multifunctional use of tensiomyography assessments in elite sports

8/13/2019 Multifunctional use of tensiomyography assessments in elite sports

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Multifunctional Use of TensiomyographicMuscle Assessment in Elite Sports

Stef Harley, MRS-PT

Synovia, private physiotherapy practice

TMG-BMC ltd., senior consultant

SASMA congress, Durban, South Africa, 26th October 2013


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47% of elite football players are forced to retirebecause of injury

1/3 of all time lost in mens elite football

92% affect 4 big muscle groups in LL.

37 days missed each season. 16% re-injuries, causing 30% longer absences.

HSI most common injury in high-speed running sports

Top 3 injuries in professional rugby; HSI, calf muscleand thigh contusions

Incidence and prevalence of HSI in cricket is

increasing

Muscle injuries are a big problem


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Muscle injuries are a big problem

...there is an enormous interest in

optimising the diagnostic, therapeutic andrehabilitation process after muscle

injuries, to minimise the absence from

sport and to reduce recurrence rates. (HSMueller-Wohlfahrt et al., 2012)


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What questions do all have in common?


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What information is missing?


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What information is missing?Today the facts still are...

47% of elite football players are forced to retire because of injury

1/3 of all time lost in mens elite football

92% affect 4 big muscle groups in LL.

37 days missed each season.

16% re-injuries, causing 30% longer absences.

HSI most common injury in high-speed running sports

Top 3 injuries in professional rugby; HSI, calf muscle and thighcontusions

Incidence and prevalence of HSI in cricket is increasing


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What can we expect from the muscle?

Changes in muscle contraction properties

fast and accessible data

selective data

non-invasive

as objective as possible

easy to measure

simple to interpret and understand


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TMG is a measurement of involuntary muscle

contractile properties; records and quantifies the oscillations generated

by dimensional changes of the active skeletalmuscle fibers (MMG)

non-invasive,

simple,

validated repeatable

Tensiomyography


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TMG measurement procedureFive simple steps:

1. Place electrodes on the muscle belly.

2. Place specially-developed sensor on skinabove muscle we wish to measure thesensor is designed to register the musclecontraction.

3. The muscle contraction is induced artificially

with an electro stimulator.

4. The contraction of the muscle under isometricconditions results in radial displacement of themuscle belly which displaces sensor tip. Radialdisplacement is recorded as a function of theelapsed time.

5. The sensor is connected to a computer wherea specially designed software plots the radialdisplacement of the sensor rod against time.


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TMG basic parameters

Basic parameters of TMG measurement

0

1

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4

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7

8

9

10

0 50 100 150 200 250 300 350 400 450 500

Time (ms)

Displacem

ent(mm)

Td

Tc

Ts

Tr

Dm

Radial displacement (mm)

Delay time (ms)

Contraction time (ms)

Sustain time (ms)

Relaxation time (ms)


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Basic Results


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Symmetry


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Basic Report


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Basic Report


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TMG applications in sports medicine Diagnostics

Muscle strain Functional imbalance around joints (joint pain, posture syndromes)

Muscle Inhibition and atrophy Neuropathy

Treatment management Clinical reasoning; assist diagnostic process & measure rehab progress (pre/post tx,

overall treatment progress)

Decision making (within therapy, return to training, return to play) Avoid local muscle fatigue during therapy (improve treatment outcome)

Injury prevention & monitoring training adaptation Regular team measurements, identify outliers, act accordingly Muscle fiber composition (individuals, whole team overview)

Adaptation to training stimuli Player motivation tool


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TMG applications in sports medicineDiagnosticsComplements functional

examinationSets baseline for therapy

Important insights for clinicalreasoning

TherapyMotivation for patient and

therapist

More accurate estimate of fatigue

Therapeutic decisions madefaster and with more confidence

Screening /

PrehabCorrelate w/ screeningquestionnaires

Group insights & reporting

Prevalence/incidence indemogrpahic samples


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Muscle strain Contractile properties of muscles change after strain

injury and is detected as changes in Tc and Dm in the

TMG signal.*

* Zupet P, Zorko M, Rozman S, Djordjevic S. Use of Tensiomyography for Early Detection of Muscle Injuries. Inconference proceedings Book of Abstracts, 17th annual Congress of the ECSS, Bruges, Belgium, 4-7 July 2012.Ed. Meeusen et al. 489-490.

Injured [L] N-injured [R]

Tc 24,11 ms 22,03 ms

Dm 7,86 mm 4,23 mm


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Functional imbalance Considerable assymmetry in BF and VM before ACL surgery VL most affected after ACL surgery; drop in asymmetry in VM and BF Overal BF showed greatest asymmetry

At 24 weeks, all muscles recovered in symmetry.

Tramullas JA. (2012, April) Monitoring of pre- and post-operative muscle adaptation of ACL reconstructionrehabilitation process. Presented at XXI International Conference on Sports Rehabilitation and Traumatology Football Medicine Strategies for Knee Injuries. London, UK.

TMG monitoring of athrophy, and functional symmetry of knee flexors andextensors (after ACL surgery) can significantly improve ACL rehab process*


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Functional imbalance

85%

75%

94%

91%

93%

14 y/o, elite youth; complete ACL rupture (r) Surgery not an option, prior PT focussed on strengthening NOT speed

development

Tc (l) 27.4 ms > Tc (r) 23.5 ms

Tc (l) 56.9 ms < Tc (r) 63.0 ms


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Posture/myofascial pain syndromes Active and/or latent triggerpoints with referred pain Changes in muscle tone and function

Restricted ROM RSWT therapy indicated

-2

0

2

4

6

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10

12

1 101 201 301 401 501 601 701 801 901

BF right

BF left before

BF left after

BF leftbefore

BF right BF leftafter

Tc 67,62 ms 28,50 ms 25,54 ms

Dm 10,88 mm 7,35 mm 4,59 mm

* Alvarez DJ, Rockwell PG. Trigger Points: Diagnosis and Management.American Family Physician. 2002; 65(4): 653-660.


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Local muscle fatigue Compromises proprioception, dynamic joint recovery and ability to

recover from injury.

Constantly changing baselines throughout therapy

Shows as increase in Tc and Dm (in excess an increased Td, Tr andTs)

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10

20

30

40

50

60

Rest Exe set #1 Exe set #2 Exe set #3 Exe set #4 Exe set #5 Exe set #6

Biceps Femoris Fatigue Protocol

Tc [ms] Dm [mm]


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Decision making

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

1 2 3

Tc(ms)

Time

Healthy

Injured

Grade I strain on the myotendinous juntion of left BF (caputlongum), interfascial hematoma between both BF heads.

Predicted 4-6 week absence Measurements on day 4, day 10 and day 16 after injury Conventional physiotherapy protocol for grade I strain Return to play 2 weeks prior to predicted rehab time


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Adaptation to training stimuli

0

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20

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30

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1 2 3 4 5 6 7 8 9 10 11 12 13

weeks

ms BF

RF

VL

Tc, showing synchonization extensor/flexor complex


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Conclusions TMG provides valuable objective information

about individual muscle functional status Non-invasive, repeatable and accurate

Increases diagnostic and rehab progressmonitoring capabilities to correctly adjusttreatment approach and protocols

Useful in return-to-play decision making Regular team monitoring will assist in injury

prevention and optimizing trainingimpulses


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Questions ?

Stef Harley, [email protected]

multifunctional use of tensiomyography assessments in elite sports

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