that has been proven in over a dozen clinical studies and published in serious peer-reviewed journals such as Clinical Biomechanics and Spine. APOS has been shown not only to alleviate knee pain but also back pain and help rehabilitate stroke victims, as well as some people with new or older spinal cord damage but with some remaining nerve function.
A study in the first journal tested 446 patients with bilateral knee osteoarthritis who underwent a gait test and filled out questionnaires at baseline and after 12 weeks. The results were that gait velocity, step length and single-limb support improved significantly and toe-out angle decreased significantly. Pain was clearly reduced and function increased.
The two doctors have also been invited numerous times to present their work at medical conferences of the Osteoarthritis Research Society International and the Academy of Orthopedic Surgeons.”
ABOUT 20,000 Israelis have undergone APOS treatment, with more than an 80 percent success rate, said Mor, and the health funds cover about 80% of the cost for members who hold supplementary health insurance. Not only does the company have its headquarters in Herzliya and a branch in Haifa, but it is due to open a new center in Jerusalem’s Har Hotzvim industrial quarter.
Abroad, the British United Provident Associations (BUPA, the largest private health insurance in the UK, provide APOS services as well in London, Birmingham and Reading. There is also an APOS center in Singapore.“We are planning centers in the US,” said Mor in an interview with The Jerusalem Post. Given the high US obesity rate, the potential is huge there.
“Basically, the way joint rehabilitation has been carried out over the past 50 years or so hasn’t changed,” Mor explained. “The most important issue is functional rehabilitation – the simulation of life and environment. For example, what do you want an injured or disabled person to be able to return to do? To be able to go out and walk in the supermarket. But what current rehabilitation methods have been doing is showing them how to stand in the clinic. We want to be able to simulate real life.”
The non-invasive APOS system, which Mor and Elbaz chose as the acronym of “All Phases of Stepcycle,” includes their patented “Corrective Walkright” shoes, a special mat on which patients walk barefoot for personalized assessment, and computerized equipment to analyze their gait and pressure on the surface.
Then an APOS technician devises a walking exercise program and decides what type of attachment the special shoes require. The orangecolored pod attachments, which are 8.5 centimeters in diameter and are screwed into the sole, look like golf or squash balls cut in half and stuck to the shoe bottoms. The pods, which are attached to the heel and ball of the shoes, come in three sizes: A, B and C, with A the smallest and C the largest or most convex; patients tend to start at A to build up their muscles and progress through to C.
The pod, said Mor, “creates multi-directional instability” that forces patients to cope and strengthens leg muscles. They are individually calibrated biomechanical units that affect movement medially, laterally, forward and backward and during the course of initial treatment over six months or so may be individually adjusted to balance loads. At first they wear the shoes for only about half an hour daily, gradually increasing the time as the weeks and months pass, during which time they might learn to regain control of their muscles and the pain is reduced.
Walking on the pods, said Mor, readjusts the way one’s weight is distributed while walking and strengthen the body’s core muscles in the abdomen, back and pelvis. One can wear the platforms at home, at work or at leisure; they don’t have to be worn all the time. The fact that people can undergo “physiotherapy in a box” just by walking and without even thinking what they are doing promotes compliance, as patients don’t have to go to a clinic for treatment every few days.
Certified and specially trained APOS physiotherapists, who constitute the majority of the company’s employees, check patients’ progress every few months, as the treatments are very personalized and each patient has a different gait.
The initial cost for assessment and shoes, before health fund subsidization, is NIS 10,000, while followup visits cost NIS 250 apiece. Abroad, the price is $5,000 plus more for maintenance.
The system, which forces the leg and other muscles to work, is nevertheless comfortable; an independent Israeli study has shown that 82% of patients comply with the regimen after six months, while 70% no longer take painkillers. Independent studies commissioned by BUPA found that APOS patients enjoyed an 80% reduction in pain and a 90% improvement in function, while 60% of those who had become homebound because of the disorder became independent. In addition, the ability to move freely allows many users to lose weight.
Mor, an orthopedist who studied medicine at the Hebrew University-Hadassah Medical School, noted that there “is no connection between what an X-ray of the joints shows and actual function.
The X-ray can look normal, but the joint can still be very painful; the opposite is also true. If we feel we can’t help a patient, we tell him that APOS could strengthen the muscles and prepare him for joint replacement. We work closely with almost all the country’s orthopedic surgeons. We also help rehabilitate patients after knee surgery.”
DR. NAAMA CONSTANTINI, a sports medicine expert at Jerusalem’s Hadassah Optimal and Hadassah University Medical Center’s orthopedics department, told The Post that OA used to be thought of as a disease solely of the joints and cartilage. But experts believe it is biomechanical, and includes what happens around the joint, especially the muscles and motor control.
She is familiar with how APOS works, and clinical studies that show its efficacy. Constantini often recommends the treatment to patients, and even gave a course that Mor and Elbaz attended in Jerusalem.