X10 Research & Data

Several research studies have been completed on the effectiveness of the X10. There is a great deal more research in the works that will be published in 2020 including more evidence behind the efficacy of X10 for Pre-hab strengthening and range of motion. Additionally work is being done on the impact of X10 on post-surgery strengthening. Individual patient accounts can be found here. X10 Research Excerpts, summaries, and abstracts are present below.

X10 In-Home Prehabilitation Increases Post-Surgical Range of Motion, Quadriceps and Calf Strength

Dr. Robert J Ference and Dr. D. Carl Freeman

DMC Harper University Hospital, USA and Department of Biological Sciences, Wayne State University, USA

Pub. May 2020


The efficacy of rehabilitation for knee surgery is controversial. Meta analyses show that range of motion has improved, but not quadriceps or hamstring strength. Here, we evaluate prehabilitation using the newly patented, computerized, in-home, X10 Knee Recovery System™ for both prehabilitation and rehabilitation. We retrospectively examined 201 patients at multiple time points for range of motion (extension, flexion), quadriceps, hamstring, and calf strength between the intervention group (n=125) which used the X10 for both prehabilitation (2-3 weeks) and rehabilitation (3-4 weeks)and the control group (n=76) which used the X10 for only rehabilitation (3-4 weeks). Range of motion was measured by the X10 machine using an ultrasensitive inclinometer and strength was measured as pressure applied to a load cell. We also compared X10 prehabilitation and rehabilitation to standard physical therapy using a literature study (Calatayud et al. 2017).

Prehab Before Knee Surgery X10 Therapy

Prior to surgery, prehabilitation significantly improved extension, 8.0°(5.8°) mean (standard deviation), flexion 12.1°(12.3°), range of motion 16.0° (16.7°); quadriceps strength 5.8 (5.4) kg, hamstring strength 2.5 (2.3) kg, and calf strength 11.2 (9.3) kg. Post-surgically, X10 prehabilitation increased flexion 120.7° (10.7°) vs 113.8° (13.0°), range of motion, 120.4°(11.6°) vs 112.9° (11.7°). X10 prehabilitation improved quadriceps strength 5.5%, while the non-prehabilitation group lost 17.1%. Calf strength improved in the prehabilitation group by 30.5%, but only 0.2% in the control group. Hamstring strength was unchanged. Compared to standard physical therapy, X10 prehabilitation and rehabilitation were superior.

Visit webpage/Download the study: Global Journal of Orthopedics Research

A New Non-Surgical Alternative to Manipulations Under Anesthesia Following Knee Replacement

Dr. Robert J Ference and Dr. D. Carl Freeman

DMC Harper University Hospital, USA and Department of Biological Sciences, Wayne State University, USA

Pub. December 2019

Abstract Stiff knee occurs in between 2% and 23% of total knee arthroplasty patients. Resolution of a stiff knee is critical for patients’ quality of life following a TKA. Historically, treatment options include physical therapy, manipulation under anesthesia, arthroscopic lysis, and open lysis. Excluding physical therapy, the other options all require anesthesia, with procedures usually being done in a hospital or surgical center. Here, we report on a new non-surgical alternative that is done in patients’ homes and is as efficacious as a manipulation under anesthesia. (X10 Research)

Visit webpage/Download the study: Global Journal of Orthopedics Research


Are Computer-Controlled, Pressure Modulated Knee Rehabilitation Machines Valuable Following Knee Arthroplasty?

Paul J Roubal and D Carl Freeman

Physical Therapy Specialists, Troy, MI USA 2 Department of Biological Sciences, Detroit, MI USA

Pub. November 2018

Background: To determine if a patented new computer controlled, pressure modulated knee rehabilitation machine was more effective, in rehabilitation of total knee arthroplasty, than the continuous passive motion machine utilizing Cochrane Review data.

Methods: Prospective study of 197 patients: 59 outpatient rehabilitation facilities; 155 homebased care, and 7 skilled nursing facilities. Patients were prospectively treated with pressure modulated knee rehabilitation and standard rehabilitation for total knee arthroplasty. Range of motion (RoM) was compared (via ANOVA) with the Cochrane continuous passive motion study. We also evaluated RoM outcomes versus start day of pressure modulated knee rehabilitation use.

Findings: Pressure modulated knee rehabilitation patient’s ROM, at 30 days, exceeded 116°; significantly greater than all shortterm (6 weeks) Cochrane Review studies (83°). Patients using the pressure modulated knee rehabilitation six or more days after surgery had a significantly lower 14-day RoM than patients who began on days 1-5 following surgery.

Interpretation: The pressure modulated knee rehabilitation patients increase their RoM following total knee arthroplasty significantly more than continuous passive motion users. (X10 Research)

Visit webpage/Download the study: Global Journal of Orthopedics Research


Building Strength on X10™

Case Report Summary

Author: Bryan Berquist, Dr. Carl Freeman Wayne State University

Timing: Spring 2015

Patient: Kevin McCaig

Surgeon: Dr. Marshall Allegra

A 58-year-old male industrial worker had a right total knee arthroplasty (TKA) due to a work related incident. One month into physical therapy (PT) the therapist ripped the patient’s right leg quadriceps tendon causing the him to cease therapy for 3 months. This patient once again stopped therapy four months later to have an emergency stomach surgery due to a problematic Meckel’s Diverticulum. When the patient was ready to restart his therapy, more than a month after the abdominal surgery, he had only 12 weeks to fully recover and return to work or his employment would be terminated. The patient’s right leg had severely atrophied by this point and his left leg was still atrophied from an incomplete recovery from a partial knee arthroplasty nine months prior to this episode. He required two canes or a walker to ambulate. The surgeon wanted to sign permanent disability papers. The patient chose to begin using the X10™ instead on March 10, 2015.

On May 18th after only 10 weeks of using the X10™ the patient was able to return to work 12 days before his deadline. He did so well his first day back that he actually worked overtime.

To watch an interview with Kevin click here.

The X10: A Revolution in Knee Rehabilitation Study

Authors: Dr. David Halley and Paul Ewing (BA, MBA)

Pub. April 2013


Objective: To determine how a patented new computer controlled, pressure modulated knee rehabilitation machine (PMKR) can treat patients with different conditions.

Design: Patients were treated with PMKR and standard rehabilitation following TKA.

Setting: Home-based therapy

Participants: Three Case Studies presented. Case #1: Severely limited right knee joint. Case #2: Typical AGE/AGF knee. Case #3: Middle age female facing MUA 3 weeks post-op.

Interventions: Patients were prospectively treated with PMKR in the home setting.

Main Outcome Measure(s): Patients exhibited faster return to normal life and significant ROM gains using the X10 in the home.

Results: PMKR patients ROM made important gains in all cases.

Conclusions: It seems a reasonable assertion that if a patient can comfortably begin rehabilitation within two to three days following surgery (made possible because of Variable Pressure) there is reasonable expectation that patients will achieve a greater range of motion in a shorter period of time. However this is a secondary goal. It is our primary goal that patients will have a more rapid recovery allowing them to become totally independent, and a member of the workforce, able to return to work in a shorter period of time following surgery.

Download the study here: DOWNLOAD

X10: A Revolution in Knee Surgery Recovery

The Continuous Passive Motion Machine

If you are curious about the CPM (Continuous Passive Motion Machine) and it effectiveness after knee surgery, click here:

The Effectiveness of the CPM Machine by Dr. David Halley

Additionally here is an article published about the CPM machine for knee replacement:

The Failure of the CPM Machine

The Continuous Passive Motion Device for the Knee: An Imperfect Solution to an Extinct Problem (Immobilization)

by Brittany Ventline, Dr. Carl Freeman

Brittany Ventline and Dr. Carl Freeman did a complete history and study of the CPM machine which sheds great light on this tool. You can read that study published in 2018, here:

CPM: An Imperfect Solution to an Extinct Problem

The X10 may be available through your insurance or as a short-term rental. Most patients do not need the X10 for more than 17 days. Our clinical team is ready to help you at any time with your knee surgery recovery. You can reach us with a phone call at 1-855-910-5633 or an email at info@x10therapy.com. To schedule a 15 minute call with us click on the Want to Learn More? image on this page.