Internal hydraulic exoskeleton theory and the sanomechanics® system as for prevention of osteoarthritis after unilateral lower limb amputation


Prof. Pitkin, M.R. Dr. Tech. Sci. Tufts University, Boston, MA 02111, USA. Phone 617-636-7000, e-mail:

In the heading: Original researches

Year: 2021 Volume: 3 Journal number: 1 

Pages: 8-18

Article type: scientific and practical

UDC: 616.72-07

DOI: 10.26211/2658-4522-2021-3-1-8-18


Introduction. After unilateral amputation of the lower limb, the preserved leg experiences asymmetrically greater loads during walking than before the operation. Overloading of its joints leads to the development of posttraumatic osteoarthritis, which negatively affects the effectiveness of prosthetic rehabilitation, significantly reducing the patient’s quality of life. A new approach to rehabilitation techniques is proposed in order to increase their effectiveness in preventing joint overload as one of the causes of posttraumatic osteoarthritis.
This approach consists of the introduction of the elements of Sanomechanics®, developed by the author, as a general strengthening system of psychophysical exercises into existing rehabilitation methods. A distinctive feature of Sanomechanics is its focus on maintaining and restoring a previously undetectable physiological system that protects articular cartilage from overload. The system, called “internal hydraulic exoskeleton,” encompasses the entire bony skeleton and includes the bursae, periosteum, entheses, and subperiosteal fluid.

Aim. The aim of the work was to propose a minimum number of exercises that develop a patient’s ability to withstand jumping loads for inclusion in the rehabilitation methods of a prosthetics clinic, as well as to modify training systems to help patients without prior athletic training to master the recommended exercises in a short time and help them make these exercises part of their daily practice.

Materials and methods. The connection of muscles with the bones of the skeleton, which could be associated with the structure and operation of the “internal hydraulic exoskeleton” system, were investigated. The concept of the internal hydraulic exoskeleton was used as a semantic filter for the analysis of well-known traditional methods of physical improvement associated with extreme loads of the jumping type. The analysis set two tasks: to select the minimum number of exercises that develop the ability to withstand jumping loads, which can be recommended for inclusion in the rehabilitation methods of a prosthetics clinic; to offer a training system to help patients with no prior athletic training to master the recommended exercises in a short time and to help them to practice these exercises daily.

Results. Despite differences in the analyzed training systems, the general theme consistent with the concept of the internal hydraulic exoskeleton was the development of flexibility in the pelvic region. Selected exercises for performance in the sagittal plane: longitudinal split, “cobra” yoga pose, “child” yoga pose. In the frontal plane, this is the transverse split. These exercises have been modified so that they can be performed in bed after waking up according to the Sanomechanics method. It is proposed to teach the technique while the patient is in the clinic before and after prosthetics services.

Conclusion. An additional element of rehabilitation methods in the prosthetics clinic, consisting of the method of psychophysical training of the internal exoskeleton system, is proposed for discussion and verification.
The technique consists of exercises to reduce intra-articular pressures by maintaining and restoring hydrostatic transmission and pressure distribution in the subperiosteal layer between the pelvis and extremities, and between the pelvis and the spine.

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