World Class Therapy Review – Part 3


In this installment I wanted people to see the science behind Tensiomyography, so we can understand how this helps sports medicine and how science can help drive innovation with coaching in the sprints. The questions received from users were heavy on that metrics can one get from TMG and how can this help rehabilitation and training. The sensor can pick up the small individual dynamics of the superficial muscle. In the chart, a graph illustrates a muscle contraction and how one can drill down, similar to pressure profiles with gait data. Coaches and therapists are interested in how the muscle responds to soft tissue treatment and loading from a neuromuscular perspective. If one has all the data, such as HRV/GSR as well as Thermography and Elastography, one can start seeing how training and therapy is helping. Often the wrong mix of accelerated therapy and training can render an athlete getting additional imaging to see what failed. Add in good blood analysis and other novel data sets, the cold and effective process of elimination can start solving deep root issues instead of trying to mask symptoms.

The reason TMG is so valuable is that functional diagnostics are different than structural and histological findings, and help create connections in why something is responding or failing to respond. For example one contraction can show delay time, displacement, relaxation time, and contraction time. Those four variables are game changing, especially in sports that are hard to quantify such as baseball, tennis, and squash. Unfortunately the US is slow to adopt technologies as many therapists are focused on getting stone age and civil war tools to scrape athletes, as the poor man’s PRP is overhyped. When drilling down to a lot of muscle groups, you can see patterns of how athletes may be struggling to get recruitment in muscle groups, or guarding by over-recruiting some muscles. After a 20 minute baseline, a few minutes a day can track changes (expected or not) of what is going on with the body.

Dr. Maffiuletti’s work with neuromuscular training created a interesting table that connects HRV and the Trinity of EMG, TMG, and Electrical Muscle Stimulation or EMG. Therapists knowing that eventually interventions are the real currency, therapeutic units, or measurements of repair or functional return, are what people are looking for with modern sports medicine. EMS is a bridge or scaffolding solution to a gait or joint dysfunction issue, but surface EMG is more biomechanics and biofeedback in nature.

A good case study is a soccer player with a hamstring issue that was having some sports hernia symptoms. I have been seeing a lot of core training and psoas problems with those that are doing way too much isolation and loading exercises. I am not for or against any specific methodology, but if patterns of injury occur from one specific approach, we need to have objective evaluation of what is working and what is causing problems. For example several teams in the EPL are doing way too much unstable surface and bosu work, creating a myriad of injuries. When stability work is loaded too much, muscles are taking over for groups that are prime movers, creating some very problematic patterns. SAID principle is real, and the wrong imposed demands leads to adaptations specifically that are not ideal. The athlete in question was working with highly public coaches who have products and education involving sports training and corrective exercise. After two years, the same adaptions in morphological changes and neuromuscular programs still existed, frankly because nobody was taking great notes or testing properly. Some complex problems are created because people are too smart, and start tinkering with trendy therapy options and radical interventions.

The athlete was a high level soccer player struggling with a few nagging issues. What was great was he fully recovered from a hamstring tear that looked like a cyclone on the MRI after receiving cyriax work and work with a therapist that teaches with Thomas Myers. The fascial work was simple, and muscular function improved dramatically. One issue was of course playing a sport year round and fitness decay and that’s why I find that Mujika’s research on detraining to be so valuable. The athlete improved joint function but power and condition was compromised, thus reducing his buffer zone. No matter what score one has on the FMS, injuries will come when one is not strong enough or fit enough to play.

My primary concern is that athletes are not getting enough hands on therapy and that data is not being fed back to the coaches and performance staff. When data of therapy zones and indices are shared, coaches can evaluate training programs based on referred and objective data such as TMG profiles and Thermograms. Nothing beats a movie clip of time lapsed TMG and Thermograms on a time line. Thus we can see patterns over time and audit decisions based on those time frames. The soccer player receives a lot of therapy in three or four days to get problems worked out fully, not just good enough to return but to exorcise the demons if you will. During the four days, the athlete received hours and hours of therapy all over the body, as the fascial system is connected everywhere. While it would be nice that rolling tennis balls on the soles would fix neck problems, it’s usually the other way around that one problem creates a cascade of small problems like a virus.

Going deep without bruising is the name of the game. No matter what someone says about parasympathetic responses or magic hands, if the tissue is not rubbed properly it will not function well. Gently applying pressure superficially isn’t going to work for issues that are very deep, and the nervous system relaxing isn’t fixing everything. HRV is nice, GSR has merit, but imaging medically is the king with repair. Too much talk about ANS on twitter when injury lists look like war monuments. Regeneration is likely to be the ability to have pain free and gliding tissue with eccentric loading. Rubbing scar tissue does not break it down, but I have seen plenty of MRIs that show reductions likely because the tissue became malleable and functioned at close to norms (as measured by TMG now) and eccentric actions replaced tissues that were not scar but had some replaced myofibrils that needed to be remodeled. I am not sure what is happening, but scars are reducing from deep tissue and training, so something in that combination is working. I have seen the opposite with Graston and other civil war tools with inflammation patterns looking like spanish inquisitions without any structural changes. Good therapy can be evaluated in multiple ways without muscle range of motion and isolated dynamometer work.

In Part 4 I will review the details of the sessions and Thermograms/TMG reports like promised, but I felt it was good to share some of the science and personal experiences observing therapy and common trends in 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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