Efficacy of Lower Body Positive Pressure Treadmill in PT Rehab
Objectives:
Following this blog, the PT’s will be able to:
Outcome
- Prepare a running program safely on the Alter-G for a patient with a variety of injuries
- Identify specific differences in running kinematics with varying BW% on the Alter-G
- Research protocols for specific injuries and utilize clinical decision making for progression/regression to prevent re-injury
Behavioral
- Correctly state 3 physiological effects of using a LBPPT
- Correctly identify 4 effects on kinetics while running on an Alter-G
- Value educating patients about the positive effects of using an Alter-G early in their rehabilitation program
How it Works
Originally developed by a researcher at NASA to maintain fitness between prolonged space flight times.
Limitations:
- Running Speed
- Fitness level of subjects
- Treadmill and LBPPT running experience
- Lack of high-level confidence
- Carryover effect
Physiological Effect:
- Lower metabolic cost
- Lower neuromuscular activation
- Lower HR
- Lower respiratory frequency
- Lower minute ventilation
- Lower RPE
- Lower Vo2
- Lower Submaximal HR
Reductions in weight and metabolic demand attributed to inflation of the chamber. (Standing weight on LBPPT was an average 7% lower than predicted BW (Body weight).
Additional vertical and horizontal support in mediolateral direction reduces the need to propel in the anterior-posterior direction.
Running Kinetics:
Direct relationships
– Increased BWS (Increased stride-length)
– Increased BWS (Increased flight duration)
– Increased Gait Speed (same BW%) =
– Increased plantar forces
Increased relationships
– Increased BWS= Decreased Cadence (Longer swing phase)
– Increased BWS= Decreased contact time
– Increased BWS= Decreased peak pressure
Shift to forefoot loading distribution. 80% BW may provide balance between Fmax and impulse while minimally disrupting in-shoe regional loading. Alter-G significantly reduces in-shoe maximum forces and impulse during running across multiple speeds. BW and relative load for each of 9 foot regions examine were different except 4 were the same between 80%-100% BW.
Achilles Tendon Surgery:
Alter-G protocol example-
- Week 9-11 post op:
Gait in AG 30-50% 1.5-2.5 MPH for 10-15 minutes. - Week 12-14 post op:
Gait in AG 50-75% 2.5-3.5 MPH, 20-30 minutes. - Week 15-16 post op:
Walk/jog 75-90% 3.5-4.0/5.0-6.0, 10 minutes.
1-5% progression if normal gait and pain free.
Stress Reactions:
Case study of Division 1 female runner with an iliac stress reaction (Tenforde et al., 2012)
- Week 1-2: Aqua-jogging, stationary bicycle, isometric cope and hip exercises.
- Week 3: 3 runs at 50-70% BW but had pain.
- Week 4: No running due to previous pain.
- Week 5: 5% BW 5-minute jog with 1 min recovery x3.
- Week 6: 70% BW for 5 minutes.
- Week 7: 85% for 35 minutes.
- Week 8: 95% for 45 minutes.
- Week 9: –
- Week 10: Qualified for NCAA track championships in 10,000m race without pain.
Knee Osteoarthritis:
2 weeks of Alter-G intervention improvements:
10 MWT, Tug Test, VAS score, Community Ambulation, Increased stride length, Increased velocity, Increased cadence, Increased Knee flexion/ext ROM.
Written by
Melissa A. Riback
References
Barnes, K. R., and Janecke, J.N. (2017). Physiological and biomechanical responses of highly trained distance runners to lower-body positive pressure treadmill running. Sports Medicine, 3(1):41. doi: 10.1186/s40798-017-0108-x
Farina, K. A., Wright, A. A., Ford, K. R., Wirfel, L. A., & Smoliga, J.M. (2017). Physiologcail and biomechanical responses to running on lower body positive pressure treadmills in healthy populations. Sports Med, 47(2). doi: 10.1007/s40279-016-0581-2
Hodges-Long, L., Cross, K., Magrum, E., Feger, M., & Hertel, J. (2020). The effect of body weight reduction using a lower body positive pressure treadmill on plantar pressure measures while running. Physical Therapy in Sport, 43, 100-107. doi: 10.1016/j.ptsp.2020.02.011
Liang, J. et al. (2019). The effect of anti-gravity treadmill training for knee osteoarthritis rehabilitation on joint pain, gait, and EMG. Medicine, 98(18). doi: 10.1097/MD.0000000000015386
Sainton, P., Nicol, C., Cabri, J., Barthelemy-Monfort, J., Berton, E., & Chavet, P. (2014). Influence of short-term unweighing and reloading on running kinetics and muscle activity. European Journal of Applied Physiology, 115, 1135-1145. doi: 10.1007/s00421-014-3095-3
Saxena, A., & Granot, A. (2011). Use of an Anti-gravity treadmill in the rehabilitation of the operated achilles tendon: A pilot study. The Journal of Foot & Ankle Surgery, 50, 558-561. doi: 10.1053/j.jfas.2011.04.045
Smoliga, J.M., Wirfel, L. A., Paul, D., Doarnberger, M., & Ford, K.R. (2015). Effects on unweighting and speed on in-shoe regional loading during running on a lower body positive pressure treadmill. Journal of Biomechanics, 48, 1950-1956. doi: 10.1016/j.jbiomech.2015.04.009
Stockland, J., Giveans, R. M., & Ames, P. (2019). The effect of an anti-gravity treadmill on running cadence. The International Journal of Sports Physical Therapy, 14(6), 860-865. doi: 10.26603/ijspt20190860
Takacs, J., Anderson, J., Leiter, J., MacDonald, P., & Peeler, J. (2013). Lower body positive pressure: an emerging technology in the battle against knee osteoarthritis. Clinical Interventions in Aging, 2013(8), 983-991. doi: 10.2147/CIA.S46951.
Tenforde, A. S, Laine, M. W., Tamara, M. J., & Fredericson, M. (2012). Use of an antigravity treadmill for rehabilitation of a pelvic stress injury. American Academy of Physical Medicine and Rehabilitation, 4, 629-631. doi: 10.1016/j.pmrj.2012.02.003
Thomson, A., Einarsson, E., Witvrouw, E., & Whiteley, R. (2015). Running speed increases plantar load more than percent bodyweight on AlterG treadmill. Journal of Science and Medicine in Sport, 19s, e57-e87. doi: 10.1016/j.jsams.2015.12.143
