What is Tai Chi?

Tai Chi originates from Ancient China. Nowadays it is practiced throughout the world as an effective exercise for health. Tai Chi consists of gentle flowing movements that are relaxed and slow; breathing is deepened and slowed, aiding visual and mental concentration. It can be practiced almost anywhere and is a suitable form of exercise for just about everyone. The correct name for ‘Tai Chi’ is ‘Tai Chi Chuan’ (Taijiquan) which means ’supreme ultimate fist’ or boxing, and is referred to as ‘Moving Meditation’.

Tai Chi is a gentle exercise that provides practical methods to help people cope better with daily tasks and improve their quality of life.

How does it work for Diabetes?

Regular physical activity can aid people with diabetes by helping them improve their blood glucose levels. As a form of exercise, it is reasonable to assume Tai Chi will help improve cellular glucose uptakes and glucose metabolism.

Diabetes research studies held by the Australian Tai Chi Institute in conjunction with St George Hospital Sydney (Australia) showed those participants who maintained regular Tai Chi classes enjoyed significant improvement in their quality of life. The mental training is effective for relaxation, which is especially beneficial to people with diabetes.

According to traditional Chinese medicine, enhancing life energy (Qi) in the appropriate acupuncture meridians (energy channels) will improve diabetes.

What is Tai Chi for Arthritis?

Tai Chi for Arthritis is a program specially designed by Dr. Paul Lam in conjunction with his Tai Chi Associates and a team of medical experts. Based on the Sun style, Tai Chi for Arthritis is easy to learn, effective and safe.

Scientific studies conducted in 2001 by the Korean and Taiwan National Universities have shown this program to significantly relieve pain and improve physical function.

Can Tai Chi help back pain?

Back pain is a common and complex problem. According to new medical findings, it is closely associated with the deep stabilising muscles of the spine. Tai Chi’s essential principles are consistent with scientific methodology for strengthening the deep stabilising muscles.

Where can we learn more?

Master Cheryl Lee

Newcastle based Master Trainer Cheryl Lee began Tai Chi training in 1988 in Australia and Hong Kong, centring her traditional training in Sydney with Master Fong Lee and Master Kam Fung.

Her ‘Tai Chi Wellness’ and “Tai Chi 4 Kidz™” Instructor Certification Courses are approved by Fitness Australia and recognised nationwide.

The only Tai Chi Master Trainer in the Hunter Region accredited to the Australian Sports Commission, her passion for the many health benefits of Tai Chi inspired her focus on ‘Tai Chi for Health’ programs. Cheryl Lee is certified in Tai Chi for Arthritis, Diabetes and Back Pain and is one of only 45 world wide accredited Master Trainers in Health Forms.

This is a revolutionary patented design and manufacturing technique that finally gives an optimal and safe tool for balance training.  This is the ideal tool for gyms and professionals as it includes comprehensive product liability insurance by Axxa – a first for this type of product and reflects the high build quality. The Turtle is latex free and non-toxic and meets all European Union safety standards.

Wide Range of Colours

The durable high weight dome is great for high impact plyometric exercises and can be used barefooted – we do recommend training in Five Fingers to avoid sweat lubricating the dome surface. Here is a PDF showing the differences between the Turtle and the BOSU.

A balance dome is a multi-purpose piece of exercise equipment. It consists of half of an exercise ball with a solid plastic plate attached to the bottom. Balance boards combine features of several different types of equipment such as the balance board and exercise ball and hence are useful for a range of different training techniques. These include balance and stability training as well as strength exercises such as push ups.

The standard size for a balance dome is around 26 inches (65 centimeters). The ball part of the dome can be inflated or deflated which makes it easy to transport. Pumping up an exercise dome requires a pump although this is usually included in the package.

Many exercise domes also include tubing that can be attached to the base. This is commonly used for stability exercises — especially if the person is yet to master all the exercises or has poor balance. Tubing and handles are also useful for people using the exercise dome for injury rehabilitation. If elasticized tubing is provided with the dome then this can also be used to provide resistance in certain exercises.

Exercise domes are sometimes used for rehabilitation of ankle and other lower leg injuries. When an injury is sustained this can often weaken muscles that provide stability. Stability training equipment such as the balance dome is used to mimic an unstable situation which helps to build up the muscles to the desired level. Sometimes these types of exercises are referred to as proprioception exercises. Proprioception is the body’s ability to sense where it is relative to other objects and is vital for stability and balance.

One of the most basic stability exercises using a balance dome is to turn it onto its ball side, stand on the flat part of the dome and hold the tubing for support. The ball will start to wobble creating an instability that must be countered by the person performing the exercise. This may be difficult to begin with but after a period of time, the person’s balance and stability will start to increase. When the exercise becomes straightforward the tubing can be dropped in order to increase the difficulty.

Earn Additional Income

What can you do with supplemental income? Plenty! Just take your pick: place the extra money into your savings account, buy stuff you’ve always wanted to have, invest the extra cash, maybe pay off a few bills or build more capital. These and more are reason enough why people seek ways to earn extra money. But how can you truly generate supplemental income and attain more financial freedom? With a little imagination and creativity, you can harness what you know and what’s available to help you attain this goal. Here are two choices for you:

Sell Products Directly

Retail is always a good way to generate supplemental income – and you have a powerful advantage because people will follow recommendations by their healthcare or fitness practitioners.

But concerns over perceived conflicts of interest, managing inventory and other issues still hinder practitioner involvement in many instances.

How much you could earn: that depends on the product you’ll be selling, your market and the demand. AOK has many of its customers earning an additional $300-$500 per month selling appropriate products to their clientele. You can buy on-line and earn bonus dollars as you increase your turnover.

Sell Products via Affiliate Marketing

Another excellent way to generate supplemental income is by joining an established business as an affiliate. All you have to do is promote a business or a brand, encourage a customer to buy, click or perform a specific action and you’ll earn as a result.

Your earning potential with this method is unlimited, since it will be determined by how successful you are at promoting the business and getting people to participate. AOK has a a great affiliate program that can link our web shop seamlessly to your website giving you full dashboard control.

Affilate Sales Grow Quickly

When asked to list the factors that most contribute to the growth of the exercise equipment industry; suppliers, marketers and manufacturers often put one thing at or near the top of the list: recommendations by healthcare practitioners. Receiving the nod of approval from doctors, physios, chiropractors, personal trainers and other practitioners is viewed as so important that numerous companies have built businesses around solely selling through these individuals. “I believe the healthcare and fitness practitioner channel is going to be one of the most vibrant and fastest-growing sales channels in the nutrition industry over the next 10 years,” said Bradley Wilson, Managing Director of AOK Health, which sells a number of its products only through practitioners.

Although selling via this channel can be quite lucrative — Wilson said his company had one of its best years ever in 2009 — it also can be very challenging. Numerous barriers — including a lack of quality exercise education and trust in exercise therapies — continue to prevent more practitioners (particularly classically trained MDs) from embracing exercise products. Even when physicians and other practitioners understand the benefits of exercise and lifestyle modification activities and programs, they still are often wary of actually selling the products to their patients or clients.

Dr. Vladimir Janda was a Czech neurologist and physiatrist. He retired as the director of the physiotherapy school at the Charles University 3^rd Faculty of Medicine in 2000. Janda has done extensive clinical research on the pathogenesis and treatment of chronic musculoskeletal pain. He is known around the world for his concepts of muscle imbalance, and continued to be active in clinical practice, research, and lecturing until his death in November, 2002.  The purpose of this paper is to review Janda’s approach to the evaluation and management of chronic musculoskeletal pain.

Janda became interested in physical medicine after falling victim to polio in his teens. He spent 3 years in rehabilitation, after which he pursued his medical degree specializing in neurology and physical medicine.  He published his first book in Czechoslovakia on muscle testing at the age of 20.  Noting the work of Hans Kraus, as well as that of Henry and Florence Kendall, Janda became intrigued by the functional role of muscles. He first observed that both polio and low back pain patients often had a dysfunctional gluteus maximus. His observations led to testing his patients with surface electromyography where he noted patterns of muscle contraction with particular limb movements, leading him to conclude that the timing or recruitment pattern of synergists should be emphasized rather than traditional manual muscle testing for strength.  His thesis, “Postural and phasic muscles in the pathogenesis of low back pain” was presented in 1968 (Janda, 1968).  In 1979, he identified his specific “crossed syndromes” of muscle imbalance (Janda, 1979) based on his clinical observations and research and theorized that muscle imbalance was predictable and involved the entire motor system.

Structure vs. Function

In musculoskeletal medicine, there are two main schools of thought, that is, a structural or functional approach.  In the structural approach, the pathology of specific static structures is emphasized; this is the typical orthopaedic approach that emphasizes diagnosis based on localized evaluation and special tests (X-Ray, MRI, CT Scan, etc).  On the other hand, the functional approach recognizes the function of all processes and systems within the body, rather than focusing on a single site of pathology.  While the structural approach is necessary and valuable for acute injury or exacerbation, the functional approach is preferable when addressing chronic musculoskeletal pain.

The Sensorimotor System

In chronic pain, special diagnostic tests of localized areas (for example, low back radiographs) are often normal, although the patient complains of pain.  The site of pain is often not the cause of the pain. Recent evidence by supports the fact that chronic pain is centrally-mediated (Staud et al. 2001).  Similarly, research on the efficacy of different modes of exercise management of chronic pain has shown a central effect of exercise in decreasing chronic low back pain (Mannion et al. 1999).  This research supports the basis of Janda’s approach: the interdependence of the musculoskeletal and central nervous system. Janda states that these two anatomical systems cannot be separated functionally. Therefore, the term “sensorimotor” system is used to define the functional system of human movement.  In addition, changes within one part of the system will be reflected by compensations or adaptations elsewhere within the system because of the body’s attempt at homeostasis (Panjabi, 1992).

The muscular system often reflects the status of the sensorimotor system, as it receives information from both the musculoskeletal and central nervous systems.  Changes in tone within the muscle are the first responses to nociception by the sensorimotor system. This has been supported by various studies demonstrating the effect of joint pathology on muscle tone. For example, the presence of knee effusion causes reflex inhibition of the vastus medialis (Stokes & Young, 1984). The  multifidus has been shown to atrophy in patients with chronic low back pain (Hides et al. 1994), and muscles demonstrate increased latency after ankle sprains (Konradsen & Raven, 1990) and ACL tears (Ihara & Nakayama, 1986).  The global effect of joint pathology on the sensorimotor system was demonstrated by Bullock-Saxton (1994). She noted a delay in firing patterns of the hip muscles and decreased vibratory sensation in patients with ankle sprains.

Because of the involvement of the CNS in muscle imbalance and pain, Janda emphasizes the importance of the afferent proprioceptive system.  A reflex loop from the joint capsular mechanoreceptors and the muscles surrounding the joint is responsible for reflexive joint stabilization (Guanche et al. 1995; Tsuda et al. 2001).  In chronic instability, deafferentation (the loss of proper afferent information from a joint) is often responsible for poor joint stabilization (Freeman et al. 1965).

Tonic and Phasic Muscle Systems

Janda identified two groups of muscles based on their phylogenetic development (Janda, 1987). Functionally, muscles can be classified as “tonic” or “phasic”. The tonic system consists of the “flexors”, and is phylogenetically older and dominant. These muscles are involved in repetitive or rhythmic activity (Umphred, 2001), and are activated in flexor synergies.  The phasic system consists of the “extensors”, and emerges shortly after birth. These muscles work eccentrically against the force of gravity and emerge in extensor synergies (Umphred, 2001).

Janda noted that the tonic system muscles are prone to tightness or shortness, and the phasic system muscles are prone to weakness or inhibition (Table 1). Based on his clinical observations of orthopedic and neurological patients, Janda found that this response is based on the neurological response of nociception in the muscular system. For example, following structural lesions in the central nervous systems (such cerebral palsy or cerebrovascular accident), the tonic flexor muscles tend to be spastic and the phasic extensor muscles tend to be flaccid.  Therefore, patterns of muscle imbalance may be due to CNS influence, rather than structural changes within the muscle itself.

It’s important to note that this classification is not rigid, in that some muscles may exhibit both tonic and phasic characteristics. It should also be noted that in addition to neurological predisposition to tightness or weakness, structural changes within the muscle also contribute to muscle imbalance. However, in chronic pain that is centralized within the CNS, patterns of muscle imbalance are often a result of neurological influence rather than structural changes.

Janda’s Crossed Syndromes

Over time, these imbalances will spread throughout the muscular system in a predictable manner. Janda has classified these patterns as “Upper Crossed Syndrome” (UCS), “Lower Crossed Syndrome” (LCS), and “Layer Syndrome” (LS) (Janda, 1987, 1988).  [UCS is also known as “cervical crossed syndrome”; LCS is also known as “pelvic crossed syndrome; and LS is also known as “stratification syndrome.”] Crossed syndromes are characterized by alternating sides of inhibition and facilitation in the upper quarter and lower quarter.  Layer syndrome, essentially a combination of UCS and LCS is characterized by alternating patterns of tightness and weakness, indicating long-standing muscle imbalance pathology. Janda’s syndromes are summarized in Figure 1.

Janda's Upper Crossed Syndrome

Upper crossed syndrome is characterized by facilitation of the upper trapezius, levator, sternocleidomastoid, and pectoralis muscles, as well as inhibition of the deep cervical flexors, lower trapezius, and serratus anterior. Lower crossed syndrome is characterized by facilitation of the thoraco-lumbar extensors, rectus femoris, and iliopsoas, as well as inhibition of the abdominals (particularly transversus abdominus) and the gluteal muscles.

By using Janda’s classification, clinicians can begin to predict patterns of tightness and weakness in the sensorimotor system’s attempt to reach homeostasis. Janda noted that these changes in muscular tone create a muscle imbalance, which leads to movement dysfunction. Muscles prone to tightness generally have a “lowered irritability threshold” and are readily activated with any movement, thus creating abnormal movement patterns. These imbalances and movement dysfunctions may have direct effect on joint surfaces, thus potentially leading to joint degeneration.  In some cases, joint degeneration may be a direct source of pain, but the actual cause of pain is often secondary to muscle imbalance. Therefore, clinicians should find and treat the cause of the pain rather than focus on the source of the pain.

Systematic evaluation of muscular imbalance begins with static postural assessment, observing muscles for characteristic signs of hypertonicity or hypotonicity.  This is followed by observation of single leg stance and gait. Static posture, gait and balance often give the best indication of the status of the sensorimotor system.  Computerized force plate posturography is often valuable in quantifying sensory and motor deficits. Next, characteristic movement patterns are assessed, and specific muscles are tested for tightness or shortness. Surface electromyography is useful in quantifying muscle activation patterns. All the above information collected provides the clinician a system to determine or rule out the presence of muscle imbalance syndromes. Furthermore, identification of specific patterns and syndromes of imbalance also provides the clinician to choose appropriate interventions to address the cause of the dysfunction.

Janda Approach to Treatment

1. Normalize the periphery. The Janda approach to treatment of musculoskeletal pain follows several steps. Treatment of muscle imbalance and movement impairment begins with normalizing afferent information entering the sensorimotor system.  This includes providing an optimal environment for healing (by reducing effusion and protection of healing tissues, restoring proper postural alignment (through postural and ergonomic education), and correcting the biomechanics of a peripheral joint (through manual therapy techniques).

2. Restore Muscle Balance. Once peripheral structures are normalized, muscle balance is restored.  Normal muscle tone surrounding joints must be restored.  Sherrington’s law of reciprocal inhibition (Sherrington, 1907) states that a hypertonic antagonist muscle may be reflexively inhibiting their agonist. Therefore, in the presence of tight and/or short antagonistic muscles, restoring normal muscle tone and/or length must first be addressed before attempting to strengthen a weakened or inhibited muscle. Techniques to decrease tone must be specific to the cause of the hypertonicity. These include post-isometric relaxation (PIR) (Lewit, 1994) and post-facilitation stretch (PFS) (Janda, 1988).  Muscles that have been reflexively inhibited by tight antagonists often recover spontaneously after addressing the tightness.  In the Janda approach, the coordinated firing patterns of muscle are more important than the absolute strength of muscles. The strongest muscle is not functional if it cannot contract quickly and in coordination with other muscles; therefore, isolated muscle strengthening is not emphasized in the Janda approach.  Instead, muscles are facilitated to contract at the proper time during coordinated movement patterns to provide reflexive joint stabilization.

3. Increase afferent input to facilitate reflexive stabilization. Once muscle balance has been addressed, Janda stresses increasing proprioceptive input into the CNS with a specific exercise program, “Sensorimotor Training” (SMT) (Janda & Vavrova, 1996). This program increases afferent information entering the subcortical pathways (including spinocerebellar, spinothalamic, and vestibulocerebellar pathways) to facilitate automatic coordinated movements. SMT involves progressive stimulation through specific exercises with increasing level of challenge to the sensorimotor system. SMT has been proven to improve proprioception, strength, and postural stability in ankle instability (Freeman et al. 1965), knee instability (Ihara & Nakayam, 1996), and after ACL reconstruction (Pavlu & Novosadova, 2001).

4. Increase endurance in coordinated movement patterns. Finally, endurance is increased through repetitive, coordinated movement patterns.  Since fatigue is a predisposing factor to compensated movement patterns, endurance is also more important than absolute strength. Exercises are performed at low intensities and high volumes to simulate activities of daily living.

The Janda approach is valuable in today’s managed care environment. Once these patterns and syndromes are identified, specific treatment can be implemented without expensive equipment.  Early detection of these causes of chronic pain allows the clinician to treat the patient with fewer visits and less expensive equipment compared to traditional interventions that emphasize modalities and passive treatments. The key to the Janda approach is in the home exercise program. Inexpensive home exercise equipment such as wobble boards, elastic bands, and foam pads are used with a specific progression of exercises as the patient improves in function.

Summary

In summary, the Janda approach emphasizes the importance of the CNS in the sensorimotor system, and its role in the pathogenesis in musculoskeletal pain.  In particular: the neurological pre-disposition of muscles to exhibit predictable changes in tone, and the importance of proprioception and afferent information in the regulation of muscle tone and movement.  Therefore, assessment and treatment focus on the sensorimotor system, rather than the musculoskeletal system itself. Using a functional, rather than a structural approach, the cause of musculoskeletal pain can be quickly identified and addressed. The Janda approach can be a valuable tool for the clinician in the evaluation and treatment of chronic musculoskeletal pain.

About The Author

Phil Page, PhD, MS, PT, ATC, CSCS

Director of Clinical Education and Research for Performance Health products, Dr. Phil Page directs the Thera-Band Academy. He is a licensed physical therapist and certified athletic trainer. His clinical and research interests include the role of muscle imbalance in musculoskeletal pain, and in promoting physical activity in older adults. He has presented internationally on exercise and rehabilitation topics, and has numerous publications. He has a master’s degree in Exercise Physiology, and a PhD in Kinesiology. He is also a certified strength and conditioning specialist. He has worked with the athletic programs at LSU, Tulane, the New Orleans Saints and Seattle Seahawks, as well as the United States Olympic Track and Field Trials.

Bibliography

Bullock-Saxton JE. 1994. Local sensation changes and altered hip muscle function following severe ankle sprain. Phys Ther. 74(1):17-28.

Bullock-Saxton J, Janda V, Bullock M. 1993. Reflex activation of gluteal muscles in walking with balance shoes: an approach to restoration of function for chronic low back pain patients. Spine. 18(6):704-708.

Freeman MA, Dean  MR, Hanham IW. 1965. The etiology and prevention of functional instability of the foot. J Bone Joint Surg Br 47(4):678-85.

Guanche C, Knatt T, Solomonow M, Lu Y, Baratta R.1995. The synergistic action of the capsule and the shoulder muscles. Am J Sports Med. 23(3):301-6.

Hides JA, Stokes MJ, Saide M, Jull GA, Cooper DH. 1994. Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Spine. 19:165-172.

Ihara H, Nakayama A. 1986. Dynamic joint control training for knee ligament injuries. Am J Sports Med. 14:309.

Janda V. 1968. Postural and phasic muscles in the pathogenesis of low back pain. Proceedings of the 11^th Congress of International Society of Rehabilitation of the Disabled”, Dublin, Ireland. Pp 553-54.

Janda V. 1979. Die muskularen hauptsyndrome bei vertebragen en beschwerden, theroetische fortschritte und pracktishe erfahrungen der manuellen medizin. International Congress of FIMM. Baden-Baden. pp. 61-65.

Janda V. 1987. Muscles and motor control in low back pain: Assessment and management. In Twomey LT (Ed.) Physical therapy of the low back. Churchill Livingstone: New York. Pp. 253-278.

Janda, V. 1988. Muscles and Cervicogenic Pain Syndromes. In Physical Therapy of the Cervical and Thoracic Spine, ed. R. Grand. New York: Churchill Livingstone.

Janda V, Va’Vrova’. 1996. Sensory motor stimulation. In Liebenson C (ed). Rehabilitation of the Spine. Williams & Wilkins: Baltimore. pp. 319-328.

Konradsen L, Ravn JB. 1990. Ankle instability caused by prolonged peroneal reaction time. Acta Orthop Scand. 1990 Oct;61(5):388-90.

Lewit, K., Simons DG. 1984. Myofascial Pain: Relief by Post-Isometric Relaxation. Arch Phys Med Rehabil 65(8): 452-6.

Mannion AF, Nuntener M, Taimela S, Dvorak J. 1999. A randomized clinical trial of three active therapies for chronic low back pain. Spine. 24(23):2435-48.

Panjabi MM. 1992. The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. J Spinal Disord. 5(4):383-9

Pavlu D, Novosadova K. 2001. [Contribution to the objectivization of the method of sensorimotor training stimulation according to Janda and Vavrova with regard to evidence-based-practice.] Rehabil Phys Med. 8(4):178-181.

Sherrington CS. 1907. On reciprocal innervation of antagonistic muscles. Proc R Soc Lond [Biol] 79B:337.

Staud R, Vierck CJ, Cannon RL, Mauderli AP, Price DD. 2001. Abnormal sensitization and temporal summation of second pain (wind up) in patients with fibromyalgia syndrome. Pain. 91(1-2):165-75.

Stokes M, Young A. 1984. The contribution of reflex inhibition of arthrogenenous muscle weakness. Clin Sci. 67:7-14.

Tsuda E, Okamura Y, Otsuka H, Komatsu T, Tokuya S. 2001. Direct evidence of anterior cruciate ligament-hamstring reflex arc in humans. Am J Sports Med. 29(1):83-87.

Umphred DA, Byl N, Lazaro RT, Roller M. 2001. Interventions for neurological disabilities. In  Neurological Rehabilitation (Umphred DA, ed). 4^th ed. Mosby: St. Louis. pp. 56-134.

Exoskeletons–wearable, motorized machines that can assist a person’s movements–have largely been confined to movies or military use, but recent advances might soon bring the devices to the homes of people with paralysis.

So far, exoskeletons have been used to augment the strength of soldiers or to help hospitalized stroke patients relearn how to walk. Now researchers at the University of California, Berkeley, have demonstrated an exoskeleton that is portable and lets paraplegics walk in a relatively natural gait with minimal training. That could be an improvement for people with spinal-cord injuries who spend a lot of time in wheelchairs, which can cause sores or bone deterioration.

Existing medical exoskeletons for patients who have lost function in their lower extremities have either not been equipped with power sources or have been designed for tethered use in rehabilitation facilities, to correct and condition a patient’s gait.

In contrast, the Berkeley exoskeleton combines “the freedom of not being tethered with a natural gait,” says Katherine Strausser, PhD candidate and one of the lead researchers of the Berkeley project. Last week at the 2010 ASME Dynamic System and Control Conference in Cambridge, Massachusetts, Strausser presented experimental results from four paraplegics who used the exoskeleton.

Assisted Steps: A patient with paralysis stands with the aid of the Berkeley exoskeleton. The exoskeleton moves the patient’s hips and knees to imitate a natural walk. Credit: University of California, Berkeley

Other mobile exoskeletons–like those developed by companies such as Rex Bionics or Cyberdene–don’t try to emulate a natural gait, Strausser says. Because walking is a dynamic motion that is essentially falling forward, Strausser says, many designs opt for a shuffle instead of a natural gait, because “it’s safer and a lot easier.” However, emulating a natural gait mimics the efficiency of natural walking and doesn’t strain the hips, Strausser says.

The Berkeley device, which houses a computer and battery pack, straps onto a user’s back like a backpack and can run six to eight hours on one charge. Pumps drive hydraulic fluid to move the hip and knees at the same time, so that the hip swings through a step as one knee bends. The device plans walking trajectories based on data (about limb angles, knee flexing, and toe clearance) gathered from people’s natural gaits. Pressure sensors in each heel and foot make sure both feet aren’t leaving the ground at the same time.

The Berkeley program was successful. The four paraplegics described in Strausser’s talk, three of whom had been in wheelchairs for years, were able to walk with the device after only two hours of training. “It’s very easy to walk in,” says Strausser. “It moves your leg exactly like you would in your normal gait.” To begin a step, the exoskeleton requires a user to press a button on a remote control; the team is working on a more intuitive interface.

When designing the medical exoskeleton–which uses parts from two military exoskeletons–the team needed controllers and a design that takes into account the user’s lack of strength. While military exoskeletons work with a soldier’s motion to add strength, medical exoskeletons do the opposite, fighting against incorrect gaits or performing the gait, explains Strausser. “The biggest problem is holding a person into the ‘exo’ safely and securely,” she says. After field testing at the University of Virginia’s Clinical Motion Analysis and Motor Performance Laboratory last year, the group developed a proprietary design that keeps users from sliding out of the exoskeleton and distributes the weight of the 80-pound machine. The group plans to make the device lighter and to make a low-cost version that patients can use in their homes. (The research group is affiliated with a company, Berkeley Bionics, that plans to begin selling a form of the technology.)

“Overall I think it’s a very good device,” says Panagiotis Artemiadis, an MIT researcher who heard Strausser’s talk. He is developing an exoskeleton called the MIT-SkyWalker that helps stroke patients practice walking on a machine that resembles a treadmill. He says he can picture the Berkeley device being used by patients in their homes, particularly if the researchers reduce the weight.

Other mobile exoskeletons to help paralyzed people are just starting to come to market. German company Argo Medical Technologies is releasing its first product, a 100,000-euro exoskeleton intended for use in rehab centers, in October. The company plans to release a home version soon after for about half the price. Unlike the Berkeley exoskeleton, this one, dubbed ReWalk, takes the user a few weeks to learn. “It’s like getting a driver’s license,” says John Frijters, vice president of business development for Argo. ReWalk is customizable, able to tailor the sensitivity of the sensors, step length, and stride depending on how the user feels. It weighs about 45 pounds and runs eight to 10 hours on a charge, according to Frijters.

While ReWalk doesn’t yet have data to share on the advantages of using exoskeletons, “dozens” of patients have tested ReWalk, and “they all enjoy the benefit of being active,” says Frijters. “They have the opportunity to get up from the wheelchair and walk again. It’s very emotional.”

By Kristina Grifantini in Technology Review Wednesday, September 22, 2010

by K.D. Christensen DC, CCSP, DACRB

Selecting the ideal exercises for patients with back conditions requires judgment based on clinical experience and scientific evidence. There are several approaches to rehabilitation, and many different types of exercises are available; however, patients have a limited amount of time, willingness, and enthusiasm to exercise. Therefore, we must always try to give our patients the most effective exercises for their condition. But, what are the “best” exercises for Chiropractic patients?

Selection Criteria

The best exercises for a specific problem are those that will be rapidly effective, easy to learn and perform, and are safe; that is, they don’t worsen the current condition or aggravate other problems. The exercises must help the patient to regain normal alignment and easy, natural movement. And the end result should include a decreased chance of similar, recurring problems.

One Leg Balancing Using Bpdyblades

A successful and appropriate rehabilitative program for the back and/or neck can be designed without the use of expensive, joint-specific equipment. While rehab type machines can be very useful, current active care concepts consider such equipment not an absolute requirement. In fact, the low-tech approach can be very effective for the treatment of most spinal conditions. Additional personnel, fancy equipment, more office space, and extra time are not always necessary. With an understanding of normal spinal function, knowledge of the involved muscles, and some updating of exercise concepts, doctors of Chiropractic can effectively rehab their patients with timely in-office instruction and patient performance followed by simple home exercise procedures .

Specific Adaptation to Imposed Demands

The “SAID” concept is one of the underlying tenets of the strength and conditioning field. [1] It describes the observation that our bodies will predictably change in response to the demands that are placed on them. If we frequently perform aerobic activities, then our lungs, hearts, and muscles become more efficient at taking in and processing oxygen. When we spend more time in activities requiring force and providing resistance, our bodies become stronger. And, if we practice balance and coordination skills, we improve our ability to function easier on unstable surfaces (such as on an incline, rolling ship or a pair of skates). In fact, these improvements in our abilities are quite specific, and we become better at doing whatever it is that we do most often.

Balancing on a Turtle

It has taken quite a while for those specialists in the treatment of spinal problems to incorporate the SAID concept into neck and back rehab programs. Recently, some of us have begun to use the same thought processes to design spinal exercises that we have used for decades to determine appropriate x-ray positions. As Chiropractors, we do recognize that the spine functions very differently when it is not weight-bearing. We now know that an ideal way to help our patients return to normal function is with exercises that imitate as closely as possible the real conditions under which the spine must function day after day. That certainly must include the specific stress of gravity in the upright position.

Kinetic Chain Exercises

When the spine is bearing weight it is part of a closed kinetic chain. This is the manner in which we use the joints and connective tissue of the spine during most daily and sports activities, and it requires the co-contraction of accessory and stabilizing muscles. Weaker or injured muscles can be quickly strengthened with the additional use of isotonic resistance to stimulate increases in strength. Isotonic resistance can come from a machine, from weights, from elastic tubing, or just using the weight of the body. Perhaps more important than the equipment used is whether the spinal support structures are also exercised in an open or a closed-chain position.

Open-chain exercises for the spine are done non-weight bearing, while either lying on the ground or immersed in water (which removes much of the effect of gravity). Both floor-based and water-based exercises have some specific usefulness, primarily during the acute stage.

A good example of this is a study comparing closed vs. open kinetic chain exercises for the training of the thigh muscles. Augustsson et al. wanted to improve their subjects’ vertical jump height. [2] Two groups exercised twice a week at maximal resistance – one group doing closed-chain exercises (barbell squats), and the other working on the knee extension and hip adduction weight machines (open-chain exercising). At the end of six weeks both groups had gained considerable strength, but the closed-chain exercisers were the only ones who improved significantly in the vertical jump. Since jumping is a closed-chain activity, the SAID concept tells us to expect that closed-chain exercising will likely be more effective.

Functional Position Exercise

We know that the functional origins and insertions of many muscles change when changing position from standing to lying down. Certainly the proprioceptive input from receptors in the muscles, connective tissues, and joint capsules is very different between the two positions. This is why it is also important to bring neck and back rehab exercises closer to real-life positions, and it explains why patients make rapid progress when they are taught to exercise in a functional (upright) position.

Patients initially may need to exercise when lying down. However, continual floor-based exercises do not train muscles and joints to function in upright functional postures. The neurological patterns that are developed on the floor or in a pool may not resolve problems encountered in upright activities. Generally, continually learning new skills and habits on the floor doesn’t translate to better functioning during upright activities And, some patients don’t like to get down onto the floor to exercise, anyway.

By staying up off the floor, exercising in a weight-bearing position is actually easier for most patients. In addition to being more focused and practical, upright exercising trains and strengthens the spine to perform better in everyday activities. Patients accept the idea of doing exercises that clearly prepare them for better function during normal activities of daily life.

How to Spot a “Sham” Exercise

When investigators want to test treatments, they always require a “control” group, which is given a treatment that is known to be ineffective. A 1998 study on back pain published in the respected journal Spine taught several popular low back exercises to the control group. As with other studies, the researchers found no improvement using these exercises. [3] The six exercises considered a “sham” treatment included: knee-to-chest stretches, partial sit-ups (”ab crunches”), pelvic tilts, hamstring stretches, “cat and camel”, and side leg lifts. The problem with these and most other commonly recommended back exercises is that the joints, discs, muscles, and connective tissues are not bearing weight during the exercise; therefore, the movements performed while exercising do not prepare or retrain these structures for daily activities. On the other hand, exercises performed with the spine upright (standing or sitting) against resistance specifically train and condition all involved structures to work together smoothly. Thus, effective exercises are ones that are performed upright, in a closed kinetic chain.

The Value of Balance Exercises

For many athletes (whether recreational or competitive), it is important to regain the fine neurological control necessary for accurate spinal and full body performance. This means that about five to ten minutes of each workout should be spent exercising while standing on one leg, with the eyes closed, while standing on a mini-tramp, or using a special rocker board. The advantage of these balance exercises is seen when athletic patients return to sports activities and can perform at high levels without consciously having to protect their backs. Back exercises done on a rocker board or while standing on one leg can be more useful than those done on a gym ball, since the entire body is in a closed-chain position during the exercises. The stabilizing muscles, the co-contractors, and the antagonist muscles all have to coordinate with the major movers during movements that are performed during closed-chain exercising. This makes these types of exercises very valuable in the long run, particularly for competitive athletes.

Floor work wearing 5 Fingers

Functional Alignment

Many chronic spinal problems develop secondary to an imbalance in weight-bearing alignment of the lower extremities. In fact, lower extremity misalignments — such as leg length discrepancies and pronation problems — are frequently associated with chronic pelvis and low back symptoms. [4] Any of these that are present will need to be addressed in order to resolve the patient’s current symptoms and to prevent future back problems. The use of adjustments, exercises, and custom, flexible orthotics for the lower extremities is especially critical when a functional approach is taken. The effects of weight bearing and the alignment of the kinetic chain must be considered.

Conclusion

Selecting the best exercise approach for each patient’s back problem is important. A well-designed exercise program allows the doctor of Chiropractic to provide cost-efficient, yet very effective rehabilitative care. Exercises performed with the spine upright (standing or sitting) specifically train and condition all the involved structures to work together smoothly. The end result is a more effective rehab component and patients who make a rapid response to their Chiropractic care. Except for brief periods in patients who are acute, caution must be heeded for continual exercises that don’t place patients in real-life, functional positions. While this may require a change in standard procedures, it is consistent with Chiropractic philosophy and treatment approaches. When you persist with this, you will experience dramatic improvements in patient outcomes.

References

1. Fleck SJ, Kraemer WJ. Designing Resistance Training Programs. Champaign, IL: Human Kinetics, 1987.

2. Augustsson J et al. Weight training of the thigh muscles using closed vs. open kinetic chain exercises: a comparison of performance enhancement. J Orthop Sports Phys Therap 1998; 27:3-8.

3. Snook SJ et al. Reduction of chronic nonspecific low back pain through the control of early morning lumbar flexion — a randomized controlled trial. Spine 1998; 23:2601-2607.

4. Rothbart BA, Estabrook L. Excessive pronation: a major biomechanical determinant in the development of chondromalacia and pelvic lists. J Manip Physiol Therap 1988; 11:373-379.

Published on www.ccptr.org July 26th, 2003. For more about the author go to http://www.ccptr.org/rehabilitation-specialist/kim-christensen-d-c/

Maybe feeling like it doesnt matter how hard you run you still don’t get that far ahead?

You love health & fitness but not sure how to make it into a profitable career?

Well we have a great story to share of two former employees from AOK Health who after years working here at AOK have made a massive success out of their new businesses

David Corin worked at AOK Health running our education division (Australian Graduate School of Health and Sports Science) from 2003 to 2008. Many AOK clients will have met David at the various AGSHSS courses that he organized or as a regular face at FILEX.

Mick Gardner worked at AOK Health from 2007 to 2008 running the export department. AOK won Exporter of the year in 2007 & 2009 so Michael knows all about quality service and the fitness industry.

David’s Story

In 2009 David purchased a Step into Life franchise and set up in Warners Bay by Lake Macquarie. Mick began his franchise with Step into Life in 2010 and has set up in Dungog and East Maitland.

David Corin

“When I was with AOK I had been lucky enough to spend 5yrs meeting a lot or trainers, business owners and senior managers in corporate positions (like Fitness First, Fernwood etc). I saw a lot of really excellent PT’s who were struggling to make a profit. I saw a lot of managers who had good jobs and worked hard but the company owned them, and they didn’t really have control over what they did each week, each day.

“I wanted to be involved in health & fitness, but I didn’t want to be a slave to the business. I wanted to build a business that would allow me to work around my family needs yet deliver me a substantial income. I wanted to build an income stream quickly and needed to have the right systems and structures for that to happen fast.

For me this is the perfect job, except that it’s not a job at all.

One thing I didn’t expect is how much joy I would get from helping others help themselves with their health & fitness. Seeing the changes my clients have been able to experience in both mind & body through their training has just been an inspiration. I love going to work each day! I love seeing my clients and hearing their stories and yes, making them sweat that little bit harder in the park!”

Mick’s Story

“Since arriving back in Australia after an 8 year stint in the UK running a Personal Training studio, I was left in a bit of a dilemma. Should I start my own business or work for someone else? I started work with AOK Health in their export department.  This was a great chance to meet and develop relationships with a wide variety of people from around the world.  These people included self-employed Personal Trainers to owners of larger retail organisations.

From communicating with these clients on a weekly basis it became apparent that everyone in the fitness industry seemed to work extremely long hours.  Now although I don’t mind working long hard hours I was sure there had to be an easier, more time effective way of helping people stay fit and healthy whilst still being able to live my own life and watch my family grow up.

Then I remembered a friend telling me about Step into Life as he had been an assistant trainer at a venue and was raving about the concept. I had a look at the website and asked for more details. I attended an info session and was sold straight away. The things that appealed to me were the systems, ongoing support, the objectives of the business and the fact that you don’t have to constantly think of new ideas. They are already there. All I have to do is promote my venue with the help of my state office.

I have been in operation since Feb 10 and have over 60 clients already. The way we train people allows me to train 60 people 2-3 times a week in a 14 hour period, enabling me to have a lot more spare time for myself.

The most rewarding part of the job (if that’s what you call it) is seeing the clients achieving their goals and realising their potential. That never ceases to bring a smile to my face.”

Could you be next?

AOK Health has teamed up with Step into Life to offer a great bonus package to anyone who wants to really start making a decent income from their fitness business but not have to work like a slave!  Contact David Corin ( warnersbay@stepintolife.com )  and he will tell you how take advantage of the $600 AOK product bonus (products at recommended retail).

If you are interested in finding out more about the Step into Life opportunity, then click here and register for more information on details on whats available to you as an AOK Health customer.

David says “Step into Life has given me what I needed. A great business model that provided the framework that helped me quickly build a substantial PT business over my first 6mths. I now have over 100 clients and my income is way higher than anything I previously earned in the corporate world. Best of all is that now I have grown to my target numbers, I can now take timeout more often and do the things I want to each day, not the things I have to!”

Over the past 10 years I have received many requests for assistance from physiotherapists, personal trainers and other therapists about starting their businesses. Recently we have developed a web site development and hosting business for our many health/fitness industry clients. One of the most often asked questions is “what shall I call myself?”

What is in a name?

Many entrepreneurs in the fitness and health industry deliberate and spend too much effort trying to come up with an appropriate business or product name. In many cases it can stall the progression of a business. The truth is that no business name is critical to success, regardless of how memorable or well-established it is.

A name is only as valuable as the marketing plan (and often the dollars you can invest) and the business behind it. A business needs to be both well run and have a marketing budget to make a name or trademark meaningful. Otherwise, it is irrelevant how memorable or clever the name is. Simplicity of often a godsend.

Just consider some of the leading names in the world today – Google, Twitter, Amazon, Rebel Sport, Fitness First and Virgin Active. It is possible that some of the most successful names were conceived by teenagers at a university bar, not by some high powered marketing executive. Keep in mind that many companies with great or even long-established business names have failed. Great names cannot make up for the lack of a good business model or adequate financing. Every name – no matter how seemingly valuable – can be changed. It is easy to believe that customers know a name so well that it cannot be changed, but that is simply not true. Here is a site with some naming strategies and and cool things to think about.

Small companies often change names when they change ownership, typically with positive rather than negative effects. Even very large companies change corporate names and are able to keep, or even expand, their customer base.

Here are some things for a business to keep in mind when deciding on a business name:

1. Ensure you business name is available. Your business name should be available as both a registered business (or company if you want protection Australia wide) and as a web address.
2. Marketing beats a good name. No matter how good a name is, a business has to be able to first reach customers. A lot of marketing exposure is a lot more powerful than the best name. If there is a choice between spending resources on obtaining a name, versus the opportunity to reach customers, the marketing path is normally the most effective. Do what has to be done to place your service or product in front of customers.
3. There is no ‘must-have’ business name, product name or trademark. No matter how great the name conceived, there is always another name out there that will work just as well.
4. Many businesses use similar names. It is easy to lose sleep over the fact that other businesses use names that are similar. Do the marketing and customers will find you.
5. A simple name may prove more effective than a clever one. A company with a straightforward name, such as ‘Highlands Dental Clinic,’ may develop a better business than a company with a seemingly memorable or clever name. Do not under estimate the obvious names.

Here are some handy sites you should visit when thinking about starting your business:

Company and business names ASIC Searches.

Web names and availability from Ipera or Melbourne IT

Starting your business in NSW, Victoria, Queensland, SA or from the Commonwealth.

By Odd-Egil Olsen et al – Sports Trauma Research Center, University of Sport and Physical Education, Oslo, Norway

BMJ  2005;330:449 (26 February), doi:10.1136/bmj.38330.632801.8F (7 Feb 2005)

Introduction

Regular physical activity reduces the risk of premature mortality in general and of coronary heart disease, hypertension, colon cancer, obesity, and diabetes mellitus in particular.

Balance Pad Drills For Throwing & Catching

However, participation in sports also entails a risk of injury for all athletes, from the elite to the recreational level.   Studies from Scandinavia document that sports injuries constitute 10-19% of all acute injuries seen in emergency departments, and the most common types are knee and ankle injuries.  Serious knee injuries, such as injuries to the anterior cruciate ligament, are a growing cause of concern.  The highest incidence is seen in adolescents playing pivoting sports such as football, basketball, and team handball. In these sports, women are three to five times more likely to contract a serious knee injury than men.

Injuries to the anterior cruciate ligament may require surgery, always entail a long rehabilitation period, and drastically increase the risk of long term sequelae.  Although treatment methods have advanced notably, there is no evidence to show that repair of a ruptured anterior cruciate ligament or isolated cartilage lesions prevents early development of osteoarthritis. 

Wobble Board Drills While Catching & Throwing

Effective methods for preventing injuries therefore need to be developed. Some studies report promising results, indicating that it may be possible to reduce the incidence of knee and ankle injuries among adults  and adolescents. However, these studies are small and mainly non-randomised, with important methodological limitations.  Prospective randomised intervention studies are therefore needed, especially among children and adolescents, to assess the efficacy of interventions aiming to reduce injuries. We conducted a randomised controlled trial to investigate the effect of a structured programme of warm-up exercises used to prevent acute injuries of the lower limb in young people playing sports.  To minimise overlap within clubs, we used a cluster design.

Conclusion A structured programme of warm-up exercises can prevent knee and ankle injuries in young people playing sports. Preventive training should therefore be introduced as an integral part of youth sports programmes.

Here is an interesting article on proprioception and ankle rehabilitation.

Evidence Now In

The risks of exposure to various classes of phthalates (plastic softeners used to make PVC soft and elastic) have been recognised for many years. Recently however a fuller understanding has been gained through various international research programs.  Studies by the University of Rochester Medical Center and the Mount Sinai Children’s Medical Health Center have shown various links to poor health outcomes as a result of phthalate exposure.

The primary risk is through injestion by chewing plastics directly or by eating food stuffs stored or processed in contact with plastics.  However while the risk of exposure via exercise products would appear to be low, users such as children or pregnant women should avoid using products containing phthalates until more research is completed.

AOK philosophy is to supply the highest quality and safest products available.  At the time of this publication we are aware of no other swiss or exercise ball manufacturer who does not use phthalates in their products. This is particularly true of Chinese manufactured balls.

For additional information regarding phthalates you should with Australia’s leading authorities – the Vinyl Association and the Phthalate Information Association.

For other safety tips you should visit www.mediball.com