GB2602334A - Exercise machine and method for rehabilitation of the lumbopelvic region - Google Patents

Abstract

An exercise machine 200 includes left and right movable knee pads 300 that are suitable for receiving the knee or lower leg of a user; the first knee pad 300 is constrained to move along a first path and the second knee pad 300 is constrained to move along a second path; the machine 200 also includes a support 90 for the hands or arms of the user that is vertically displaced from the first and second paths. In use a user kneels on the pads in an upright position. The machine may include a further support 290 for the hands or arms that is horizontally displaced from the paths for use in a prone position. The machine may also include a belt (360, fig 5) worn by a user and a system for applying a load (380, fig 5) to the belt (360).

Description

EXERCISE MAGI TINE AND METT TOD FOR RETIABILIT TTON OF THE IIIMEOPELVIC REGION

The present invention relates generally to an exercise machine and a method of exercising and finds particular, although not exclusive, utility in rehabilitation of the lumbo pelvic region.

Babies grow up quickly and efficiently with significant neuroplastic and musculoskelettl movement advances in a time span of roughly 5 years. Being born with a primary kyphotic curvature of the spine, babies then go on to develop the secondary lordotic curves as the infant advances to movement and manipulation of the body.

The crawling process for the infant is paramount in the formation of the cervical and lumbar lordotic curves, creating dynamic spinal curves for suspension, stability, protection of the nervous system, and a solid foundation for movement manipulation of the upper and lower limbs. The cross-crawl process conditions the brain and strengthens 1 5 the body, creating core stability, enabling the infant to advance to bipedal movement once that infant is ready to advance.

With stability throughout the lumbopelvic complex and hip articulations, the infant can stand and manipulate the knees, ankles and feet in a dynamic, flexible, fluid way. Furthermore, the action of the at-ins with the crawling process results in shoulder girdle stability, to open-up the ribcage for breathing, support the neck and head, and strengthen the upper limb for later articulation and grip strength.

Sitting unsupported in a slouched position degrades the integrity of the lumbar lordotic curvature, and the primary movers of the lumbopelvic complex (i.e. iliopsoas and gluteus muscles etc.) can become inhibited. The long-refill impact is increased "wear and tear", excess biornechanical strain on alternative structures including knees, ankles and feet, and a change in centre of mass that results in neurologically toxic afferent input into the nervous system (dysaffercntation), that can result in inefficient uncoordinated efferent changes (ncuroplastic change).

This can lead to a wide range of musculoskeletal symptoms, reduced flexibility, increased risk of tissue injury etc. For example, with the iliopsoas and gluteus muscles being inhibited, when movement is demanded of them they pull and distort the lumbopelvic structures in an unbalanced way, resulting in the common symptoms of lower back pain (LIM) and stiffness, and long-term degenerative changes.

Accordingly, crawling is a simple and effective means of stabilizing the core musculoskelctal regions of the body, reducing stress on the appcndicular skeleton and strengthening its movements and articulations. Til particular, crawling is a functional exercise that eliminates movement stress at the knee, ankle and foot for patients that have painful gait due to dysfunction in these areas, whilst simultaneously rebalancing the core areas that are designed to support and reduce stress.

According to a first aspect of the present invention, there is provided an exercise machine, comprising: a left movable knee pad configured to receive a left knee and"/or lower leg of a user thereon, and configured to be moved by said left knee and/or lower leg, the left movable knee pad constrained to move along a first path; a right movable knee pad configured to receive a right knee and/or lower leg of the user thereon, and configured to be moved by said right knee and/or lower leg, the right movable knee pad constrained to move along a second path; and a support configured to receive hands and/or lower arms of the user thereon, the support vertically displaced from the first and second paths such that, when in use, the user kneels in an upright position.

Tn this way, movement is focussed at the lumbopelvic and hip articulations, and thus aids reestablishment of movement control from the lumbopelvic region and eliminates and changes any compensatory THOVCITICilt patterns in gait from the knee down, where the primary movers were dysfunctional.

The exercise machine of the present invention may be similar to the kind known as an elliptical-and/or cross-trainer, but instead of the user standing on footplates, the user may kneel on knee pads.

The user may be an operative of the exercise machine, such as a person requiring rehabilitation and/or a patient. The term 'when in use' is used merely to indicate how a user would interact with the exercise machine while undergoing exercise and"/or rehabilitation.

The knee pads may be movable in the sense that movement of these knee pads may be achieved by the user directly by moving their legs. The knee pads may be disposed on a rail/runner"/track and/or in a groove/channel, and the knee pads may roll (e.g. on wheels/caster) glide (e.g. on relatively low-friction surfaces), and/or slide (e.g. on skids).

The knee pads may comprise a gel layer. In this way, the knee pads may be comfortable for users having a bony patella and/or artificial joints, tender knees, etc. Infants have a soft malleable patella (kneecap), that does not inhibit the crawling process; thus, the invention may take into account the bony patella in adults.

An alternative, the knee pads may comprise another form of padding, such as foam, WOOL upholstery, etc. Receiving a knee and/or lower leg may comprise the user resting a patella on the knee pad, and/or resting a shin of the lower leg on the knee pad. In some embodiments the user may also rest their feet on the knee pads, for example with their toes pointed (e.g. resting an upper part of the foot). Alternatively, the user may also rest their toes on the knee pads, for example with their toes in a curled-back position (e.g. so that an upper part of the foot does not rest on the knee pads). In this way, the feet of the user may be kept away from any mechanism used for moving the knee pads (e.g. rails, etc.).

Movement may be substantially unimpeded; for instance, resisted only by natural resistance of the components involved, which may be chosen to be relatively low-friction components. However, in some embodiments, movement may be further impeded by some form of resistance. For example, rails/runners may comprise relatively high-friction components, a clamping member (in which the applied clamping force may be variable) may be used to increase the resistance, and/or a biasing member may be used to oppose motion in one direction only (e.g. a spring and/or elastic resistance band).

Being constrained to move along a path may involve the knee pads being mounted on a track that traces out the path in question, or some other form of constraining system.

The first/second path may comprise a linear path in which motion is reciprocating (back and forth). Alternatively, the paths may comprise a closed loop, for example an elliptical path, or even a circular path, or even some other form of closed loop not described by a simple geometric shape. In the case of an elliptical path, the path may have a semi-major axis of approximately 60cm and a semi-minor axis of approximately 7cm; in other embodiments, the path may have a ration between its semi-major axis and its semi-minor axis of at least 7:1, in particular at least 8:1. The elliptical path may be orientated with the semi major axis substantially horizontal (for example, within 30 degrees of horizontal, in particular within 25 degrees of horizontal).

The support may comprise a handle and/or grip for the user to grip with their hands. The support may comprise a rest onto which the user may place their hands and/or forearms. The support may be padded in a similar manner to the knee pads.

The support rnay be fixed or movable. For example, the support may be movable/adjustable (when not in use) between fixed configurations (when in use). Tn this way the support may be optimally located for users having different heights.

Alternatively or additionally, the support may be fixed but may be elongate such that users of different heights may hold it and/or rest on it in a variety of positions.

Further, the support may comprise a plurality of handles/grips/rests fora similar purpose. For example, the support may comprise a fixed bar/rail, or a pair of such bars/rails. Alternatively or additionally, the support may be movable when in use, such that the user can manipulate the support, either for ease of grip, or to exercise the upper body, such as in a conventional elliptical trainer. For example, the support may be configured in a similar manner as described above in relation to the knee pads, and/or may be pivotable.

The support may be vertically displaced from the first and second paths in that in use it may be located at a height substantially above the first and second paths, for example at least 30 cm above the first and second paths, in particular at least 60 cm above, more particularly at least 80 cm above. Being at least a certain height above merely refers to its extent above the first and second paths, and does not preclude embodiments in which the support also extends below the recited heights.

Tn any event, the support may be located to enable the user to kneel in an upright position; that is, resting on their knees or lower legs (on the knee pads) with at least one of their thighs substantially vertical (e.g. orientated between zero and forty-five degrees to vertical, in particular between zero and thirty degrees to vertical), and their torso substantially vertical.

For example, the support may not be substantially horizontally displaced from the first and second paths. That is, the support may be horizontally displaced from the first and second paths by a distance that is substantially less (e.g. at least a factor of three, five or ten less) than vertical displacement.

Tn this regard, where the location of the support is discussed, what is intended is the location of a portion of the support that may act as a support to the user's hands and/or lower arms. In practice, the support may extend such that multiple portions of the support may be treated as 'the location' of the support; within the meaning of this application, it is sufficient that merely one of these 'locations' meets the conditions recited in the claims.

The exercise machine may further comprise a liwther support configured to receive hands and/or lower arms of the user thereon, the further support may be horizontally displaced from the first and second paths such that, when in use, the user kneels in a prone position.

For example, the further support may not be substantially vertically displaced from the first and second paths. 't that is, the further support may be vertically displaced from the first and second paths by a distance that is substantially less (e.g. at least a factor of three, five or ten less) than horizontal displacement.

The further support may form part of the support, may be distinct from the support, or may be the support. For example, the support may comprise an elongate member that may be held by a user in a first location for use in the upright kneeling position and in a second location for use in the prone position. Alternatively or additionally, the support may comprise a single place for a user to hold, but the support itself is movable between a first position in which the user may be in the upright kneeling position and a second position in which the user is in the prone position The exercise machine may further comprise an inclination mechanism for selectively adjusting an inclination of the device to the horizontal.

In this way, the device may be inclined such that a crawling TI10-6011 may be performed in a simulated uphill environment.

The inclination mechanism may be configured to selectively adjust inclination from the horizontal of up to 30 degrees, in particular up to 25 degrees. The selection of inclination may be smooth/continuous, in that substantially any inclination may be chosen within the available range. However, in other embodiments, the inclination may be indexed such that only specific inclinations within the range may be chosen.

The inclination mechanism may be mechanical, pneumatic and/ or hydraulic.

Incline and resistance to movement may be manually and/or electronically controlled, and for instance may be incorporated with distance, speed, and heart rate measurement features, for instance on an electronic display.

The exercise machine may further comprise a belt for a user to wear around their lumbar region. For example, this may be worn when in the prone position. In this way, the correct lordotic curve may be encouraged. In particular, the lordotic curves relationship with the sacroiliac joints in motion and the iliopsoas gluteus relationship, along with other musculoskeletal relationships in that region may be encouraged.

Small load application option is intended to help with lumbar flexibility, bringing the origin and insertion of the psoas major muscle closer together, to reinforce or reestablish normal lumbopelvic motion. A contraindication for loading would be if the user has the condition of "hypermobility", or any such conditions that result in ligament laxity, and also spondylolisthesis (a disease that causes one of the lower vertebrae to slip forward). Encouraging lumbar lordosis is a recognized therapeutic approach, such as lumbar supports in car seats, or lumbar rolls, or structures designed to passively "lie on" in a supine position. However, research has shown that passive intervention is very temporary and doesn't reinforce the brain or teach it how to actively maintiin this position. My approach is more active. Crawling alone without load will encourage the lumbar lordosis to a degree with the gravitational pull on the torso (as with a supple child); however, adults get stuck/stiff, and inflexible and lose brain body connections, so the small load feature can be used to encourage flexibility (like cat cow yoga poses) or serve as a "tactile" reminder, similar to a practitioner's hand, to guide the patient in that 1 5 movement of relaxing the torso and not tucking the pelvis etc. Bringing the origin and insertion of a muscle closer together helps it re-establish a tiring pattern and with practice you can bring that muscle back into the long position and have it fire again normally, hence the feature of progression to the upright crawl.

The exercise machine may further comprise a load system for applying a load to the belt For example, a load of up to 15kg may be applied to the belt In particular, a load may be selected in a range of between ikg and 15kg, selection may be continuous/ smooth, or indexed in a similar manner to the inclination.

In some embodiments, the exercise machine may comprise a cradle system to support a user (i.e. remove the intrinsic load of the user's ONVI1 weight). This could be useful for stroke patients (for example) in their rehabilitation to regain movement stability and coordination, supporting their return to walking According to a second aspect of the present invention, there is provide a method of exercising, the method comprising: providing an exercise machine according to any preceding claim; a user: placing their left knee and/or lower leg on the left movable knee pad; placing their right knee and/or lower leg on the right movable knee pad; and placing their hands and/or lower arms on the support; and the user, while in an upright kneeling position: moving the left movable knee pad with their left knee and/or lower leg along the First path; and the user moving the right movable knee pad with their right knee and/or lower leg along the second path.

The above and other characteristics, features and advantages of the present invention will become apparent from the following detailed description, taken in conjunction with the accompanying drawings, which illustrate, by way of example, the principles of the invention. This description is given for the sake of example only, without limiting the scope of the invention. The reference figures quoted below refer to the attached drawings.

Figure 1 is an exercise device for a user in an upright crawl position.

Figure 2 is an alternative arrangement of the exercise device of Figure 1.

Figure 3 is an exercise device for a user in a prone crawl position.

Figure 4 shows the exercise device of Figure 3 in an inclined configuration. Figure 5 is an exercise device showing a user in a prone crawl position.

The present invention will be described with respect to certain drawings but the invention is not limited thereto but only by the claims. The drawings described are only schematic and are non-limiting. Each drawing may not include all of the features of the invention and therefore should not necessarily be considered to be an embodiment of the invention. In the drawings, the size of sonic of die etc:Ira:las may he exaggerated and not drawn to scale for illustrative purposes. The dimensions and the relative dimensions do not correspond to actual reductions to practice of the invention.

Furthermore, the terms first, second, third and the like in the description and in the claims, are used for distinguishing between similar elements and not necessarily for describing a sequence, either temporally, spatially, in ranking or in any other manner. It is to be understood that the tams so used are interchangeable under appropriate circumstances and that operation is capable in other sequences than described or illustrated herein. Likewise, method steps described or claimed in a particular sequence may he understood to operate in a different sequence.

Moreover, the terms top, bottom, over, under and the like in the description and the claims are used for descriptive purposes and not necessarily for describing relative positions. It is to be understood that the terms so used are interchangeable under appropriate circumstances and that operation is capable in other orientations than described or illustrated herein.

Tt is to be noticed that the term "comprising", used in the claims, should not be interpreted as being restricted to the means listed thereafter; it does not exclude other elements or steps. it is thus to be interpreted as specifying the presence of the stated features, integers, steps or components as referred to, but does not preclude the presence or addition of one or more other features, integers, steps or components, or groups thereof Thus, the scope of the expression "a device comprising means A and B" should not be limited to devices consisting only of components A and B. It means that with respect to the present invention, the only relevant components of the device are A and B. Similarly, it is to be noticed that the term "connected", used in the description, should not be interpreted as being restricted to direct connections only. Thus, the scope of the expression "a device A connected to a device B" should not be limited to devices or systems wherein an output of device A is directly connected to an input of device 13. It means that there exists a path between an output of A and an input of B which may be a path including other devices or means. "Connected" may mean that two or more elements are either in direct physical or electrical contact, or that two or more elements are not in direct contact with each other but yet still co-operate or interact with each other. For instance, wireless connectivity is contemplated.

Reference throughout this specification to "an embodiment" or "an aspect" means that a particular feature, structure or characteristic described in connection with the embodiment or aspect is included in at least one embodiment or aspect of the present invention. 'thus, appearances of the phrases "in one embodiment", "in an embodiment", or "in an aspect" in various places throughout this specification are not necessarily all referring to the same embodiment or aspect, but may refer to different embodiments or aspects. Furthermore, the particular features, structures or characteristics of any one embodiment or aspect of the invention may be combined in any suitable manner with any other particular feature, structure or characteristic of another embodiment or aspect of the invention, as would be apparent to one of ordinary skill in the art from this disclosure, in one or more embodiments or aspects.

Similarly, it should be appreciated that in the description various features of the invention arc sometimes grouped together in a single embodiment, figure, or description thereof for the purpose of streamlining the disclosure and aiding in the understanding of one or more of the various inventive aspects. this method of disclosure, however, is not to be interpreted as reflecting an intention that the claimed invention requires more features than are expressly recited in each claim. Moreover, the description of any individual drawing or aspect should not necessarily be considered to be an embodiment of the invention. Rather, as the following claims reflect, inventive aspects lie in fewer than all features of a single foregoing disclosed embodiment. Thus, the claims following the detailed description are hereby expressly incorporated into this detailed description, with each claim standing on its own as a separate embodiment of this invention. Furthermore, while some embodiments described herein include some features included in other embodiments, combinations of features of different embodiments are meant to be within the scope of the invention, and form yet further embodiments, as will be understood by those skilled in the art. For example, in the following claims, any of the claimed embodiments can be used in any combination.

In the description provided herein, numerous specific details are set forth. However, it is understood that embodiments of the invention may be practised without these specific details. In other instances, well-known methods, structures and techniques have not been shown in detail in order not to obscure an understanding of this

description.

In the discussion of the invention, unless stated to the contrary, the disclosure of alternative values for the upper or lower limit of the permitted range of a p2muneter, coupled with an indication that one of said values is more highly preferred than the other, is to be construed as an implied statement that each intermediate value of said parameter, lying between the more preferred and the less preferred of said alternatives, is itself preferred to said less preferred value and also to each value lying between said less preferred value and said intermediate value.

The use of the term "at least one" may mean only one in certain circumstances.

The use of the term "any" may mean "all" and/or "each" in certain circumstances.

The principles of the invention will now be described by a detailed description of at least one drawing relating to exemplary features. It is clear that other arrangements can be configured according to the knowledge of persons skilled in the art without departing from the underlying concept or technical teaching, the invention being limited only by the terms of the appended claims.

Figure 1 is a perspective view of an exercise device suitable for a user in an upright crawl position, the exercise device including an elongate base 10 supported by feet 20. A flywheel 30 is located at one longitudinal end of the base 10, the flywheel 30 having a disc shape. An upper support 40 extends vertically from the other longitudinal end of the base 10. Two knee pad supports 50 extend longitudinally substantially parallel to the base 10. One end of each knee pad support 50 is pivotally connected to opposing radial positions on the flywheel 30. This configuration allows for each knee pad support 50 to move in a substantially elliptical path relative to the base 10. A knee pad 60 is connected adjacent to the longitudinal centre of the top surface of each knee pad support 50, each knee pad 60 for supporting a lower limb of a user. 't he lower limb may include a foot and/or a knee. The other end of each knee pad support 50 is pivotally connected to an upper handle 70. Each upper handle 70 extends vertically from the knee pad support 50 and through a bracket 80 pivotably connected adjacent to the upper end of the upper support 40. Each bracket 80 extends substantially horizontally from the upper support 40. The upper end of each upper handle 70 extends beyond the vertical height of the upper support 40 and is doubly bent for an ergonomic shape, and has a textured handle grip 90 at its distal end. The upper end of the upper support 40 is connected to a lower handle 100, which has a bent ergonomic shape and has textured handle grips 90 at its distal ends.

Figure 2 is an alternative arrangement of the exercise device of Figure 1, where the flywheel 30 is elevated above and located at the other end of the elongate base 10 than that shown in Figure 1. The base 10 is supported by feet 20 and has tracks 110 running longitudinally 110 along each side. One end of a riser 120 is slidably mounted within a track 110 on each side of the base 10. Each riser 120 passes through a slot in each knee pad support 50, where the other end of the riser 120 is pivotally connected to opposing radial positions on the flywheel 30. This configuration allows for each knee pad support 50 to move in a substantially elliptical path relative to the base 10. A knee pad 60 is connected adjacent to the top surface of one end of each knee pad support 50, each knee pad 60 for supporting a lower limb of a user. The lower limb may include a foot and/or a knee. The other end of each knee pad support 50 is pivotally connected to an upper handle 70. The upper handles 70 extend substantially perpendicularly from the longitudinal extension of the knee pad supports 50, and pass through brackets 80 pivotably connected adjacent to the upper end of the upper support 40. Each bracket 80 extends substantially horizontally from the upper support 40. The upper end of each upper handle 70 extends beyond the vertical height of the upper support 40 and is bent for an ergonomic shape, and has 21 textured handle grip 90 at its distal end. 't he upper end of the upper support 40 is connected to a lower handle 100, wh ch has a bent ergonomic shape and has textured handle grips 90 at its distal ends.

Figure 3 is an exercise device fora user in a prone crawl position, the device having an elongate base 200. The base 200 comprises two elongate tracks 210 which extend between a front mount 220 and a rear mount 230. The base 200 is supported on feet 240 located at each corner. The front mount 220 has an upright support 250 extending substantially vertically from the centre of the top surface of the front mount 220. the top of the upright support 250 is connected to an electronic display 260. Below the display 260, two L shape handles 270 extend perpendicularly from either side of the upright support 250 and have textured handle grips 90 at their distal ends.' hand support 280 is slidably mounted on each elongate track 210. Each hand support 280 is substantially cuboid in shape, and includes a hand support handle 290. The hand supports 280 are configured to slide linearly with respect to each elongate track 210. A lower limb support 300 is also slidably mounted on each elongate track 210, and is configured to slide linearly with respect to each elongate track 210. The lower limb support 300 are padded and comprise several depressions, making them suitable for supporting a foot, shin, knee and/or thigh of a user. the end of the base 200 proximal to the front mount 220 has hand rails 310 attach to it. One end of each hand rail 310 is connected to an end of the front mount 220, with the other end connect to a point substantially halfway along the longitudinal length of each elongate track 210. the user therefore has at least three different components to assist their supporting weight with their hands, namely the L shape handles 270, the hand support handles 300 and the hand rails 310.

Figure 4 shows the exercise device of Figure 3, where the feet 240 extending from the ends of the front mount 220 have been extended in length. In this way, the base 200 and elongate tracks 210 are inclined upwards towards the direction of the front mount 220.

Figure 5 is an exercise device showing a user in a prone crawl position. The exercise device is similar in configuration to the device shown in Figures 3 and 4, in that it comprises an elongate base 200, two elongate tracks 210, a front mount 220, a rear mount 230, feet 240, hand supports 280, hand support handles 290 and lower limb supports 300. The user is shown with their hands holding the hand support handles 290, and their feet positioned adjacent to the front of the lower limb supports 300. In this configuration, the user may alternately move opposing limbs back and forth to simulate a linear crawling motion. In an alternate position, the user may place any part of their lower limbs, for example their shins, knees and/or thighs on the lower limb supports 300. Two weight supports 320 extend vertically from the ends of the front mount 220.A first roller 330 is positioned adjacent to the top end of the weight supports 320 and between the weight supports 320. Positioned adjacent to the centre of the front mount 220 and between the weight supports 320 is a second roller 340. A third roller 350 is positioned substantially halfway along the longitudinal length of the elongate tracks 210 and between the elongate tracks 210. 't he user is shown wearing a lumbar support belt 360, which is attached to a weight line 370. the weight line 370 is a flexible elongate member that runs downwards from the lumbar support belt 360 towards the third roller 350. After traversing the right-hand side and lower side of the third roller 350, the weight line 370 continues substantially parallel to the horizontal extension of the elongate tracks 210 until it reaches the second roller 330. After traversing the lower side and left-hand side of the second roller 330, the weight line 370 continues upwards substantially parallel to the vertical extension of the weight supports 320 until it reaches the first roller 330. After traversing the left-hand side, top side and right-hand side of the first roller 330, the weight line 370 continues downwards substmtially parallel to the vertical extension of the weight supports until it reaches a weight 380. The weight 380 may be fixed, or may be adjustable anc/ or removable. In this way, the weight 380 acts to exert a force on the user's lumbar region, where the force is transmitted along the weight line 370 and to the lumbar support belt 360.

Claims (6)

1. CLAIMS1. An exercise machine, comprising: a left movable knee pad configured to receive a left knee and/or lower kg of a user thereon, and configured to be moved by said left knee and/or lower leg, the left movable knee pad constrained to move along a first path; a right movable knee pad configured to receive a right knee and/or lower leg of the user thereon, and configured to be moved by said right knee and/or lower leg, the right movable knee pad constrained to move along a second path; and a support configured to receive hands and/or lower arms of the user thereon, the support vertically displaced from the first and second paths such that, when in use, the user kneels in an upright position.
2. 2. The exercise machine of claim 1, further comprising a further support configured to receive hands and/or lower arms of the user thereon, the further support horizontally displaced from the first and second paths such that, when in use, the user kneels in a prone position.
3. 3. The exercise machine of claim 2, further comprising an inclination mechanism for selectively adjusting an inclination of the device to the horizontal.
4. 4. The exercise machine of claim 2 or claim 3, further comprising a belt for a user to wear around their lumbar region.
5. 5. The exercise machine of claim 4, further comprising a load system for applying a load to the belt.
6. 6. A method of exercising, the method comprising: providing an exercise machine according to any preceding claim; a user: placing their left knee and/or lower leg on the left movable knee pad; placing their right knee and/or lower leg on the right movable knee pad; and placing their hands and/or lower arms on the support; and the user, while in an upright kneeling position: moving the left movable knee pad with their left knee and/or lower leg along the first path; and the user moving the right movable knee pad with their right knee and/or lower leg along the second path.