Apos treatment tackles knee and back pain

One of the biggest problems for the healthcare industry in recent years among people of working age is the impact of knee and back pain. With almost 19 million working days lost annually because of back pain alone,1 affecting up to eight in 10 people at some time during their lives, the costs to the healthcare industry (NHS and private) of £1.6bn per year,2 and the UK economy up to £5bn a year2a are of concern to employers, employees and OH practitioners.

New research reveals that in the past year, around half of those with knee or back pain who have taken time off work have taken a week or more off.3 With around 22 million back pain sufferers and 13 million knee pain sufferers in the UK,4 sickness absence and the costs associated with back and knee pain affect all employers and the productivity of UK PLC. Back pain was the second most significant cause of short-term absence in 2007.5

As occupational health (OH) professionals, we are often involved in the fitness-to-work assessments of people who have knee or back pain either at the pre-employment stage or following a period of sickness absence, and these cases can be a challenge to achieving a satisfactory outcome in planning an effective return to work.


Those with long-term illnesses need time to recover. However in some cases, like those involving back or knee pain, working and keeping active can actually aid recovery. When Dame Carol Black, in her review of the health of working-age people, set out a new vision for health and work, which was based on an acknowledgement of the positive relationship between health and work, she recognised that achieving this vision requires abandoning the idea that it is inappropriate to be at work unless 100% fit, and that being at work normally impedes recovery.

As OH professionals know, whether employers are dealing with long-term or recurrent short-term sickness absence, early and effective intervention strategies are a central part of the solution. Key to these are:

  • Absence management policies

  • Management training on attendance management, return-to-work interview techniques, telephone interviews, home visits and case conferences

  • A comprehensive reporting system to identify trends and reasons for sickness absence – including, where possible, the measurement of the financial costs of employee absence – can be instrumental in convincing the financial director of the benefits of the active management of employee absence

  • Sufficient support from OH and other involved health professionals taking into account the bio-psychosocial model of illness.


New UK research also reveals:

  • around half of back pain sufferers (54%) and half of knee pain sufferers (47%) feel that treatment options are limited.

  • a third of back pain sufferers (33%) and around three in 10 knee pain sufferers (29%) feel disappointed by existing treatments.

  • more than 80% of those who have used or received some kind of treatment do not think that pain killers are very effective at treating their back pain (84%) or knee pain (85%).

  • whether or not a treatment is non-surgical is an important factor in treatment selection for around eight in 10 of those who have used/received some kind of treatment for back pain (82%) or knee pain (77%).

  • around two-fifths agree that their back pain (41%) or knee pain (39%) has a significant impact on their quality of life.

  • This research was conducted for the launch of a biomechanical treatment for back and knee pain, which showed that it can eliminate the need for prescription pain relief for seven out of 10 people.6

Apos treatment

The Apos treatment (which stands for All Phases of Step Cycle) consists of the Apos WalkrightsTM, high-tech footwear which is individually adjusted to address patients’ specific pain needs, following a consultation with a clinician and a computerised gait analysis which assesses the way they walk. A six-month programme of care that provides ongoing clinical assessment follows.

The Apos treatment combines two simple principles for treating lower back and knee pain: realigning the body as it walks and introducing a mild instability, which encourages the retraining of the systems that stabilise the joints, resulting in improved joint function and a reduction in pain.

The results can be remarkable. For example, this treatment regime has been reported as reducing the intensity of knee pain by an average of 66% after just eight weeks.7 Looking to the future, it may be that such biomechanical approaches will form a valuable part of the overall management of knee and back pain rehabilitation, allowing staff to return to work or even avoid being off work in the first place. Achieving this would be a valuable contribution to the agenda that Dame Carol Black has set.

In the UK, Bupa is offering Apos treatment at selected centres.


1 Health & Safety Executive ill-health costs www.hse.gov.uk/costs/ill_health_costs/ill_health_costs_intro.asp

2 Maniadakis A, Gray A, The economic burden of back pain in the UK. Pain 2000;84:95-103

2a Department for Work and Pensions

3 Research Now – online survey of a representative sample of 4,008 UK adults (aged 16+) between 4 and 11 June 2009.

4 As above – Source 3

5 CBI/AXA Absence Survey 2008

6 Communications Centre of the Brandman Institute in Tel Aviv. Telephone interviews conducted in March, 2008 among 200 people, aged 35+, using the APOS Treatment.

7 Department of Orthopaedic Surgery, Assaf Harofeh Medical Center. Zerifin, Israel. A medical study of 57 people with knee osteoarthritis was carried out in Israel between September 2005 and February 2006. The study has been registered with Clinicaltrials.gov – www.clinicaltrials.gov/ct2/show/record/NCT00457132

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