Surgery: kinesitherapy – Kinesitherapy – Exercising appliance
Reexamination Certificate
1999-11-08
2002-12-03
Yu, Justine R. (Department: 3764)
Surgery: kinesitherapy
Kinesitherapy
Exercising appliance
C472S095000
Reexamination Certificate
active
06488640
ABSTRACT:
BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention relates generally to the field of physical exercise and, in particular, to that of exercise leading to an enhanced range of back motion and concurrent reduction in back discomfort. More particularly, the present invention relates to an exercise device and method for applying continuous passive motion (CPM) to the lumbosacral spine. More particularly yet, the present invention relates to such a device and method that causes the lower body of the person being exercised to move back and forth horizontally in a motion mimicking that experienced by a horseback rider on a horse at the walk, thereby subjecting the lumbosacral spine to repetitious flexion and extension resulting in rotating the pelvis, a movement called pelvic tilting.
2. Description of the Prior Art
Limited back motion may be a normal function of back configuration, varying greatly from individual to individual, or it may be abnormal reflecting some structural change resulting from genetic deformity or some degenerative or traumatic process causing arthritic deformation, either recognized or unrecognized. Nevertheless, most limitations of back motion and, hence, most incidences of back pain, are not associated with an identifiable anatomic deformity. Usually the reported limitations are not investigated beyond a spinal x-ray. Specific soft tissue imaging techniques, such as CAT or MRI studies, are usually reserved for individuals with unremitting and severe back pain and stiffness with or without neurological findings. In contrast, most stiff and painful back complaints are initially placed in a common category and treated empirically. Although the individual may relate the complaint to some specific event such as lifting a heavy object or twisting the back excessively, it is just as common that there is no identifiable causative incident. In other words, in most cases no anatomic abnormality or other identifiable cause is found for the limitation. Patients are frequently told semi-whimsically that the major part of back complaints results from humankind's “decision” to walk erect supported in part by a vertical column of vertebrae. If the back limitation is incapacitating and resistant to the usual home remedies, the individual often seeks the help of chiropractor, an osteopath, a physical therapist or an orthopedist, clinicians much involved in relieving individuals with back complaints. In the absence of a clear causation, the limitation is managed by one or several modalities with relief ranging from non-existent to full. This is one of several examples illustrating the maxim that the more intractable a condition is to cure, the greater is the number of “cures”. In other words, management of back stiffness remains far from a mature therapeutic modality.
Regardless of the cause of the back stiffness, its cause relates to some degree of muscle spasm restricting the back's range of motion, commonly asymmetrically limiting one motion more than another. Pain is a common accompaniment of this stiffness. There commonly is some associated degree of tenderness over the spastic muscle group. Traditionally, these subjects have been advised to stay in bed for several days until the complaint remits or greatly reduces. Then, several years ago, it was found that such prolonged inactivity actually caused a worsening of the disability attributed to further muscle weakness from disuse. Good muscle tone is essential to the erect posture, the full range of motion and freedom from discomfort. This observation was further supported by the quicker return to good function of individuals who resumed walking after only a couple of days of rest. While the precise mechanism of the recovery remains obscure, many investigators suspect that in addition to the resumption of normal muscular activity there may be some additional factor of recovery attributed to the effects of spinal motion.
Animal studies have suggested that one mechanism of recovery may be related to the distribution of nutrients transferring into and out of the intervertebral discs, those cartilaginous plates separating the bodies of the vertebrae. It is well established that, in arthritis of the spine, these discs narrow, causing a constriction of the small passageways between the vertebrae and creating abnormal pressure on the segmental nerves emerging through these spaces. Such pressure commonly causes muscle spasm and accompanying discomfort. If it is that pressure that gives rise to the reported pain, then improved disc-nutrition mediated by spinal motion may be the mechanism by which early return to activity (including spinal motion) following acute back discomfort results in more efficient relief of back pain.
In any event, since the discovery of the beneficial effect produced by back motion in these individuals, new therapies have been designed to enhance the early return to back motion through devices that flex and extend the lumbar vertebrae. The common name for the maneuver is “pelvic tilt,” from the fact that the alternating flexion and extension of the lumbar vertebrae results in a tilting back and forth of the pelvis. In the traditional pelvic tilt exercise, the individual is supine (lying on his back) and actively rotates the pelvis forward and backward. The benefit from the pelvic tilt exercises is attributed to the strengthening of the abdominal muscles so essential in maintaining the erect posture. There may be some yet unidentified beneficial factor caused by the motion itself possibly the direct stretching of the muscles and ligaments occasioned by this range of skeletal movement. It then follows that if the active motion of pelvic tilting produces this effect, why may not passive motion through the same range of movement result in the same beneficial result.
At this point it is well to reemphasize that stiffness and discomfort are consistently associated in limited back motion. This affliction is increasingly experienced with advancing age. Past the age of 35, individuals are more susceptible to stiffness when they rise from bed in the morning or when standing after a period of immobilization from sitting. Normally, stretching or moving around brings prompt relief. The back becomes more flexible and the discomfort disappears. It has become a commonplace that the trained athlete stretches before exercise and those of us who learned the discipline of daily exercise are advised to devote a period preceding the exercise to a stretching routine.
Only recently have clinicians started to recognize that patients who complain of back pain may symptomatically benefit from passively induced flexion and extension of the lumbar spine, that is motion occasioned by an external force moving the pelvis forward and backward and, thus, flexing and extending the lumbar spine. This type of motion has been termed Continuous Passive Motion (CPM) and has been described in, among other places, “The Power of CPM: Healing Through Motion”,
Continuing Care,
vol. 8, No. 10, November 1989.
A typical device applying CPM for back-pain relief is that disclosed by Riddle et al. (U.S. Pat. No. 5,500,002; issued 1996). The device of Riddle et al. provides a three-panel horizontal support on which the patient lies. The central panel supports the buttocks of the patient, and the other panels the upper body and legs, respectively. While the central panel remains static, one or both of the other panels tilt up and down. Thus, tilting the upper panel up and down, for example, will result in a motion that serves to flex the lower back region. Care must be exercised to position the body accurately so that flexion will occur in the intended segment of the spine. Beyond this consideration though is the undesirable and possibly harmful result of bending the trunk forcibly to a degree that causes pain and further spasm in the back muscles. There is no built-in mechanism to monitor the flexion according to the discomfort the device may produce. It may be postulated that the patient's position, lying instead of u
Hood, Jr. Robert T.
Little David H.
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