Multifunctional Use of Tensiomyographic Muscle 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

Muscle injuries are a big problem

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 thigh contusions Incidence and prevalence of HSI in cricket is increasing

Muscle injuries are a big problem

...there is an enormous interest in optimising the diagnostic, therapeutic and rehabilitation process after muscle injuries, to minimise the absence from sport and to reduce recurrence rates. (HS
Mueller-Wohlfahrt et al., 2012)

What questions do all have in common?

What information is missing?

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 thigh contusions Incidence and prevalence of HSI in cricket is increasing

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

Tensiomyography
TMG is a measurement of involuntary muscle contractile properties; records and quantifies the oscillations generated by dimensional changes of the active skeletal muscle fibers (MMG) non-invasive, simple, validated repeatable

TMG measurement procedure

Five simple steps: 1. Place electrodes on the muscle belly. 2. Place specially-developed sensor on skin above muscle we wish to measure the sensor is designed to register the muscle contraction. 3. The muscle contraction is induced artificially with an electro stimulator. 4. The contraction of the muscle under isometric conditions results in radial displacement of the muscle belly which displaces sensor tip. Radial displacement is recorded as a function of the elapsed time. 5. The sensor is connected to a computer where a specially designed software plots the radial displacement of the sensor rod against time.

TMG basic parameters

Basic parameters of TMG measurement

Radial displacement (mm)

Displacement (mm)

10

Tc
9 8

Tr

Delay time (ms) Contraction time (ms) Sustain time (ms) Relaxation time (ms)

7 6 5 4 3 2

Ts Dm Td
0 50 100

1 0 150 200 250 300 350 400 450 500

Time (ms)

Basic Results

Symmetry

Basic Report

Basic Report

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

TMG applications in sports medicine

Diagnostics
Complements functional examination Sets baseline for therapy Important insights for clinical reasoning

Screening / Prehab
Correlate w/ screening questionnaires Group insights & reporting Prevalence/incidence in demogrpahic samples

Therapy
Motivation for patient and therapist More accurate estimate of fatigue Therapeutic decisions made faster and with more confidence

Muscle strain
Contractile properties of muscles change after strain injury and is detected as changes in Tc and Dm in the TMG signal.*

Injured [L] Tc Dm 24,11 ms 7,86 mm

N-injured [R] 22,03 ms 4,23 mm

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

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.

TMG monitoring of athrophy, and functional symmetry of knee flexors and extensors (after ACL surgery) can significantly improve ACL rehab process*
Tramullas JA. (2012, April) Monitoring of pre- and post-operative muscle adaptation of ACL reconstruction rehabilitation process. Presented at XXI International Conference on Sports Rehabilitation and Traumatology Football Medicine Strategies for Knee Injuries. London, UK.

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

75% 94%
Tc (l) 27.4 ms > Tc (r) 23.5 ms

93%

85%
Tc (l) 56.9 ms < Tc (r) 63.0 ms

91%

Posture/myofascial pain syndromes

Active and/or latent triggerpoints with referred pain Changes in muscle tone and function Restricted ROM RSWT therapy indicated
12 10 8

BF left before Tc Dm 67,62 ms 10,88 mm

BF right 28,50 ms 7,35 mm

BF left after 25,54 ms 4,59 mm

6 4 2 0 1 -2 101 201 301 401 501 601 701 801 901

BF right BF left before BF left after

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

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 and Ts)
Biceps Femoris Fatigue Protocol
60 50 40 30 20 10 0 Rest Exe set #1 Exe set #2 Exe set #3 Exe set #4 Exe set #5 Exe set #6 Tc [ms] Dm [mm]

Decision making
Grade I strain on the myotendinous juntion of left BF (caput longum), 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
45.0 40.0 35.0 30.0 Tc (ms) 25.0 20.0 15.0 10.0 5.0 0.0 1 2 Time 3 Healthy Injured

Adaptation to training stimuli

40 35 30 25

20 15 10 5 0 1 2 3 4 5 6 7 8 9 10 11 12 13

BF RF VL

ms

weeks

Tc, showing synchonization extensor/flexor complex

Conclusions
TMG provides valuable objective information about individual muscle functional status

Non-invasive, repeatable and accurate Increases diagnostic and rehab progress monitoring capabilities to correctly adjust
treatment approach and protocols Useful in return-to-play decision making Regular team monitoring will assist in injury

prevention and optimizing training

impulses

Questions ? Stef Harley, stef.harley@tmg.si