AposTherapy Review – Does It Work?

February 11, 2013

Is there any proof that Apostherapy works and does proof even matter if people get results?

 

What Is AposTherapy

 

AposTherapy, involves the use of a convex shaped (think dome) rubber device (known as a ‘pod’) on the bottom of your shoe – a shoe you are meant to wear for one hour each day. These pods are adjustable to move the mechanical loads off the stress points in the knee of someone with osteoarthitis, thereby in theory, reducing pain.

 

As far as I can tell, the AposTherapy shoe uses a technology that is similar to the Power Plate phenomenon. The principles of power plates or vibration is to stimulate the body’s natural response to vibration. Vibration creates instability throughout the body and these vibrations transmit waves of energy that cause muscles to contract to stabilize the body. There is some evidence for vibration and the science of vibration plates has been used by Nasa.

 

The Apostherapy analysis involves walking over a computerised plate and the therapist reads the calibrations on a computer terminal. This approach seems similar to the sports shop that uses computers to measure for sport shoe insoles or orthotics. The draw back here is that, you are not getting your insoles fitted by a professional podiatrist and the insoles are usually far more expensive than the professionals charge. This does have a similar feel to the approach being used by the Apos technology. Remember that AposTherapy is a technology (a rubber dome on a shoe to be precise) and not a treatment as such. There doesn’t appear to be any actual hands on knee, physical examination performed as far as I can ascertain.

 

So in theory, the pod device introduces instability to the knee joint that stimulates muscles to adopt a different walking pattern. The idea of Apos does seem to be grounded in some science although the AposTherapy itself does not have any research in peer reviewed medical journals as yet but this doesn’t really bother me.  AposTherapy does have plenty of anicdotal evidence (case studies) behind it which is certainly something to be considered.

 

What The Critics Say

 

Critics may ask just how long do they actually follow up and monitor their patients and this is a valid question. Critics may also say that if the ‘treatment’ was as good as they claim then the National Health Service would take it on. Ha, I say to that! There are many available treatments available for musculo-skeletal problems that have hundreds of studies in peer reviewed medical journals that have been proven to work that the NHS has not adopted.

 

Chiropractic is a very good example. Chiropractic has been proven to be cost effective and ‘best clinical practice’ for chronic and acute low back pain. It is even recommended for use by the department of health in their Musculoskeletal  Services Framework, but it has yet to be fully utilised by the NHS and so patients continue to suffer and the NHS continue to waste money needlessly in many cases.

 

The other problem I see with AposTherapy is that it uses a very mechanistic approach (vs. holistic) and does nothing to address the underlying cause of knee arthritis.

 

* previous injury to joints (falls, car crashes, broken bones etc)

* congenital (born with) anomalies of bone

* bad posture habits

* acidic foods – alcohol, caffeine, wheat, sugar, nicotine, fizzy drinks

* manual professions

* exercise levels & body weight

 

How Much Does AposTherapy Cost?

 

A lot! I don’t like this as it has a Harley Street ring to it (yet another orthopod making a fortune on Harley Street – gosh I’m usually not so cynical) – so fine if you have osteoarthritis and are independently wealthy but for most, this will be an inaccessible therapy option.

 

To be quite honest, I like the underlying theory as a bit of a structural posture geek myself, and the lack of evidence other than case studies wouldn’t necessarily put me off, but the price and lack of physical examination does.

 

So you tell me, has it helped you? I really want to hear from some of you who have use AposTherapy shoe pods.

 

  • mon

    It’s Apos not Epos Therapy….. and they do full assessment and measurments as well as walking analisys before they fit the ‘pods’ so it is very holistic…

    • http://www.posturevideos.com/ Dr Paula Moore

      Well spotted I’ll go back and correct all the typos!! What constitutes the walking analysis exactly? And what measurements do they do? Thanks for reading.

  • AposTherapy

    Hello Dr. Moore,

    Thanks for the review on AposTherapy. I would like to address
    some of your questions about AposTherapy to help you and your readers better understand our process.

    All patients come in for a free, no obligation initial assessment. During that initial assessment an AposTherapist, a specially-trained chartered physiotherapist, will conduct an in-depth clinical evaluation,

    including pain, function and quality of life questionnaires, in order to
    assess suitability for the treatment and develop a personalised therapy program that responds to a patient’s unique treatment needs.

    In addition we use state-of-the-art computerised equipment (as
    you mentioned), to obtain an in-depth analysis of the patient’s: Step
    length (knee pain can cause shorter steps); load distribution on each leg (less weight tends to be placed on an injured leg); walking velocity
    (injuries often make people walk slower); and gait symmetry (which can assess any limping). This gives us a clearer picture of how the way you move may be causing your pain, and how we can provide lasting pain relief.

    Based on the above assessment the patient is fitted with their own personally-calibrated foot-worn biomechanical device. As part of
    the treatment package, along with the device the patient receives 1 year of follow-up appointments to monitor progress and make any adjustments to the device that might be required.

    You can view clinical studies published in peer-reviewed medical
    journals here.http://apostherapy.com/en/healthcare-professionals/medical-research.

    We would love to invite you in to one of our AposTherapy centres for you to meet with our clinical team and to see first-hand exactly the
    patient journey and how it works.

    • http://www.posturevideos.com/ Dr Paula Moore

      Thank you David for your reply. Here are my thoughts on your comments:

      Physios do ‘in-depth’ assessments ‘including pain, function and quality of life questionnaires.’ So as I said before, it seems no one actually physically examines the knee joint. Just about anyone can monitor the results of a questionnaire. Has anyone had the apostherapy and had an actual physical examination? Please do clarify.

      A ‘personally-calibrated foot-worn biomechanical device’ is a plastic pod for under the shoe; just to clarify.

      I’ve reviewed the research and this is what I found: Most studies were very small (10, 12, 19, 24, 25, 34 subjects). Several of the studies were using ‘healthy subjects’ so straight away that is a problem. Several other studies focused not on pain but on gait and recorded, improved walking speed or reduced knee adduction (the inward angling of the knee). This is a good thing as the angling potentially causes more wear in the joint but again, these studies did not report on pain outcomes.

      One large study of 654 had good pain improvement measured only for 12 weeks but still a nice sized study. One long term study (2 years) if you read the entire paper as I did reports: “The majority of improvements with the biomechanical therapy are achieved within the first eight weeks,” and “the results did not show a big difference in improvements over time.”

      Now I know I sound a cynic here but really i’m not. I’m all for natural interventions but as I said before I feel someone needs to be physically examining the body (at the very least all joints in lower limb involved in gait – feet, ankle, knee, hip, pelvis). The research is very early days but certainly promising but not yet clinically very relevant from my own readings. Would I consider Apostherapy myself? Well, I think I’d consider it, only as part of a total approach – nutrition and foods good for joint health, regular physical treatments and then the addition of the pod. If it didn’t work for pain control, it looks to me like the only potential damage, is that to your wallet.

      • AposTherapy

        Hi Dr. Moore,

        Thank you for your response. Forgive me but I forgot to mention that as part of the initial assessment a physical examination and a full anamnesis is performed.

        We require that all AposTherapists are qualified and registered physiotherapist and must adhere to the CSP and HPC guidelines.

        All assessments, including the initial assessment, carried out are in line with physiotherapy training and registration guidelines. The initial assessment
        includes in-depth interview and objective assessment including hip, knee, ankle and lumbar region assessment. These assessments include amongst other things; range of motion, palpation, stability testing, manual muscle testing, reflexes,
        accessory movements, special tests (MacMurrays, Lachmans etc.) and functional tests

        • http://www.posturevideos.com/ Dr Paula Moore

          Thank you David for your response. For our readers, an ‘anamnesis’ is simply taking a case history.

          Thank you for making clear that indeed an initial physical examination is carried out. So in time, I look forward to reading some research on larger numbers and hopefully research that shows benefit outside the first 8 weeks as currently your studies show this to be the period of most benefit. But a promising start and yes, I may take you up and book an appointment to visit your clinic and report back to our readers.