Aspinall et al. Journal of Orthopaedic Translation 2021. Medical stretching devices are effective in the treatment of knee arthrofibrosis: A systematic review.

• Independent study with no Ermi involvement comparing CPM, SPS, dynamics splints and Ermi.
• Ermi devices are more effective than SPS and dynamic splinting devices and may be more effective than SPS.
• Ermi devices have the advantage of a shorter treatment time than other devices.

Papotto, Orthopaedic Nursing, 2012. Treatment of severe flexion deficits following total knee arthroplasty: A randomized clinical trial.

• Comparison of Ermi Knee Flexionater and SPS device.
• 91% of Ermi patients reached at least 110° of flexion vs. only 22% of SPS brace patients.

Stinton, Journal of Orthopaedic Surgery and Research, 2022. Efficacy of non-operative treatment of patients with knee arthrofibrosis using high-intensity home mechanical therapy: a retrospective review of 11,000+ patients.

• In a retrospective study of over 11,000 knee patients suffering motion loss showed significant flexion gains (average of nearly 30 degrees) in under 8 weeks of treatment.
• The average final knee flexion was above the level needed to complete activities of daily living.

Yenchak et al. Journal of Orthopaedic & Sports Physical Therapy 2011. Criteria-based management of an acute multi-structure knee injury in a professional football player: a case report.

• Case study using the Ermi Knee Extensionater in a treatment protocol for a multi-structure injury in an NFL player.

Uhl and Jacobs, Sports Health, 2012. Torque measures of common therapies for the treatment of loss of knee flexion.

• The force applied by Ermi devices is similar to what is applied by a physical therapist. The force applied by Ermi devices is significantly higher than low-intensity mechanical therapy devices (SPS and dynamic brace devices).
• The Ermi Knee Flexionater can apply over 8 times the flexion torque of a low load brace type device

Stephenson et al. Current Medical Research & Opinion 2010. Knee-attributable medical costs and risk of re-surgery among patients utilizing non-surgical treatment options for knee arthrofibrosis in a managed care population.

• Study of 60,000+ patients that evaluated economic outcomes for patients with knee arthrofibrosis that were treated with high-intensity mechanical therapy, low-intensity mechanical therapy, or physical therapy alone.
• The Knee Flexionater resulted in nearly $9,000 savings per patient when compared to low-intensity therapy.
• The cost savings was driven by a significantly reduced re-hospitalization rate in patients treated with the Ermi device.
• Patients treated with PT alone were almost twice as likely to require reoperation vs. those treated with the Ermi device.

Dempsey, et al. Sports Medicine, Arthroscopy, Rehab Therapy & Technology, 2010. High-intensity mechanical therapy for loss of knee extension for worker’s compensation and non-compensation patients.

• Treatment with the Ermi Knee Extensionater effectively reduced knee extension deficit by 8°.
• Workers’ compensation patients achieved equivalent results as non-workers’ compensation patients.

Heckmann – GATA Symposium Presentation, 2007. Treatment of arthrofibrosis following total knee replacement using high-intensity stretch mechanical therapy devices. 

• Gains using the Knee Flexionater and Knee Extensionater averaged 38° and 10.6° respectively
• All 58 patients were able to avoid an additional surgical procedure
• 93% of patients reached at least 106° of flexion after treatment with the Knee Flexionater.

Wilk et al. Cartilage 2010. Rehabilitation following microfracture of the knee.

• Case study using the Ermi Knee Extensionater in a treatment protocol for microfracture surgery.

Branch – American Journal of Orthopedics, 2003. Mechanical therapy for loss of knee flexion.

• 2% of patients reached at least 115° of flexion after treatment with the Knee Flexionater
• 1% of patients avoided additional surgery.

Stinton, et al. Journal of Orthopaedic Surgery and Research, 2022. Efficacy of high-intensity home mechanical stretch therapy for treatment of shoulder stiffness: a retrospective review.

• In a retrospective study of nearly 2000 Shoulder Flexinator patients, average gains in ROM were 29.9° in external rotation, 40.5° in abduction, 30.3° in forward flexion and 15.2° in internal rotation in under 9 weeks of treatment.

Wolin, et al. Annals of Physical Medicine and Rehabilitation, 2016. High-intensity stretch treatment for severe postoperative adhesive capsulitis of the shoulder.

• Patients with postoperative adhesive capsulitis were retrospectively reviewed to evaluate treatment in two groups of patients: (1) patients who used the Ermi Shoulder Flexionater after reaching a plateau in their recovery with PT, and (2) patients who showed no plateau in their recovery with a standard protocol of traditional PT alone.
• Patients with postoperative adhesive capsulitis that are worse off than the average postoperative patient can “catch up” to the average patient and finish with equivalent or improved range of motion in the same overall treatment time.

Teytelbaum et al. BMC Musculoskeletal Disorders, 2024. Efficacy of a high-intensity home stretching device and traditional physical therapy in non-operative management of adhesive capsulitis – a prospective, randomized control trial.

• Patients treated with PT only, with the Ermi Shoulder Flexionater only, or with both PT and the Shoulder Flexionater were compared.
• Range of motion recovery was greater in the groups treated with a Shoulder Flexionater whether used alone or in conjunction with PT.
• The rate of recovery was also significantly faster in both groups treated with the Shoulder Flexionater.
• Total scores for the Simple Shoulder Test and American Shoulder and Elbow Surgeons score were improved at a significantly greater level in groups treated with the Shoulder Flexionater when compared to the group treated with PT alone.

Dempsey, et al. American Journal of Physical Medicine and Rehabilitation, 2011. Maximizing total end range time is safe and effective for the conservative treatment of frozen shoulder patients.

• 97% of patients were able to avoid additional surgery to treat their motion loss.
• The Ermi device was successful in treating adhesive capsulitis regardless of irritability status.

Beckley, et al. Submitted to the Journal of Orthopaedic Surgery and Research, 2024. Evaluating the effectiveness of high-intensity mechanical stretching devices in treating ankle stiffness: a retrospective case series analysis.

• The Ermi Ankle Flexionater was effective in restoring dorsiflexion ROM loss in the ankle.
• Patients achieved a final range of motion that would allow them to return to activities of daily living such as walking.
• The device was effective even in severe motion loss patients.
• The Ermi Ankle Flexionater was an effective form of treatment amongst Worker’s Compensation patients to restore ankle dorsiflexion ROM.

Jacobs and Sciascia, Sports Health, 2011. Factors that influence the efficacy of stretching programs for patients with hypomobility.

Davies and Ellenbecker, BioMechanics, 1999. Focused exercise aids shoulder hypomobility.

• Both of these papers describe the TERT (Total End Range Time) formula which the Ermi program is based on.
• The TERT formula is based on intensity x duration x frequency of the stretching.
• Intensity is the maximum stretch intensity the patient can tolerate based on their pain threshold.
• The duration would be 20 minutes with the tissue in the stretched position.
• Frequency should be 3 times per day for a total TERT time of 60 minutes.