So I had some long standing cartilage damage to my left knee. I went to the surgeon at the BMI Runneymede and had Xrays and MRI's taken which showed that I had medial cartilage damage from poor liftng technique, a small cyst and a lateral femoral tear that seemed to go down to the bone. The surgeon informed me that he could tidy up the torn cartilage and remove the cyst without any problems, but if the lateral tear did indeed go to the bone that he would like to do some microfracture surgery to repair.
I hadn't heard of microfracture before so I started reading around and although it has been around since the late 80's it is still a work in progress. It was actually developed by Richard Steadman, founder of the Steadman Clinic. The basic idea is that if you can make bone bleed the blood is rich in mesenchymal stem cells that can become a number of tissues. So special tools are inserted into the bone to create a rough, broken surface, deep enough to cause bone bleeding. A super clot or blastema then forms over the damaged bone, the bone heals and also new cartilage grows to cover the operated area.
Although new tissue will be formed in 6 weeks there is a long process of tissue remodelling that is required to cause the tissue to become what is required. Articular cartilage that covers the ends of bone is strong and elastic so it can last and absorb the impact forces it is subjected to. Unfortunately the new cartilage that formed during the early years of this technique was fibrocartilage, a much stiffer and less robust cartilage. It seems the great progress in the last 20 years has not been in surgical technique but in rehabilitation. Actually doing the right things to tell the tissue what it needs to become is the main focus of rehabilitation. Unfortunately the physio dept. at the Nuffield Woking seemed only to want me to be walking again and that was the limit of their care.
So post surgery I was non-weight bearing on the left leg for 6 weeks. Not a pleasant experience but it certainly grew my respect for those who use crutches on a daily basis. I was told by my consultant only to do mobilisation exercises for the 6 weeks. This didn't seem consistent with what I was reading so I decided to take control of my own rehab. For 2 weeks I only did mobilisation to get the full range of motion. After that I bought a cycle exerciser from ebay (an exercise bike is fine but place no resistance through the wheel) and started doing 5 mins of cycling twice per day as well as my mobilisation exercises. I very slowly and carefully and watched how my body responded to gauge what was too much. Any swelling or discomfort I took as my limit, when I could complete that without any symptoms I increased the duration. Eventually I built up to 40 mins of unloaded cycling per day.
Another technique I used was Revitive: Circulation Booster. This is a device I have worked on and I had one so I thought I know it improves circulation so it should speed my recovery. I used this 2x per day for 20 mins each time. Again building up the intensity as I got used to it. I would perform my mobilisation exercises after using Revitive: Circulation Booster as I found that I could get much larger ranges of motion after my leg was warmed up. Within a month I had full range of motion back in my leg. I did suffer from swelling in the leg and Revitive: Circulation Booster quickly removed this.
I also kept using my aerosure: youbreathe training device to keep my lung performance up to speed and this helped a lot especially whilst on crutches.
So 6 weeks came and went and when I went back to the surgeon he was very happy with the condition of my knee, full ROM and no pain or swelling. So he took my crutches away and sent me back to physio. I decided to move physio to a team I had used before, Balance Physiotherapy in Clapham North. I saw a knee specialist Paula Coates and she started me on a programme of knee strengthening and flexibility. I cannot jog till next year but I am back swinging my kettlebells which was the main aim for me. I am getting stronger and fitter by the day and knee feels great, very smooth and little discomfort. One important thing Paula added to my rehab is stretching as the quad had shortened from lack of use, getting the muscle back to normal length has been hugely helpful.
The links to some interesting research are here:
Pulsed ultrasound
Pulsed ultrasound observational study
LIPUS in rats
Microfracture rehab 1
Microfracture rehab 2
In my next entry I will describe my nutritional and supplement strategy.
Tune in!
Showing posts with label youbreathe. Show all posts
Showing posts with label youbreathe. Show all posts
Tuesday, 17 July 2012
Monday, 17 December 2007
Targeted Vibration Training
Introduction
Vibration stimulation is gaining popularity as a neuromuscular training method with the potential to elicit muscular performance adaptations similar to those produced by explosive strength training. Studies on vibration have shown transient increases in muscle power output and chronic strength enhancement and significantly improved gait and body balance in elderly people. In addition, whole body vibration induced positive adaptations in peripheral blood circulation (increased blood volume and speed of blood flow), probably due to decreased blood viscosity and peripheral resistance and arterial vasodilatation. Additionally, vibration has the potential to activate large amounts of musculature during a movement, and appears to inhibit activation of antagonist muscles which would decrease the braking force during a movement. Other studies have shown that vibration may be able to
influence the excitatory state of the peripheral and central structures of the brain, which could facilitate subsequent voluntary movements.
Targeted Vibration Training
Due to the conflicting results and potential side-effects of whole-body vibration, applying the vibration directly to the exercising muscle only has demonstrated performance gains more than 300% greater than conventional training. Therefore, researchers Dr Mileva and Dr Bowtell hypothesised that vibration applied during a single resistance-training session would promote larger acute increases in strength than those induced by an identical session performed in the absence of vibration. It was further hypothesized that vibration stimulus would provoke a greater response when training at lower contraction intensity, where a smaller percentage of muscle fibers would be voluntarily activated. To accomplish this, researchers compared the acute effects of vibration stimulus during and after high- (70% of one-repetition maximum (1RM) and low intensity (35% 1RM) knee extension exercise.
Methods
Nine healthy male adults completed four trials on a knee extension machine (Technogym UK Ltd) either with (Vibrex, Exoscience Ltd) or without superimposed vibration at low (35% 1RM) and high (70% 1RM) contraction intensities.
Results
The main finding of the study was that vibration applied during knee extension exercise improved the mechanical performance of the quadriceps muscles, as manifested by increased dynamic muscle strength and power. Additionally, peak torque was significantly higher during the vibrated than the nonvibrated trials.
The improvement in strength and power after vibration training could be explained by the finding that the median frequency of the quadriceps muscle electrical activity was significantly higher in the vibrated than nonvibrated trials. This suggests that vibration increases muscle fiber conduction velocity and/or increased recruitment of muscle fibers with faster conduction velocities such as fast powerful muscle fibres.
A very novel finding from this study is that superimposing the vibration-like stimulus during low-intensity exercise simulates the response induced by higher-intensity exercise, evidenced by increased electrical activity in the quadriceps muscle.
The increase in contraction force implies that reflex feedback from the muscle receptors in contracting muscle is increased. One might expect such increases in exercising muscle activation level to elevate the oxygen requirement, and vibration tended to increase the rate of muscle deoxygenation during exercise, which is indicative of increased oxygen utilization.
Conclusions
Neural adaptations are the earliest changes that occur in the exercised muscle (first 3–5 wk of a training
program), permitting gains in strength and power without significant increase in muscle cross-sectional area. The acute enhancement of neuromuscular performance following vibration is probably related to an increase in the sensitivity of the stretch reflex. This would result in more rapid activation and training of a larger number of high-threshold motor units. Vibration-induced discharge of the muscle receptors also recruits previously inactive motor units into the contraction, as well as re-recruiting motor units that are already fatigued, and even increasing their firing patterns.
It is also an intriguing possibility that a chronic vibration training program may potentially increase the neuromuscular adaptations arising from light/moderate training. This would be of importance for individuals, such as the elderly, osteoporosis and rehabilitation where people are unable to complete more intense exercise programs.
Vibration stimulation is gaining popularity as a neuromuscular training method with the potential to elicit muscular performance adaptations similar to those produced by explosive strength training. Studies on vibration have shown transient increases in muscle power output and chronic strength enhancement and significantly improved gait and body balance in elderly people. In addition, whole body vibration induced positive adaptations in peripheral blood circulation (increased blood volume and speed of blood flow), probably due to decreased blood viscosity and peripheral resistance and arterial vasodilatation. Additionally, vibration has the potential to activate large amounts of musculature during a movement, and appears to inhibit activation of antagonist muscles which would decrease the braking force during a movement. Other studies have shown that vibration may be able to
influence the excitatory state of the peripheral and central structures of the brain, which could facilitate subsequent voluntary movements.
Targeted Vibration Training
Due to the conflicting results and potential side-effects of whole-body vibration, applying the vibration directly to the exercising muscle only has demonstrated performance gains more than 300% greater than conventional training. Therefore, researchers Dr Mileva and Dr Bowtell hypothesised that vibration applied during a single resistance-training session would promote larger acute increases in strength than those induced by an identical session performed in the absence of vibration. It was further hypothesized that vibration stimulus would provoke a greater response when training at lower contraction intensity, where a smaller percentage of muscle fibers would be voluntarily activated. To accomplish this, researchers compared the acute effects of vibration stimulus during and after high- (70% of one-repetition maximum (1RM) and low intensity (35% 1RM) knee extension exercise.
Methods
Nine healthy male adults completed four trials on a knee extension machine (Technogym UK Ltd) either with (Vibrex, Exoscience Ltd) or without superimposed vibration at low (35% 1RM) and high (70% 1RM) contraction intensities.
Results
The main finding of the study was that vibration applied during knee extension exercise improved the mechanical performance of the quadriceps muscles, as manifested by increased dynamic muscle strength and power. Additionally, peak torque was significantly higher during the vibrated than the nonvibrated trials.
The improvement in strength and power after vibration training could be explained by the finding that the median frequency of the quadriceps muscle electrical activity was significantly higher in the vibrated than nonvibrated trials. This suggests that vibration increases muscle fiber conduction velocity and/or increased recruitment of muscle fibers with faster conduction velocities such as fast powerful muscle fibres.
A very novel finding from this study is that superimposing the vibration-like stimulus during low-intensity exercise simulates the response induced by higher-intensity exercise, evidenced by increased electrical activity in the quadriceps muscle.
The increase in contraction force implies that reflex feedback from the muscle receptors in contracting muscle is increased. One might expect such increases in exercising muscle activation level to elevate the oxygen requirement, and vibration tended to increase the rate of muscle deoxygenation during exercise, which is indicative of increased oxygen utilization.
Conclusions
Neural adaptations are the earliest changes that occur in the exercised muscle (first 3–5 wk of a training
program), permitting gains in strength and power without significant increase in muscle cross-sectional area. The acute enhancement of neuromuscular performance following vibration is probably related to an increase in the sensitivity of the stretch reflex. This would result in more rapid activation and training of a larger number of high-threshold motor units. Vibration-induced discharge of the muscle receptors also recruits previously inactive motor units into the contraction, as well as re-recruiting motor units that are already fatigued, and even increasing their firing patterns.
It is also an intriguing possibility that a chronic vibration training program may potentially increase the neuromuscular adaptations arising from light/moderate training. This would be of importance for individuals, such as the elderly, osteoporosis and rehabilitation where people are unable to complete more intense exercise programs.
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