Here is the original letter:

<< I’ve just been awarded a research bursary and am planning to investigate
the possible link between hamstring strength and core trunk stability. I’m
planning to measure concentric/eccentric hams strength intially, send
subjects off to do hams strength work, transversus abdominus strength work
and placebo exercises. I’ve been able to get lots of literature re hams
strength, transversus abdominus (mainly Hodges, Jull and Richardson) and hams
injury prevention. What I haven’t been able to get is much information on
hamstring/muscular trunk control interaction. Anybody out there able to point
me in the right direction? >>

Here is my response:

***Just a small point about which I have written before – how does one assess
“core stability” statically or dynamically under conditions in which
peripheral stabilisation does not play a significant role in the overall
stabilisation process or confound the results? For instance, if one wishes
to assess “core stability” in a standing position, then how do we rule out
the major role played by the lower extremity musculature in the process?

Moreover, stability is not necessarily a result of adequate strength, but the
amount of “strength”, force or torque exerted at crucial stages of joint
action throughout any given movement. If someone produces inappropriate
patterns or timings of motion, then, no matter how strong a given muscle may
be, then stability will be severely compromised. This point often seems to
be forgotten in many studies of relationship between injuries and muscle
strength. Though the intrinsic strength of a muscle may be adequate in the
execution of a given task, it may not be utilised efficiently in that or
other tasks.

Moreover, if strength is adjudged to be adequate as estimated by static or
isokinetic tests in a given action, this does not imply that strength under
other conditions will be adequate. We simply cannot ignore the vital fact
that strength is not only the result of muscle action, but of neuromuscular
facilitation in response to specific stimulation in a given motor task. It
is not valid to extrapolate findings from isolated joint testing to a process
as multifactorial as dynamic stabilisation.

In this regard, articles such as the following can be very revealing:

Zajac FE & Gordon MF(1989) Determining muscle’s force and action in
multi-articular movement Exerc Sport Sci Revs 17: 187-230

Andrews JG (1985) A general method for determining the functional role of a
muscle J Biomech Eng 107: 348-353

Andrews JG (1982) On the relationship between resultant joint torques and
muscular activity Med Sci Sports Exerc 14: 361-7

What does all of this imply for the researcher? Well, it means that the
research protocol, and possibly the title of the project, needs to be devised
very carefully to take these problems into account. One has to be especially
careful as to how one defines and measures “stability”, especially the
“stability” of a portion of a dynamically linked system. So far, I am not
very convinced that many researchers are adequately addressing this problem -
maybe you could take a significant step forward to rise above the
perpetuation of some dubious traditional and relatively unchallenged
hypotheses. Best wishes in your task!

Mel Siff
Denver, USA
Mel Siff Dot Com
Supertraining Twitter Feed

You may recall a post on the value of belts in lifting which requested that I
review a series of articles which Paul Chek, a regular speaker on the fitness
circuit, recently wrote on the subject in Testosterone emag (see the archives
of the Supertraining eGroup). Relying on some rather dubious biomechanics
and clinical anecdotes, he deduced that all belt usage is detrimental to
lifting. Well, he posted some rather unhappy reactions to my review on
another weights user group. In one of these letters, he stated:

<<In summary, it is not a case of believing in the belly button “going in, or
going out”, it is a case of the order of events. If the body functions
correctly, segmental stabilization via the inner unit will prepare the system
for force generation. This is why I often say in my lectures, “in order for
the musculoskeletal system to stay healthy, stabilization must always precede
force generation”. >>

My response may be of interest to some of you:

*** “It is totally incorrect to state that stabilisation precedes
mobilisation. Neither is this taught or applied clinically in physical
therapy (e.g. in the application of PNF, Bobath etc), nor is it supported by
scientific research into the mechanisms of motor control. The annual
series of Bernstein memorial lectures on motor control offer just one source
of an extensive body of information which shows that stability is established
via ongoing feedback or error-correction processes acting on a foundation of
ongoing, varying levels of movement. If you have information to the
contrary, then you would be able to revolutionise the entire world of control
theory, not only in biology, but also in aeronautics, space exploration and
many other fields of human endeavour. And you would become an enormously
wealthy man in industry! ”

It is important to note that a system that is completely stable or following
a precisely described regular pattern (e.g. an unmodulated sine wave) carries
no information, so that it becomes very daunting to try to control a system
that tells you nothing about its current state. It is also fairly well known
that systems which are very close to equilibrium can display catastrophic
changes of state in response to very small perturbations (e.g. see work on
non-equilibrium systems by Nobel Prize winning scientist, Ilya Prigogine).

The process of stabilisation is by no means as simple and clearcut as Chek
seems to imply. Once again,this stresses how important it is for public
lecturers and authors in the fitness and training world to understand the
science behind the ideas and methods that they are trying to teach, sell or
apply.

Mel Siff
Denver, USA
Mel Siff Dot Com
Supertraining Twitter Feed

Dr Mel Siff and a Supertraining Yahoogroup member going back and forth

<If you hit bounce off the box correctly you will not experience any problems
with the lower back. The bounce needs to be make on the hamstrings and not
directly with your butt. If you perform it correctly you will the hamstrings
and to some extent the gluts will absorb the impact.

If you perform it incorrectly, you will experience some pressure in the
spine. Sitting back on the box places a lot of pressure on the lower back.
If you perform the bounce correctly, this is no more loading on the
spine…maybe even less that sitting back on the box. >

*** It certainly is useful advice to make most of the contact with the back
of the thighs rather than ever sitting with any significant pressure on the
glutes. However, cases have occurred where poorly understood and
technically hazardous bouncing off a box has caused fractures of area such as
the lumbosacral region of the lower spine, while back pain is also not
uncommon among those who use a definite bounce — and that is the problem
with novice users of the box squat. One cannot emphasize Kenny’s advice
strongly enough that the exercise be done with a correct, very light touching
bounce which does not longitudinally impose impact along the spinal column or
cause the spine to lose its lumbar concavity

Remember that the act of sitting down tends to elicit a relaxation of the
lumbar spine and posterior tilting of the pelvis, which leads to flattening
of the lumbar concavity. If you sit down on a box, you have to make very
definite actions to prevent these spinal relaxing processes from happening,
as is constantly stressed by the Westsiders.

<Bouncing off the box provides a greater stretch reflex. Minimize the risk
by performing it correctly and you’ll illicit a greater training effect in
the stretch reflex.

*** Bouncing off the prestretched muscle complex stimulates the myotatic
stretch reflex more strongly if you do not sit on a box at all. Any
superficial contact with the skin that you sit on will tend to diminish the
intensity of this reflex, plus any delay incurred while you are sitting (even
for less than a second) will diminish it further. Advocates of the box
squat do not even advocate “bouncing” off the box, especially under heavy
loading with a weight or a weight and bands combination.

If you wish to retain enough of the stretch reflex in the muscles of the
“posterior chain”, you should not use the box to offer anything more than a
slight brief touch to the backs of the thighs to enhance proprioceptive
awareness of the position at which you wish to commence your upward drive.
You can gain a good awareness of the prestretch in that position by using a
“Romanian” deadlift — i.e., by lowering and raising the bar from upper thigh
to below the knees by pushing your rear end backwards. Bent-knee good
mornings with glutes thrust back (rather than relying solely on hip flexion
or simple “leaning forwards”) will also enhance one’s awareness of that same
prestretch process.

<You should ease into ballistic box squatting. Once you learn to do it
you’ll illicit a greater training effect in the stretch reflex.>

*** See above – ballistic box squatting will not elicit a greater “training
effect in the stretch reflex”. If you are using box squats to enhance
performance in the squat, the reason is not mainly because you are trying to
“train” the stretch reflex, especially since the competition squat has to be
done without a box and methods of acquiring specific neural programmes tend
to be rather specific to the way in which they were learned. Anyway, I am
sure that this is what Kenny is advising – namely not using the box to sit
upon, but to serve as just a gentle warning system to offer tactile contact
so that you know exactly when to begin your upward drive in the squat. In
this way, you will retain the necessary prestretch and manage to execute the
movement explosively.

There are several reasons why one may use some forms of box squatting, but
“training the stretch reflex” is not one of them. However, the main problem
here is more a matter of scientific correctness and differences in phrasing
the advice more accurately. Some of the box squatting and Westside fans out
there might like to list some of their reasons for using box squats with and
without the added effect of bands for those who have never used box squats.

Mel Siff
Denver, USA
Mel Siff Dot Com
Supertraining Twitter Feed

PUZZLE & PARADOX 72

The effects of joint manipulation or mobilisation may not be as clearly
related to traditional explanations of their underlying mechanisms as
suggested by various therapists.

Most sports scientists, physiotherapists and athletes are very aware of the
various classes of mechanical ‘realignment’ of joints (including
manipulation and mobilisation) that are applied by physical therapists or
chiropractors. These twists, thrust, pulls or pushes of the spinal column,
in particular, are often accompanied by an audible ‘click’ or ‘pop’.

The professional therapists who apply this form of treatment attribute any
subsequent relief from pain or mobility symptoms to processes such as the
reduction of subluxations, stretching of connective tissue, the release of
nitrogen bubbles within the joint fluids, the realignment of joint surfaces,
nerve release and so forth.

This type of procedure is the central foundation of chiropractic and to
manipulative therapy in physiotherapy, with its users totally committed to
its effectiveness. Some long-term studies, however, indicate that joint
manipulation or mobilisation makes no statistically significant difference to
the rate or degree of recovery of the client from pain or malfunction. In
some cases, these procedures have resulted in far greater damage to the
patient, with periodic reports of hemiplegia, quadriplegia or exacerbation
of existing spinal damage appearing (frequently a result of inadequate
collaboration with medical, radiographic or surgical experts).

While the controversy between the merits and demerits of manipulative
procedures will no doubt continue to rage, this is not the main thrust of
this P&P. What appears to remain uncertain is the reason why these
procedures are successful in certain instances. All of the reasons
mentioned above need to be examined carefully before we can state
scientifically that there is a cause-effect relationship between any of them
and rehabilitation from back pain and/or dysfunction.

For instance, let us examine the contention that a quick, sharp thrust of
certain vertebrae will stretch the ligaments in that region and produce
greater mobility at that level. This presumes that a rapid movement will
cause permanent plastic deformation of the connective tissue, which happens
to be viscoelastic in nature. This means that rapid thrusts should evoke a
more elastic response from the appropriate vertebral ligaments, rather than
plastic deformation, which usually is a result of prolonged stretching above
a certain threshold level of strain in the tissues. So, if plastic
deformation is unlikely, this leaves only one other alternative, namely
tissue rupture, which is the last thing that any therapist wants.

However, all of this presumes that the therapist can produce sufficient
manual force to deform ligamentous tissue, which is highly unlikely, because
of its enormous mechanical tensile strength.

This immediately leads us to the hypothesis that many ‘back problems’ are
due to subluxations (small dislocations) of the vertebrae relative to one
another. We immediately have to ask if normal daily activities can
temporarily stretch enormously strong ligaments sufficiently to permit these
subluxations to persist for prolonged periods until the therapist
intervenes.

We have to examine the proof for the existence of these temporary
subluxations such as MRIs or CAT scans – is there unequivocal evidence to
show that ligaments (which are extremely inextensible) can be temporarily
stretched to allow adjacent vertebrae to stay dislocated relative to one
another? If so, then it will be interesting to carry out a biomechanical
analysis of the stresses and strains involved. It will be even more
interesting to understand how the slightly, but powerfully stretched,
ligaments manage to return to their original length along an hysteresis path
that shows no residual strain after prolonged stretching.

Even if one suggests that the subluxation or displacement that is reduced by
manipulation is the sum of tiny contributions from many vertebrae, it does
not eliminate the fact that ligament is very difficult to deform, especially
if subjected to a single sharp thrust.

What then of traction, that is probably used as widely as manipulation? Can
one state that traction stretches ligaments as well and relieves pressure on
nerves? Or is the idea of traction simply to overcome a persistent myotatic
stretch reflex which has temporarily forgotten to become inoperative or a
Golgi tendon reflex that has omitted becoming involved?

Possibly this would then offer a more rational approach to explain why
manipulation might relieve back pain or dysfunction. Such an hypothesis
would suggest that the muscles cause the ligaments to be pulled in a certain
direction, thereby producing and sustaining a subluxation. Of course, we
then have to examine how long a stretch reflex can remain operative and how
long a muscle can remain submaximally contracted. In the case of some back
pain sufferers, we might have to wonder at the impressive local muscle
endurance involved.

There are several other questions remaining regarding manipulation, such as
the cause of the ‘pop’ or click’. If it is indeed produced by the release
of air or nitrogen bubbles into the joints, then this would imply the
occurrence of cavitation, which is known to produce very detrimental shock
waves in engineering systems. If gas bubbles are released in the
cerebrospinal fluid, does this not imply the possibility of micro-shock wave
damage to structures in the spine, especially if manipulation is applied
regularly? Is there any evidence for the release of gas bubbles with
manipulation and, if so, are there any studies to show that they are
harmless artifacts?

Maybe the acute relief afforded in certain cases is more a consequence of
neural stimulation rather than mechanical realignment, caused by stimulation
of the nerves passing from the foramina of the spine. Would this also be a
reasonable hypothesis? Naturally, this would give us the opportunity of
invoking the ubiquitous placebo effect!

This P&P could be extended into the broader territory of deep transverse
friction, structural integration (‘Rolfing’) and so on to create a broader
base for examining the mechanical manipulation of the entire musculoskeletal
system. Indeed, this would probably be of enormous value in removing some
of the controversy associated with all of these procedures.

Comment on any of the issues raised by the above focus on manipulation and
mobilisation as currently practised by various therapists, quoting any
scientific studies which appear to support or disprove the value of these
procedures and the explanations presently given to validate them. Regarding
the mechanisms involved – Is it in the back or is it all in the head?

——————

Mel Siff
Denver, USA
Mel Siff Dot Com
Supertraining Twitter Feed

INTRODUCTORY NOTE

For newcomers to this forum, these P&Ps are Propositions, not facts or
dogmatic proclamations. They are intended to stimulate interaction among
users working in different fields, to re-examine traditional concepts, foster
distance education, question our beliefs and suggest new lines of research or
approaches to training. We look forward to responses from anyone who has
views or relevant information on the topics.

PUZZLE & PARADOX 126: SUBLUXATION PARADOX

We constantly hear from colleagues and some therapists that someone’s spine
or neck is “out of alignment” or that the bones in some or other part of the
body are “subluxated” (or held in a prolonged state of chronic partial
dislocation or “mal-location”). At the same time research informs us that
the ligaments and connective tissues involved with those joints are extremely
tough, only slightly extensible and resist deformation very powerfully.

Even outside the body in being tested in vitro, ligaments and fasciae have to
be subjected to considerable force to produce significant extension for even
short periods, so how is it possible for apparently resting levels of muscle
tension to produce sufficient force to maintain persistent “subluxation”?
Of course, if the connective tissues concerned are actually damaged or
herniated, then dislocation may be one of the well-known consequences, but if
the alleged deformation is not of that magnitude, then how can a “partial”
dislocation be maintained?

Naturally, the use of therapy to “release” the hypothetical tension assumes
that these viscoelastic tissues, despite prolonged imposition of tension,
display perfect hysteresis and return to their pre-pathological state
immediately after manipulation or whatever treatment is deemed to be
appropriate.

How can one reconcile these diametrically opposed views? Are there any
radiological scans or other studies which have confirmed the existence of
“subluxations” or low level connective tissue disturbances which allow
“partial dislocations” or “misalignments” to occur chronically, even though
powerful
muscles contractions from adjacent muscles may override the alleged chronic
tension produced by tissues which are hypothesized to maintain those
alleged displacements?

———–

Mel Siff
Denver, USA
Mel Siff Dot Com
Supertraining Twitter Feed

Mel Siff:

*** This claim is not necessarily correct. In fact, the opposite may occur,
because reflex muscle activation very frequently occurs to limit the degree
of spinal traction offered by “bat boots” or other traction devices, unless
the person is skilled in learning to relax or if there is no significant
pathology, soreness or stiffness involved. Even if some degree of
decompression occurs, the moment that one places full weight on the floor
again, the effect decreases rapidly. So, in using inversion or other spinal
traction methods, one has to begin with a gradual increase in tension and
progress gently from there. Once the traction period is over, tension must
also be returned gradually to normal, something which you cannot do with
those boots unless something is used to control how much traction is applied
by use of your bodyweight.

That is why physical therapists and chiropractors use special tables which
can be gently inverted and return one to the normal upright standing position
after treatment. Any sudden change in tension or compression of the spine
can elicit reflex increase in the musculature of the spine. Use of a
swimming pool generally is a far more useful and more readily controlled way
of reducing spinal loading. Anyhow, after heavy lifting, the muscles of your
spine and trunk in general will quite naturally relax and allow the spine to
“decompress” itself, especially if you simply lie down or have a warm
shower/bath and then lie down. If you spend a few hours sleeping, your spine
will lengthen by a few centimetres (depending on age, state of hydration
etc).

The use of “bat boots” will make no significant difference in helping the
spine to return to its normal level of compressive stress. Just take a
relaxing shower or bath, lie down and enjoy yourself! …and don’t forget
that inverted hanging (or head standing) can place great stress on the blood
vessels of the brain and eyes, something which has been known to cause brain
and eye haemorraghes in susceptible individuals.

Mel Siff
Denver, USA
Mel Siff Dot Com
Supertraining Twitter Feed

<…. Also, it is not uncommon to see respiratory disease patients with
chronic low back pain, since they cannot effectively utilize their TVA to
help control the segmental stability (note I did not write “core stability”)
of their spines. I had never considered that resistive breathing might be a
training aid, but it sounds very interesting. >

Mel Siff’s response was as follows
*** That is why I have hypothesized for many years that TVA activity is
really a secondary effect produced by appropriate control of intra-abdominal
pressure via involuntary or voluntary breath management. Most of the time I
even consider that the TVA activates quite automatically when the body is
forced to stabilise or react to any positional or movement changes. I have
often quoted EMG work by Basmajian to remind people that TVA activation is
intimately linked to any actions which elicit changes in breathing status,
especially if forced breath holding or exhalation takes place.

Remember Beevor’s Axiom, namely that the body (generally) knows of actions
not muscles? So — just learn some appropriate methods of controlling one’s
breath in different situations or carry out dynamic activities which compel
the body to produce such breathing actions, and the rest will follow quite
naturally! Anyway, in suggesting this, I fully appreciate that some ancient
Eastern guru (not the fitness type!) several thousand years ago would have
reminded me that all of this is really nothing new! Let’s not keep putting
the TVA cart before the breath-control horse and, for once and for all,
restore some sanity to this “Transversus in Wonderland” saga.

Mel Siff
Denver, USA
Mel Siff Dot Com
Supertraining Twitter Feed

*** Nobody has commented on one issue yet, namely the fact that you struggle
to hang snatch 60kg even though you could power snatch 110kg. My best lifts
would appear to be quite similar to yours, but I never struggled to hang
snatch 100kg without straps. However, on warmer days, sweating of the palms
certainly can make it difficult to grip a bar without chalk, especially if
you are not using a hook grip. It is very
unrealistic to ban the use of chalk AND straps — it is fact that someone
people perspire more than others, plus some athletes have small hands. Is
this the reason why you struggle to hang snatch only 60kg or is it because of
some genuine gripping weakness?

If he is concerned about training specificity, then I trust that his players
are all squatting and power snatching with football cleats on and possible
even with full padded gear on, because executing any plays without that sort
of apparel is very different from doing the same in gym attire.

Even if occasional use of straps or chalk may result in some (unlikely) loss
in gripping strength, American football does not permit holding opposing
players or gripping helmets, so what is his point? If you played in a rugby
scrum where you firmly hold your teammates, I could vaguely appreciate his
dictates, but in American football, there appears to be no logical reasoning
behind his authoritarian manner. Does he offer any scientific or practical
reason why the use of chalk and straps is so detrimental to the conditioning
of a footballer who doesn’t use gripping as a major part of the play? –
Don’t let him tell you that this makes a difference to tackling ability (as
opposed to blocking), because the hand grasping actions involved in snatching
and tackling are radically different.

So far, unless you have a major gripping problem, it would appear as if he is
playing like a military sergeant who commands recruits to clean out the
toilets with a toothbrush, just because that is the way it has always been
and that is the way it always shall be! I prefer all athletes to know and
fully understand the genuine reasons why I am prescribing any training drill.
His “telling” style of leadership (as opposed to “selling” style – see Ch 6
of “Supertraining”) may be appropriate for complete novices, but not for more
experienced athletes.

Mel Siff
Denver, USA
Mel Siff Dot Com
Supertraining Twitter Feed

MACROCURRENT AND MICROCURRENT ELECTROSTIMULATION IN SPORT

Mel C Siff PhD

(Note: This article draws extensively on material from the textbook, Siff MC
Supertraining 2000. Anyone requiring further information on this topic
should consult Ch 4 of this book.)

The use of electric current on the human body largely has been restricted to
use by physiotherapists to facilitate the healing of musculoskeletal
injuries and control pain. It is fairly arbitrarily applied in two broad
categories:

* Macrocurrent Stimulation (currents over about 1 milliamp)
* Microcurrent Stimulation (currents below about 1 milliamp)

The former usually refers to Faradic, Interferential, Galvanic and TENS
(Transcutaneous Electrical Nerve Stimulation) devices, whereas the latter
refers to specialised microcurrent devices for application either to the
musculoskeletal system or as a non-invasive form of electroacupuncture via
the acupuncture points of the body or the auricular points of the ears. The
differences between these applications will be discussed later in this
article.

The concept of electrostimulation for physical conditioning is not new, and
for years has been used by physical therapists in clinical applications such
as muscle rehabilitation, relief of muscular spasm, reduction of swelling and
pain control. Its possible value in sports training is still considered
controversial. In strength conditioning, the potential applications of
electrostimulation fall into the following broad categories:

* Imposition of local physical stress to stimulate supercompensation
* Local restoration after exercise or injury
* General central nervous and endocrine restoration after exercise or injury
* Neuromuscular stimulation for pain control or movement patterning

Electrostimulation usually involves feeding the muscles low current
electrical impulses via moistened electrode pads placed firmly on the skin.
The effectiveness, comfort and depth of excitation depends on factors such as
pulse shape, frequency, duration, intensity and modulation pattern. The
resulting number of possible stimulation combinations immediately emphasizes
how difficult it is to determine the optimum balance of variables and compare
the results of different researchers.

The typical clinical machine supplies pulsating direct (galvanic) and/or
alternating (faradic) current in the form of brief pulses. The frequency of
faradic current is most commonly chosen in the range of about 50-100 Hz,
while pulse duration (width) ranges from about 100 mi–croseconds to several
hundred milliseconds. This brevity of pulse duration is important for
minimising skin irritation and tissue damage. However, the duration at any
particular intensity of faradic stimulation should not be too brief.
Although they may be suitable for decreasing pain, pulses that are too brief
will supply insufficient energy to cause full, tetanic muscle contraction.

Machines are designed to apply alternating currents directly at a preset or
selected frequency (conventional faradism), or in the form of low frequency
currents superimposed on a medium frequency (2000 to 5000 Hz) carrier wave. A
variation of the latter method, using two pairs of electrodes each supplying
medium frequency waves carrying low frequency waves dif–fering slightly in
frequency, forms the basis of what is called interferential stimulation. A
major advantage of using a higher frequency carrier wave is that impedance
between the electrodes and skin is lowered, enhancing comfort and
effectiveness.

American interest in electrostimulation as a training adjunct was aroused in
1971, when Kots in Russia reported increases of more than 20% in muscle
strength, speed and power produced by several weeks of electrotraining.
Unable to produce comparable results, the Canadians invited him to lecture at
Concordia University in 1977. Armed with the new information that Kots
employed a sinusoidally modulated 2500 Hz current source applied in a
sequence of 10 seconds of contraction followed by 50 seconds of relaxation,
they again tried to duplicate Russian claims.

Applications of Macrocurrent Stimulation

A literature review reveals the following major uses of macrocurrent
stimulation in the realm of therapy. A more detailed discussion or the
citations are not quoted here, but appear in my review on this topic [Siff M
C (1990) Applications of electrostimulation in physical conditioning: a
review J of Appl Sports Science Res 4 (1) : 20-26 ], as well as in the
textbook: Siff MC (2000) Supertraining, Ch 4.2

1. Increase in muscle strength
2. Re-education of muscle action
3. Facilitation of muscle contraction in dysfunctional or unused muscle
4. Increase of muscular and general endurance
5. Increase in speed of muscle contraction
6. Increase in local blood supply
7. Provision of massage
8. Relief of pain
9. Reduction of muscle spasm
10. Promotion of relaxation and recuperation
11. Increase in range of movement
12. Reduction of swelling
13. Reduction of musculoskeletal abnormalities
14. Preferential recruitment of specific muscle groups
15. Acute increase in strength
16. Improvement in metabolic efficiency

The Emergence of Microcurrent Stimulation

Recent research and clinical experience have revealed that electric currents
as much as 1000 times smaller than that of all the traditional physical
therapy modalities can be far more successful than the latter in achieving
many of the benefits outlined in the previous section.

Currents as low as 10 microamps (millionths of an amp) pulsating at between
0.1 to 400Hz are too weak to cause muscle contraction, block pain signals or
cause local heating, yet their effectiveness and safety is often superior in
many applications to that of faradism, interfer–entialism and conventional
TENS (Matteson & Eberhardt, 1985).

The steps to satisfactorily modify the existing paradigm for ES may be sought
in the research findings quoted earlier in the section: ‘Reasons for
conflicting research’. There, it was learned that cellular and subcellular
processes not involving cell discharge, propagated electrical impulses, or
muscle contraction, appear to be involved with cellular growth and repair.

Some studies have produced findings which offer partial answers to the
questions posed by microstimulation. For instance, work by Becker and others
suggests that small, steady or slowly varying currents can cause
sub-threshold modulation of the electric fields across nerve and glial cells,
thereby directly regulating cell growth and communication (Becker, 1974;
Becker & Marino, 1982). In this respect, some of Becker’s applications
included the acceleration of wound healing, partial regeneration of amphibian
and rat limbs, and induction of narcosis with transcranial currents.
Nordenström maintains that these electric currents can stimulate the flow of
ions along the blood vessels and through the cell membranes which constitute
the body’s closed electric circuits postulated by his theory (Nordenström,
1983).

Pilla (1974) has paid particular attention to electrochemical information
transfer across cell membranes. The model in this case hypothesizes that the
molecular structure of the cell membrane reflects its current genetic
activity. Here, the function of a cell at any instant is determined by
feedback between DNA in the cell nucleus and a macromolecule inducer
liberated from the membrane by means of a protein (enzyme) regulator derived
from messenger RNA activity within the cell. The activity of these
membrane-bound proteins is strongly modulated by changes in the concentration
of divalent ions (such as calcium Ca++) absorbed on the membrane. ES may
elicit these ionic changes and thereby modify cell function.

It has been shown that ES at 5Hz stimulates synthesis of DNA in chick
cartilage cells and rat bone by as much as 27%, but not in chick skin
fibroblasts or rat spleen lymphocytes (Rodan et al, 1978). Not only does the
effect of ES appear to be tissue-specific, but the increase in DNA synthesis
occurs 4-6 hours after 15 minutes of ES. The process of membrane
depolarisation carried by sodium ions seems to be followed by an increase in
intracellular Ca++ concentration, thereby triggering DNA synthesis in cells
susceptible to the particular stimulus. Further work by Pilla (1981) has
confirmed the existence of cellular ‘windows’ which open most ef–fectively to
certain frequencies, pulse widths and pulse amplitudes. To attune the ES
signal to these parameters, monitoring of tissue impedances is preferable, a
system employed by so-called ‘Intelligent TENS’ devices.

In addition, Cheng et al (1982) have shown that stimulation with currents
from 50-1000 microamps can increase tissue ATP concentrations in rats by
300-500%, and enhances amino acid transport through the cell membrane and
consequent protein synthesis by as much as 40%. Interestingly, the same study
reported that increasing the current above only one milliamp was sufficient
to depress tissue ATP and protein synthesis – and traditional ES most
commonly applies currents exceeding 20 milliamps, at which stage this
depression being nearly 50%.

An Integrated Theory of Electrostimulation

Therefore, it appears as if macrocurrent stimulation (MACS – currents
exceeding one milliamp) acts as a physiological stressor, which in the short
term causes the typical alarm response described by Selye (1975). This is
supported by the work of Eriksson et al (1981), who found that the acute
effects of traditional ES are similar to those found for intense voluntary
exercise. Furthermore, Gambke et al (1985) have found in animal studies that
long-term MACS causes some muscle fibres to degenerate and be replaced by
newly formed fibres from satellite cell proliferation. This fibre necrosis
occurs a few days after application of ES and seems to affect mainly the FT
fibres. The fact that the various muscle fibres do not transform at the same
time may be due to different thresholds of each fibre to the stimulus that
elicits the transformation. Possibly, the earlier changes might induce
subsequent ones.

Thus, if Selye’s General Adaptation Syndrome model is applied to MACS-type
stimulation, the body would have to draw on its superficial adaptation energy
stores and adapt to the ES-imposed stress by increasing strength or
endurance, or by initiating transformation of muscle fibre types. If the ES
is too intense, too prolonged or inappropriately used to augment a weight
training programme, adaptation might not occur or it might increase the
proportion of slow twitch fibres and thereby reduce strength. This could
explain some of the negative research findings discussed earlier.

Furthermore, excessively demanding MACS conceivably might cause the body to
draw on its deep adaptation energy and lead to permanent tissue damage.
Consequently, any athlete who may derive definite performance benefits from
MACS should not assume that increased dosage will lead to further
improvement. The contrary may well prove to be true.

Microcurrent stimulation (MICS – currents below one milliamp), on the other
hand, would not act as a stressor. Instead, the evidence implies that it
elicits biochemical changes associated with enhanced adaptation, growth and
repair. Since MICS appears to operate more on the basis of resonant
attunement of the stimulus to cellular and subcellular processes, the
specific therapeutic effects are determined by how efficiently the
stimulation parameters match the electrical characteristic of the different
cells, in particular, their impedance at different frequencies. MICS may be
applied in several ways to facilitate restoration:

* locally over specific soft tissues
* transcranially via electrodes on the earlobes or on sites on the surface
of the skull
* at acupuncture points on the body, hands or ears.

It is generally entirely safe to apply MICS anywhere on the body, because the
current and energy transmitted is too low to produce any thermal or
electrolytic effects on vital tissues. Under no circumstances should MACS be
applied across the brain, as it can cause serious harm. It is generally not
advisable to apply any form of ES to epileptics, pregnant women, cardiac
patients or persons with heart pacemakers.

The Validity of Microcurrent Application?

There has been considerable debate about the value of microcurrent (small
electrical currents of less than 1 ampere) in physical therapy, with its
supporters claiming consistently good results and its detractors claiming
that any benefits are probably due to a placebo effect. Some therapists
have stated that there is scant evidence of any research and practical
evidence of the value of microcurrent, so, for their interest and that of
others conducting research into microcurrent therapy, I have compiled a
lengthy, but incomplete, list of English language references that relate to
the theoretical foundations and clinical applications of microcurrent.

My own interest in this field was piqued while I was gathering research
information for my M.Sc into the mechanisms underlying the
electroencephalogram (EEG) in brain research. While browsing in the old
science library located in the physics building at the University of the
Witwatersrand, South Africa during 1971, I encountered a few fascinating
texts: one edited by Barnothy (1969) and another by Presman (1970), as well
as several articles by Robert Becker, with whom I later had periodic contact
over the years (these are all referenced below).

Microcurrent References

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————–

Mel Siff
Denver, USA
Mel Siff Dot Com
Supertraining Twitter Feed

INTRODUCTORY NOTE

For newcomers, these P&Ps are Propositions, not facts or dogmatic
proclamations. They are intended to stimulate interaction among users working
in different fields, to re-examine traditional concepts, foster distance
education, question our beliefs and suggest new lines of research or
approaches to training. We look forward to responses from anyone who has
views or relevant information on the topics.

PUZZLE & PARADOX 70

The treatment of knee conditions such as chondromalacia patellae by leg
extension exercises to alter ‘muscle balance’ may be based on faulty or
doubtful premises.

Treatment of the condition involving deterioration of the articulating
surface beneath the patella (often referred to as chondromalacia patellae -
CPAT) is usually based on the premise that some muscular imbalance between
vastus medialis and vastus lateralis causes the patella to track imprecisely
over the femur.

Apparently, a weaker v medialis relative to the v lateralis permits the
patella to be pulled laterally out of its most efficient trajectory over the
femur, thereby leading to uneven wear of the cartilagenous bearing surface
beneath the patella.

Consequently, therapists have tried to strengthen the v medialis with knee
extension exercises on isokinetic dynamometers or with various forms of
electrostimulation (faradism, interferentialism or so-called ‘Russian
stimulation’) in an attempt to improve the medialis/lateralis strength ratio.
Many clinical and theoretical studies have attested to its success and
validity, but the underlying mechanical process might not be as clearcut as
has been suggested.

The traditional explanation of strengthening v medialis implies that
strengthening of this muscle causes the patella to be ‘pulled in’ closer to
its ‘ideal’ trajectory during any movement which involves significant knee
flexion. A simple geometric analysis of the situation implies further that :

1. v medialis must then shorten more than it did before treatment; or
2. v medialis has been shortened chronically by the treatment.

If either of these implications is correct, then there must be some evidence
either that training causes any given muscle to contract to a greater extent
than the same unexercised muscle or that extended range training causes a
muscle to shorten progressively. If this suggested analysis is incorrect,
then another possible explanation has to be sought, possibly in altered
neuromuscular control or kinaesthetic processes.

This does not deny the fact that this type of therapy often may diminish
peripatellar pain and improve knee extension strength, but it serves to point
out that some of the traditional rationales for this type of injury
management may not be correct or as simple as are implied by the current
theories.

This analysis may also have profound implications for the entire concept of
testing and training muscles to enhance performance, facilitate
rehabilitation or prevent injury. In trying to understand the relevance of
muscle ratios, we have to search for rational hypotheses in structural,
functional or combined (structural-functional) processes.

For instance, has it been proved beyond a shadow of doubt that ‘muscle
imbalances’ are a major cause of injury or impaired performance? Or is the
cause of any problem rather to be sought in inappropriate patterns of muscle
recruitment, irrespective of the balance between the strength of any muscles
involved? In other words, is the dominant cause of injury or impaired
performance due more to neuromuscular control or motor skill factors than
‘muscle imbalances’?

Moreover, in attempts to analyse muscle balance and imbalance, how solid are
the current norms against which these balances are measured? We also have to
examine differences in muscle balance under static or static stabilising
conditions, as well as under dynamic conditions at different velocities and
in different patterns of cocontrative and ballistic action.

We cannot simply assume that balance under dynamic conditions implies equal
balance under explosive, slower or static conditions. Is this type of
biomechanical analysis carried out yet with this degree of thoroughness or
are therapists quite blindly extrapolating fixed path analysis on an
isokinetic dynamometer to all other multi-dimensional stabilising and moving
conditions to be encountered by the athlete? If the latter, why do
therapists continue to use such a flawed and dubious method of treatment and
assessment?

So, our critical analysis of the idea of an idealised perfect patella
trajectory under ‘balanced’ muscle action has led us to re-examine the entire
concept of testing and rehabilitation based on machine measurement under very
rigid mechanical conditions.

Comment on the current explanations for the validity of CPAT rehabilitation
and on the general concept of specific, fixed muscle balances concerning all
other joints in the body. The validity of extrapolating machine testing to
sports functional performance may also bear some critical analysis.

—————-

Mel Siff
Denver, USA
Mel Siff Dot Com
Supertraining Twitter Feed