WO2013060388A1 - Lower back pain training device - Google Patents

Abstract

This invention belongs to the field of Lower Back Pain Syndrome, the extensive field of analysing medicating and preventing ailments of the lower back. It belongs in the sub field of monitoring and recording of body movements and the sub field of portable training and monitoring devices. This is a training device that indicates to the user when a lower back forward flexing movement is made and provides possibility to install electronic monitoring of said movement.

Description

LOWER BACK PAIN TRAINING DEVICE

Description

1. Technical Problem

1.1. The various forward flexing movements and LBFF.

There are several ways to flex forward and they all involve a mix of body part movement types which can be listed as follows:

a. Knee flexing, pelvis tilting and balancing

b. Forward flexing rotation of the hip-pelvis joint.

c. Thoracic forward flexing.

d. Cervical forward flexing

e. Shoulder and spine twisting

f. Spinal lateral flexing whereby processi articulari are asymmetrically disjointed

g. Lower Back Forward Flexing( hereafter abbreviated by LBFF).

These are isolated atomic movements involving specific bodily musculo skeletal elements.

The movements made in daily life consist of various combinations of above movements whereby several of the above specific types are more or less expressed. For example, when kneeling to grab something before you, many of the above types of movement will be involved. The content of a daily life movement very much depends on the individual as well: Some people will naturally express more thoracic flexing others more LBFF flexing when bending forward to pick something up.

LBFF is the specific spinal movement whereby the vertebrae elements sacrumSl, belonging to the pelvis, and lumbar vertebrae L1,L2,L3,L4,L5 rotate and shift with respect to each other, and rotate on themselves and thereby evolve into a more aligned state, when a forward flexing is performed from a normal standing position.

The skeletal lumbar curvature, the lumbar lordosis, visible in the normal standing and colloquially called the back sway, gradually disappears when making this LBFF movement, as the vertebrae Sl- L1-L5 align.

The back sway can be identified in the normal standing side view (sagittarian plane) position as the hollow area formed by the Body Back Sway Curve/Contour (BBSCC), on the back body skin surface, and the Back Sway Span (BSS) which is the imaginary straight line leading from the lower thoracic (T11-T12) to pelvis (Sacrum SI). See Fig.1

LBFF expression causes the BSS to elongate and finally equal and align with the BBSCC. See Fig.2

LBFF is part of most day to day flexing movements , but is expressed more, or less, depending on individual and on the daily life movement that is made. In some daily life movements it is often expressed more: For example when one tends to reach forward from a standing position LBFF is frequently over expressed. Vacuum cleaning is a frequent expresser of LBFF.

2 views of the LBFF movement can be identified with respect to the invention:

A first view is how the vertebrae move with respect to one another in a vertebrae pair. See Fig.3 The movement of the upper vertebra in a lumbar vertebra pair, compared to the lower vertebra is as follows:

-the upper vertebra slides forwards (in the anterior or belly direction) and upwards, while it rotates (inclines) on its own. The joint side connections between the lower and upper vertebrae get hereby slightly disjointed. This is the vertical relative displacement of the processi articulari , also called vertebral facets. The inter vertebral discs have a wedge form, when the user is standing in normal position, with their large wedge base on the anterior side. This wedge form disappears or even inverses (wedge on posterior side) during the inclination of the lower vertebra. This wedge deformation causes a vertical elongation of the vertebra pair its height, and thus the height of the overall spine.

This relative motion of upper vertebra versus lower vertebra repeats for the whole lower back.

See Fig.4

A second view on LBFF movement is then the resulting, grand motion, which is the superposition of all these above described small relative motions of the vertebra pairs, and shows us how the lumbar column is driven by the downwards rotating thoracic column and complete torso system, into a downwards and forward rotation and thereby makes the lumbar dorlosis disappear and the lumbar spine elongate. But ,importantly, we see the BSS elongate and align to the BBSCC, which only elongates slightly. See Fig.5 . This BSS elongation is exploited by this invention.

As an indication of magnitude the elongation of the spine is 2cm and the elongation of the imaginary BSS is of 8cm. The total curvature or opening angle of the lumbar lordosis is 45 degrees. These measures are only indicative and have a lot (30-200%) of variation depending on individual and age. 1.2. The need for LBFF awareness

LBFF is warned against as it is a complex risky movement involving rotations and shifts, of the lower back vertebrae and their whole associated spinal system of ligaments muscles tendons joints veins and nerves. Moreover, the lower vertebrae are naturally ,due to their position, subject to the highest stress forces and pressures in the skeleton. Much of the health advice around lifting objects implicitly aims at reducing the LBFF movement.

From purely mechanical point of view it is obvious that LBFF movement should be kept to a minimum while lifting loads.

1.3. LBFF training

It is difficult for people to identify LBFF as most daily life flexing movements are complex combinations of spinal/skeletal movements. To become aware of the amount of expression of LBFF in daily movements, even when it is understood LBFF can occur, is difficult and to start to learn to avoid to over express LBFF under load conditions is even more difficult as these daily movements have been ingrained in individuals. Modern physio therapeutic insights teaches that people should remain as mobile and active as possible but should become more personally aware of the health risks of what they are doing, their posture and movements in active life, and their posture and movements related to what they do , like carrying weights,picking up and lifting loads.

So, there is a need for a LBFF warning device that allows full mobility for all movements, forward flexing movements included, but clearly indicates to the user ,and optionally to an electronic monitoring device, when the more risky LBFF flexing movement is made or over expressed. The device should be easy to wear and easy to activate and de activate anywhere any time and on the go. The device should be lightweight and avoid skin contact and difficult set-up. The device should not pose problems to shop and airport security systems.

Use of metals and electronics should be avoided unless a monitoring and recording protocol is undertaken because they cause hindrance and extra care. The facility should be there, on the other hand, to built sensors and electronics in into the device as this is a modern day requirement for optional posteriori feedback and analysis.

There is a preference for a non electronic warning and training device, but when a monitoring and recording protocol is undertaken, an electronic audible warning should be acceptable as electronics is already present for the recording anyway. This invention addresses this need. 1.4. LBFF monitoring

Monitoring comprises the electronic capturing and processing of measurements and recording them 95 for posterior feedback and analysis and converting them to immediate feedback signals .

The preparation (calibration phases etc) and electronic processing and recording details are not considered in this invention. The types of measurements and the mechanical details of sensor and electronics installation as part of the device are considered. Modern training and feedback equipment cannot do without the option of posteriori feedback and analysis so any training device 100 has to consider this option in its implementation details.

There is a need for more accurate spinal motion monitoring , outside the laboratory, from body external observed variables, without requiring skin adhesives etc.

A problem with present lower back measurement state of the art and measurements on the skin surface is the disturbing factor of the skin and the dependence of the skin movements not only on 105 the close by vertebrae movements one wants to monitor, but foremost on the whole spinal body system which consists of fat muscles and ligaments , veins, nerves and the bony ends of vertebra.

When flexing forward, the lower back skin moves up generally, and the buttocks flatten to provide skin coverage. Other areas in the back body,for example the waist, where there is fat built up will also flatten under the stress.

110 There is also skin movement in the horizontal plane as the dorsal curvature straightens. See Fig.6 , bottom parts. Also the ventral side plays a role as it remains immobile or rather goes in compression during LBFF. See Fig.7

A misunderstood measurement disturbance factor is the way the skin is hung up in the overall skeletal system in the body. It is a distributed system and local (elongation) effects trickle up and

115 down. When lower vertebra rotate they cause a lengthening of the complete spine and this causes effects in principle over all the length of the spine and this reflects on the skin movements. This is because the whole spinal column lengthens due to their displacement: Thoracic Tl gets higher referred to SI, and this has to be made possible by some 2^nd order skin movement, also at Tl .

The body mass under the skin (fat!) is very much dependent on individual and this makes the skin

120 movements dependent on the individual.

Furthermore the skin is humid or changes humidity and does not like adhesives or any other contraptions for restraining sensors or devices.

So any measurement on the skin is very error prone and especially measurements taken in a small 125 confined area or with both references on the skin have a lot of variability and uncertainty.

This invention proposes a feature that addresses these issues, notably by using a body tight, and providing a larger scope and context to reference the sensors from.

Mechanical measurements for stress and elongation need 2 well defined fixing points. Also, a stress measurement sensor should be embedded "in series" with the device under test, it should provide an 130 impression of the whole stress surface under consideration, and one expects the measuring sensor not to unduly disturb and elongate the device.

Similarly an elongation measurement sensor is embedded kind of "in parallel" with the device under test and one expects it not to influence too much the stresses in play at the device. The measurement disturbance , which is inevitable, should be minimised.

135 These are considerations which need to be met for accurate measurements, and are addressed by this invention, notably by offering the well defined restraints.

Miniaturised inclination sensors are in the present state of the art made of micro mechanical silicon etched circuitry (MEMS) and packaged as integrated circuits. Their dimensions are typical 10x10x3 mm, for inclination sensors that can provide inclination output in 2 dimensions. They typically 140 provide an output that can be interpreted as the sensors plane (defined its largest 10x10 mm surface size) inclination versus the gravity vertical. They are mechanical devices that produce their output from stress movements caused by gravitation.

To have reasonable output, inclination sensors need to have a context. They need to be embedded so their output makes sense, as otherwise the slightest motion or misalignment gives wrong readings. 145 One of the embodiments (notably body tight) of this invention addresses this need.

2. Solution to Problem

The main idea of the invention is to exploit BSS elongation in a controlled way.

This requires some device part that spans the BSS and is restrained at the BSS ends, or proxies 150 thereof.

When you have such device part and the wearer makes a movement that expresses LBFF, the restraint will come out of eventual slack and will go in tension which will then provide the sensorily indication in some way which provides the desired training feedback.

There exists a myriad of simple mechanical contraptions to transform an external stress force into a 155 indenting movement , pinch or squeeze which can be sensorily experienced but in this invention it is proposed to combine this function with the required function of deferred anchoring.

The problem of fixing/anchoring both sides of the restraint that spans the BSS can be resolved with belts or girdles or adhesives but it is proposed in this invention to defer the anchoring to a better further away and more appropriate location at neck/shoulders and pelvis respectively. Clothes are

160 the inspiration for this method of anchoring and standard clothing material like cotton can be used for material as it is sufficiently inelastic. Other materials like polymer webbing , or string, or body tight material which is made stronger and inelastic in specific parts are considered as well and define the various embodiments of the device. The body geometry at neck or shoulders are ideal for anchoring against downward pull, and the body geometry at pelvis is ideal for anchoring against

165 upward pull.

The sensorily experience desired is then simply the sensed pull.

Fig.8 conceptually illustrates this main idea behind the device, whereby an inelastic material ,a string, gets under stress when opening a hinge that widens the distance between the deferred 170 constraints of this string.

2.1. Set-up

Regardless of the embodiment the device has 3 main parts: the top bottom and central part. See Fig.10

175 Top and bottom part provide for the anchoring of the device to the body and assuring a restraint against BSS elongation. The anchoring is done by a tying up or looping around the body parts with string, or wrapping around the body parts with clothing like material.

Top and bottom part are connected to the central part, where a buckle with adjustable straps are 180 located. The central part is made out of a polymer webbing strip, and spans the BSS.

The central part can be made entirely out of 1 type of inelastic webbing, or of several types of webbing with different elastic properties as discussed further. The central part can be a string but it is proposed to be webbing based as this allows for a webbing buckle and webbing makes for a better choice to keep the central part flat against the user's back. Webbing buckles with integrated 185 adjustment straps and side release buttons are a well engineered commodity used in many

applications. A few possibilities are presented in the cloth and string embodiments. The buckle in the central part allows for easy splitting, by means of for example easy to find and operate side release buttons ,the central part , and thus deactivating the device.

The adjustable straps allow for buckle positioning and for manual introducing or removing of the possibly different types of webbing.

Top and bottom parts are made out of the material choices as per the chosen embodiment.

Connection between the 3 parts can be done with simple straps , sewed or glued, or be more elaborate and the engineering design choice for this will be determined by cost, aesthetics, user preference and a design for allowing a certain movement degree of freedom between the 3 parts under the forces at play.

2.2. operation

The device is installed by mounting the parts on the body separately, dressing up, and then closing the buckle 2 unite the 2 central part halves. This 2 part assembly allows for mounting like one would dress into normal clothes, which is an important feature of this invention. See Fig.34.

Slack or pre tension is then applied which defines the amount of LBFF expression needed before the user feels considerable stress from it, and before the user subsequently feels movement restriction from it. The pre tension is applied with the adjustable straps at the buckle. This is an important feature as the user may wish to change this on the go dependant on which activity he is doing and which specific movement awareness he is training for. The user may also wish to deactivate the device during the day which only requires opening the 1 buckle in central part. Once the straps are adjusted the user can go to toilet during the day and by simply opening the buckle will discard the device from the back and when refitting his clothes and closing the buckle, the device will still be well adjusted.

While wearing the device in active or closed buckle condition, when the wearer expresses LBFF, the device tensions: The tension is propagated through the central webbing strips and top and bottom parts to the neck or shoulders and pelvis where the device is anchored and the wearer will sensorily experience this increasing tension as a warning.

This is the desired training feedback for LBFF expression. See Figs 12, 15, 29.

While LBFF is expressed, the length restraint of the device is absorbed by device stress elongation for a small part but mainly by body mass indentation at the shoulders and thighs device anchoring areas. If the user flexes further he will experience increased stress although the movement is allowed. This consistent stress increase is an essential feedback mechanism lacking in prior art. At a certain stage of LBFF expression, if at all, the user will feel a movement restriction. See Fig.17.

When the user redresses and assumes normal position again, the device tension disappears, and the elasticity of the body tight materials and/or the elastic material used in the central part and the overall elasticity of the device-body system will realign the device in the normal position.

In the normal standing position the user can introduce or remove slack in the device by introducing or removing webbing strip via the buckle adjustable straps. This allows the user to fine tune when the LBFF indication , and eventually movement restriction starts. This allows for hassle free movement for flexing movements which only incorporate a little hence non-dangerous LBFF (eg thoracic flexing and hip joint flexing). It can be that movement restriction sets in too early or is not desired or that the window of LBFF indication during LBFF expression is just too small. This is dependent on the individual's geometry. This also can be circumvented by introducing material strip that is more elastic as is discussed below. 235 2.3. Stress, elasticity, working modes, slack and pre tension

Stress propagation.

The symmetrical layout of the device entails symmetrical stress propagation and this can be exploited to position stress sensors or stress safety relieves. The symmetry promotes alignment under the forces at play at all times. See Fig.16.

240 Stress accentuation.

For the top and bottom device parts, cloth , string or body tight material can be cut or tuned in width to accentuate more sensorily experience in one location (eg on 1 shoulder) only. If wider cloth , string or cloth is chosen for the bottom part of the device, the LBFF induced stress will be less experienced there, which adds to the comfort of the device. A plastic implement can be positioned

245 on top of one shoulder to accentuate the sensorily experience there , especially for the cloth and body tight embodiments. See Figs 9-10,12 where an implement is located on the user's left shoulder.

To make for a reliable training device, providing the same feedback over and over again for the 250 same LBFF expression profiles, the elasticity of the body+device need to be considered and

eventually fine tuned for by introducing or removing webbing material strip of appropriate types and by choosing and setting the lengths of all device parts.

Users with a lower Body Mass Index will have less body mass to provide elasticity and in this case the device needs to provide the required elasticity: More webbing strip needs to be introduced in

255 the ensemble with elastic properties adequate for the forces which are at play when the lower back forward flex is been indicated ( indicatively 5 Newton). This material strip is provided with adjustable straps and a natural choice to locate these straps is in the central part of the device. See Fig.21. The same reasoning is valid for users with a lower back body geometry with over expressed (large) lumbar lordosis angle: They will be restricted in their forward flexing movements if no extra

260 elasticity is provided by the device.

4 working modes for the device can be identified. See Fig.17 :

A 1st working mode is where the device is in slack. Any initial LBFF will not be felt by the user. This is useful as LBFF movement is always present for some small part in hip flexing, or thoracic 265 flexing.

A 2^nd mode is where the device is under full operating stress during the main part of LBFF movement. Although the user can make the movement he feels the stress by the restrained parts of the device against its upper and lower skeletal anchoring. This is the training mode with increased intensity of sensorily experience for increased LBFF expression.

270 A 3^rd mode is where the restraints restrict further movement as the elasticity of body+device have played their part to the maximum. Here the device works in the limit as an orthosis. To prevent it from working as an orthosis, more initial slack could be set, or more webbing material stripcould be introduced with elastic working mode under nominal LBFF force. Alternatively the safety relieve can be tuned or selected to set in at a lower force. This has to be a repeat safety relieve then , not a

275 destructive one.

a 4^th working mode is then the safety release that kicks in and allows more material in the stressed device sliding in, or opens up the device making it inactive. This safety release can be implemented as a string clamp for the string embodiment anywhere in the top device part, or as breakdown stretching solution in the central webbing, for example with a velcro™ strip.

280 Slack.

While device slack is useful to set the point of noticeable LBFF experience for the user, it is a risk for the proper alignment of the device. This slack can be made invisible for clothes and user by using a 2 mode elastic strip in a part of the central part of the device. The slack will be concealed by a ,for the user barely noticeable, redressing force (indicatively 1 Newton) exerted by the 2 mode 285 elastic strip , and this specific strip will be lengthening as if a slacking strip during initial LBFF expression without exerting a larger restraining force, and from a certain elongation δ onwards the 2^nd mode of this strip will kick in whereby LBFF expression is indicated and the material of this strip behaves inelastic. See Fig.18

2.4. Measurements

290 1. Device stress measurement can be done on the device central part, or anywhere for the string embodiment.

This stress output is a time stamped proxy for LBFF presence and amount of expression of it. The intensity is indicative for LBFF expression.

Both sensor restraints are on the stress propagating part and cover the full width of this part thereby 295 providing a correct stress measure.

2. The device scaffolding and stress outlay provides for the installation of spine direction measurement with inclination sensors. The averaged direction of the lower back can be measured with inclination sensors on the device central part and the thoracic spine direction with inclination 300 sensors installed on the device leads to the neck or shoulders. The measurement gives a stable body macro measure of direction as provided by the overall device construct. This in contrast with what inclination sensors stuck on possibly erratically moving skin or body clothing would provide. The measured directional output provides a time stamped record of the overall user body position and activity which can be used for body movement analysis with respect to LBFF movements.

305

3. Spinal elongation measurement can be done when a body tight is used, either as an adapted part of the device body tight embodiment or as an accessory under the device parts when the device has a string or cloth embodiment . One sensor restraint is then on the central part and one on the body tight. The body tight averages out local skin movement disturbances. The sensor end on the central 310 part references the lower skeletal position. The measured output will be a measure of spinal

elongation between lower skeleton(pelvis) and the sensor end on the body tight. As such the measured output is correlated to LBFF expression when the sensor end on the body tight is at Thoracic T12.

An inelastic neck collar could be used to make an elongation measurement possible without body 315 tight. In this case the complete spinal elongation would be measured as the neck collar is a good reference for the upper skeleton.

The measured output provides a timestamped record of spinal elongation which can be used for body movement analysis with respect to LBFF.

320 4. One body tight embodiment (See Figs 32-33) shows inclination sensors installed on the lower back BBSCC along the spinal tract, on the body tight. 1 or more sensors are installed on the upper half of the lumbar lordosis and 1 or more sensors should be installed on the lower half. The differences between the measured inclinations result in a correct calculation of the lumbar lordosis angle. The measured interpreted output provides a timestamped record of lumbar lordosis angle.

325 3. Embodiments

A CLOTH , STRING and BODY TIGHT embodiment are presented.

This provides a material choice of 2 dimensional, 1 dimensional or 2 dimensional sticky material properties.

The embodiments differ in the choice for material used in the device top and bottom part.

330 The device central part has its own embodiment choices not described in this chapter, and these choices are dependant on user specific tuning requirements, and is made of string or a variety of thin polymer webbing materials with possibly different elastic characteristics as described in the above stress and slack discussion.

The proposed ways of anchoring and embodiment material choice can be mixed and combined. 335 See Fig.26 and 31.

The various embodiments have different advantages which will suit different types of users and their respective active lives and body geometries and needs. Eg a string embodiment provides the solution as a mere clothing accessory ,the user can still decide what to wear underneath, and might be easier to fine tune, whereas a cloth embodiment might provide more wearing comfort and a body 340 tight embodiment needs only little tuning and is ideal to combine with a monitoring activity.

The cloth and body tight embodiment will have to be specially designed for or adapted from standard retail available products to allow for proper stress handling to assure device lifetime and minimise deformation under the stresses required and generated by the device restraints. They will have a distributed solution for safety breakdown, eg a perforated line or will have a safety provision 345 in the device central part.

The materials used are all standard clothing materials and as such will not pose problems with shop and airport security , and are maintained and washable like normal clothes. This is an important feature of this invention.

3.1. Cloth embodiment

350 SET-UP See Figs 9-12.

The top and bottom part are implemented as clothing which is not elastic in vertical direction. The clothing material used can be cotton or polymer webbing material such as commonly used in outdoor equipment like back packs, or can be throw away material like paper as sometimes is used in patient hospital care attire.

355 Anchoring is done via wrapping of material around neck or shoulders ,and pelvis respectively.

Fig 11 shows the simplest configuration whereby the top part follows the spine and then wraps around the neck by which the top part is anchored. While this design is most efficient and least disturbance prone it will not fit or be disliked by many users as the sensorily experience will resemble choking.

360 There might be engineering solution for this however, notably an extra release snap. The neck wrap cloth embodiment is for the rest similar to the further discussed shoulder wrapped cloth

embodiment so the figures are not repeated for this reason.

OPERATION

as explained in solution

365 The device remains to some extent unaffected by the various spinal and body movements in the same way as normal clothes do. The alignment stress from applied pre tension exacerbates this.

STRESS, ELASTICITY, SLACK AND PRETENSION

as explained in solution

The restraining stress is 2 dimensionally distributed at neck or shoulders and at pelvis respectively, 370 only at the central part is there a narrow funnelling which makes it the only possible location for stress measurement.

EASE OF USE, FEATURE COMPARISON

Comfortable wear. A lot of pre tensioning can be applied as the anchoring of the device is widely spread over shoulders and pelvis areas, which makes the device fit for a set-up where some 375 movement restriction is desired or where the specific user body geometry leaves no other option.

MEASUREMENTS

1 - Stress measurements can be performed on the central part only.

2- Inclination measurements for spinal direction on central part only. 3 - Spinal elongation measurements as described in solution, with an inelastic neck collar or with under laying standard retail body tight top.

4- Inclination measurements for lumbar lordosis angle monitoring as described in solution with an under laying standard retail body tight top and bottom.

3.2. String embodiment

SET-UP See Figs 13-16.

This embodiment is a clothing accessory: The device can be worn on the skin directly or on top of a body tight.

The material used is plastic or natural cordage made of nylon polyproylene or other polymer or natural twine or sisal , with a diameter of 2-6mm.

Anchoring is done via tying and looping around the neck or shoulders and pelvis respectively.

Additional provisions are sewed loops, rings or conduits to facilitate the movements of the strings and facilitate the movement of top and bottom device part with respect to the central device part.

The detailed set up for a string embodiment with rings is described as follows:

A ring is sewed to the top end of the central part webbing.

A tied (knotted or manufactured) loop of string is pushed through the ring for half its length, thereby making 2 half loops of string one at each side of the ring.

The user puts his arms through each half, having the half loop strings run over the shoulders and under the arms while the ring is positioned on the back.

The ring positions itself automatically at the lower end of the top part as it is connected with the central part which pulls it down by its weight.

A similar construct is used for the bottom part, whereby the legs are stuck through each half loop. In this case the ring will situate itself at the upper end of the bottom part, where it is held up by its connection with the central part. The purpose of the use of rings is to allow the string loop to self align thereby slide frictionless through the ring to give one string half loop more string and the other half loop less so, as the changed body positions and forces demand for it during wearing of the device in normal daily activities.

The rings can be more elaborate constructs, polymer extruded conduits, that better allow the string ends to slide independantly from each other and the central part connection and that keep the conduit and whole assembly flat against the back.

Instead of rings the central part webbing upper and lower end could be looped and sewed thus forming a simple conduit for the string loops , as well. This is a cost design issue.

The string loop length is bespoke tailored to the user body.

The string length is chosen so that the upper ring (or webbing loop, or conduit) will be situated at, and be a reference of the upper BSS end , so it will be positioned above the lumbar curvature proximate to L6-L7.

The ring in the bottom part will be a reference of the BSS bottom end, at location Sacrum SI . The central part will follow and cover the BSS span as described in the overall solution.

The forces at play in complete assembly of both top and bottom part string loops and the device central part act in a concerted way to provide a self aligning positioning for the 2 rings, during all movements of the user and his context(clothing). The mobility of the strings through the

rings(conduits, sewed loops) allows for minimising slack during all possible movements. See Figs.22-25. This is an essential feature of this embodiment compared to span jacket embodiment, as explained below.

OPERATION

As explained in solution The strings will move under the various stresses as they search for a balanced configuration.

The design is such that the central part keeps covering the BSS during all movements and that all other spinal and bending movements except LBFF go unhindered.

This is an essential feature of the device whereby for this embodiment:

430 -extension movements of spine go unhindered as they only produce temporary slack in the device, -lateral spinal flexing go unhindered as they only produce temporary slack in the device,

-hip flexing goes unhindered as the hip joint rotates the whole device assembly without any disturbance on it.

-kneeling is not affected as it acts below device.

435 -thoracic flexing is unaffected due to the lower position of the central part - top part connection end, and the rotation of shoulder strings that leave the central part- top part connection end its location unaffected.

-spine twist remains unaffected due to the centrally(along spine trajectory) location of the central part of the device.

440 The central part - top part connection end remains most of the time in correct position and the more so when a proper string sliding conduit is used for the connection, See Figs 22-25.

STRESS, ELASTICITY, SLACK AND PRETENSION

the stress is propagated in a one dimensional way as strings are. This makes very accentuated sensorily experience possible which can be tuned with string width selection.

445 EASE OF USE, FEATURE COMPARISON

Less comfortable wear compared to the cloth embodiment but this embodiment will give a clear strong indication and is easily tunable to customer needs. No off site bespoke tailoring to individual needs to be considered.

MEASUREMENTS

450 1 -Stress measurements can be performed on the strings located anywhere in the device.

2- Inclination measurements for spinal direction on central part and inelastic strings to shoulders

3 - Spinal elongation measurements as described in solution with an inelastic neck collar, or under laying standard retail body tight top.

4- Inclination measurements for lumbar lordosis angle monitoring as described in solution with an 455 under laying standard retail body tight top and bottom.

3.3. Body tight Embodiment

SET-UP See Figs 27-30

The device top and bottom part consist of a body tight top/shirt and a body tight trunks/briefs. With body tight clothing I mean clothing made out of tight fitting partly polymer based materials 460 like Spandex™ ,Lycra™ ,elasthane™ which are often used in sportswear like swimming wear and bicycle trousers and which most of the time contain a material mix with a polyurethane component in it.

The anchoring is similar to the cloth webbing embodiment and is a 2 dimensional distribution at top of shoulders and around pelvis and legs, but there is also an additional distributed restraining force 465 via the shear stress between body tight and skin present.

A body tight material embodiment will require adaptation of standard retail available body tight clothing as the parts are subjected to the forces for LBFF indication.

The central part connects to the top and bottom parts at reinforced and sewed in landing patches in 470 the body tight material. This is because the body tight material would simply stretch under the forces required to indicate LBFF feedback to the user. The pads must distribute the injected stress around the body tight material with sewed-in veins that have higher strength and less elasticity than the surrounding body tight material. Also instead of strings, similar stronger sewed-in seams are used to lead most of the pulling forces during LBFF from central part to the neck or shoulders and 475 the pelvis respectively.

OPERATION

as described in solution

The device is robust against various non LBFF flexing and other bodily movements , as is inherent for this type of tight fitting material. It does not come out of alignment thanks to the sticky shear 480 stress skin-material.

EASE Of USE, FEATURE COMPARISON

Easy to handle and prone against deformation due to the various bodily movements by the very nature of this material.

This solution is less tunable to the end user geometry ,by the end user, as the string embodiment just 485 allows for fine tuning by cutting string lengths.

Bespoke tailored and cut out design of the body tight pieces with patches of different elasticity is the preferred way to tune this to the specific user geometry.

MEASUREMENTS

1 -Stress measurements as described in solution, on central part only

490 2-Inclination measurements for spinal direction on central part and inelastic seams

3 - Spinal elongation measurements as described in solution

4- Inclination measurements for lumbar lordosis angle monitoring as described in solution

3.4. MIX Embodiments with Elongation measurement

SET-UP See Fig.31

495 As described in solution.

The embodiments are a mix of string embodiment and body tight embodiment, one embodiment has a body tight top/shirt , the other a body tight bottom/trunk.

The elongation sensors are conceptually depicted. It is an engineering issue how to implement this in detail and which technology (sensor gauges)to use for them and the only concern here is how the 500 invention provides proper restraint and context for such sensors.

3.5. string Embodiment with Bodytight, stubs and strips

SET-UP See Figs34-36.

All as explained in string embodiment chapter but a body tight shirt and trunks are worn under the device. In this configuration the body tight clothing parts are not subject to the forces in the device 505 that generate and indicate the training feedback stress to the user.

The purpose of the body tight in this configuration is to provide protection against eventual skin friction irritation by the device, and to allow the device strings to slide smoothly over and find easier their natural position subject to the forces at play.

The body tight allows to package and present the overall device assembly as 2 distinct parts only, 510 which are easily mounted (dressed on) like a top/shirt and a briefs/trunks. The strings of the top and bottom part are thereby put under strips which are with both ends fixed with adhesives to the body tight. The strings have enough mobility for their purpose under the strips but will not slide off when the user dresses or undresses.

515 Furthermore the body tight provides a muscle compacting and composure and balance improving effect on the back body, as is its marketed wont in sports attire, and provides for a scaffold to fix the sensor ends on, without requiring adhesives on skin.

An additional improvement on the device workings in this embodiment, are polymer foam stubs which can be glued to the bottom body tight , or similarly tied and positioned on a trousers' belt, and 520 which allow the use of normal trousers and belt on top of the device. The stubs increase the clearance naturally formed by the spinal dorsal curvature in the horizontal plane as can be seen from a top view on a normally standing user. This clearance allows for the central part and bottom part material to move vertically up and down without being hindered by the back body and vice versa, during all daily movements.

525 4. Drawings

The figures are all organised with 9 figures in 1 page , 3 rows by 3 columns, equal space for each figure.

(38),(39),(51)-(54),(62),(63),(67),(68),(69),(75)-(81),(84) are not applicable.

530 Figure 1

User standing in normal position , side view.

The Back Sway (1) is the space between the imaginary BSS (3) and the BBSCC (2)

The lumbar lordosis forms a curvature with angle=a and is formed by the lower back vertebrae Ll-

L5 , between the pelvis Sacrum (4) and the thoracic spine (5)

535 Figure 2

User has Lower Back Flexed Forward,LBFF motion is expressed, side view.

As the lower back vertebrae aligned, the BSS elongated (~8cm) and approached the user's back, to become equal to the slightly elongated (~2cm) BBSCC.

Figure3

540 Shows the start of LBFF movement of a lower back vertebra pair at the top of the drawing, and this movement its end result as the vertebra pair configuration at the bottom part of the drawing. The skin(6) moves up as can be seen from the imaginary skin markers (7). The inter vertebral disk (14) loses its wedge shape . The upper vertebra rotates (11) around an axis through its major anterior body element in the horizontal plane, which lifts the upper vertebra its posterior part upwards

545 including its Processi Articulari(8). The mutually lodged Processi Articulari of the pair get

dislodged: they get further apart vertically(lO). The upper vertebra also moves slightly in anterior direction(9).

Figure4

Normal standing position, side view, lumbar vertebrae detailed, at start of LBFF.

550 When LBFF expression starts, LI (12) moves with respect to Sacrum SI and all the lower back vertebrae L2-L5 move similarly relative to the vertebra they have below them. This makes each of the inter vertebral disks (14) change shape and loose their wedge. The aggregate movement (13) is shown with an arrow for lower vertebra L5 (16) , as it is shown with an arrow as well for L4 , L3 and for the thoracic column.

555 Figure 5

LBFF expressed, side view, lumbar vertebrae detailed.

Due to the changed inter vertebral disk shapes and the dislodged PA, the BBSCC is slightly lengthened(15) because of the LBFF expression(~2cm)

Figure 6

560 Column skin movement

A skeleton is schematically represented with head(17) , shoulders(18), vertebrae(19), pelvis (20) and inter vertebral disks(14). The lumbar dorlosis and the way it changes its shape is not shown here as a driver for skin movement, for simplicity. The spinal column elongates because the inter vertebral disks change during vertebrae rotation. The distributed skin, fat, muscle, ligament system

565 experiences the effects of this and realigns. This causes skin movement as indicated with the

arrows. The buttocks (21) flatten as does other fat muscle build ups (22) in the system, and this flattening allows the skin to absorb the column elongation.

At the bottom of the figure are user top views which show a similar muscle fat skin movement in horizontal plane ,because of LBFF, as the concave curvature around the spine changes.

570 These skin movements and underlying fat and muscle movements make stress and elongation

measurements with both references on the skin difficult and the results interpretations very user dependent. Any such measurements will require detailed calibration.

Figure 7

This drawing shows how the spinal system and skin movements due to LBFF affect belly side less 575 than on the back side. A similar remark is in place as for Fig6 which holds that interpretation of measurements on the skin , and positioning of sensors on the skin, have to take this into account.

Figure 8

A match stick model in a perspective drawing explaining how a string/cord restraint can indicate LBFF expression.

580 This set up explains the basic working of the invention.

The skeleton is represented with one dimensional representation of shoulders(23) spine , lumbar dorlosis as a hinge and pelvis. An inelastic string(25) is tied around shoulders and pelvis(24), spanning the back sway at (3). When the back sway opens as a hinge, there is not enough string to span the whole length from shoulders to pelvis and the system comes under stress whereby the most

585 elastic part in the overall system gives way to allow for the demand of more string length spanning the back sway. If shoulders and pelvis are the most elastic, they will indent at (26) . The stress and indent in body is sensorily experienced which is a training feedback indication to the user. When all reverts back to normal position the indent goes away due to the body elasticity and all returns to original position , making the set up repeatable and fit for a training device.

590 Figure 9

Cloth embodiment of the invention with webbing or other cloth like material which is inelastic. User shown in normal standing position, back view, with following parts: the top part (30)which is wrapped or anchored like a jacket around (34) the shoulders, providing a restraint against downward pull. The bottom part (31) wrapped around (35) thighs and pelvis providing a similar 595 restraint against an upward pull. The central part (32)which is made of inelastic material and can be for example a polyethylene webbing. The central part covers the BSS. The buckle(33) with adjustable straps in the central part can split the central part in 2 for activation deactivation of the overall device functioning.

An implement(27) made of polymer, a protruded part ,can be positioned under the cloth on top of 600 one of the shoulders where most of the sensorily experience is desired. This accentuation is needed as the anchoring force is distributed over a large area on the shoulders/pelvis.

Figure 10

cloth embodiment , side view , shoulder wrapping, normal standing position,

Figure 11

605 cloth embodiment ,back view, normal standing position, but

with top part wrapped and anchored around neck instead of shoulders.

This is the simplest embodiment of the device to engineer but has the disadvantage that its training feedback might cause a choking experience.

This can be engineered away with a release snap at the user's front side under chin >< that releases 610 before such choking experience. The training feedback indication for this device will then be that the user notices the snap has released and needs to be put back in place.

As there is little chance for tearing side movements of the device under normal use, the top part follows the spine over all of its length, the connections of top part to central part can be with adhesive strip(28).

615 Note an additional safety perforation line (29)which will tear up when the snap does not work.

This is a destructive safety relieve for when the snap does not work.

Suitable cloth material could be hospital patient throw away clothing for an indoors setting.

Figure 12 620 Cloth embodiment side view, shoulder wrapped, LBFF expressed.

The exclamation marks show the areas of focused stress of the anchoring webbing.

This is where the sensorily indication will be experienced.

Figure 13

String embodiment, with the user normal standing, back view, with: (36) top loop made of string 625 (37) bottom loop made of string. Top and bottom loops connected to central part with rings.

(40)is the top ring, large enough to allow both string loop halves to slide through and allows for the connection to the central part. The ring can be of plastic and can be of a more elaborate form in order to optimize balancing of forces and comfort of wearing, then called a conduit. It could also be a loop made out of same webbing material strip as the central part in its simplest implementation. 630 Its main feature is that it allows string sliding and stays pressed flat against the user's back and does not hinder.(41) is the bottom ring, of the same layout as (40) but form and choice of material might differ due to further design considerations like cost and comfort. The string embodiment finds a natural optimal position (along geodesic lines on the human body form) as the parts are subject to forces from the body restraints. This positioning maximises comfort and minimises risk for faulty 635 positioning and malfunctioning of the device.

Figure 14

String embodiment, with the user normally standing, side view.

Figure 15

640 String embodiment, with LBFF expressed, side view.

The device has found an optimal position being subject to the new forces and configuration.

The string parts located at the top of the shoulders and at the inner thighs exert pressure to the body parts , which is felt by the user. They cause an indentation. The more the user flexes the more this is pronounced and felt. This is the main purpose of the device used as a training device. The string

645 parts that experience most likely the restraining stress can be optimised in width so as to exacerbate or diminish the sensorily experience there. The inset at the top of the drawing shows part of the user's back making the indentations visible at the exclamation marks.

Figure 16

Stress propagation in string embodiment.

650 Thanks to the choice for string in the top and bottom parts, and the choice for string or thin webbing material in the central part ,the stress in the device is propagated in a well defined way, as is shown by the force arrows. The stress which is the main feature of the device is funnelled through the central part.

This set up allows to relocate stress sensors and electronics to most appropriate location for use. 655 Also this allows to place a safety release clamp at the shoulders as is shown in the figure inset: the clamp consists of a spring which presses the string against the clamp's housing thereby causing a defined friction against the pulling force of the string. When this friction is exceeded the string will glide.

This set up also allows to adjust for slack with just one adjustable strap in the central part.

660 Thanks to to this stress funnel is is possible to have a part of the central part webbing to be replaced with a more sophisticated 2-mode elastic material (42) which has its first mode of working when LBFF is not expressed and which then exerts a retracting force. In this mode the elastic material has enough force (~1 Newton) to pull down the top part thereby concealing the possible slack in the device which might hinder the user. It also pulls up the bottom part similarly. The slack might be set

665 purposely in the inelastic material overall length to allow for desired postponed activation of LBFF indication.

When LBFF gets expressed and hence when the elastic material (42) is stretched beyond a set limit, its accompanying embedded inelastic material reaches the 2^nd work mode and bears the further increasing load. When the device reaches some predefined maximum stress a safety clamp (43) 670 will engage by introducing more string into the device. Figure 17

This graph shows the the stress in the device versus the imaginary BSS elongation. It is a good proxy for the users experience "device LBFF indication" versus "LBBF expression", as well. It shows the 4 different modes of working of the device+body system.

675 In Mode I the device is in slack and the BSS elongation is undefined over a range(44) and there is little stress (45).

In Mode I LBFF is being expressed and there is no slack any more so the stress proportionally increases with more LBFF expression. The relationship is not linear as the stress is an expression of the complete complex system device+body anchoring. The body indentations provide leeway to 680 allow for the inelastic device material spanning the BSS to increase. The system as a whole shows elastic behaviour as indicated by the slope.

In Mode HI the device does not get any more leeway from body indentation at its body anchoring around shoulders and pelvis experience a limit and hence the BSS elongation stops and there is movement restriction. The system as a whole becomes inelastic as seen by the steep slope (46). 685 In Mode IV the user has expressed even more LBFF thereby increasing the stress to a safety

breakdown level (47) whereby the safety clamp operates and this makes the BSS elongation further possible as seen by the levelled slope in this mode .

Introduction of some 2 mode elastic material into the device would change the slope(48) in Mode I and make the slack invisible and the device aligned in slacking mode and the BSS elongation more

690 defined and reduce the possibility of hindrance.

Introduction of some elastic material with a stiffer elasticity modulus into the device ,will allow for extending mode I, as indicated by (49), so that users will avoid getting in movement restriction too early or at all. This material only elongates from forces and stress at play during LBFF Mode I. The buckle straps in the central part allow to tune for introduction of more or less of the webbing

695 strips with these properties as user variability will demand.

In a body tight embodiment the situation would be similar but there would be in modes I and HI also elongation of the body tight material surrounding the connection pads, and the elasticity of the device+body is in greater part provided by this body tight material.

Figure 18

700 This figure shows a 2 mode elastic material part embedded in device central part and its 2 modes.

A slack δ is possible and will be redressed and made invisible by the 2 mode elastic material. Instead of visible slacked material we have tightly aligned material but which is compressed by a smaller force or stress than the ones at play in the device during LBFF expression. When LBFF expresses so far such that the BSS elongates more than this pre set slack , the 2^nd mode of the elastic

705 material takes over whereby the more inelastic embedded material (50) takes over the load in the 2 mode material and the overall device will experience an increasing stress associated with LBFF indication only. These 2 mode elastics are a commodity and widely used as the 2^nd mode is simply a protection against over stretching the elastic.

Figure 19

710 String embodiment top ring, close up

The ring(55) is subject to the downward pulling force(57) from the central part webbing(32) which is looped around the ring and sewed (56).

The lower string loop half (58) presses the ring against the users back at (59) while the upper string loop half(60) does that at (61). The upper loop half will exert a pulling force on the ring which 715 originates from the shoulder's string anchoring.

The purpose of the ring is to keep the device flattened against the back, to allow for string sliding through and allow the device central part and top part some degree of freedom of movement.

A bottom ring is of a similar set up with the connection to the central part at the top of the bottom ring.

Figure 20 string conduits used with string embodiment of top and bottom part.

The parts are made out of polymer material. The additional features of these parts are that the strings cannot hinder each other any more as they slide separately (64), (65) inside the conduit from 725 each other and from the central part connection(66). The strings have more contacts with the

conduit which allows for better force balancing and hence easier self alignment of the conduit and overall device. The geometry can further be made in such way (smooth , flat) that the conduits provide some further shield against possible mutual hindrance from normal clothing accessories like bra and belt.

730 Top and bottom conduits have different geometries , as the strings will approach the conduits from a different angle due to the body geometry.

Figure 21

Central part with side release webbing buckle and integrated webbing straps and top ring connection and bottom sewed webbing strip connection. The adjustable straps allow to introduce or 735 remove webbing active strip and allow for setting pretension or slack in the device and allow to position the buckle vertically.

(70),(71) webbing adjustable straps integrated with buckle. Pulling the webbing loose ends further out of the straps will reposition the buckle or will further tension the device.

(72) this is a looped and sewed central webbing end that connects the central part to the top ring 740 conduit. (73) this is a looped and sewed central webbing strip end that connects the central part to the bottom part , which is just a string loop, and acts as conduit for this bottom loop.

(74) is a side release button of the buckle for easily snapping the central part in 2 parts by hand and deactivating the device. The buckle can easily be reached in daily life by arm and hand tending backwards to deactivate the device. This is an important feature of the device.

745 Figure 22

string embodiment, User is flexing laterally

The device does not hinder this spinal movement,

The movement does not hinder the device and does not give false indication for LBFF

The device remains well centred with its central part over the BSS.

750 In the depicted lateral flexed position the right half of the string loop needs less string as the torso is inclined towards the right and the left half needs more string, so the string has slid through the top ring/conduit to allow for this.

Figure 23

Thoracic and cervical forward flexing

755 The device does not hinder this spinal movement type.

The movement does not hinder the device and does not give false indication for LBFF.

The device remains well centred with its central part over the BSS,

because the device is wired below the cervical vertebrae so not affected by them, and flexing the thoracic vertebrae does not modify the top ring/conduit position on the wearer's back as the

760 shoulders roll under the string. As the torso is bent forward there is extra string length required dorsally but less length required ventrally, and these requirements are met.

(82) =outer (back) curvature upper loop requiring more string length

(83) = inner (torso) curvature upper loop requiring less string length

string -and shoulder- turn or roll so as to give leeway and allow for new configuration but this does 765 not affect ring/conduit so the device remains unaffected and will not indicate LBFF.

Figure 24

Hip joint flexing: The device does not hinder hip joint flexing

The central part of the device remains aligned over BSS.

There might be some string sliding now in the bottom ring/conduit to allow for string demands 770 during the hip flexing, but overall the hip rotation does not affect the assembly at all as its rotation point (axis line in the horizontal plane) is mostly below the assembly. The flexing is further described in the drawing by the hip joint(85), the pelvis ischia(88), the femur bone(87), the pelvis illium (86) and the torso inclination angle (89) around hip-joint axis

Figure 25

775 Torsion , spine twist, top view

Left shoulder turns backward, right shoulder turns breast wards (forwards)

the left shoulder parts get closer to the spine the right shoulder parts get further from the spine, where the upper ring/conduit is located.

The device does not hinder movement as the central part of the device has little width and does not 780 hinder the rotation. The rotation does affect the required string lengths in the upper loop however, string will slide through the ring/conduit to enable optimal arrangement.

Head(90)Left shoulder(91) Left buttock(92)

Figure 26

An example embodiment which is a mix of string(top) and cloth(bottom) embodiment with textile 785 in bottom loop for comfort.

(93) =audible alarm and electronics and optional stress measurement for LBFF.

The string embodiment allows for positioning sensors and electronics anywhere in the device.

(94) =stress relieve safety. When a certain tension is exceeded the clamp gives the string leeway.

(95) =anchoring of the lower part of the device is done with relatively elastic material integrated in 790 the underwear, which causes friction / shear stress with the body in the spinal direction. This mix embodiment will allow best comfort while still remaining well aligned as the string choice is used for the top part of the body which undergoes the most diverse types of movements.

Figure 27

Body tight embodiment , standing position, back view.

795 The device top part is implemented as a body tight top/shirt (101), and the device bottom part is implemented as a body tight briefs/trunks(102).

The anchoring forces for the device are partly distributed and not just provided by wrappings around shoulders and pelvis but partly provided by the body tight skin contact (96) (97)and are shear stress based. The standard retail body tight top and bottom are adapted with sewed in or glued 800 in reinforcement pads (98),(99) to connect the body tight parts to the device central part. Inelastic seams (100) are sewed into the body tight parts to provide for the shoulder and pelvis anchoring.

Figure 28

Body tight embodiment , standing position, side view.

The shear stress anchoring spreads to the side of the users body.

805 (104) is a cross section view of the shoulder.

Figure 29

Body tight embodiment , LBFF flexed position, back view.

Due to the shear stresses the body tight will elongate a little.

A plastic protrusion implement between a shoulder and the body tight to enhance bodily experience 810 indication of the device and is needed as the stress forces will be weaker compared to the string embodiments.

Figure 30

Body tight embodiment , LBFF flexed position, side view.

Figure 31

815 Elongation sensor (105) measurements.

The left setup has a string top part and a body tight trunks bottom part.

The left setup sensor uses an inelastic neck collar (106) for one end and the central part for the other end and allows for an accurate measurement of the complete spine elongation as the references of this measurement relate in a well defined way to lower and upper skeleton. The right setup has a 820 body tight shirt top part, and a string bottom part. The right setup has 2 sensors and uses adhesive patches on the body tight top for one end of both sensors ,the other end is for both sensors again on the central part. Both set ups allows for simpler sensor wiring and avoid skin contact. The body tight will filter for skin movement variability unrelated to overall LBFF flexing. The bottom measurement in the right setup will provide a measurement of spinal elongation biased towards the 825 lower back flexion. Upper measurement will do similar for upper back flexion.

Figure 32

Inclination measurements on body tight embodiment, back view

Inclination sensors (107) are positioned on the inelastic seams towards shoulders, on the device central part and along the BBSCC on the body tight. Using more sensors allows for sensor failure 830 filtering. The sensors are placed on pads (108) to provide for mechanical contacts and electronic interfacing. The sensor circuit wiring (109) follows the inelastic seams for reason of stress protection of the pad's connectors. The use of a sensor on the central part gives a contextual independent indication from the body tight indications, as the central part has a macro context from the device. This allows for faulty or wrong positioned sensor detection.

835 Figure33

Inclination measurements on Body tight embodiment, side view, close up

As there are sensors along upper and lower part of the BBSCC it is easily possible to calculate the lumbar dorlosis its overall angle = a from their output differences as depicted in the drawing.

When all inclination sensors in Fig 32 and Fig 33 measure same inclination within their accuracies,

840 it indicates there is hip joint flexing. This is extra confirmed by the inclination sensors their output on the central part and the inelastic shoulder seams. When the BBSCC sensors their output approach the output of the central part sensor this is an extra confirmation of LBFF expression. When the sensor on the seams give increased output without a display of LBFF expression from the lower sensors, this indicates thoracic flexion expression. Majority lateral deviations obtained from

845 sensor output provides a check for the overall spinal alignment of the device. A lateral deviation from a sensor provides a clue for sensor malpositioning.

The macro whole body anchoring of the device provides valuable sensor output (seam sensors and central part sensors) that is independent from the BBSCC sensors which makes the overall monitoring much more reliable.

850 Figure 34

shows a disassembled device in 2 parts. A string embodiment is used with adhesive strips (116) holding the string wires against a top/shirt and bottom trunks/briefs standard retail body tight.

The central part holds 2 webbing material types(HO), (112) with possibly different working modes and elastic properties and with remaining material (111), (113) available to introduce via the straps. 855 The central part is split in 2 by the buckle leaving 2 buckle halves (114), (115). the other ends of the central part webbing are the straps of the adapted conduits (117), (118)

Figure 35

Shows the user in normal standing position , wearing a transparent trousers (119) with belt (120) and buckle(121).The figure shows how polymer foam stubs (122) can be introduced to increase the 860 clearance between belt and body tight/skin so that the device central part and body and clothing do not interfere with each other. This is required for users with very little back concavity and clearance.

Figure 36 Shows the same polymer foams as seen from top showing waist(123) and clearance(124)

5. Prior art

PRIOR ART

865 I refer for the prior art related to lower back pain to the Reference Work of Rene Cailliet (ISBN 0- 8036-1607-4)

For analysis and description of vertebra movements I refer to standard musculo skeletal anatomy works, eg the works of author I A Kapandji.

There are many lower back monitoring patents eg NL 1023363, US 3608451, US 5143088, US 870 0047232 and their linked patent families.

L 1023363 exploits the reducing width of the back sway during LBFF.

Many patents describe heavy, largely metallic spinal exoskeletons to provide accurate laboratory measurements only.

I also refer to the technical report "A simple device to monitor flexion and lateral bending of the 875 lumbar spine" , GJ Donatell et al. , IEEE transactions on neural systems and rehabilitation

engineering, vol 13, no 1, march 2005.

This report describes, I believe, an exploitation of BSS elongation , although the mechanical setting requires electronic amplification to provide posterior training feedback only. Elasticity is provided by a large metal strip. The device monitors lateral lumbar flexion in frontal plane as well as sagittal 880 plane lumbar extension. The restraining is provided via a torso girdle and a waist belt which limits its usefulness for healthy and active people. Measurement is done with stress gauges on the slipping metal strip which results in a LBFF presence indication (on/off) rather than sustained intensity feedback as is apparent from the included measurement plots. It is unclear how the apparatus will discriminate for hip flex and thoracic flex as the girdle and belt restraints are subject to them.

885 I also refer to the technical report in manual therapy journal (Elsevier publishers ,

manualtherapyjournal.com) Volume 15 issue 2, april 2010. "The Spineangel®: Examining the validity and reliability of a novel clinical device for monitoring trunk motion". The report discusses spinal inclination measurement with one device only located at the hip. It does explore the feasibility of inclination sensors for various spinal movements, but it does not go into detail how to

890 monitor lumbar lordosis angle or how thoracic flexion can be accurately measured and

distinguished from lumbar flexion from the device's position at the hip.

6. Terminology and abbreviations

Anterior: in the direction of the user's front, belly.

BSS: Back Sway Span, imaginary line in air between SI and T12 delimiting the back sway

895 BBSCC: Body Back Sway Curve Contour , the area on the user's lower back body delimiting the back sway

Body Tight: material or clothing part of said material containing elasthane or similar and tightly fitting the user's body in a comfortable manner.

Elasticity Modulus: the slope in a stress versus elongation graph, flat slopes indicate very elastic 900 materials, steep slopes indicate stiff materials.

Horizontal plane: parallel with the ground surface

LBFF: Lower Back Forward Flexing

LBP: Lower Back Pain

Lumbar: of the lower back, lumbar dorlosis is the lower back curvature

905 Posterior: in the direction of the user's back

Sagittarian plane: a vertical plane showing a side view of the user

Vertical: Following the gravitational direction

Claims

CLAIM1 What I claim is :

A device that is worn by the user and is mounted on the user's back, as a clothing accessory or is worn as an integrated part in clothing, and

-provides the user a purely mechanically induced sensorily indication when the user expresses lower back forward flexing only, in a reproducible and repeatable manner and

-provides no indication or any substantial hindrance of any kind for all other types of spine related flexing movements or any other bodily movements,

whereby this device does not require electronics for the indication generation or amplification and does not require metallic parts for providing device elasticity and embodiment requirements, thereby providing the user with a training device to become aware of this specific LBFF movement in an ordinary daily life environment. CLAIM2

as claim 1, and the device exploits the elongation of the back sway span, which is the direct geometrical span over the lumbar lordosis, during LBFF,

-by incorporating a mechanical restraint against this elongation between the back sway span ends, being the external body positions of vertebrae Sacrum S I and Thoracic T12, or suitable proxies thereof, which during the LBFF comes under increased stress and

-by incorporating an implement in the device which mechanically transforms this stress into a suitable sensorily experienced indication to the user,

whereby this stress indication is provided with an increased intensity at more expression of said LBFF movement in a reliable and repeatable manner.

CLAIM3

As claim 2 and the BSS restraint anchoring is deferred from the back sway ends to the neck or shoulders and pelvis respectively, using inelastic material of some form that is

looped or tied or wrapped around neck or shoulders forming the upper deferred restraint and similarly looped or tied around pelvis and legs forming the lower deferred restraint,

thereby creating a new enlarged length limiting restraint of this inelastic material between these two new proxy deferred restraints for the back sway span, and

thereby using the restraining material at the restraint bearing body contact areas as the implement that produces the sensorily indication for LBFF to the user by causing indentation at these body contact areas,

thereby exploiting the shoulders or neck , and pelvis geometry respectively, for anchoring against downward respectively upward pull and

thereby exploiting the body mass at the contact areas for providing elasticity at repeated pulls and relaxation

whereby the inelastic material can be of any type used in clothing like cotton, paper, polymer webbing, polymer or natural cord string, or body tight materials,

thus providing a well defined setting for LBFF indication not experiencing unduly slippage during most of a LBFF movement and not experiencing loosening or breaking apart during normal wear. CLAIM4

as Claim 3 and the device consists of 3 main parts being a top part, a central part provided with webbing buckle and adjustable straps, and a bottom part

whereby the central part spans the back sway and

whereby the central part is made of one or more types of webbing material strip with possible different elastic properties and

whereby the central part buckle allows for activating or deactivating the device by splitting the central part in two parts effectively enabling or removing stress propagation in the device, and whereby the central part straps allow for manual tension of the device by removing webbing strip from the central part and allow for positioning the buckle for easy reach, and

whereby the central part connects to the top part and connects to the bottom part in a way that allows a degree of freedom of movement between the three parts promoting self alignment of device and

whereby the central part channels all the stress between top and bottom part and is thin in width in the vertical direction

thereby providing an appropriate location for a stress safety release

thereby avoiding hindrance to spinal twist movement and avoiding hindrance to lateral flexing and thereby also avoiding that these movements hinder the device alignment and working,

and thereby providing top and bottom part the downward respectively upwards pulling forces which are necessary for the device workings, and

whereby top and bottom part provide restraining anchoring and have their own optimization for the specific body geometry requirements and can be made of different materials from central part, thus forming a well defined assembly with parts that have their specific function in the overall training device. CLAIM 5

As Claim 4, and the top part consists of a string loop led around both shoulders and the bottom part consists of a string loop led around the thighs and pelvis and

whereby the top part loop is made by pushing a loop of string halfway through a ring in this manner forming 2 half loops a left half loop that is led around the left shoulder and a right half loop around the right shoulder,

and whereby this top part loop is connected with this ring to the central part thereby allowing some rotational freedom of movement between top part and central part in sagittal and frontal plane and whereby this top part ring is positioned above the back sway upper end near a position of vertebra Thoracic T12

and whereby the bottom loop is similarly constructed with a loop of string and a ring connecting the bottom part to the central part at a position below the back sway lower end which is near vertebra Sacrum SI,

as is indicated in figure 13,

whereby the strings can be polymer or natural and of different widths at different locations, thereby forming an overall construct that spans from shoulders to pelvis and is inelastic for elongation in the vertical direction and allows for top and bottom part to be made different and allows top central and bottom part some degree of freedom of movement relative to each other which allows the device to stay properly aligned and flattened against the user's back with the device central part following the back sway span,

and thereby allowing the strings to slide through the rings

thus enabling self alignment during mounting of the device and various bodily movements while wearing the device and

thus making the device unaffected from all spinal flexing movements and causing no hindrance to these flexing movements

and thereby forming a symmetrical construct that propagates the same stress, generated by the restrained lower back forward flexing, over the whole top part, thus allowing a over stress safety relieve snap to be installed at a shoulder of the user

CLAIM 6

as Claim 4 and a webbing or cloth or body tight material is used for the embodiment of the device top and bottom parts, and the induced sensorily stress indication is maximized towards one or both shoulder parts by inserting a protruded plastic implement between shoulder and device material at the desired location and

as Claim 5 and a similar indication maximization is implemented by selecting a narrower width for 105 the top part string which provides the restraining contact of the device to the shoulder, where accentuated indication is desired, and by selecting a wider width for the string for all the other body anchoring contacts in the device top and bottom part thus increasing comfort there.

CLAIM 7

110 As Claim 5 and more elaborate polymer conduits are used instead of rings, comprising of separate sliding paths for the upper and lower strings respectively and a separate strap for the connection to the device's central part all built in one encased polymer top conduit part and one encased polymer bottom conduit part which are positioned flat against the user's back body ,

and thereby allowing the forces in play on the strings more contact points to the conduit

115 and thereby also allowing the string ends that leave the top and bottom conduit with set directions which are optimal for the top and bottom body geometries respectively and their natural layout under the forces at play

and thereby also allowing for a more balanced and self aligning construction

and thereby also reducing the chances of mutual hindrance of strings and webbing in the device 120 and thus providing a set up for the conduit and overall device to remain flat against the user's back body and well aligned for proper functioning.

CLAIM 8

As Claim 5 and a body tight material shirt and trunks are worn under the device,

125 thereby allowing easier frictionless gliding of the strings as they search a balanced configuration and thereby avoiding eventual string interference with bra holder

and thereby providing the device a better and more reliable body composure and balanced context, and thin strips are adhered to the body tight material under which the device strings can slide with enough clearance and required mobility

130 thereby making mounting and dismounting of the device easier to the user

and polymer foam stubs are adhered to the body tight material ,at waist location left and right of the spine, in order to increase the clearance for the central part, whereby this clearance is defined by the user's back concave curvature at the spine as seen from the top,

135 thus avoiding skin contact and irritation of the device and allowing for better tuning to user body geometry diversity

CLAIM 9

140 as Claim 4 and the central part one directional stress funneling setup is exploited for stress

measurement by installing a stress sensor over the width of the central part and installing related capturing electronics on the central part,

or as in Claim 5 and the one dimensional string construction of the device top part with same stress funneling is exploited similarly and sensor and electronics are installed on a shoulder,

145 whereby the measured stress is indicative for the stress of the complete setup consisting of device and related user body parts and higher stress is measured for more expression of lower back forward flexing

thereby providing a time stamped measure that represents lower back forward flexing expression thereby providing the user with a posteriori training analysis and feedback information of his daily 150 life movements with respect to lower back forward flexing

thereby avoiding any additional skin contact to enable these measurements

CLAIM 10

As Claim 4 and the straightened and aligned set up of the used device material, and the inelastic 155 provisions to lead stress to shoulders or neck in the device, are exploited for installing two or more inclination sensors in the top part and an inclination sensor in the central part thereby providing a good measure and recording of the spinal direction and

thereby providing a comparison measure for discriminating between thoracic and lower back flexing and a recording of these variables and

160 thereby providing a means to identify hip joint flexing as manifested by same inclination amount for all inclination sensors and

thereby avoiding any additional skin contact to enable these measurements and

thereby extending the record of timestamped user behaviour and activity for posteriori training feedback and analysis

165

CLAIM 11

As Claim 4 and specific types of webbing material strips are made available independently in the central part which can be introduced or removed with the two or more adjustable straps in the central part which allow for pre tension or slacking the device in the normal standing position and 170 the type of material that is introduced or removed with each strap allows for modifying the device working mode behaviour with regard to stress and elasticity,

whereby slack or pretension define the moment at which the user will experience the first onset of lower back forward flex indication and after further expression of this movement will experience movement restriction,

175 and whereby introduction of a 2 mode elastic webbing material strip with initial low elasticity

modulus will allow to conceal the eventual preset slack thereby minimizing hindrance and safeguarding an aligned device composure,

and whereby introduction of an elastic webbing material strip with a higher elasticity modulus , comparable to the elasticity modulus of the overall body and device system at which lower back 180 forward flex is indicated, allows for making the overall device and body system more elastic for a longer window in LBFF expression and allows for avoiding movement restriction to set in during accentuated expression of LBFF,

thus allowing for fine tuning by the user for optimal working of the device and allowing for the wide user variability in body configuration.

185

CLAIM12

As Claim 4

and the device top part and bottom part are made with adapted body tight material

whereby the central part is connected to top and bottom parts by means of sewed or glued

190 connection pads which are integrated in the body tight material and spread the stress over a larger area of the body tight material

and whereby the body tight material in the top and bottom part have sewed-in seams of lesser elastic material in order to channel the stress forces to the shoulders and pelvis where most of the anchoring of the device subsists

195 thereby exploiting the body tight material its elasticity for slack prevention and misalignment and thereby avoiding mutual hindrance between device and spinal twist and lateral flex and thoracic and cervical flexing and extension movements and

thereby assuring minimal deformation at the connection pads under high stress conditions and thereby exploiting the conforming effect and minimal freedom restriction of the bodytight material 200 on the skin and user's body and

thereby providing a scaffold for sensor installation for body movement monitoring,

thus assuring a more comfortable wearing experience to the user while not losing device performance with respect to indication for lower back forward flexing.

205 CLAIM 13

As Claim4 and Claim 5 and Claim 12 whereby the choices for material embodiment can be selected differently for the top part and for the bottom part

thereby implementing a mix embodiment

whereby wider and more elastic material body contact restraint surfaces allow for more comfort and 210 less sonsorily indication and narrower and less elastic material choices allow for more accentuated LBFF indication to the user

and material choices for elasticity for the central part can be selected depending on the user body geometry and more specifically the user's body mass index

and material choices for elasticity of the top and bottom part can be selected to this purpose as well 215 thus allowing more freedom for better adaptation to user requirements and user body variability

CLAIM 14

As Claim 4 and an elongation sensor is implemented with one sensor anchoring end on the device central part and the other sensor anchoring end on a non elastic neck collar

220 whereby the neck collar anchoring provides a reference to upper skeleton

and the anchoring on the central part good referencing with respect to pelvis

and thereby makes the sensor provide a measurement of the overall spine lengthening under various movements,

and as Claim 12 and elongation sensors are installed

225 with a similar central part anchoring and the other sensor anchoring end on the body tight material whereby this body tight anchoring end can be glued or sewed

thereby providing a measured output which is a function of the skeleton lengthening and skin transport at the location of sensor end on body tight

thereby exploiting the composure improving effect of the body tight material on skin and fat 230 distribution of the back and allowing for a more reliable measurement

thereby avoiding non standard skin contact with the device and sensors and limiting back body skin contact to normal clothing

CLAIM15

235 As Claim 12 and two or more inclinations sensors are installed on the body tight in the area of the lumbar lordosis along the spinal path

whereby the sensors by their positioning and nature fixing on the body tight are independent from each other and retain a mobility that is highly proportional to the below body skin and nearby body movement.

240 whereby the inclination measurement technology is based on inclination versus the gravity vertical and whereby the sensors are so positioned and are in such number that some of them do provide a measurement from the lower half of the lumbar lordosis inclination at any time and some do provide a measurement of the upper half of the lumbar lordosis inclination at any time during normal wear and use of the body tight

245 thereby allowing to calculate the lumbar lordosis curvature angle correctly as a difference of the inclination that is measured by the 2 inclination sensors ,one each on separate halves of the lumbar lordosis, whereby this difference will allow to observe and record the straightening of the lower back under LBFF and the lower back its curvature angle at all times and

whereby installation of more than 2 sensors can be exploited to increase accuracy and have the 250 ability to filter out non working or mal positioned sensors and a more detailed registration can be obtained abut how the lumbar lordosis evolves

thereby providing inclination measurements avoiding body contact to sensors and limiting skin contact to comfortable clothing material only,