World Class Therapy Review – Part 2

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I looked down at my Twitter feed and saw an update of a Physiotherapist from Europe with an update from Indianapolis. My first thought was he was coming from Italy to work with with Danny Granger because of the tendon injury, but then I realized he was getting ready for the NFL Combine after his comments about sprinting tests.Two NFL prospects were tested with Tensiomyography, and yes they were big draft picks. Another twitter update during the same time from RED (Recuperación y Entrenamiento Deportivo) showing a hotel bed set-up. This is a common way to get data on athletes and private medical approaches are the norm in elite sport.I estimated that five to six spaniards alone were in the US testing athletes with Tensiomyography privately, and I expect this to double in the next few months with the Economy struggling and flights from Spain at only 500 Euros.

I would guess only 10 consultants globally have enough experience to properly combine all three data sets – TMG, Thermography, and Elastography because of the software and methodologies needing so much individual expertise. When I visited a therapist who had expertise in soft tissue therapy, the Spanish and Danish experts all agreed to use a collaborative approach with solving a specific injury with a high level hockey player as well as other professional athletes getting treatment. The issue the athlete had was surprising, he was dealing with low back pain and recently had his orthotics removed because the new strength coach was all about barefoot training. After 3 months the athlete developed a bulging disk and was struggling with sports hernia. In fact, 5 of the 8 athletes treated had similar issues, mainly stemming from gait issues and poor training backgrounds.

The first step was Thermography of the Hockey player. I was just a fly on the wall, but the player was imaged with the camera on a table as well as standing. I was impressed that the athlete was imaged both ways as some only do the standing option. This was done to help see that the right foot was getting far less activity and the feet look completely different with the thermogram. What was telling was the adductor and hip area was very different with hot spots. After the image was taken the software was uploaded to Dropbox and Dr. Ortega in Valencia was rendering a full report live. Minutes later the report indicated some interesting trends and then TMG testing was done to cross validate the findings. Often thermograms are not accurate because of capture methods, and seeing the details involved makes me wonder how many consultants are missing problem areas because of poor training. Even certified experts in the US don’t have the right methodologies because it’s not a popular method and requires additional testing to confirm the pattern.

TMG testing was done on the superficial muscle groups. This was very rapid as the consultant used a different tripod to have the sensor lock in place and worked with two additional assistants. One properly trained therapist can do an entire body in 20 minutes, and one muscle group bilaterally in two minutes. Often after baseline testing, only a few minutes a day are needed to track and monitor the progress. It was interesting to see what different people believe in with regards to frequency. Most of the people involved are influenced by the work of Julio Tous, but now new experts are taking things to a new level with his combination of Thermography and other technologies and cloud tools. The excel file was produced and the report was made similar to the Thermogram with a upload to dropbox and a report coming from a consultant in Prague that uses the spanish software. HRV and GSR was taken live with the smart strip, and it was great to see the process was comfortable with the athlete.

Elastography was done earlier to estimate histological changes to tendons and tissue in the area. Filters from the Netherlands were used to estimate repair rates, and all of the information was placed in a dashboard on a custom App. I asked about pricing and got a uncomfortable look of what would be interpreted as a lot of money! After the reports were viewed the final process was allowing the 3 hour soft tissue therapy session to begin. The first hour was light and a 20 minute break was allowed, then 90 minutes of hard work in the areas was done. After dinner another TMG test was done to confirm the craftsmanship of the therapy and the low back area was even on the new thermogram. This process was repeated the next day before the game. The consultants left to the new away game city and the athlete was pain free and felt like he drank a youth potion. While all of this was impressive it left me thinking about what the future will be like for teams in the US.

Manual Therapy still needs to be better with higher paid therapists. You get what you pay for and it’s interesting to see how many good therapist become gurus after realizing that manual therapy is manual labor. Everyone likes talking about activation when rubbing 300 pound lineman becomes too hard. I think a professional football team should outsource 10 therapists during the first 4 days after Sunday games and focus on an hour per athlete per day. This will make a huge impact.

TMG is easy to do, but hard to master, especially without good software. The raw excel files are not easy to read but this is not a problem with all of the reporting options available. I have my own but they are not easy to ready or tufte compliant. Some of the reports now are really helpful for having all parties, including the athletes read and understand the problems.

Thermograms are highly interpretive and contextual and is far harder than TMG. TMG interprets fatigue, stiffness, displacement, and rise time of each muscle group. No need to interpret and the graphs are easy for laymen to follow. Thermograms can get the entire body rapidly but need software outside the manufactures native stuff because it’s so engineering based. Third party vendors are growing and the best stuff is in Spain.

Elastography is key to see issues with repair over weeks. If something takes 6-8 weeks to heal, use it each week to benchmark objective change. Functional readiness is highly subjective, and pain is often hard to use as a gage of repair and should not be used. Also blood analysis as well as real time bluetooth HRV are good tools to help gage how the athlete is repairing. A big picture is needed and this requires multiple data sets.

My next post will be an athlete getting a tune-up with therapy and TMG and thermography, and I will provide charts and graphs, as well as thermograms to illustrate how easy it is to use the technology for elite sport.

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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