MedX computerized testing/strengthening programs provide relief for those in chronic and sub-acute pain, and effective therapy also for those in poor health, susceptible to injury, de-conditioned, or in a state of atrophy following surgery or immobilization. Its function is described in various terms such as rehab, therapy, sports medicine, functional restoration, or medical exercise.
MedX physical therapy protocol is able to accurately test and safely strengthen muscles of the back, neck and knee. Its extensive research and development began decades ago at Nautilus Sports/Medical Industries, then owned and operated by Arthur Jones.
The University of Florida ‘s Center for Exercise Science conducted numerous research projects using equipment built by Arthur Jones, first at Nautilus and later at MedX Inc., formed in 1986 with headquarters on Jumbo-Lair Ranch in Ocala Florida . Michael N. Fulton, MD, a fellow of the American Academy of Orthopedic Surgeons and adjunct associate professor in the Department of Orthopedics, University of Florida , College of Medicine , was involved in both the research and application of this technology for more than two decades. MedX medical machines feature elaborate restraint mechanisms to isolate targeted muscles. This isolation both eliminates the risk of harmful impact forces and pinpoints deficient areas that can then be addressed during exercise sessions. MedX has developed a testing procedure consisting of sequential isometric (static) contractions. MedX’s engineers and researchers tested motor-driven dynamic exercise methods (e.g., isokinetic devices) during research, but found static testing to provide far greater accuracy and repeatability.
The MedX clinician administers the test by locking the machine’s movement lever at these selected points, or joint angles, along a bio-mechanical range of motion. The range of testing points can be restricted to areas the patient finds free of pain. Once set at a testing point, the patient then contracts isometrically for three to five seconds, presumably to his or her maximum exertion pain-free.
Utilizing a strain gauge the computer software measures force output, or foot-pounds of torque, which it then correlates to the angular position. After completing the test at one angle, the clinician then releases and relocates the movement lever to the next testing point, usually 6 to 12 degrees further along the range of movement. At the conclusion of the entire test the computer software connects sequential static force measurements like connecting the dots into what is termed a strength curve.
Comparison to Norms
Both the strength level and curve shape can be compared to age- and gender-matched normative data established through extensive clinical research at the University of Florida . It’s when these norms are reached that pain diminishes, typically. The software can also compare previous test results, selected group results, or a variety of data which can be displayed in tabular or graph format, and also printed.
A rehabilitation program consists of repeating this computerized assessment at regular intervals of one per month, interspersed with weekly or twice-weekly exercise sessions. The typical treatment protocol involves approximately 20-24 total sessions although patients who demonstrate expedient progress with diminished symptoms and restored strength may require fewer visits. MedX-based therapy is reimbursed under basic physical therapy insurance coverage by most carriers
Your patient’s reports are available to you at any time, and will be routinely faxed to your office upon the patient’s discharge from the program.
The Strengthening Component
During directed, lumbar-specific, cervical-specific, or thigh-specific exercise sessions a weight stack is engaged, set at an appropriate level of resistance based upon test results. Dynamic repetitions are performed within a pain-free arc. The computer tracks duration of each repetition, the number completed, and the range of motion on each.
Effective protocols of testing and exercising combinations have been established through research not only at the University of Florida , but also in numerous independent clinical studies published in peer-reviewed medical and exercise journals.
These machines can also detect fatigability of the targeted muscles. This is determined by use of a three-part session: test, exercise, and then text again. The difference in the pre-exercise to post-exercise strength levels represents the fatiguing effect of dynamic exercise. The amount of fatigue (inroad) will vary among individuals, and is indicative of fiber-type characteristics of the targeted musculature. Individuals with significantly lower than normal strength or abnormal endurance may be at increased risk for spinal injury.
Research-Proven Results
MedX has accumulated an impressive array of research findings, much of it published in peer-reviewed journals. Its use has demonstrated increases in bone mineral density20-21 and has been used in industrial settings to reduce disability4-5 and with geriatric patients22. Its computerized testing machines are used in therapy centers around the world.
The body of scientific literature on conservative injury management is rapidly expanding and the MedX corporation provides ongoing scientific updates through its online Applied Research Review available at www.medxonline.com.
Clinician training and educational support is provided independently by University of Florida ‘s Center for Exercise Science, Colleges of Medicine and Health and Human Performance. Certification on all five medical exercise machines requires 8 days of intensive training at the University of Florida , which culminates in written and practical examinations. Additional research and training has been conducted at the University of California at San Diego, CA .
REFERENCES:
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2. Risch SV, Norvell NK, Pollock ML, Risch E, Langer H, Fulton M, et al. Lumbar strengthening in chronic low back pain patients: physiologic and psychologic benefits. Spine 1993; 18:232-8.
3. Nelson BW; A rational approach to the treatment of low back pain. The Journal of Musculoskeletal Medicine, May 1993
4. Mooney V, Kron M, Rummerfield P, Holmes B; The Effect of Workplace Based Strengthening on Low Back Injury Rates: A Case Study in the Strip Mining Industry. Journal of Occupational Rehabilitation, Volume 5, Number 3, 1995.
5. Carpenter DM, Nelson BW; Low back strengthening for the prevention and treatment of low back pain. Medicine & Scienece in Sports & Exercise, Vol. 32, No. 1, pp. 18-24, 1999.
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7. Graves JE, Pollock ML, Carpenter DM, Leggett SH, Foster D, Jones A, a et al. Quantitative assessment of full range-of-motion isometric lumbar extension strength. Spine 1990; 15:289-94.
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18. Graves , JE, Webb DC , Pollock, ML, Leggett, SH, Jones, A, MacMillan, M, et al. Effect of training with pelvic stabilization on lumbar extension strength. International Journal of Sports Medicine 1990; 11:403-9.
19. Graves JE, Fix CK, Pollock ML, Leggett SH, Foster D, Carpenter DM. Comparison of two restraint systems for pelvic stabilization during isometric lumbar extension strength testing. J Orthop Sports Phys Ther 1992; 15:37 -42.
20. M. L. Pollock ML; Effects of Isolated Lumbar Extension Resistance Training on Bone Mineral Density of the Elderly. American College of Sports Medicine Annual Meeting 1992.
21. Braith RW, Welsch MA, Mills RM, Keller J, Pollock ML; Resistance Exercise Training Restored Bone Mineral Density After Heart Transplantation. Medicine and Science in Sports and Exercise. S25(5), May 1995
22. Holmes B, Leggett S, Mooney V, Nichols J, Negri S, Hoeyberghs A; Comparison of Female Geriatric Lumbar-Extension Strength: Asymptomatic Versus Chronic Low Back Pain Patients and Their Response to Active Rehabilitation. Journal of Spinal Disorders, Volume 9, Number 1,1996.