Skeletal muscles represent 40% - 50% of whole body mass and are therefore one of the largest organic systems of human body. Their influence on other body systems is enormous and because of multilateral connection and dependence on other systems they represent important picture in which, not only local changes, but also general body status reflects. One of nowadays globally widened problems, for example obesity, clearly manifest at muscle atrophy. With implementation of new high tech diagnostic tools and application of new methods for detecting skeletal muscle properties, we monitor one of the most important body systems and broaden information about whole body functioning.

I. Abstract

TMG (Tensiomyography) and its applicable value Tensiomyography is a simple and non-invasive method for measuring muscle properties (contraction speed, and consequently, percentage of fast and slow muscle fibres) and their functional profile/response and adaptation (chronic and acute fatigue and the extent of muscle tissue damage after injury).

How Does It Work Muscle contraction is initiated with an electrical

stimulator. A displacement sensor measures radial

enlargement of the muscle belly. TMG software records the movement and

generates measurement results.

Types of TMG Measurements and The Benefits They Provide

1. Assessment of the initial muscle state (the initial measurement) This helps us to determine the general profile of all muscle groups (distribution of different muscle fibre types), their genetic predisposition, and adaptation potential. These measurements can be used for selecting athletes, optimisation of training, and for elimination of weak links in the kinematics chain.

2. Monitoring changes in muscle performances (contractile properties) during the training process on indicatory muscles The main purpose of this measurement is to determine the influence of training on certain muscle groups. This approach enables us to optimise and individualise training process.

3. Monitoring muscle imbalance These measurements help us to synchronize the muscle activity during training. Consequently, we are able to reduce the risk of injuries that are more likely when there are asymmetries between the left and right side of the body and imbalance between the agonistic and antagonistic muscle groups or between synergistic muscles.

4. Monitoring posttraumatic recovery Because of its non-invasive nature, the TMG method can provide us with useful information about the extent of damage to the injured muscle. Obtained information can than be used to determine the type, intensity, and frequency of training in order to make the recovery quicker and more effective.

5. Optimisation of training (Speed development, Strength development) With TMG we can evaluate local muscle fatigue and monitor individual muscle recovery back to the initial state. This enables us to determine the level of local muscle fatigue compared to the initial state. TMG helps us to evaluate fatigue process (basic phenomena of all sports) more accurately than other known methods, as lactate measurement and different types of force measurements. TMG measurements can also help determine the optimum knee joint angle that is important for the optimisation of the strength training protocol (selective development of hypertrophy of fast twitch fibres or maximal total hypertrophy).

II. What is TMG?

TMG is newly developed, original method for measuring contractile properties of skeletal muscles. It was developed as a diagnostic tool in medicine (monitoring of post operation and rehabilitation process), but soon became one of the most accurate ways to determine muscle status at selection of young talents, at professional and recreational sportsman and at patients with muscle pathologies.

Its main benefits are: Non-invasiveness: the measurement is not painful; Selectiveness: we can measure muscle groups, isolated muscle and but also different regions of

the muscle; Objectiveness: there is no influence of the motivation factor of measured person; Low variability: the variability between different measurements is inside the variability frame of

biological systems; High quality information: the method gives us broad spectrum of information: contraction time

of the muscle, activation level, relaxation time, acute and chronic response on different stimuli (training or rehabilitation protocol);

Simplicity: measurement doesnt require specific laboratory conditions (the equipment is mobile). The results are obtained immediately after measurement.

III. How does the measurement look like?

The measured person sits or lies totally relaxed. Muscle contraction is initiated with short electrical stimuli. A displacement sensor measures radial displacement of the muscle belly. TMG software translates the mechanical movement of the sensor to a time/displacement graph.

Fig. 1: Principle of voluntarily evoked contraction When skeletal muscle contracts, its middle part (muscle belly) is radially thickened.

Fig. 2: At TMG measurement Muscle belly enlargement is achieved with electrically evoked contraction. There is no influence of motivation and the method is highly objective.

IV. Measurement results

Measurement results are presented as time/displacement curves, where muscle belly enlarges due to muscle contraction.

Td, Tc, Ts and Tr are TMG based parameters.

With respect to parameter Tc measured muscles are classified into slow or fast twitch muscles.

Fig. 3: TMG based parameters: (Td) delay time is time between 0% and 10% of the maximum value of the muscle response (dmax); (Tc) contraction time is time between 10% and 90% dmax. Correlation between this parameter and percentage of Type I muscle fibres is statistically significant.; (Ts) sustain time is a period of time in which TMG response remains greater than 50% dmax; (Tr) relaxation time is time in which the TMG response decreases from 90% to 10% dmax.

1. BASIC MEASUREMENT

PURPOSE: Basic measurement determinate muscles fibre types; detect muscle imbalance and old unhealed injuries. When comparing parameters of different muscles, we defer two types of symmetry: lateral and functional. Muscle pairs which have the symmetry between the contraction parameters at least 80% or higher, count for balanced. Under the limit of 80 % we talk about imbalanced muscles, which should be treated with special complex of exercises for strength and activation.

GOAL: Test enables us early disclosure and prevention of asymmetries, which could develop in serious injuries. The goal of this measurement is to diminish or totally reduce muscle imbalance.

BENEFIT: Bringing muscles back to balance!

1.1. Functional symmetry: Comparison between contractile properties of the antagonistic muscles, for example: comparison between quadriceps m. and back hamstring m. Functional symmetry is especially important in sports with predominant cyclic movement and high importance of speed component (sprint, football).

We also check the symmetry between synergistic muscles, which is extremely important for normal function of tendons: patella in knee joint (we check the ratio between contractile parameters of vastus

medialis, vastus lateralis in rectus femoris), achilles tendon (we check the ratio between contractile parameters of gastrocnemius lateralis and medialis).

1.2. Lateral symmetry: Beside the functional symmetry, lateral symmetry (the symmetry between left and right side of the body) is also very important.

This symmetry is especially important at lower back muscles (erector spinae), where asymmetry can influence muscles and joints of lower extremities. We also found out that the back muscles follow asymmetric movement and adapt to it very quickly.

From our experiences we can affirm that most of the examples of lower back pain origins from erector spinae lateral asymmetry. Pathologic changes in muscles usually demonstrate in higher muscle tonus, which causes change in activation level of one or both sides of erector spinae. TMG is the only known method, which enables us separate measurement of left and right side of erector spinae. All other known methods can measure just the ration between back muscles and abdominal muscles.

What can cause asymmetry? Asymmetry can be caused by past injuries, improper training or nature of the sports (where one side of the body is constantly more active: golf, tennis). With 31 million active recreational golf players in USA, we can see magnitude of the problem, if we just focus on one of todays popular recreational activity. What is even more interesting is the fact, that high percentage of asymmetry at average population origins from their working place conditions or from improper body posture.

Asymmetry in every day life Graf shows huge lateral asymmetry of erector spinae measured at professional sports photographer. He travels a lot and he always carries heavy bag with photo equipment on his right shoulder. The erector spinae on left side becomes more endurance and slower, because of compensation of heavy load. In long period of time this asymmetry becomes significant and can develop in chronic lower back pain.

___ Left erector spinae ___ Right erector spinae

Fig 4: With measurements we determine the percentage of asymmetry and proceed this information to the personal trainer. With special complex of exercises we can diminish or totally reduce lateral asymmetry.

2. USE OF TMG IN MEDICINE

TMG is strong diagnostic tool for detecting contractile muscle properties and their changes in time. TMG measurement results describe also functional muscle status. Thats why TMG has enormous advantage in the field of pre-surgery diagnostics and post-surgery rehabilitation and determination of damage that occurs on each, separate muscle. Because of its total non-invasiveness the method can be used immediately after operation. There is no other method that can be used so early in rehabilitation process, because on all isometric machines patient needs to develop some muscle force. TMG is also the only known method that enables us measurement of each isolated skeletal muscle and also different parts or regions of the muscle. From contraction pattern we can easily determine if functional muscle pathology originates from nerve or from the muscle itself.

2.1. Application of TMG in Medicine

Complete biomechanical muscle check up detection of Locus minor resistensis

Diagnostics of pathological muscle changes (muscular or nerve origin)

Muscle status at: Atrophic changes Dystrophies Amputees Patients with plegia Denervated muscles Neuropathies and degenerative changes of lower back muscles (lumbago)

Diagnostics of muscle injuries Lower back pain Prediction of the injury Functional and lateral symmetry of antagonistic muscles and symmetry of synergistic muscles

Optimization of the rehabilitation process

Diagnostics in the field of anti-aging (detection of muscle atrophy)

2.2 Optimisation of the Post-operative Rehabilitation Process

With the TMG method, we: Record basic condition of the muscles before the operation Detect muscle imbalance after surgery Implement the findings during the rehabilitation process and physiotherapy Shorten time needed for rehabilitation

In last years we have monitored professional athletes in the rehabilitation process after knee joint surgery. We found out that not all quadriceps muscles are affected by operation and immobilisation by the same intensity. With detecting the weakest muscle, we can significantly shorten the rehabilitation process.

Fig.5: Measuring of Vastus medialis muscle the most affected muscle after crucial ligament surgery.

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Lateral asymmetry in the knee 4 days after the operation (operation of crucial ligaments took place on right knee joint):

Fig 6: Rectus femoris muscle ___ Right RF Tc = 49 ms ___ Left RF Tc = 24 ms

Huge difference between contraction times talks about lateral asymmetry, which is 59% and is already critical.

Fig 7: Vastus lateralis muscle ___ Right VL Tc = 17 ms ___ Left VL Tc = 18 ms

Vastus lateralis was not very affected by operation. Contraction times on both muscles are nearly the same. There is a small difference in displacement (operated muscle has lower activation level). Lateral asymmetry is 79%, which is on the limit of acceptance.

Fig 8: Vastus medialis muscle ___ Right VM Tc = 22 ms ___ Left VM Tc = 24 ms

There is nearly no difference in contraction times, but huge difference in displacement (activation level). Graph shows that vastus medialis on operated leg has much lower activation level (shows on huge muscle atrophy). Lateral asymmetry is 53%, and is the biggest measured of all three muscles.

Conclusion: In the rehabilitation process main stress has to be directed towards Vastus medialis muscle. To monitor the improvement the measurements should take place every second day.

2.3. Use of TMG in the field of medical diagnostics:

Fig 9: TMG as a complementary diagnostics method. In this case TMG upgrades the MRI diagnosis

The professional sportsman had constant problems with inability of producing the same force on both biceps femoris muscles. MRI showed there was something wrong in the region of L5 S1 vertebra. With measurement of back hamstring on 12 different points (both legs) we could see which part of the back hamstring muscle is non-functional (on 3D graph we can see that on whole region of points {8-9-10-11} the activation is much lower than on healthy region: 1 - 7). From the TMG measurement we could conclude that distal lateral side of biceps femoris has lower activation level and with this information we could exactly determine that vertebra nerve is affected in L5 S1 region.

On 3D graphs we can see initial measurement taken on 17th of July and second measurement taken after first phase of therapy, on 4th of September same year. We can see the improvement of affected region (the level of points from 8 to 11 is a little bit higher).

This case is example of complementary use of TMG with other modern diagnostic methods.

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Before injury Tc=26ms 2 days after, Tc=22ms 5 days after, 12 days after, Tc=22ms

2.4. Use of TMG in monitoring of rehabilitation process after muscle injury (rupture)

The best condition for the quality monitoring of rehabilitation process is that we have muscle status before the injury occurred. If we do not have muscle status of the muscle before injury we can still use other, healthy leg, for comparison. Time tracking shows the reanimation of the muscle and its improvement in activation and structure of activation.

Fig 10: Twelve days after the injury, muscle has the same contractile properties as before the injury. At this point is totally safe for the athlete to start with normal training again.

2 days after injury

5 days after injury

before injury (black curve)

12 days after injury

III. TMG references

Our R&D department is on Electrical Faculty in Ljubljana (University of Ljubljana) in Laboratory for biomedical imaging and muscles biomechanics. We cooperate with many worlds famous research laboratories.

To mention some of them: Istituto Politechnico di Torino, Italia (prof. Maletti) University of Wollongong, Australia University of Craiova , Romania University of Toledo, Spain Stirling University, UK University of Bath, UK University of Seville, Spain University of Ljubljana, Slovenia Manchester Metropolitan University (UK) University of Primorska, Slovenia

Results obtained by TMG method were published in more than sixty original scientific papers and conference proceedings.

Some sport clubs and training facilities that use TMG technology:

FC Barcelona (ESP) Spanish football association (ESP) FC Fiorentina (ITA) FC Almeria (ESP) FC Villarreal (ESP) FC Atalanta (ITA) FC Racing Santander (ESP) FC Dinamo Kijev (UA) FC Livorno Calcio (ITA) FC Bari Calcio (ITA) VF Sport Sevilla (ESP) FC Kelag Karnten (AUT) Athletic federation of Slovenia FC Interblock (SLO) FC Publikum (SLO) UK Sport institute (UK) SIS Scottish Institute of Sport (UK) Austrian Olympic centre Norwegian Sport Federation Olympic committee of Slovenia Football federation of Slovenia Hockey federation of Slovenia

IV. OUR USERS EXPERIENCES:

FC BARCELONA

We use the Tensiomyography (TMG) in the medical department of FC Barcelona for about three years now and we believe that this technique is very useful in the evaluation of the mechanical properties of the muscles during training. We use TMG in the recovery process of muscle injuries where it helps us to make right decisions on the performance improvement in the regeneration process after muscle injury. These measurements taken during the healing process of muscle injuries help us to bring injured muscles in the normal state as fast as possible.

Dr. Jordi Ardvol i Cuesta Head of the medical department of the FCB

DR. JOERN RITTWEGER (Professor of Clinical Physiology, MMU Cheshire )

TMG is a promising technology which I want to apply in various research projects in the future. My current use is centered around the differential effects of ageing and disuse upon the musculoskeletal system. As a non-invasive technique, tensiomyography can be easily applied in most of my studies

GIANPIERO VENTRONE (Former first team fitness coach: FC Juventus, FC Livorno, FC Bari)

The Tmg is a valuable tool. We have used it to make microscopic assesment, but it can be also valid for macroscopic measurements. We had good results and will certainly continue to use it in the future.

FC Fiorentina is the first coustomer where we are also involved in injury preventions. We developed special services and also new sensors in order to gain all neccesery information.

TMG method and brand name is patent pending and is the property of:

TMG-BMC d.o.o. Tbilisijska 59 1000 Ljubljana SLOVENIJA

http:// www.tmg.si e-mail: info@tmg.si