this study - Chung Shi USA Site
Transcription
this study - Chung Shi USA Site
Influence of Chung Shi AuBioMo Technology on the Spine Stabilization Musculature A Prospective Study Sports Medicine Upper Country ® Am Moraltpark 1E 83646 Bad Tolz Tel: 08041-7919570 meichsner@sportmedizin-oberland.de CREATIVE KINETICS Brandl 5 82549 Königsdorf Tel: 08046-188030 info@creative-kinetics.de Table of Contents 1. Introduction ......................................................................................................................................................3 2. General Methodology ....................................................................................................................................5 2.1. Object of Study ............................................................................................................................................5 2.2. Test Materiel (Subjects) ..........................................................................................................................6 2.3. Examination Procedures .........................................................................................................................8 2.4. Statistics ...................................................................................................................................................... 15 3. Presentation of Issues, Specific Methodology, and Results ........................................................ 16 3.1. Activation Characteristics of Trunk and Neck Muscles Between AuBioMo Shoes and Normal Shoes .......................................................................................................................................................... 16 3.1.1. Question ................................................................................................................................................. 16 3.1.2. Methodology......................................................................................................................................... 16 3.1.3. Results..................................................................................................................................................... 18 3.2. Maximum force development of the trunk muscles after wearing AuBioMo shoes in combination with strength training............................................................................................................... 24 3.2.1. Question ................................................................................................................................................. 24 3.2.2. Methodology......................................................................................................................................... 24 3.2.3. Results..................................................................................................................................................... 26 3.3. Development of spinal posture for regular wearing of AuBioMo shoes .......................... 31 3.3.1. Question ................................................................................................................................................. 31 3.3.2. Methodology......................................................................................................................................... 31 3.3.3. Results..................................................................................................................................................... 34 4. Practical Everyday Consequences......................................................................................................... 36 5. Outlook ............................................................................................................................................................. 36 6. Summary.......................................................................................................................................................... 37 7. Bibliography ................................................................................................................................................... 39 8. Raw Statistics................................................................................................................................................. 40 2 1. Introduction Back pain is pervasive in our society (Fraunhofer Institute, Federal Institute for Occupational Medicine, Working Group on "Healthy Back", a study Globe 91). The causes of back pain are varied and are often caused by more than one factor. The combination of lack of exercise and poor biomechanics is almost always responsible for back pain and in the long term can lead to permanent damage to the bony spine. The physical inactivity and biomechanical failures continuously increase the overwork of trunk muscles. Strong, well-trained core muscles are significantly important for humans to achieve and maintain upright posture and prevent paid. The body center, e.g. these core muscles, also form the "abutment" to help with stresses in the extremities. The body core is defined as the area of the pelvis and the lumbar spine. The underlying muscles stabilize the abdomen, back, and pelvis. Muscular deficits in these areas lead to a significant deterioration in load distribution. The passive structures, including the vertebrae, inter-vertebral discs, and facet joints (Facets) are overloaded in the long term, possibly resulting in irreversible degeneration. The result: painful facet joints wear, disk protrusions, discs prolapsing, etc. Acute back pain of muscular origin can temporarily be treated with drugs, heat treatments and physical therapy. The immediate goal is to reduce pain and muscle detoning. It favors early mobilization and specific exercise therapy over immobilization and bed rest. But, what is best is preventive action to eliminate first the lack of exercise. Individuals should seek targeted strengthening of all of the involved muscles. In addition to special strengthening programs as part of therapy, especially demanding motor sports such as Nordic Walking, back and front crawl, and cross-country skiing are particularly effective because they use large muscle groups for a complete body workout. Of course, patients in pain should always consult with their physician or therapist before engaging in these activities. 3 Another, different, way to activate the muscles is to wear and train in "Active Shoes" with specially shaped outer soles that incorporate rangedependent different materials. They call for the muscle activation and coordination rather subtly and unconsciously. A product in this market segment is footwear of the brand name Chung Shi with AuBioRig Technology (AuBioRig = Auto Biomechanically correct walking). [Reader note: In English-speaking countries, the technology is known as AuBioMo, “Automated Biomechanical Motion”.] Wearing these shoes activates the muscles of the lower extremities during standing and walking. The increased muscle activity in the lower extremities was already scientifically evaluated at the University of Calgary (Human Performance Laboratory, University of Calgary, 2006). AuBioMo shoes are manufactured in two models (although there are many styles of each model). The Comfort Step model has a forefoot-rearfoot angle in the sole of 15°, and the Balance Step model has a forefoot-rearfoot angle in the sole of 20 °. Studies will reveal the effect extensive use of Chung Shi’s AuBioMo technology has on the center core trunk muscles previously discussed. If successful, such a product would be a great approach to improving the strength and stability of center core muscles without additional expenditure of time, or of engaging in aggressive programs to which the wearer may be ill-suited. With the erection of the spine and strengthening the body core, one may expect relief of back pain problems. (by Laar, Meichsner, VitArea study, Bad Tolz, 2007, Freiwald 2006, Huber, 2008). This leads to the following questions: 1. What degree of activation of the trunk and neck muscles can AuBioMo be expected to deliver as compared to normal shoe? 2. How much improvement in trunk muscle power will these shoes, with regular wearing time, provide in combination with targeted strength training? 3. Does regular wearing of Chung Shi AuBioMo shoes influence the attitude of the Spine? 4 2. General Methodology The following describes the general methodological aspects of the study are presented. 2.1. Object of Study The footwear studied are AuBioMo shoes in each of the two models: Comfort Step, in the 15° forefoot-rearfoot angle, and Balance Step, in the 20° forefoot-rearfoot angle. Sole Angle Fig. 2.1. – 1: Representation of the sole angle (Figure 2.1.—1). For the study, only the “Sport” style in the Comfort Step model (15 ° angle sole) were used. To maintain the sole constant angle under load in the area of the fulcrum, a steel plate was inserted. The aim of the angle is first to reduce the contact area (Figure 2.1.—2) to ensure that the interior stabilizing muscles activate. The second objective is that during the rolling process when walking, the individual is forced to actively provide slight resistance to the Fig. 2.1. – 2: declined—stood flat angle. This should lead to a more active and more fluid gait. The Metatarsal in this case runs from the outside rear slightly diagonally forward inside (Figure 2.1—3). The crosssections of Forefoot and Heel have an opposite position angle to each other. The heel is characterized by an increased 2mm medial edge of a slight supination from the foot strike. The metatarsal and forefoot, on Fig. 2.1. – 3: Diagonal course of the metatarsal the other hand, are at a 2mm increased lateral edge, provided to guide the foot into a pronated position. The slightly diagonal metatarsal corrects for pronation. Inside the shoe is provided a midfoot upward curved insole for support of the longitudinal arch. Furthermore, a stimulation of the foot muscles occurs. The transverse holelike recess in the heel area dampens the shock. 5 2.2. Test Materiel (Subjects) For the study, a total of 20 subjects (12 women and 8 men) in the Ages range from 25 to 64 years were selected. The average age (arithmetic mean) was 48.81 years (± s = 11.41 years). Age in years Figure 2.2.—1: Age distribution of the total sample n = 20 The test subjects were divided into four groups of samples (groups A, B, C and D), with five subjects in each group. The classification was performed by randomization. The gender distribution within each sample group is in Figure 2.1.—2. Group A Group B Group C Group D Women 4 2 2 2 Men 1 3 3 3 Figure 2.2.—2: Sex Distribution Within The Sample Groups 6 The age groups within the samples were as follows: Age in Years Figure 2.2.—3: Age Range and Average Age Within The Sample Groups 7 2.3. Examination Procedures The investigation was done at the beginning and the end of the study period of 8 weeks, with three methods of investigation. The investigations were completed in the following order: • Surface EMG (SEMG) • Spinal surveying with MediMouse® • Maximum isometric trunk muscle strength measurements (MTS) AuBioMo – Study Wearing Instructions The shoes that you received from us during the ALTAG (and possibly also during your training in VITAREA) are yours to keep. Please wear the shoes as long during each day as indicated in the table. An initially unfamiliar feeling is quite normal and will reduce over time. If you unexpectedly experience pain or other problems, Contact us at the addresses below immediately. Wearing Time (Hours per day) 1st Day 2nd Day 3rd Day 4th Day 5th Day 6th Day 7th Day 8th Day 9th Day 10th Day until end 1 1.5 2 2.5 3 3.5 4 5 6 At least 6 Of course you can keep your shoes!!! Figure 1.3.—1: Fact sheet on wearing requirements of the AuBioMo shoes for the subjects from Group A, B and C. 8 The four test groups (A, B, C, D) received the following treatments for a Period of 8 weeks: Group A: Daily wearing of shoes AuBioMo by default (Figure 1.3 - first). In addition, this group completed a deficit-oriented strengthening program for the core muscles (at least 2 times per week) in a health center (VitArea, Bad Heilbrunn). The AUBIOMO shoes were also worn during training. The subjects received a second identical pair of shoes. Group B: Same as group A, but the AuBioMo shoes were worn only in everyday life by default (Figure 1.3—1). During the training sessions were, however, the group was using only normal sports shoes. Group C: AuBioMo shoes were worn in an everyday setting (Fig. 1.3—1). There was no training completed. Group D: Control group. No AuBioMo shoes, no training. Normal everyday behavior. After 8 weeks of follow-up all groups that completed the above studies were listed in the same order with the same test conductors. The measurements were performed in standardized form. Surface Electro Myographic Measurement (SEMG) The surface EMG recorded over the skin used glued together bipolar electrodes connected to muscle action potentials, measured in units of millivolts (mV). This is how the activity of a muscle under the skin is measured. By using amplifiers, the potentials are visibly displayed on a screen. Special software analyzes the patterns of activation and intensity of the potential. The data collected was subject to the usual scientific quality criteria (LM Knutson et al., 1994, Winter DA, Yack HJ. 1987, 1999). Figure 2.2.—4: Electromyographic Measurements and their Results The electromyographic study used an 8-channel surface EMG Company SinfoMed GmbH (St. Kalscheurener 19.50354 Hürth). By the multi-channel technique, four different pairs of muscles were measured at the same time. 9 It has a surface EMG (SEMG) under standardized conditions in individual familiar, everyday shoes and even brought in AUBIOMO shoes in three different positions (Fig. 2.2 - 2) over 10 seconds each recorded. First, the backfoot stance, 2nd, the through stance, and 3rd, the Forefoot Stance. Figure 2.2.—2: a) normal shoe, b) AuBioMo shoe rearfoot position, c) AuBioMo shoes Forefoot position, d) AuBioMo shoes metatarsal position Muscles were measured following characteristics (Fig. 2.2—3) with the reference electrode at the 7th Cervical vertebra (C7): a) b) c) d) e) M. lumbar erector spinae (at L3) M. trapezius - ascending portion (amounting TH6) M. trapezius - descending part M. rectus abdominis - lower compartment M. external oblique Figure 2.2.—3: Electrode placement on the reference muscles and the reference electrode The measurement frequency was defined as 240 Hz. For the evaluation the SEMG raw signal rectified. The subjects were in identical pre- and post-test positions, as several photos of each subject were from taken of subject after the pretest. For the photos in the post-test, the electrodes were reapplied. This was done for better comparability of results. We measured the mean levels of activity, using a "sliding mean "(Average Rectified Value, AVR1) in 10 second intervals. 1 Def. AVR: Rectification and integration of the raw SEMG signal over a defined time window and dividing by the window length. 10 Trunk strength diagnostics For this purpose, a torque measuring chair (Fig. 2.2—4), for representation of the maximal isometric force of trunk muscles, was used. Measured were the flexors, extensors, flexors and rotators of the spine in the region of the body core (Lumbar and thoracic spine transition). The torque developed is over 16 calibrated daily, in the slide on thoracic height positioned strain gauges (DMS) and registered for evaluation via Bluetooth connection transmitted to a PC. The data analysis and evaluation based on a dynamic biomechanical Model (Blümel, G., Fa BfMC Leipzig, 2004). Figure 2.2.—4: Torque measurement firm chair SinfoMed and position of strain gauges Measurement procedure: The subject is seated in the chair for torque measurement (MTS Medical Training System) of the company SinfoMed, gets clamped, and is given direction to press against the post with maximum force. The following standardized process was used to prevent design and test errors: • • • • • No warm-up A clear notice to execute: No use of the arms and hands permitted, an indication of breathing, call for maximum use, the end of the individual measurement (length and timing) Always same order: flexion, extension, lateral flexion left, right lateral flexion, rotation left, rotation right Prior to any new direction there is always a short motion description and a test run, to the exclusion of coordination errors. Execution errors were corrected by the test administrator. The trial run should be to preserve the memory and creatine kinase neuronal resources only be performed with sub-maximal force. After the trial run, two maximum force measurements of each 5 seconds, with 12 seconds rest in between, were performed. 11 The analysis includes the following three anatomical planes of motion with the corresponding directions of movement and the accompanying Main function muscle groups: Plane of Motion Movement Sagittal Flexion Frontal Lateral Flexion Transversal Rotation Main Muscle Function m.rectus abdominis m. obliquus externus abdominis m. obliquus internus abdominis m. errector spinae m. obliquus externus abdominis m. obliquus internus abdominis m.quadratus lumborum m.errector spinae m. obliquus externus abdominis m. obliquus internus abdominis m.errector spinae To determine the maximum force, steps were carried out as follows: Of the torque curves of the two measurements each direction was measured. The curve with the higher maximum power value is selected. The Maximum force value was determined by the software. It is defined by the Average of all readings in the corridor of ± 0.15 seconds to the maximum peak value of the torque curve (Fig. 2.2—5). To assess and define, the reference values for the statistical evaluation were calculated using a biomechanical model of the dynamic target or reference values according to Dr. sc nat. G. Blümel, from Leipzig BfMC calculated. Figure 2.2.—5: Mathematical Determination of maximum force. Arithmetic mean from the highest force value and all values ± 0.15 sec See the white corridor. 12 Factors to determine the reference values are: • Gender • Height • Body Weight • Fuselage segment length (= length of individual levers of the torque measurement chair during clamping of the subjects measured) The evaluation of the subjects are presented in tabular (Fig. 2.2—6) and graphic (Fig. 2.2 –7) form. Two key statements can for the subjects are taken: 1. Expression of maximum force in any plane of movement in relation to Reference value (2.2 –6). It should be pointed out that in the indicated reference values, a minimum value for the performance of the core muscles to protect everyday stresses can be seen. "Ordinary" is therefore a physically defined average working person. This is physically difficult for working people and therefore for an athlete, a much higher torque to stabilize passive structures in the body core is expected. 2. Balance of power relationship within a plane of movement (Fig. 2.2.—6). Through the biomechanical and anatomical differences of the opponents of the sagittal plane is here by an ideal ratio of Nat flexion to extension with 40:60 to Dr. sc. G. Blümel gone out. Frontal and transverse planes at the ideal ratio should trivially on the basis of body symmetry at 1:1 lie. Difference from The Nominal Value Deviation from the Ideal Ratio Figure 2.2. - 6: Exemplary tabular result of isometric Maximum force measurement Reference Value Reference Value Figure 2.2. - 7: Exemplary graphical result of isometric Maximum force measurement For ease of statistical analysis, the system has a data Export function in Microsoft Excel. 13 MediMouse ® The MediMouse idiag Company (Switzerland) is a computerized medical device for clinical practice, by the simple manual retraction of the back, the shape and mobility of the spine in the sagittal plane can be determined. The subject can be measured in different positions. Within this study only standing subjects were measured. The MediMouse measures the length (in mm) and the local inclination relative to the vertical (in degrees) of the spine between the 1. Breat (BWK1) and the 3. Sacrum (SWK3). From this the information software calculates the sagittal contour (Fig. 2.2.— 2) of the spine (thoracic vertebrae, Lumbar spine and sacrum). An intelligent recursive algorithm calculated from the superficial form below into account the local curvature (kyphosis or Lordosis), information on the relative position of Vertebral bodies of the underlying bony spine. As a result one obtains a height accurate localization of the vertebral body as a projection of their Centers lie on the superficial back contour. Furthermore, the algorithm computes the angles of all segmental mobile segments of the thoracic and lumbar spine and the sagittal position of the pelvis (tilt and erection). Figure 2.2. - 8: Measurement of the MediMouse Idiag company and the graphical implementation in the representation of the spine Barefoot position Rear-foot position Forefoot position Mid-foot position By default, the measurement was within the individual study in four standing positions (Fig. 2.2.— 9) was carried out. By comparing the results in the different stances, the measurement system provides information on changes in the segmental spine posture. For determining the degrees of each vertebral body each other, has the opposite MediMouse the classical X-ray to be superior been found (Schulz, p 1999; Keller, S. et al. Figure 2.2. - 9: Medi-Mouse Measurement sequence for the Level positions in chronological order from top to bottom re-measurement and the change in overall inclination of the spine Vorzu Posttest. 2000). The analysis was based on clinical the change in angular degrees of pre-and post measurement and the variation of the entire inclination of the spinal column of before test to after test. 14 2.4. Statistics The statistical analysis was performed exclusively on the personal computer using the software program Microsoft Excel 2000. The following statistical measures and testing procedures found in this Working application: Arithmetic mean The arithmetic mean () of measured values is defined as the sum (Σ) divided by their number (s) (Clauss / Finze / Partzsch 1994). Variance and standard deviation The variance (s ²) of a sample is the sum of squares of all measured values (n) of a distribution from their arithmetic mean ()., Divided by the diminished by 1 number (n-1) of the measurements (Clauß / Ebner 1985). The standard deviation (± s) is calculated as the square root of the variance (Clauss / Ebner, 1985) Frequency distribution The presentation of the results in the frequency distribution is a form of descriptive statistics is in tables or graphs to help of characteristic measures, such as for example arithmetic mean (). it can to assess whether the empirical frequency distribution of a typical distribution shape is similar (bell-shaped, Ushaped, J-shaped, unimodal, bimodal, schmalgipflige or flat curve). Furthermore, the analysis can be a frequency distribution comparison to similar empirical distribution investigations. Way analysis of variance When a factorial analysis of variance tested whether an independent variable has an influence on the mean values of a dependent variable. The variance analysis is based on a partitioning of variation. The total scattering is here from a scattering between the groups, the scatter of the residuals and the spread between the subjects together. For the mathematical Derivation we refer to Clauss / Ebner (1985), Sachs (1984) and Winer (1971). 15 All significance tests are based on the following limitations: p> 0:05 is not significant p ≤ 0.05 slightly significant (*) p ≤ 0.01 significant (**) 3. Presentation of Issues, Specific Methodology, and Results 3.1. Activation Characteristics of Trunk and Neck Muscles Between AuBioMo Shoes and Normal Shoes 3.1.1. Question On the basis of social development to more passivity, inactivity and lack of time, innovative approaches are in demand for the prevention of health problems. Any such concepts that would reduce the amount of time or physical effort have to be perceived as an attractive opportunity, especially in our society. "Active-shoes" of the brand Chung Shi are a very interesting approach to people during their everyday life, subtly and unconsciously causing you to activate muscles. This is extremely useful for better joint stabilization and structural improvement of the lower extremities. The impact of technology AuBioMo were already evaluated at the University of Calgary (2006). Looking at the joint and muscle chains of the human body can, an increased activation of the lower extremities and an influence on the activation of the central core muscles is expected. Increased tension in the trunk muscles favors the functional derivative the forces acting on the body (Gottlob 2007) and is thus extremely profitable. The following question was examined in this study: Does the regular wearing of AuBioMo shoes activate of trunk and neck muscles to a higher degree as compared to normal shoes? 3.1.2. Methodology To investigate this question, two research groups from the total sample used. Groups C and D together were compared. In Group C, the AuBioMo shoes were worn regularly (See page 8) for 8 weeks in everyday life, while Group D is used as a control group (cf. P.9). Group D was only the initial and final measurement AUBIOMO shoes. This study resulted in the following sample constellation: 16 Group C Group D Women 2 2 Men 3 3 Total 5 5 While each subject was standing, the muscle activity was measured in individual normal street shoes and AuBioMo shoes in the forefoot and rearfoot Metatarsal position over 10 seconds was measured. Five key muscles (in brackets are the abbreviations for each muscle) were using surface-EMG (SEMG) is sampled (see p.9ff.). • Erector spinae at L3 lumbar (L3) • Trapezius - ascending portion in the amount TH8 (TH8) • Trapezius - descending part (OTP) • Rectus abdominis - lower compartment (ABR) • External oblique (OAI) To determine the influence of permanent wearing of AuBioMo shoes has on the muscle activity, we evaluated the change in muscle activity between Pre-and post-test comparison. For the classification of increased muscle activity, there is little information on reference data (Freiwald et al., 2007). Since SEMG levels individually must then be considered for this study, the reference values chosen were very conservative. For measured values <10 mV (microvolts), the muscle is seen in the resting tone. In the case of measuring values> 10 mV with a high degree of certainty of an increased muscle activity can be expected. 17 3.1.3. Results Figure 3.1.3—1: shows the average percentage change in the relative muscle activity of the two sample groups between pre-and posttest. Standard Shoe AuBioMo AuBioMo Hindfoot Forefoot Group C rel. 0 Muscle OTP right OTP left TH 8 right TH 8 left L 3 right Left L3 ABR right ABR left OAI right OAI left Group D rel. 0 Group C rel. 0 Group D rel. 0 Group C rel. 0 Group D rel. 0 AuBioMo Metatarsus Group C rel. 0 Group D rel. 0 % Change % Change % Change % Change % Change % Change % Change % Change In In In In In In In In Activation Activation Activation Activation Activation Activation Activation Activation 101.3 25.12 -6.87 5.67 -4.89 -1.97 14.79 21.68 -1.38 -6.61 28.2 10.06 -12.81 29.22 -15.94 11.49 -16.66 -8.28 -15.52 -0.68 46.15 117.05 2.94 0.26 10.62 24.39 13.02 19.53 11.11 -7.42 99.62 16.74 -29.52 36.11 -10.16 23.89 -24.12 -14.82 -2.03 0.43 33.53 137.89 27.37 42.67 18.1 28.3 14.87 14.76 10.22 -8.32 101.76 11.41 -26.22 16.91 -11.62 17.66 -27.35 -16.31 -12.4 0.31 4.3 44.83 40.49 24.58 8.83 14.21 10.77 7.06 -15.05 -19.38 101.76 11.41 -26.22 16.91 -11.62 17.66 -27.35 -16.31 -12.4 0.31 Figure 3.1.3—1: Table showing the mean percentage change relative pretest to posttest of between group C and control group D. Distribution of activity increase or reduction: The changes in standard shoe (Figure 3.1.3—2) show a rather diffuse picture. Here, 50% of the measured muscles in an increase in activity. The second 50% show a decrease. It is similar with the control group. 60% the muscles showed a decreased activity level, 40%, a slight increase. This results in no significant change in the trend results in the summary of all measurements in one direction. 18 Figure 3.1.3—2: Graphical representation of the mean percentage change from Pretest to posttest in the normal standing shoe. The picture changes when measured in AuBioMo shoes. On the standing hindfoot (Abb.3.1.3 - 3) the statistics show a more uniform image in the group C compared to the control group. Group C showed 90% of the measured muscles increase activation, while in the control group we have the rather diffuse image with 60% activity reduction and 40% increase still increased. Figure 3.1.3—3: Graphical representation of the mean percentage change from pre-test standing on the posttest AuBioMo shoe on the backfoot. 19 When set the subject wearing the AuBioMo shoe on the forefoot (Abb.3.1.3 - 4), it yields a very similar picture with respect to the rearfoot position. Group C has an over 90% increase in the measured muscle activity, while the control group a second time has a diffuse image of a distribution of 50% increase and 50% reduction. If the position of the metatarsal (Figure 3.1.3—5) is changed, the results differ only minimally. Since the AuBioMo shoe requires balance through the midfoot rocker position, it should be expected to activate all the muscles. Amazingly, the previous picture changed only minimally. 80% of the muscles of group C have an increase in activity compared to the preliminary investigation. In the control group, the picture is unchanged at 50% increase to 50% reduction. Figure 3.1.3—4: Graphical representation of the mean percentage change from pre-test standing on the posttest AuBioMo shoe on the forefoot. 20 Figure 3.1.3—5: Graphical representation of the mean percentage change from Pretest to posttest in AuBioMo shoe on the metatarsal balancing. Overall, there is a tendency with AuBioMo shoes, at a regular and long development period, for the core muscles to activate more than relax. Critically, it must be noted however that due to the low sample size, this result may represent only a tendency. To clarify the question of the significance of change between the Groups of samples within each individual muscle that were measured, the data is subject to a variance analysis. This is the only way to make valid statements about the ability of the shoe to invoke lasting changes. Figure 3.1.3 - 6 shows the result of analysis of variance. The goal was to show whether the AuBioMo carrier of group C had a significantly higher change activity than the control group. 21 Muscle OTP right OTP left TH 8 right TH 8 left L 3 right L 3 left ABR right ABR left OAI right OAI left Significance test (F test) Standard Shoe AuBioMo AuBioMo at at Heel Forefoot 4.29 9.96 * 15.85 * 15.04 * 9.82 * 112.00 ** 1.01 1.69 1.03 4.32 3.5 8.83 * 2.78 11.64 9.57 * 1.24 1.9 1.21 4.54 7.38 * 8.32 * 1.13 1.62 1.67 3.04 1.98 1.5 1.2 2.2 4.1 AuBioMo at middle 11.40 * 67.27 ** 4.51 1.69 9.55 * 4.22 2.96 3.63 1.61 7.20 * Figure 3.1.3—6: Results of testing for homogeneity of variance between group C (AuBioMo carrier) and the control group. p<=5% p>=1% Slightly Significant* Significant** Significant increases compared with the control group show in Figure 3.1.3—6. The significant changes to show a rather diffuse picture, as often Relative frequency of increased SEMG activity of all measurements Elevated levels in the VT Elevated levels in the NT Group C 31.00% 29.00% Group D 17.00% 17.00% Figure 3.1.3—7: Graphical and tabular representation of the percentage increased Comparison of muscle activity in the pre-test (VT) to posttest (NT) within Group C (AuBioMo carrier) and the control group (D). Only one side of a muscle pair (standard shoe: m trapezius pars descendens. left; AuBioMo hindfoot and forefoot: m. right rectus abdominis; AuBioMo Midfoot: m. and left external oblique m. errector spinae L3) shows a striking increase. A reaction in terms of muscle activation is made to the AuBioMo technology, however, for the measured paired muscles at the same time expects a similar intensity, if not pathological phenomena. It should thus rather changes in response to the wearing of AuBioMo shoe to be scored, which occur in pairs significantly. In order to remain changes in m. trapezius - pars descendens in all AUBIOMO positions as well as the change in m. errector spinae in TH8-AUBIOMO forefoot position. To this classify this observation even better; the basic activity level (Figure 3.1.3—7) of all measurements was examined quantitatively. It was 22 noticeable that in group C in the pretest and posttest 31.00% 29.00% almost unchanged for all measurements increased activity levels (> 10 mV) showed. In the control group D had only 17.00% in the pre-and post-test is an increased level of activity (> 10 mV). About two thirds of all subjects from Group C or more than three-quarters of all relative frequency of increased SEMG activity of the OTP in relation to all remaining muscle groups with increased levels m.trapezius compare VT m.trapezius compare NT Group C 29.31% 27.87% Group D 85.29% 88.24% Figure 3.1.3 - 8: Graphical and tabular representation of the percentage of the increased muscle activity values in the comparison of pre-test (VT) to posttest (NT) within Group C (AuBioMo carrier) and the control group. Subjects from Group D were thus Ruhetonuswerte (<10mV) on. within the Range of 0 to 10mV are activity changes in the range of measurement tolerances and therefore mean very little. The statistical significance of paired m. trapezius pars descendens of Figure 3.1.3—6 suggest although one real influence of AuBioMo technology, however, this conclusion must be relativized be, as to just 29.31% in the pretest and posttest 27.87% in the whole the elevated readings fall outside the measurement range of tolerance (Figure 3.1.3—8). A significant activating or relaxing effect on the core muscles can therefore not confirm first. A filtering out of the values is at a study with a significantly higher number of subjects is recommended. 23 3.2. Maximum force development of the trunk muscles after wearing AuBioMo shoes in combination with strength training 3.2.1. Question An active muscular joint protection is the basis for a pain-free life with respect to the passive and active musculoskeletal system. Especially in the area the spine is a high power level of assurance is essential muscles. A majority of back pain can be attributed to too weakly traced back muscles (Denner, 2003). Therefore, it should aim and duty of everyone to have spine-stabilizing muscles with a minimal level of strength. To improve the muscular ability of the body are in the therapeutic sense physiotherapy and medical training therapy (MTT) or prevention. Post rehabilitative commercial area health centers and gyms are used. It is believed that active-brand shoes like the Chung Shi with AUBIOMO technology activate the core muscles while walking and standing. The question is whether the activation perhaps leads to even a power increase in the trunk muscles. This would allow the shoe to effectively be used as a standalone training tool. Perhaps the effect in combination with a strength training program would be even more effective. The shoe could be a supplement to the training and be classified as "effective enhancer". Therefore, the investigation is to clarify the following question: Could AuBioMo shoes, with regular wearing time, in combination with deficit oriented targeted strength training, help maximize the strength of the core muscles? 3.2.2. Methodology To investigate this question, four research groups from the total sample were used. There were Group A, Group B, Group C and Group D compared with each other (see p.9). First, a preliminary investigation was completed. This was the maximum isometric force by a body torque measuring chair (see S.11ff) charged. We were able by the measurement to reveal existing power imbalances and deficiencies in the flexion-extension, lateral flexion to left-right rotation and right-left rotation. These results formed the basis for strength training of the groups A and B. In connecting the sample groups, they were given different treatments (Fig.3.2.2— 1). The groups received the following treatments: Group A: Daily wearing of shoes AuBioMo by default (see p.8). In addition, a deficit-oriented strength training on machines and with free weights at least 2x per week based on the results of trunk strength diagnostics in a health center (VitArea, Bath Heilbrunn graduated). The specific training exercises were professional coaches trained together. the AUBIOMO shoes were also worn during training. The subjects received a second identical pair of shoes. Group B: Same as group A, but the AuBioMo shoes were worn only in everyday life as specified (see p.8). During the training sessions they however, only wore normal sports shoes. 24 Group C: This group only wore AuBioMo shoes in an everyday setting (see page 8). There was no training completed. Group D: This was the control group. No AuBioMo shoes, no training, and normal everyday behavior. Group D was only during the beginning and final measurement wearing AuBioMo shoes. Deficit-Oriented Strength Training Group A Group B Group C Group D YES YES NO NO Deficit-Oriented Strength Training With AuBioMo YES NO NO NO AuBioMo In Everyday Life YES YES YES NO Figure 3.2.2—1: Overview of matrix on the care of individual samples. After 8 weeks, the maximal isometric trunk strength among standardized conditions was measured. A note on sample: A male respondent in group B was sick, so he did not complete the measurement and could not complete the study. An additional male subject of this group became ill during the treatment period for three weeks, so that the duration he performed his treatment was three weeks. Although final measurement was completed, but its measuring results were worse than his baseline measurement and in order to falsify the results were not included in our analysis. In group C there was no time made available for a female volunteer to complete the force measurement. There was no further date within the time window of followup to locate her. The SEMG-examination, however, was completed. This resulted in this investigation, the following sample array: Female Male Total Group A 4 1 5 Group B 2 1 3 1 3 Group C 4 2 3 Group D 5 To determine the influence of permanent wearing of shoes on AuBioMo has on the capability of the fuselage stabilizing muscles, the change in trunk strength between pre-and post-test measurements were compared. 25 3.2.3. Results The three-body force torques in the diagnosis were measured in Unit Newton meter (Nm). There were directions of movement in the following order of testing: FLEXION (FLEX) EXTENSION (EXT) Lateral flexion (LATFLEX) ROTATION (RED) = flexing the trunk forward = stretching the fuselage to the rear = flexion of the torso to the side = rotation of the torso to the side 22% Increase from the reference value 90% in the pretest with respect to the target value achieved 112% in the Posttest achieved Mid=100% Nominal Value Figure 3.2.3—1: Illustration of the relative reference as the basis for the statistical analysis Important for the next results: Documented here are the changes in trunk muscle strength between pre-and follow-up. To improve inter-individual (between the different subjects) to establish comparability, all statistical calculations not on basis of the results created in Nm. Instead, in this documentation resorted to relative values in percent (Abb.3.2.3 - 1). The values are individually to the testing of the hardware and software calculated nominal value. Since a maximum isometric force was measured, and motivation play day form is not to be underestimated. Therefore, measuring tolerance ± 10% is taken into account (i.e. an increase of a power value below 10%, or a degradation of less than 10%, were unchanged as performance interpreted. Frequency of change in the Isometric Maximum hull strength: Image 3.2.3—2 shows the average frequency of occurrence of a force change between the groups of samples in each direction. This was to simplify the presentation, three classes created: IMPROVED = Max-body strength increased by more than 10% UNCHANGED = No change in maximum force by more than 10% AGGRAVATED = Maximum body strength by more than 10% worse 26 Improved Deteriorated Unchanged Figure 3.2.3 - 2: Graphical representation of the mean value of the frequency distribution of force changes across all groups of samples and directions It turns out that all sample groups have improved. Group B with 61.11% showing improved strength values, the best positive development. This is followed by Group A at the 50.00% of the subjects with improved values. Interestingly, Group C with 8.33%, the lowest degradation rate exhibits. Very evenly distributed is the control group with an improvement rate of 33.33%. A more detailed look at the frequency of changes occurring within the individual directions of movement is an indication of whether certain patterns exist within certain groups of subjects. See Figure 3.2.3—3. Figure 3.2.3—3 Graphical representation of the frequency distribution of force changes in the sample groups within the individual directions of movement found that the control group always in each direction of movement also has deterioration. 27 However, this is similar to the Group A. Only in the inflection point in this test group do subjects experience no deterioration. It is interesting that within only a few subjects of Group C deterioration occurs. These occur at low frequency in the number flexion (5.88%) and in the left lateral flexion (5.88%) on. To speak of a recognizable pattern that would be due to the low sample size but not very serious. A look at the amount of change can be within the experimental groups. However, it is another view of the effectiveness of AuBioMo technology. Qualitative changes in Isometric Maximum hull strength: Figure 3.2.3—4 shows that within an average of 33.33% of group A of volunteers increased maximal isometric trunk strength by over 30%. A mean increase (20 to 29.99%) still had a 16.67% increase, and a slight (10 to 19.99%) showed a 10% increase in the subjects from Group A. % Change - 100 to -30 - From 29.99 to -20 - From 19.99 to -10 - 9.99 to + 9.99 + 10 to + 19.99 + 20 to + 29.99 + 30 to + 100 Group A 10.00% 6.67% 6.67% 16.67% 10.00% 16.67% 33.33% Group B 0.00% 0.00% 5.56% 5.56% 16.67% 16.67% 55.56% Group C 4.17% 4.17% 4.17% 41.67% 25.00% 12.50% 8.33% Group D 26.67% 10.00% 3.33% 33.33% 6.67% 6.67% 13.33% Figure 3.2.3—4: Summary table of the average frequency distribution of qualitative changes in power over all directions of movement Even more clearly fell out of the positive values in group B. It improved over half of the subjects (55.56%) by more than 30% of Isometr. maximum force in the fuselage. A medium-sized and small improvement still showed each 16.67% on. And only 5.56% showed only a slight deterioration (-19.99 to 10%) of the force values over all planes of movement. This cuts at the group B clearly positively. Within group C, showing 41.67% of the subjects with unchanged force values (-.99 to 9.99%) in the trunk muscles. Only 8.33% showed a high increase in strength. We reported a mean change 12.50% of the subjects. However, 25.00% reported at least a slight improvement in power, while on the other hand, the maximum power loss of light (4.17%), medium (4.17%) to severe (4.17%) can be classified as relatively low. It may not be forgotten in this group that only AuBioMo Shoes were worn and were not familiar with the usual sporting activities engaged in. The control group gave, as expected, the force worst change of all the sample groups. Wherein still 13.33% significantly, an average 6.67% and 6.67% had a slight increase in strength. In contrast, however, are 26.67% of subjects with significant, 10.00% with medium and 3.33% with mild motor loss. 33.33% were unchanged Force values. Figure 3.2.3 - 5 shows the overall results again at a glance. 28 Group A Group B Group C Group D Figure 3.2.3 - 5: Graphical summary of the average frequency distribution of qualitative changes in power over all directions of movement The significance test (Fig. 3.2.3 - 6) showed that group A in the lateral, light significant improvements occurred compared with the control Group D. Group has slightly significant changes in the extension, the imbalance between extension and flexion, lateral flexion to the left and in the imbalance on the lateral flexion. p<=5% Slightly Significant* p>=1% Significant** Significance test of all groups compared with the control group D FLEX EXT. DYSBex flex LATFLEX LI LATFLEX RE DYSB LATFLEX ROTLI ROTRE DYSB ROT VARIANCE Group A 510.09 1,338.44 624.47 711.81 810.51 504.27 618.05 817.05 33.20 VARIANCE Group D 275.95 2,038.85 1,076.35 7,971.12 4,445.47 1,911.98 450.87 695.69 147.33 1.85 1.52 1.72 11.20 5.48 3.79 1.37 1.17 4.44 VARIANCE Group B 744.60 115.96 57.26 368.89 1,550.58 67.72 43.78 170.91 47.65 VARIANCE Group D 275.95 2,038.85 1,076.35 7,971.12 4,445.47 1,911.98 450.87 695.69 147.33 2.70 17.58 18.80 21.61 2.87 28.23 10.30 4.07 3.09 VARIANCE Group C 641.48 199.93 314.49 1,060.62 191.59 179.36 24.74 81.66 98.14 VARIANCE Group D 275.95 2,038.85 1,076.35 7,971.12 4,445.47 1,911.98 450.87 695.69 147.33 2.32 10.20 3.42 7.52 23.20 10.66 18.22 8.52 1.50 Result F-Test Result F-Test Result F-Test Figure 3.2.3 - 6: Summary table of the results of significance tests. The Groups A, B and C were compared with the control group. Group C has the most significant changes compared with the Control group. In the extension, lateral much right on both sides (Latflex significantly **) and its imbalance as well as in the rotation on both sides (red links highly significant **) showed significant changes compared with the control group. It is thus a tendency that AuBioMo shoes are seemed to have favorable effect on the body force, as compared to the wearing of normal shoes. Due to the small sample size, the results 29 of qualitative changes in maximal isometric force are at best a tendency to evaluate and require an investigation to verify with higher with number of samples. Changes in individual existing power deficits: It appears (Abb.3.2.3—7), that over all groups of samples in relation to the existing power deficits for each subject only slightly changes have occurred. It must be noted, however, that many subjects of the investigations have no strength deficits in the trunk muscles that have been reported. The changes are assigned as follows: IMPROVED = an existing deficit has been reduced, thus improving UNCHANGED = a change may indeed have taken place, but an existing deficit has not been eliminated nor created. WORSE = a deficit was created or increased Group B with 22.22% showing improved strength values and with only 5.56% deterioration in the most favorable development of all groups. Group C intersects in the overall summary were the weakest. On average, at this group is not subject improved, however, have deteriorated to 8.33% and 91.67% remained unchanged. This is in the region of the control group, which has also not worked specifically on deficits. It has a deterioration rate of 16.67% and 76.67% unchanged values nor minimal improvement rate of 6.67% respectively. Amazingly, even results for group A, which has trained deficit-oriented, not really a dramatic difference in the compared to the control group (13.33% improved, 73.33% unchanged, 13.33% worse). Improved Deteriorated Unchanged Figure 3.2.3—7: Graphical representation of the frequency distribution of all groups all directions In summary, the deficit-oriented view did not determine significant differences. There purposefully normally at least for the coaching groups A and B is an improvement rate is expected (Laar, Meichsner 2008), is also the small sample 30 size in any suspected representative statements to make. Summary With respect to the targeted training of core muscles to increase performance, the data rather suggests that training without AuBioMo technology with volunteer coaches from the coaching part, exercises were completed. With AuBioMo as their shoes, the proprioceptive properties developed were as not so good. In future students, however, the low sample size must be addressed, as it is perhaps not as representative for the whole population as the result may suggest. The aim was to identify possible trends. And here we can say that Group C (AuBioMo in everyday life, and no training) from the control group certainly stands out. This in turn suggests that these shoes seem to produce subtle muscular effects, less in the area of global moving muscles, but tend to be in the local short-joint stabilizers. Therefore, wearing in daily life is recommended. The answer to the question at the moment, however, can only be: The AuBioMo technology has no significant effect on the maximum isometric body force. 3.3. Development of spinal posture for regular wearing of AuBioMo shoes 3.3.1. Question The spine is a flexible but robust structure of our body. It provides the basis for the human upright posture. Position of the individual vertebral bodies to each other is affected by passive structures such as ligaments, intervertebral discs and in the highest degree of surrounding muscles. The anatomical structure provides for a complex biomechanically favorable bracing system to protect the spine, to secure loads and effectively dissipate forces (Gottlob 2007). By deficits in attitudes, problems are inevitable over longer periods. A function described of the AuBioMo technology is setting the body in a spinal upright posture and a more biomechanically favorable position. If an individual adopts a good attitude about improving his back health, AuBioMo is a useful preventive agent for posture correction. This yields the following relevant questions, which in this part of investigation in focus: Does the regular wearing of AuBioMo shoes influence the attitude of the spine? 3.3.2. Methodology To investigate this question, the four study groups the total sample used. There were group A, group B, group C, and group D compared with each other (see p.9). Initially was in the context of preliminary investigation prior to the survey of the maximum isometric trunk strength measurements (see S.11ff), the posture of the 31 spine using MediMouse ® (From Idiag, Switzerland). This kind of diagnostics allows a valid image (Schulz 1999, Keller, Mannion, coarse 2000) of the spine in the sagittal level (see S.14ff). Measurements were taken in the order of barefoot, and in AUBIOMO shoes in the hindfoot, midfoot and forefoot positions. After 8 weeks of treatment, the individual groups of samples were standardized in all subjects. We measured again with the follow-up MediMouse. The treatment (Abb.3.3.2—1) of the sample groups followed these steps: Group A: The subjects were wearing the shoes AuBioMo by default (see p.8). Zusätzlich is a deficit-oriented strength training on machines and with using free weights at least 2x per week based on the results of trunk strength diagnostics in a health center (VitArea, Bath Heilbrunn graduated). The specific exercises were TRAINING ¼ of professional coaches trained together. the AUBIOMO shoes were also worn during training. The subjects each received a second identical pair of shoes. Group B: same as group A, but the AuBioMo shoes were only worn in everyday life as specified (see p.8). Normal sneakers were worn exclusively during the exercise training. Group C: There were AuBioMo shoes worn exclusively for daily life (see page 8). There was no training completed. Group D: Control group: No AuBioMo shoes, no training, and normal everyday behavior. Group D was only for the beginning and final measurement in AuBioMo shoes. Deficit Oriented Strength Training Group A Group B Group C Group D YES YES NO NO Deficit Oriented Strength Training with AuBioMo YES NO NO NO AuBioMo Worn In Everyday Life YES YES YES NO Figure 3.3.2 - 1: Overview of matrix on the care of individual samples. Note on the sample: A male respondent in group B was sick, so he did not complete the measurement and could not complete the study. An additional male subject of this group became ill during the treatment period for three weeks, so that for the duration he could perform his treatment only during three weeks. Although final measurement was completed, the measuring results were not included in our analysis. After 8 weeks, the spine posture among standardized conditions was measured. Through the re-mapping of the spine, the change in the attitude could be clearly documented. To ensure that the sustainability of the effect of AUBIOMO technology 32 could be clearly documented, measurements were only taken while subjects were barefoot. The changes were assessed clinically and evaluated individually. A clinical assessment is superior to a purely statistical evaluation, since an attitude change of a subject not only on the basis of degrees may be seen as positive or negative. It has the overall development of the spine, including their inclination (= forward tilt and back tilt) also to be considered. The evaluation question is therefore not only provided after the change, but the question is: Has anything in a positive direction for the subjects developed? The evaluation of the results is divided into two perspectives: 1. Have the arcs (lordosis) in the lumbar spine (lumbar =) or (Kyphosis) in the thoracic spine (= BWS) harmonized? A good and healthy attitude is it pronounced by a naturally Lordosis in the lumbar spine and a mean Brustwirbelkyphose considered. The perpendicular from 7.Brustwirbel (TH7) it should for optimal power dissipation fall through the sacrum. 2. Has the inclination (tilt of the entire spine) changed? An inclination of about 1 ° degrees forward in his assessment as the optimum viewed (from IDAG, notes on interpretation). Depending on the strength of the deviation from these values, you will change as positive, negative or rated neutral. The overall pattern of change in spinal posture is the critical factor and is documented as follows: The assessment is via a simple classification: + = Positive change in the attitude of individual spine O = Neutral, positive or negative change - = Negative change in spinal posture 33 3.3.3. Results In Figure 3.3.3—1 it is clear at first glance, all groups have developed attitude (spinal alignment). Group A— Comfort Step In Life and Training Subject 1 Subject 2 Subject 3 Subject 4 Subject 5 Change Before Versus After Group B— Comfort Step In Life and Not Training Subject 1 Subject 2 Subject 3 Change Before Versus After Group C— Comfort Step In Everyday Life Subject 1 Subject 2 Subject 3 Subject 4 Subject 5 Change Before Versus After + + + + + + + + + + + o + Group D Change Before Control Group Versus After Subject 1 o Subject 2 Subject 3 Subject 4 Subject 5 Figure 3.3.3 - 1: Results of the change in spinal posture Group A and B show a 100% improvement in the posture of the spine. Whether the over eight weeks using AuBioMo shoes contributed to this result or have only the strength training to thank is for group C show. This group only wore AuBioMo 34 shoes everyday without any strengthening program. 4 of 5 subjects in Group C showed a significant improvement in the spine posture. Only one subject showed the spine image unchanged. Some exemplary figure shows changes 3.3.3 – 2. Figure 3.3.3—2 Some examples selected MediMouse representations compared before (1) vs.. Nacher (2). the illustrated recordings were barefoot stand recorded. Shows by means of examples also the individuality of sine posture. To this individuality in the evaluation of needs, was a clinical assessment of the logical consequence. Thus AuBioMo technology alone seems to have a sustainable influence on the attitude of the spine - even without any muscular training. The significance of this result is mainly driven by the control group are underlined. In four of five subjects in this group (D) the spine shape over the study period become even worse. Only one test subject in this group maintained same attitude (spinal alignment). In summary, despite the small sample size, a very clear tendency to be pointed out is a sustainable AuBioMo technology influence on the spinal column, and thus on the position. AuBioMo has shown it can improve spinal attitude in addition to influencing a targeted fortifying of back muscles. 35 4. Practical Everyday Consequences On the basis of the measurements AuBioMo shoes can certainly be a large social circle are recommended. Daily longer wear recommended Since it is the muscle activity in the body that is needed to intensify, the AuBioMo shoe would not be regarded as too aggressive on these structures. Wearing over a period of 6 or more hours would be a significant demand (cause fatigue to) on the core muscle, which one would expect could result in decreased hedging of the spine. This is probably in the 15 ° version of the shoe AuBioMo. The shoe is thus from this perspective appropriate even for long wearing periods (4 hours and more are recommended). No weight training replacement and still an interesting addition When training for improvement of the global large superficial deep-lying trunk muscles, results cannot be seen from AuBioMo technology. Unfortunately, the influence on the deeper layers of muscles is not technically measured. However, is the presumption is compelling that the shoe has an effect on the small local stabilizers of the spine that is similar to a simple non-aggressive sensorimotor used as a training device (e.g. therapy gyro, etc.). Therefore, the use in patients with back pain quite apart of the adjuvant treatment is recommended. Also, AUBIOMO Technology is recommended for preventive use. Prevention and optimization of posture Poor posture in our own time by is a phenomenon of all social classes. The body adapts to the often sedentary life style. This is accompanied primarily by attitude changes in the spine. The proven positive impact on the attitude of the spine by AuBioMo indicates it should be the shoe for people who want to prevent or to improve existing deficits in the attitude of the spine. 5. Outlook The active segment of footwear is so far little explored scientifically. There are different concepts and approaches. The science is only a small part of their proven effects. Therefore, we must look beyond merely scientifically recommended product comparisons, to a much more nuanced look at this product gaining market acceptance. This would allow recommendations to be made to vendors, therapists, physicians, or make the product easier to select. The producers would also make sure of the core positioning of the product. This investigation provided us with an interesting impression of AuBioMo footwear. For the future, we should the first eliminate the recognized weaknesses of this particular study. Above all, the next study will be carried out with a larger sample size. But there are still many unanswered questions that should be clarified. 36 The obvious would be the following questions as to the effect AuBioMo Technology: • • • • • • • • Effect on back pain? Impact on the attitude while walking? Achieved structures AuBioMo sustainable change in the arch of the foot? Impact on gait in orthopedic cases in the problem area the lower extremities? Impact on the balance of power? Effect when used in free weight training as an additional sensorimotor component? Functional comparisons of different product lines or manufacturers U.v.m. The development and implementation of AuBioMo technology should definitely continue to operate as an enriching part of the Health products market. 6. Summary In the SEMG study, AuBioMo shows quite a bit of a tendency to higher muscle activity within the measured trunk muscles in compared to the control group. The activity level is very low, however on a higher level. A significant difference is therefore not sustainable. However, a muscular claim in homeopathic doses people with low levels of physical activity already generate positive effects. Since changing the attitude in a positive way while wearing shoes AuBioMo provide lasting change, the question arises, what makes this effect. Within the short examination time, the passive structures like ligaments hardly are given the time to adapt. Rather, a muscular phenomenon must be happening. The authors assume that the underlying local stabilizers (mm. multifidus, mm. interspinali, etc., which are unfortunately not measurably changed). From this could be concluded that the shoes very, very, subtly affect the mentioned muscular structures and improve them, and a change of attitude cause. With regard to the maximum isometric trunk strength seems to be a specific training the trunk muscles to increase the efficiency in the segment to the mid-body effect. The data rather suggests that training without AuBioMo technology is critical, but it should be said that in the exercising of subjects, in part exercises were completed in combustion engines. Only at the machines could AuBioMo shoes sensorimotor properties be properly evaluated. However, here is a tendency in favor of AuBioMo technology recorded. The group, which has AuBioMo worn in everyday life, and no training completed, stood out from the control group entirely. The difference is not significant. This in turn 37 suggests that these shoes seem to muscular effects produce, the less the area of global moving muscles, but tend to be in the local short-joint stabilizers. Seen as highly representative, however, the sustained positive change posture of the spine, even without additional training. An attempt by the explanation was given already in connection with the SEMG-examination. In summary, despite the small sample size, a very clear tendency to be pointed is a sustainable technology AuBioMo technology influence on the spinal column, and thus on the position. AuBioMo also shows a fortifying influencing on all back muscles. With respect to all three study programs (muscle activity in the body, maximum power increase in the fuselage and improve posture seems) the AuBioMo technology based on the investigations carried more positive than negative attention. Thus, a significant number of our company highly recommended AuBioMo products. Finally, there is a factor worth mentioning, for which within this study no data was collected. But it is of crucial importance. The feedback from participants about the AuBioMo shoes they have worn was consistently without exception absolutely positive. The subjective feeling has been widely commented upon and all subjects have continued to wear the shoes in everyday life. 38 7. Bibliography BÖS, K.: Statistics Course 1 New York: 1983 Esprint CLAUSS, G., EBNER: Statistics. Volume 1 Basics. For sociologists, educators, Psychologists and physicians. Thun and Frankfurt: Harri German 1985 CLAUSS, G.; F.-R. FINZE, L. PARTZSCH: Statisktik. Volume 1 For sociologists, Educators, psychologists and physicians. Thun and Frankfurt: Harri German 1994 DENNER, A., et al. Muscular deconditioning: the case of our civilization Society?, Journal Orthopaedic practice, No.39, 2008 FREIWALD, J.: Pain and Strength Training, p.71-85 Sammelwerksbeitrag, Bern 2006 FREIWALD, J., C. BAUMGART, P. KONRAD: Introduction to Elektromyograpgie. Sports-prevention-rehabilitation, Balingen 2007 GOLLHOFER, A.: Functional testing of thr mbt shoe Compared with a sensorimotortraining, University of Freiburg 2007 GOTTLOB, A.: Differentiated strength training with a focus on spine, Munich 2007 HUBER, G.: back pain and strengthening approaches, physical therapy journal Health and Sports, No.2, p.46-50, Stuttgart 2008 KELLER, S., A. MANNION, D. GROB: Reliability of a new measuring device ("SpinalMouse") in recording the sagittal profile of the back. European SpineJournal, Vol 9, no. 4, 2000, 303 KNUTSON, LM, et al. Journal of Electromyography and Kinesiology 4:47-59, 1994 NEW, P.R., J. M. PEARCE: The effects of MBT footwear on posture. An experimental designed study, University of Southampton, United Kingdom 2006 NIGG, B., C. EMERY, L. HIEMSTRA: The effectiviness of MBT shoe in the reduction of pain in knee osteoarthritis with subjects. A randomized controlled trial, University of Calgary, Canada 2005 NIGG, B: The MBT shoe-in its biomechanical / therapeutical effects, University of Calgary, Canada 2004 SCHULZ, S.: Measurement of the shape and mobility of the spine. validation of the "Back mouse" by comparison with X-functional images. dissertation 39 Medical Faculty of Ludwig-Maximilians-University, Munich 1999 SEGESSER, B, et al. Biomechanical analysis of the MBT shoe, clinic Racetrack, Basel, Switzerland 2002 SEGESSER, B, et al. MBT shoe for ankle instabilities as therapeutic, clinical practice Racetrack, Basel, Switzerland 2007 SEICHERT, N., E. SENN: Sagittal shape of the spine and mobilitiy validity and Reliability of the MediMouse. www.spinalmouse.com/reports/studies4.htm, rehabclinic Bellikon (Switzerland), 2000 STEFANYSHYN, D.: Biomechanical development and evaluation of functional sports footware, Human Performance Laboratory, University of Calgary in 2006 WINTER, DA, HJ: YACK: Electroencephalography Clinical Neurophysiology 67:402411, 1987, Morrish Crit Rev Phys Med Rehabil. 11:171-205. 1999 8. Raw Statistics (Detailed data sheets are available upon request). 40