I wrote my original article on tensiomyography (TMG) to make sure people knew what the technology was, but this piece is different. Instead of just exposing people to what the readings could do for sports medicine and sports performance, I wanted to tackle the science and practice at a deeper level. If you work with elite performers and don’t have the equipment or access to testing services, you should. However, even if you don’t have TMG at your disposal, you need to think like a practitioner who does have access to the system.If you work with elite performers, you should have TMG equipment or access to testing services. CLICK TO TWEET

In this article, I cover the populations and subject matter that anyone in human performance will want to know, especially the following:

  • How to observe neuromuscular trends in sport and tactical athletes.
  • Why profiling with tensiomyography works well and how to replicate the studies.
  • Where tensiomyography fits into a high-performance team environment.
  • Who may benefit the most from monitoring and what rhythms of assessment are realistic and practical.
  • What are the limitations of the technology and when to combine options for better outcomes in applied settings.

As you can see, the article is far more in-depth than the first one, and I encourage you to read the original blog before getting started. If you are familiar with TMG, know enough to understand the fundamentals, and want to skip around, feel free. Each section of this article can be read independently, but it’s wise to read the entire piece to appreciate the power of the instrumentation. While one research study may be the soul of a section, think of all the examples as short case studies.

Decoding Neuromuscular Performance of the Body

Central nervous system (CNS) fatigue is a bit of a mystery, as some research shows conflicting patterns in the response to intense training. Coaches have anecdotally seen a pattern where athletes seem to respond slowly, systemically, even if their legs (peripheral nervous system) feel recovered. Some research found the opposite pattern, where the higher centers were recovered but the local muscles seemed to still need time to recover. My conjecture is that this is more complicated than two systems simply not in agreement, and this is the reason I look at both TMG readings and specific training data.

For example, I look at peak velocity of chest medicine throws now, as they require very little skill and correlate well with bench press power. I would not look at load velocity or force-velocity relationships with a soccer player utilizing a bench press, but I would with an NFL cornerback if I could get data from TMG. Upper body fatigue in speed and power athletes isn’t a crystal ball for CNS fatigue, but when you look at the trends compared to lower extremity data, it is compelling. Superficial profiling of pressing muscles and barbell velocity transforms a strength and conditioning program into a high-performance monitoring program.

Blood analysis is great for early evaluation or higher frequencies if the athlete is compliant, but honestly, weekly assessments like some clubs do is really not a good idea. If you would not find value in a monitoring program with Olympic sport, don’t try it with team sport. Not only is it not realistic because of cultural differences, but the ability to really identify the cause and effect isn’t there.

For example, a recent study looking at eccentric damage and blood biomarkers was promising, but the key issue with interpreting creatine kinase (CK) is understanding that the measure is a cardinal sign of eccentric damage, not a trend in recovery. While I like the correlations to CK trends, it’s too crude of a relationship to see a perfectly direct cause and effect. I have written about the limitations of CK monitoring, but adding in a panel is super cheap, so if you can test athletes with blood biomarkers, toss it in so you can tease out more from the process.

TMG CK Chart
Image 1. Creatine kinase requires other data points to ensure that the interpretation of what is happening internally is relevant. Tensiomyography is a promising solution for monitoring athletes without invasive sampling of biomarkers.

Most rehabilitation programs are nearly interchangeable with conventional strength training programs, especially at the end of return-to-play phases. In the past, most therapy sessions were disproven modalities or painfully low intensity sessions that had no hope of really restoring power that was lost during resting or immobilization. Now, we are seeing a rise in flywheel training thanks to Julio Tous and other practitioners, and they include TMG.

If an athlete does get injured, I think tensiomyography is one of the best complementary tools you can use. Unlike imaging, neuromuscular function is far more interesting with regard to discharging athletes. Of course, you will need to use outcomes like sprinting, jumping, throwing, and actually playing, but TMG is worth consideration by any high-performance organization.Tensiomyography is potentially useful to quantify damage patterns after exercise interventions. CLICK TO TWEET

As the researchers concluded, tensiomyography is a potentially useful way to quantify damage patterns after exercise interventions. I believe you can go a step further by showing how different forms of damage trend with small groups of athletes when using subjective questionnaires, autonomic nervous system monitoring, and central fatigue readings. You will be surprised by what you find, as I see rapid yet incomplete restoration of the central side of the nervous system, but your program may find a different pattern.

Drilling Down to Profile Relationships of Power and Muscle Groups

I never thought I would get excited about a Wingate test with Olympic rugby athletes, but I was most impressed with the potential to see narrow differences within a population of elite athletes. In the study, the researchers tested three anterior thigh muscles, compared their tensiomyography readings to their peak power output (PPO), and found an intriguing relationship. The better performers had specific patterns of neuromuscular characteristics with their vastus lateralis; namely, the delay time with the muscle contraction. I was excited because the statistical confidence was high enough that it could be used in modeling performance for other tests, such as jumping and sprinting.

When I invested in testing a soccer academy with TMG a few years ago, we did an enormous amount of field performance testing along with neuromuscular evaluation. We found that hamstrings that were anatomically tighter and larger, and that tested stronger, had perfect relationships to a few TMG parameters. Years later, athletes with hamstring parameters that performed higher were playing and it was interesting that their speed was a part of their offensive game.

My conjecture here is that we shouldn’t be afraid to test athletes with lab-standard technology, but we really want to add tensiomyography to help give explanations for why athletes are likely to perform well or get injured more frequently. With this study on elite rugby, I think it’s a good idea to focus on muscle structure and neuromuscular performance to see how individuals adapt, and not use TMG for talent identification alone.

How High Performance Environments Use TMG Creatively

A few times in other articles I showcased how tensiomyography was used to show recovery and activation activities with progressive users. The best example was foam rolling, or self-myofascial release techniques. When research comes out, it’s easy to hope the intervention prescribed by the science team can be easily inserted into practice without evaluating the outcome. However, it’s not a good idea to assume the results of a study, whether positive or even negative, will hold true in your own environment. Therefore, I encourage coaches in high-performance environments to make their own science by replicating the studies.Don’t assume study results will hold true in your own environment—try to replicate them yourself. CLICK TO TWEET

Image 2. Simple interventions—like foam rolling—do work, but they are limited and specific. Tensiomyography offers a huge value with internal experimentation to help get more out of interventions and know what emerging ideas may not prove beneficial.

The unique value of foam rolling is mainly the cost and scalability of a small intervention. For a very small investment, an athlete can do a few transient modifications to their legs for training or recovery, depending on the sequence and specific needs. Several researchers have investigated the benefits and physiological effects of foam rolling, but most of them included field testing or a very primitive evaluation of tissue.

Tensiomyography readings of foam rolling aren’t really exciting, but the truly interesting finding is using the study design for other equipment options such as compression treatments and vibrational therapy. For example, the amount of interest in the Theragun and Hypervolt is staggering, mainly because they create a dermal experience that feels good to athletes, but the physical effects are unknown at this moment. Tensiomyography helps decipher what is happening when novel options are available, allowing coaches to investigate their own athletes and environments.

The above research study on foam rolling from the Scottish group was a great example of how colleges can scale with simple internal experiments. A few years ago, Landon Evans demonstrated one of the best applied solutions for modality evaluation by using TMG. His findings were interesting because they really replicated a lot of what was believed to be true, giving me confidence to know that, while foam rolling has value, it could be used later after training and with specific muscles. It’s frightening to see some of the extensive foam rolling protocols from a decade ago, as they were arbitrarily prescribed based on the notion that applying pressure would automatically help an athlete. Now, after dozens of research studies, we see the limitations and benefits of foam rolling, but adding TMG really removes a lot of the guesswork.

Rhythms of Monitoring and Modeling in High Performance

Henk Kraaijenhof has a great mantra—“train as much as necessary”—and the same can be said for tensiomyography. If you are worried about injury, focus on the high-risk areas or the areas that are difficult to evaluate with other means. The best example is the NFL with hamstring injuries to players, especially athletes who run faster and farther. Small clubs with a few stars, such as baseball’s minor leagues, want to protect investments, so they are more interested in longitudinal data with a few athletes than large populations where many of the players are there to help develop a small number of talents. With talent that can be traded or brought in from free agency, the value of player development in baseball is sometimes overinflated, but the investment is skyrocketing today.

ACWL TMG Infographic
Image 3. Fatigue is not just a line plot of acute chronic work ratios (ACWR) over time. It’s actually a fractal-like pattern with various systems of the body, ranging from the autonomic system to an individual bone in the foot.

Remodeling requires stress and recovery, and coaches who can improve the resolution of their training programs will really take a step forward with training and competition programming in a few years. We already see this with some of the work by Sam Robertson and Martin Buchheit, but they spend most of their time with player tracking and physiological data, not on the sports medicine realm. Those in the medical arena need to work more with biomechanical researchers, start focusing on anatomical areas that are at risk, and integrate their data.

In the long run, coaches are going to need machine learning and other forms of artificial intelligence (AI). While I cringe when I have discussions with coaches about the subject, some clubs and organizations are already doing this at high levels because they need to. When an organization is truly running on all cylinders because of data collection, analyzing it becomes really interesting.The key to TMG and any other data set that requires measurement is to use a sustainable rhythm. CLICK TO TWEET

Thus, the key to TMG and any other data set that requires measurement is to use a sustainable rhythm. Ideally, this means a preventive audit could catch potential problems, but the likelihood of this happening is slim unless there’s a daily rhythm. An alternative is running short screening periods during heavy training phases, knowing that it’s not a sustainable process but the information gleaned can be used later.

This Spanish TMG study with futsal players is an example of getting more out of conventional repeated sprint tests, which are fair assessments of athletes in team sport. I was pleasantly surprised when I found out David Bishop was involved, as his pioneering work with mitochondrial studies, as well as repeated sprint ability, gave me confidence that the information had bite. Using this study is a great way to build a small model with very specific interventions, and gradually expand to meet a wider and deeper demand.

Combining Tensiomyography with Other Technologies

One of my favorite examples of combining technology comes from the turf research utilizing natural grass and comparing it to synthetic grass. At first glance, the research may be a little confusing, as some surfaces test differently with athletes. When utilizing tensiomyography monitoring or testing, it’s convenient to want to believe that one instrument will tell the whole story, but when combined with other sensors, such as IMUs and pressure mapping, a clearer picture is available to coaches and support staff.

Tensiomyography is very powerful when professionals want the neuromuscular response to training or competition, but it’s not a live or real-time product. The inclusion of pressure mapping can determine how specific footwear and surfaces are interacting with the athlete, and TMG is excellent to see if the accumulation of work has indeed created a pattern. While this study didn’t show any neuromuscular cost after the simulated play, it’s not saying that the interaction is acutely the same with all of the surfaces.Using TMG as a diagnostic tool requires clinical experience, but an injured muscle is very clear. CLICK TO TWEET

Fusing technologies is like pairing wine; individually, it’s far easier to select, but it takes a bit of sophistication to truly extract the best from both simultaneously. In my Kinetics Manual, I embedded the Electromedicine Triad and the concept really caught on with a few clinics working with complex injuries. The first capitalized on electromyography as an estimation of activity, and some went straight into electrical muscle stimulation without really understanding the ramifications of workload on actual muscle. The solution? Tensiomyography. Using TMG as a diagnostic tool requires clinical experience and outside decision-making, but an injured or exhausted muscle will be very clear in the readings and will not require advanced statistics.

When reading research and no pattern or correlation is found, don’t assume the true limitation is the machine or metric—it’s usually the absence of additional information that creates context and a better perspective. Using tensiomyography alone will result in a dramatic improvement in the outcomes of return-to-play programs and athlete development systems, but combined with other data sets, the cliché-sounding synergy is too good to give up.

Learn from Science and Your Peers

Science is not the enemy and is far from perfect, mainly because it’s still a human process. It’s not that we should ignore science, but it’s just one part of solving problems. Most of this information is not my opinion, but me sharing information from some very bright researchers using TMG in ways it can help practitioners.Think about integrating TMG if you need deeper insight into common human performance problems. CLICK TO TWEET

Tensiomyography is an investment, as it’s a medical-grade device and requires a time outlay to leverage its power. It can bring a lot of value to colleges, teams, hospitals, and private facilities. I recommend reading the new research that was posted in 2018—much of it is open access—and think about integrating the technology with people who need deeper insight into common or complex problems in human performance.

A true love for sports

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