World Class Therapy Review – Part 1


I wanted to review some interesting findings I learned recently at a collaborative summit on Tensiomyography (TMG), Elastography, and Thermography. I feel that it’s wise to write down my thoughts after being just an observer of how medical practices are changing elite sport, specifically in US. From what I know, no current professional team is using TMG and we will see an explosion in the matter of months. Due to the expenses and expertise shortage of the above technologies, it will create a need for more conferences and workshops to help with the education gap. What I am going to do instead of sharing notes or recap of events, I will share some thoughts in a somewhat organized fashion and hope coaches and therapists can see where things are going.

Many teams are not using objective methods to evaluate athletes, since independent audits may reveal that one is not doing what they think they are doing. Confirmation bias is huge with injury diagnostics and we need to look at more data sets to find out the most probable culprit. I will focus on Thermography first since it’s very old technology. Thermography is video or photography using infrared cameras and has some practical use with sports. What I like about it is the rapid ability to take pictures of the entire body and look for clear signs of problems. While it’s quick on the capture side, interpretation and data management on the software side is slightly cumbersome because the native software by the manufacturers. The poor software is a common problem with manufacturers because hardware is usually a focus and power users are independent and usually do their own things.

When athletes are injured, thermography is a great tool to quickly capture any obvious issues. It’s not a standalone tool by any means, but if used with TMG it can help connect the dots greatly. Temperature pattens can reveal interesting findings such as inflammation or lack of it. Chronic problems sometimes show cold spots and some acute issues will show wildfire. Noted sports science expert Dr. Sands presented some good information on injuries and thermography here, but his use of camera model is not what most experts feel is ideal. Still, it’s a great way to see how thermal imaging is useful to longitudinally monitor things. A picture is worth a thousand words.

The best software is in the Netherlands for medical interpretation, since interpretation is the difficult part of thermal imaging. Currently equine sports do the best job with thermography because horses are athletes that clearly don’t talk and symptoms must be predicted to prevent lameness. I have been looking at equine sports because they are expensive athletes, even the slowest still cost millions. When looking at the Barbaro injury, I really started thinking about the value of pressure mapping and thermography to help athletes reduce injuries by preventing them. The medical software by Dr. van der Westen is now allowing coaches to quickly score and rank changes with a very novel approach. With so many possible causes of false positives or negatives, the software is really helpful.

Tensiomyography is another technology I wish I investigated earlier. After 2000 some athletes said a few athletes were using a machine to get information on their muscles and I scoffed at fiber typing with anything that doesn’t do biopsies. If I was more open I would have found out that the technology not only estimates fiber type, but it is perhaps a game changing technology that can track muscle fatigue and stiffness. Fast forward to 2012 olympics, Dan Pfaff and others in the UK were using TMG to get information on training and rehabilitation functionally, not just MRI and MSK Ultrasound. TMG is a game changing technology that can collect objective muscle readiness. Every superficial muscle can get tested, and I have had athletes get tested to evaluate rehabilitation effectiveness. Combined with EMG and EMS, Tensiomyography is a fantastic tool every professional team should have.

Elastography isn’t new, but methodologies are embryonic with sports medicine. One high profile athlete bought his own machine after experiencing the daily monitoring benefits of a tendon injury. Like MSK Ultrasound, you can use the imaging daily to track changes, specifically with healthy and injured tissue. While more expensive, the resolution and filtering techniques with cloud software by private vendors is another advantage for elite athletics and professional team sports. Radiation and expense of medical imaging reduces the frequency of use, so alternatives are changing how we approach the frequency of use with medical imaging methods.

In Part 2 I will go over the integration of the three methods with some professional athletes and world class therapists, and will illustrate how practical the technologies are.

Carl Valle

Carl Valle

Track & Field Coach
Carl is an expert coach who has produced champions in swimming, track and numerous other sports. He is one of the foremost experts in the fields of nutrition and restoration.
Carl Valle

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