AU2013100838A4 - Muscle tone promotion - Google Patents

Abstract

A pair of shoes, inserts for shoes or other supporting surface for each of a persons feet providing higher inner and lower outer transverse slopes effecting autonomous triggering of corset muscles of the person. WO 2008/043133 PCT/A1J2007/001519 -3

Description

1 MUSCLE TONE PROMOTION This invention relates to muscle tone promotion for humans including an arrangement for footwear which provides muscle tone promotion and also a method of assisting muscle tone promotion. BACKGROUND OF THE INVENTION The human body has a number of muscles which are used and activated for various and sometimes different purposes. There are, among other muscles, a set of muscles often referred to as the "corset" muscles which are especially of value in stabilising the spine and which are activated only in certain circumstances which will normally not coincide with those muscles that might be exercised in conventional muscle strengthening exercising or activities. The result of this is that many people, over time, find that they have not used these corset muscles sufficiently and the muscles themselves then will become weaker or atrophy. This can cause serious difficulties where the stability of the spine is involved and may result in excessive tensions which are not able to be countered by other muscles thus distorting and straining the spine itself with potentially serious results. It is perhaps enough to explain that it is of great value for people to ensure that their corset muscles are "switched on" from time to time and by use therefore will either maintain tone or increase tone. THE PROBLEM TO WHICH THIS INVENTION IS DIRECTED The problem to which this invention is directed relates to the difficulty of ensuring that a vital set of muscles are switched on from time to time. A person, unless well trained 2 to recognise it, will not know whether such corset muscles are switched on or not although it is known that a number of conventional physical actions for instance climbing stairs or walking quite quickly with long steps does have this beneficial effect although walking with quick short steps does not appear on those persons tested so far to switch these muscles on. Unfortunately, a very large number of people will not perform these exercises either at all or regularly and even if they do, the effect of switching on corset muscles will last only for a modest period after the exercise has been finished. OBJECT OF THIS INVENTION An object of this invention is to provide a means in one case and a method in another case whereby a human can be assisted in having their corset muscles toned up or increased in tone. BRIEF DESCRIPTION THE INVENTION Throughout this specification we will variously refer to shoes or sometimes boots, shoes, sandals, thongs and slippers. We intend that the term shoe should be read as a generic reference where the context admits to footwear which may include any one of boots, shoes, sandals, thongs, or slippers. We have discovered that a trigger that has provided and maintained activation of the corset muscles for a number of people, is for a person to have, for each foot, a foot support with a transverse slope with a higher side being on the inside of a leg and the lower side being on the outer side in each case. This can be achieved by providing a base on which a person stands or it can be an inner sole within shoes or it can be a slope designed into the soles of a pair of shoes. The degree of slope can be quite modest and on trials that we have conducted so far, the effect appears to be useful where there is a slope anywhere from 10 to 60 with respect to a horizontal.

3 What appears to happen is that this degree of slope in relation to both a left and right item of footwear is detected by the brain and this autonomously triggers the corset muscles into a turned on status. In experiments conducted thus far, the amount of slope especially at the lower end of the range is not normally able to be perceived consciously by a person using the footwear so that the advantage is then that the footwear can be worn as one would normally wear any footwear and yet it autonomously triggers and maintains the ongoing on status of the corset muscles. We have also found that further muscles providing support and stability will in many people also be turned on. These corset muscles are to be distinguished from other muscles which might be used for as conventional discretionary activated purposes where for instance efforts involving conventional strength might be used even with traditional exercises. For reasons which are simply not understood, the corset muscles seem conventionally not to be always or reliably at least to be switched on in such exercises although it is known that there may be other exercises which are dedicated to detecting and effecting activation of these muscles in a discipline for instance "Pilates". Because of the autonomous nature of the switching on or off of these muscles, we do not know if we have clarified all of the aspects of the trigger effect or those factors that may affect some parts of the foot as compared to others and in which cases these may or may not have a desirable effect. Thus far we have found however that it is preferable not to have any arch support within either items of footwear where the arch support is of sufficient height to have a direct engagement of the arch of the foot using the item of footwear.

4 In preference also, it is found preferable to have an inclination which is consistent through a full length of at least weight bearing portions of a foot e.g. from heel to toe in each item of footwear. In preference, it is also further found that the effect still occurs at least in those examples we have trialled where there is a forward slope where for instance the shoe may be a high heeled shoe or even a conventional men's shoe with a high heel or even where there are conventional shoes in which there is a slight forward slope which is to say it is higher at the back than the front. In preference however, the effect does appear to be countered if the slope is higher at the front of a shoe or item of footwear than the back. According to the above then, the invention could be said to reside in a pair of shoes where a first shoe is a for a right foot of a wearer, and a second shoe is for the left foot of the wearer, each of the shoes having a sole shaped or having an insert within each respective shoe being shaped so that, when each shoe is located to be resting in a usual upright position on a flat and horizontal surface, the foot of a wearer of that shoe will have the foot supported at substantially all areas which contact the sole of the foot on a transversely orientated sloping surface where the extent of the slope is within a range of from 10 to 60, with an inner side of the shoe for each of the shoes being the higher side of the slope. In an alternate form of this invention it could be said to reside in a pair of shoes including for each of a pair, a sole and an upper attached to the sole, there being within each unit of the pair, an inner sole that has a thickness which is greater on an inner side of each unit of the pair and an outer side of each unit of the pair, so that an upper surface of both inner soles has a slope when resting on a horizontal plane that is within a range of from 10 to 60 of slope from an inner side to an outer side and along its effective length when viewed in cross section which cross section is transverse to a direction of elongation of the inner sole.

5 In a further alternate form the invention could be said to reside in a support for both feet of a person standing where the support is adapted to rest on a horizontal surface and provide an upper support surface where there is a sloping surface for each respective foot where the slope for a left foot is within a range of from 1 degree to 6 degrees with a highest side being on an inner side of the support and where the slope for a right foot is within a range of from 1 degree to 6 degrees with a highest side being on an inner side of the support. In a further alternate form this could be said to reside in a combination of a person when standing on a support for both feet of the person where the support provides an upper support surface where there is a sloping surface for each respective foot where the slope for a left foot of the person is within a range of from 1 degree to 6 degrees with a highest side being on an inner side of the support and where the slope for a right foot is within a range of from 1 degree to 6 degrees with a highest side being on an inner side of the support. In a further alternate form of the invention this could be said to reside in a method of assisting maintaining corset muscle tone of a person including the step of wearing a pair of shoes where a first shoe is for a right foot of a wearer, and a second is for the left foot of the wearer, each of the shoes have a sole shaped or having insert within each respective shoe being shaped so that when each shoe is located to be resting in a usual upright position on a flat and horizontal surface, the foot of a wearer of that shoe will have the foot supported at substantially all areas of contact of the sole of the foot on a transversely orientated sloping surface where the extent of the slope is within a range of from 10 to 60, within an inner side of the shoe for each of the shoes being the higher side of the slope. In relation to any of the above, it is in preference that the degree of slope is substantially constant along an effecting length of the shoe. In preference there is either no or a small arch support in each shoe where the support does not have an arch supporting effect. This is achieved by providing that 6 the transversely orientated sloping surface is provided by a substantially planar surface shape. In preference there is no structure that wraps around and provides a stabilising supporting shape for a bottom of a foot be this the heel or other parts of the foot In preference, any slope in a forward to rearward direction of a shoe is only such that a rearward end of each shoe is higher than a forward end. In relation to the specification and claims, a reference to the word "shoe" is intended where the context is appropriate to also include boots, shoes and slippers as well as sandals and thongs. We have found in our experiments thus far that it can be quite difficult to establish when and if the corset muscles have been switched on or are switched off. However, we have now discovered a method that does appear to indicate quite quickly the actual status of the corset muscles. This involves having the person to be tested present hands out forwardly with bent elbows and then have a measured extent of pressure apply downwardly on those hands. When the corset muscles are on, the set of the body does appear to be different and a very much higher resistance to being overbalanced by such applied pressure exists. This effect is believed to be caused through the action of our invention causing greater activity of core and other postural muscles together. The effect therefore is not limited to only the core muscles but a challenge to balance will also bring into play other muscles but if the core muscles are not active then there is this greater vulnerability. In another form of this invention then it could be said to reside in footwear having modified transverse slopes such that an inner side of the footwear is higher than an outer side in relation to both of a pair of footwear for a left and right foot and being 7 such that there is effected by such slope when the person wearing the shoes is standing on horizontal planar surface that their corset muscles are toned up. In preference, such a person has muscles triggered to the extent that they can resist downward pressure on their outstretched hands with bent elbows to a substantially higher degree than would otherwise be the case. We have disclosed an extent of slope being within the range of from 1 degree to 6 degrees. In preference the slope for each side is approximately 2 degrees. In the alternative there is provided a method of assisting maintaining corset muscle tone of a person comprising the step of putting on then wearing while walking, a pair of shoes where a first shoe is for a right foot of a wearer, and a second is for the left foot of the wearer, each of the shoes having a sole shaped or having an insert within each respective shoe being shaped so that when each shoe is located to be resting in a usual upright position on a flat and horizontal surface, the foot of a wearer of that shoe will have the foot supported at substantially all areas of contact of the sole of the foot on a transversely orientated sloping surface where the extent of the slope is within a range of from 10 to 60, within an inner side of the shoe for each of the shoes being the higher side of the slope. We will now describe in greater detail results that have been obtained from a number of different people with different degrees of inclination from which it will be seen that the results are reasonably consistent through those persons that have been tested so far. However, while it is clear that a substantial number of people react in a similar way, the human body can vary so that we do not know that this apparatus or shoe technique will assist everyone but it will on the evidence that we have assist a substantial number of people and the range of slope is preferably as small as possible while still providing an effective and consistent result for a significant number of people.

8 It is known that a person needs movement to maintain health of their spine. Movement is needed to assist in blood flow to the various parts supporting and providing the skeletal structure, which includes health of synovial fluid, ligaments and so on. However historically, movement for a person with apparent spinal challenges has been contraindicated. By being able to maintain muscle tone, movement which is considered essential for good health can now therefore be encouraged with significant benefit. BRIEF DESCRIPTION OF THE DRAWINGS For a better understanding of this invention it will now be described with reference to examples and with description of the footwear and the results as seen in individuals. Accordingly, Fig 1 is a schematic cross section along a medial line of a shoe according to a first embodiment where there is an insert within an otherwise standard shoe, Fig 2 is a schematic cross section along a medial line of a shoe according to a second embodiment in which the transverse slope is integrated into the sole, Fig 3 are the respective cross sections as shown in figure 1, Fig 4 are the respective cross sections as shown in Figure 2, Fig 5 is a perspective view of an insert as would be inserted into a shoe as shown in Figure 1, Fig 6 is a schematic illustrating the expected change in posture with a person using the embodiment as compared to the same person without this embodiment, Fig 7 is a side elevation of a person with the muscle sets being identified with the transverse abdominal being the identified corset muscle, 9 Fig 8 is a table of results using the balance test where the extent of slope and distinction between use of the slope with one foot as compared to two is compared this being for Fran a 52 year old woman, Fig 9 is a table of results using the balance test where the extent of slope and distinction between use of the slope with one foot as compared to two is compared this being for Liam a 21 year old male, Fig 10 is a table of results using the balance test where the extent of slope and distinction between use of the slope with one foot as compared to two is compared this being for Clinton a 22 year old male, Fig 11 is a table of results using the balance test where the extent of slope and distinction between use of the slope with one foot as compared to two is compared this being for Michael a 52 year old male, and Fig 12 is a plan of a shoe sole illustrating approximate positions in which the foot of a wearer will contact the inner upper surface of the shoe. DESCRIPTION OF THE EMBODIMENTS Now referring to the drawings in detail the shoe in Figure 1 includes an upper 1 and a sole 2. Within the shoe there is an insert 3 which is a sheet of pliable material (EVA "ethylene-vinyl acetate" is a suitable material for this purpose) which when laid on a horizontal surface has an upper surface which from one side to an opposite side has a consistent slope in this case 20. The thickness at the thinnest side is sufficient to withstand reasonable wearing by a user and the resiliency is such that this slope will be substantially maintained with a person standing on the material.

10 The thickness is also chosen so that its insert within an ordinary shoe will not unduly affect the overall size of the shoe so making it uncomfortable from being too tight to a wearer where the shoe previously was satisfactory. The 20 slope has been chosen as being somewhat midway between 10 and 60 which range has been established by experimentation some results of which are listed in the tables in Figures 8 through 11 and as little as reasonable to get the effect without it being uncomfortable to a majority of users. An upper surface of the insert 3 when the insert itself is laid onto a planar surface will also then be planar even though having this transverse slope. Further, the extent of slope is consistent so that it will be 20 whether measured at the front end or the rear of the shoe 1. In this way, the pliable nature of the insert 3 will normally be able to be inserted into a shoe where it is appropriately shaped to follow an inner lower perimeter of the inside of the shoe 1 but it will not provide any wraparound stabilising shape either at the arch area of the foot or around the heel or around an underneath of the front of the foot. Again, it is not known why this should be the case and such characteristics have been determined by experiments so far on a limited number of people. However, in order to provide a modification to footwear that will be widely applicable and of help to at least a significant number of people, these features have been found to be of value. These features in particular can be seen by the various cross sections in Figure 3 where these are shown for both left and right feet and it is a feature that it is also required that the slope as is shown in the drawings will be higher on the inside of the foot and lower on the outside.

11 Figure 3 now shows the respective cross sections along the lines AA, BB, CC and DD. There are two shoes shown for each section which is on the left hand side a left foot and on the right hand side for a right foot. Section AA shows a cross section through four of five toes and illustrates simply the extent to which the toes at least to each side rest on the infill 3. Section BB is a cross section through the front of the foot, section CC is through a portion of the foot showing the arch and as well be seen in the drawings, this means that most of the foot is above any supporting surface of the infill 3. Finally, the back of the foot showing generally the heel illustrates that the heel is resting on the infill but only to an extent that its sides are not supported by any shape of the infill itself. Figure 2 in many ways is the same as in Figure 1 except in this case the sole 4 of a shoe 5 has the same effective features as in Figure 1 but the slope is integrated into the structure of the sole 4. This is now shown by again the set of drawings in Figure 4 where we see both left and right feet in the sequence of sections which to a large extent duplicate those in Figure 3 except the construction of the sole is different showing the slope again at 20 so that an inner side shown typically at 6 is higher than an outer side shown typically at 7. This again is a slope that is provided so it is consistently 20 transverse to an elongate direction from front to back of the shoe and in this case there is a slight slope from the rear of the shoe to the forward end of the shoe but such a slope does not of itself appear to remove the triggering effect obtained.

12 In Figure 5 this is a perspective view of an inner liner of wedge shape which in this case is for a right foot but for this invention there would be two of these one for the left which would mirror the one shown which is for the right foot. This unit 8 then has a consistent slope along its full length of 20 and the material from which it is made is a pliable material such as a soft polyurethane plastic material or a rubber material formulated to be relatively pliable but not deformable to the extent that it would naturally collapse and wraparound the foot of a wearer. Figure 6 is a side view illustrating in an exemplary way a typical altered posture when someone is wearing the modified shoes as compared to when someone is not. The more upright position being the position when the transverse abdominal muscles or the corset muscles are having their tone increased. In this same drawing, there is shown a position in which the person can also then be tested as to the ability to resist downward force in the direction of the arrow and it is also then illustrative if the force is higher that those corset muscles are being toned or if the resistance is lower, then both the posture and the ability to resist overbalancing is reduced. Figure 7 simply illustrates typical muscle sets and identifies particularly the transverse abdominus which are considered to be the corset muscles, and separately identifies the rectus abdominus, gluteals, vastus lateralis and tibialis anterior. We now refer to four tabular sets of results where the load in kilograms was applied downwardly onto the outstretched hands of the subject and the measure shown is the maximum load that was able to be supported before either the person overbalanced forwardly or in several cases resisted any overbalancing even with "high loads". The effect is observed then as an ability to resist such a force applied straight downwardly at the distance provided by the forearms extending directly out from the body of the subject where the load is applied to the hands.

13 For each of these tests the subject is not informed until after the tests as to the expected results or the specific features of inclination of the base on which they might stand. The abbreviations are b=back, f=front, I=left (or low where appropriate), R=right, AS=Arch support, L=low where appropriate cf left and H=high. Also where not specifically stated otherwise there is no arch support and the support surface is planar and the slope is higher at the centre and of 2 degrees. The first of these is for Fran a 52 year old woman. It will be noticed that there is some muscle tone exhibited at the -1.5 degrees which is a slope with the outer side higher than an inner side whereas this is reduced at 0 degrees to 6 kgs. The prime effect in this instance lies between +1.5 degrees through to +4 degrees. There is advantage to a user if the slope is smaller as it is not then apparent and is more comfortable. The range of from 1 degree to 6 degrees is found to be a slope range that provides assistance in the effect for many people. However a range of from 1.5 degrees to 5 degrees is likely to include more people and a range of approximately 2 degrees is further likely to include even more people. In each case the person was not told what slope existed and mostly were not aware through feel as to the slope extent. One issue is that once the corset muscles have been toned then there will be a period during which these then will remain toned although some exercises will cause a relaxing. Therefore there has been a sufficient time allowed for each test to ensure that the muscles have been relaxed before the person further mounts test support. The test in each case involves the person standing on the test support with arms bent with the forearms both projecting forwardly and the pressure being applied on both hands together. The measure is then the amount of pressure applied before either the person is starting to pivot forwardly without apparent restraint. In other words it is the extent of available resistance provided by the person upwardly by the 14 hands. An indication of muscle tone is obtained then by a comparison of the resistance offered by a person when presented with an increasing force when standing on a platform as indicated. The subjects in each case also had no shoes on so that the reaction was only to slope as such and they were positioned for each with a big toe against a front stop and a ball of the foot in each case against a side stop. As will now be further seen the resistance for Fran indicates that the arrangement is providing a switching of the corset muscles through approximately 1 degree to slightly higher than 4 degrees. For the rest of the tests it shows that with an arch support high or with a front higher than a back or the slope being for one side only the muscle tone is maintained low in that the resistance measured is all below 8.3 kgs cf at least 12 Kgs and above for the appropriate slopes. For Liam a 21 year old male the general level of resistance is somewhat higher but by comparing it can be seen that the level is markedly higher for 2 degrees through to greater than 4 degrees indicating that the corset muscles have been toned by these individual slopes. Where the slope is not specified eg when the arch is high or low the inner as compared to an outer slope is set at 2 Degrees. However the tone has been generally switched off by the reverse slopes eg with front higher than a back but there is some apparent partial return (32) with one side sloping only. With Fig 10 the results are for Clinton a 22 year old male the effect becomes apparent at 1.5 degrees for both feet and remains to greater than 4 degrees for both feet.

15 We now look at Michael a 52 year old man Fig 11. There is a distinct lift in resistance when the slope for both feet are on a slope of 2 degrees. Further, when the trunk is rotated about the waist in one direction 45 degrees or in the opposite direction 46 degrees the effect is still observed. What we have now seen is that each person is different but that for the trials conducted so far and these are representative there is a relatively consistent advantage for these people where the slope is for each foot and higher in the middle and the slope is approximately 2 degrees. Case histories including diagnosis and results: CASE 1 52 year old woman of Scottish and Irish ancestry, 175cm tall, weighing 63 kg and above average fitness complaining that her posture was deteriorating to the extent that her shoulders were hunching over. She had to constantly remind herself to stand upright. Frequent stiffness and aching was present. This problem has been present for some three years or more and was progressively worsening. Physical examination showed a forward head carriage, kyphotic thoracic spine (exaggerated forward curve of the upper back), anterior scapulae and a compensatory sway back. The whole upper back including paraspinal muscles, Upper Trapezii and scapula muscles were tender to palpation consistent with muscle fatigue and stiffness related to her posture. Trigger points were found within these muscles also. The joints of the upper half of the thoracic spine were hypo-mobile as a result of the muscle tension. This lady agreed to try wearing innersoles consisting of an upper surface that was flat other than a 2% slope high on the medial edge for the whole length of the inner sole. The upper surface of the soles of the shoes worn were substantially flat, the original inner sole with an arch support having been removed. The purpose of this approach was to switch on to a greater extent the deep corset (core) muscles which stabilise 16 the spine and maintain the curves of the spine. Also it was intended to counter the 'switching off effect' of the work posture and activities on the corset muscles. Within a few weeks of wearing the innersoles daily and whenever shoes were worn her posture has visibly improved and she finds she stands upright automatically without conscious effort. The discomfort reported initially had gone within a few days. The muscles that were previously tender to palpation were no longer so and trigger points were not found. This effect has lasted for 52 weeks. CASE 2 21 year male old cook working at a bench or at stoves, hotplates, ovens or serving food to tables frequently 10 or more hours a day feeling fatigued and stiff in his upper back. This complaint was present for about one year. He has Irish and Polish ancestry, is very fit, 190cm tall and weighs 86kg. Physical examination showed a forward head carriage, anterior scapulae and hypomobility of the C7 -T2 intervertebral joints. Palpation to the Upper Trapezii muscles was quite tender consistent with muscle fatigue and stiffness. These physical findings are consistent with working standing, looking down, frequently bending forward and taking short steps all of which causes switching off of the corset and other trunk muscles resulting in a more slouched posture and less spinal stability and predisposing to pain and injury. Innersoles, to be fitted to both shoes, were recommended consisting of an upper surface that was flat other than a 2% slope high on the medial edge for the whole length of the inner sole. The upper surface of the soles of the shoes worn were substantially flat, the original inner sole with an arch support having been removed. The purpose of this approach was to enable the central nervous system to more effectively switch on the trunk muscles, including the core muscles, to provide spinal stability and to co-activate them with other postural muscles to maintain balance and better posture.

17 From the first shift wearing the innersoles the discomfort has gone. The posture has significantly improved and the young cook says his shoulders are totally relaxed even after a long busy shift. The spinal hypomobility described in the upper back has gone. This cook volunteered the information that he found lifting heavy boxes at work easier when wearing the innersoles. The reason is that a load being lifted exerts a turning moment on the spine working to over balance the person lifting. The innersoles acting as described above better enables the lifting person to overcome the balance challenge of the load being lifted. CASE 3 53 year old masseuse complained of aching upper and lower back after massaging her clients. She was 170cm tall, weighs 64kg and of average fitness with Anglo Saxon heritage. Physical examination showed fixation of the C7 -T1 L4-L5 intervertebral joints. Observation of work posture showed spinal flexion when bending over a client which is consistent with switching off of the 'core' muscles reducing spinal stability and production of pain and muscle tension and fatigue. Innersoles were recommended to be worn when massaging. The innersoles consist of an upper surface that was flat other than a 2 degree slope high on the medial edge for the whole length of the inner sole. The upper surface of the soles of the shoes worn were substantially flat, the original inner sole with an arch support having been removed. The purpose of this approach was to switch on to a greater extent the deep corset (core) muscles which stabilise the spine and maintain the curves of the spine. From first use of the innersoles there were no more problems. CASE 4 60 year old engineer complained of upper and lower back ache after working with lathes, milling machines and at a work bench. Bending and lifting to various degrees 18 is also part of his work. This man is of above average fitness, 180cm tall, weighs 88kg and is of Anglo-Saxon heritage Physical findings included a kyphosis and forward head carriage. Tenderness was elicited in the upper trapezius muscles with palpation. Lower lumbar intervertebral hypomobility was noted. These findings are consistent with reported discomfort and observed work postures. However the observed kyphosis is likely to have a developmental component but would also be likely to be an exacerbating factor in this case. Because the work involved long periods of standing in one position looking down and frequent forward bending we could expect turning off of the corset muscles resulting in pain and stiffness. Also this situation is a predisposition to injury. Wearing innersoles while working was recommended consisting of an upper surface that was flat other than a 2% slope high on the medial edge for the whole length of the inner sole. The upper surface of the soles of the shoes worn were substantially flat, the original inner sole with an arch support having been removed. The purpose of this approach was to switch on to a greater extent the deep corset (core) muscles which stabilise the spine and maintain the curves of the spine. Also it was intended to counter the 'switching off effect' of the work posture and activities on the corset muscles. The discomfort resolved once use of the soles was commenced and has not returned. Over twelve months the kyphosis and forward head carriage has significantly reduced. CASE 5 50 year old chiropractor , This man was very fit, slim, 183cm tall and weighs 90 kg. He is of Irish and Polish ancestry. Exhibits frequently recurring neck tension from standing most of the working day looking down at subjects on a treatment table or taking short steps around the office. Physical examination showed a forward head carriage and sway back typical of a slouched posture resulting from this type of work.

19 Standing looking down and taking relatively short steps for much of the working day will result in switching off of the corset muscles causing less spinal stability and a slouching posture predisposing to pain and injury. Upper cervical intervertebral joint hypomobility was present consistent with forward head carriage and resulting muscle fatigue. Severe ankle pronation was also present which is consistent with the posture described. Symptoms typical of a left plantar fasciitis had been present in excess of one year after a step on which he was standing collapsed. Walking had become uncomfortable. Since the posture and other findings suggested likely weakness or switching off of the corset muscles it was decided to recommend wearing innersoles while working or walking consisting of an upper surface that was flat other than a 2% slope high on the medial edge for the whole length of the inner sole. The upper surface of the soles of the shoes worn were substantially flat, the original inner sole with an arch support having been removed. The purpose of this approach was to switch on to a greater extent the deep corset (core) muscles which stabilise the spine and maintain the curves of the spine. Also it was intended to counter the 'switching off effect' of the work posture and activities on the corset muscles. The neck discomfort resolved once use of the soles was commenced and has not returned after 9 months. Within two weeks the pain that was related to the left plantar fasciitis had gone. A plausible explanation is that as the corset muscles are switched on to a greater extent and as posture improves the arches of the foot are also raised taking stress off the plantar structures of the foot and ankle. The ankle pronation is largely reduced as is the forward head carriage. The sway back is less evident. CASE 6 26 year old woman with significant balance problems to the extent that falling over is a day to day danger to her. A brain injury at age 2 years was the cause. She has 20 maintained above average fitness, is of slim to medium build, 165cm tall and weighs 57.2 kg. She has Anglo-Saxon heritage. An awkward gait is obvious. Further physical exam indicates painful hard muscles that restrict joints to flexed positions preventing normal range of passive or active movement. A significantly reduced ability to resist balance challenges is evident on testing. It was suggested to this lady to try wearing, fitted to both shoes, innersoles that had a higher medial (inside) edge than the lateral (outside) edge such that there was a constant 2 degree angle along the whole length of the innersoles. First the original innersoles were removed from inside each of a pair of lace- up walking shoes. The original innersoles were shaped to conform to the under side of a foot. The suggested innersoles were placed in the same walking shoes, making sure that they covered the top surface of the sole of the walking shoes which were determined to be essentially flat. Feet would be substantially in contact with the top surface of the innersole. The purpose of this exercise was to see if the replacement innersoles would cause increased activity of trunk muscles, including core muscles, and co activation with other postural muscles and thus improve the lady's response to balance challenges. This hopefully would help with her balance issues. With the lady standing in the walking shoes with the replacement innersoles fitted as described, the lady's balance was checked by pressing down on her upturned palms that were held in a horizontal position. This test was repeated at the full extent of trunk rotation to either side and approximately every 10 degrees in between. These tests was repeated with the new innersoles removed, with the old innersoles replaced and then with both a new and old innersole in each shoe. The new innersoles conferred a greater resistance to balance challenges as described. The original innersoles did not. The combination of old and new innersoles did not improve resistance to the balance challenges.

21 Ten months later the lady reported that improvement to her balance was ongoing. She had used the innersoles for walking and weight training. CASE 7 22 year old waiter has suffered back pain after activity since early teen years. No particular diagnosis had been given. Physical examination showed a sway back and forward head carriage. Lower back muscles are tender to palpation with restricted movement between lower lumbar vertebrae. This is typical posture and pain pattern of a person with weak postural and spinal stabilising muscles including the core muscles. Present occupation of waiting tables over long hours was causing considerable low back pain. He agreed to trial soles having a 2 degree slope each with a higher side on the inside and the slope consistent along the length of the slope. and remove orthotics and innersoles that were designed to conform to the shape of the underside of the foot or control it while wearing the innersoles. After two weeks he was pain free. Six months later the pain had not returned even after working long hours. CASE 8 83 year old woman fell to the floor getting out of bed. Severe pain over her low back resulted which was aggravated by movement. She was able to get up from the floor and back to bed herself. Tapping over the lumbar vertebrae increased the pain. X-ray examination revealed that three lumbar vertebrae bodies were fractured. Prior to the fall this woman had suffered a debilitating illness, had lost much muscle tone and was generally physically weak with poor fitness. She was 157 cm tall, weighs 38 kg and of Irish decent. Medical treatment consisted of pain relief which enabled the woman to cope at home with help.

22 A slouched standing posture would increase the pressure on the fractured vertebrae. Physical weakness from the recent illness would compound the difficulty arising from bed and walking with any degree of stability. It was suggested to this lady to try wearing, fitted to both shoes, innersoles that had a higher medial (inside) edge than the lateral (outside) edge such that there was a constant 2-degree angle along the whole length of the innersoles. This lady owned a light but well made comfortable pair of shoes. Innersoles shaped to conform to the underside of the foot and stabilise the heel were removed from her shoes. The suggested innersoles were placed in the same walking shoes, making sure that they covered the top surface of the sole of the walking shoes, which were determined to be essentially flat. These shoes could be left on in bed. The reason for suggesting the inner soles was to increase activity of trunk muscles, including core muscles, and co-activation with other postural muscles. This would help with arising from a sitting position, help with stability when standing and walking. Also by helping maintain an upright posture, pressure on the fractured vertebrae and pain levels could hopefully be reduced. Since total bed rest was not required for treatment, increasing muscle activity when possible would help reduce any further muscle tone loss. A reduction of the severity of stabbing pains was noted on standing and walking. Better abdominal and back muscle support, reducing the degree of forward slouching was the likely reason. Arising from the chair was easier as was walking due to increased stability. Initially the innersoles were only used for walking inside her unit, but as the pain reduced the walks were extended to up to half a kilometre on level footpaths. After the pain had gone, the lady continued to wear the suggested innersoles because she found "she was no longer looking at the ground all the time." CASE 9 23 33 year old Male Factory Manager with frequently recurring headaches and back pain. Had a prolapsed disc and spinal fusion in L5 51. 25 years of age when he had the injury. He spends an average of 6-9 hours a day on his feet wearing the innersoles, 5 days a week. He is 95kg, 180cm tall, Anglo Saxon and is of poor fitness. He does not wear orthotics. While working it was recommended wearing innersoles consisting of an upper surface that was flat other than a 2% slope high on the medial edge for the whole length of the inner sole. The upper surface of the soles of the shoes worn was substantially flat. They were worn in sneakers with small arch support. Since wearing the innersoles for 26 weeks now, he claims to feeling like his back is stronger and has not had severe headaches since wearing the innersoles. CASE 10 10. 56 year old Female Writer diagnosed at the age of 12 with rheumatoid arthritic disease. Her back has suffered from chronic weakness and many times has put her in hospital with 'episodes' of major pain. In between these times, should she lift too many heavy things such as shopping or watering cans, she needs to go to bed for at least 24 hours with painkillers and Valium. She is 166cm tall, 57.2kg, good fitness, Anglo Saxon and has arched feet. She has been wearing the innersoles for 6 weeks, 7 days per week at an average of 6-9 hours per day. She wears sneakers / boots with the innersoles and does not wear orthotics. She does mostly walking and gardening with the innersoles in. For the first week of using Strength Soles she noticed muscle pain in my buttocks and thighs - nothing serious but unusual. Then in the weeks that followed the discomfort began to disappear, and she began to notice that after lifting heavy items, 24 although her back would immediately begin to protest, the recovery rate was becoming faster and faster. Her back now feels stronger and she feels more confident. CASE 11 49 year old male, self employed lawn mower suffered with stability in the lower back area. This is due to bulging discs confirmed by X-Rays. This initial injury occurred when he was 35. He spends an average of 12-15 hours a day on his feet and he wears the innersoles 3 days per week, 4 hours per day. He did lawn mowing and gym work with the innersoles in. He is 76kg, 163cm tall, Anglo Saxon and has reasonable fitness levels. He normally wears orthotics in his Nike shoes but took them out to wear with the innersoles. He wore the innersoles in his Nike's and his Blundstone boots which both have little arch support. While working he was wearing innersoles consisting of an upper surface that was flat other than a 2% slope high on the medial edge for the whole length of the inner sole. Having worn the innersoles for 3 months he reports that there is an improvement in the support of his back. He feels to have lesser problems with his lower back pain and more stability when walking and moving on his feet. CASE 12 53 year old female Book-keeper suffered back pain, spinal stability and poor posture. She has bursitis of the hip, sacral lumbar and lower back pain. Her initial problems occurred when he was 52 and she was diagnosed by a Physiotherapist and received 3 Cortisone injections in her hip.

25 She spends an average of 3-6 hours a day on her feet. She wears the innersoles 5 days per week, 8 hours per day in sandshoes that have small arch support. She does not normally wear orthotics. She did sport and just everyday activities with the innersoles in. She is 60kg, 164cm tall, slim, Anglo Saxon and has good fitness levels. While playing sport and undertaking everyday activities it was recommended wearing innersoles consisting of an upper surface that was flat other than a 2% slope high on the medial edge for the whole length of the inner sole. Having worn the innersoles for 5 weeks she reports increased stability, increased confidence in running and no lower back pain after sport.