1) Muscle monitoring using EMG during rehabilitation and training can provide valuable feedback to optimize recovery and prevent re-injury. It allows assessment of muscle balance, activation, relaxation and quality of movement. 2) A case study of 4 athletes recovering from ACL injuries found that EMG monitoring helped identify issues like lingering hamstring imbalance and informed changes to training programs. All athletes showed improved muscle balance over the course of rehabilitation. 3) EMG data collected from a skier during isokinetic testing, sprints and sports-specific drills provided insights into eccentric strength deficits and activation asymmetries to target in training, helping enable a safe return to competition after ACL reconstruction.

1. “Monitoring is the Key for Successful
Muscular Rehabilitation Process”
Muscle monitoring for optimal rehabilitation & sports performance
MEDICA Medicine + Sports Conference
12/13 November 2014, Germany
Petri Lehikoinen
Sports performance coach – sports physiotherapist
Physio1 Inc.
Myontec Ltd.

2. INTRO ”HOW TO REDUCE (THE COSTS OF) INJURIES AND KEEP THE PLAYERS ON PITCH”
LOT OF INJURIES IN LOWER BODY
ACL INJURIES
HAMSTRING & QUADS INJURIES TYPICAL IN MANY (RUNNING) SPORTS
$$$ EXPEN$IVE TO TREAT
£OT OF MISSED DAYS IN $PORT$
NEW TECHNOLOGY - NEW POSSIBILITIES FOR TRAINING & REHABILITATION
INJURY PREVENTION, SCREENING
FASTER & MORE EFECTIVE REHABILITATION
RETURN-TO-PLAY FASTER & SAFER
HIGH PERFORMANCE LEVEL
PREVENT RE-INJURY
“FIND THE PROBLEMS BEFORE THEY WILL FIND YOU”

3. OLD TOOLS & NEW POSSIBILITIES TO OPTIMIZE PERFORMANCE
OLD SCHOOL & TOOLS
-Measurement tape
-Stop watch
-kg
-Reps
-Protocols (time based)
NEW POSSIBILITIES
-Video analysis, GPS…
-HR, Recovery analysis
-wearable tech EMG
*see inside the movement
*balance
*movement quality
*activation – relaxation
-More feedback
-Algorithms
Together to optimize neuromuscular function &
movement (control)
-Speed up rehab & RTP
-Prevent re-injury & teach athletes
-High performance
-Save $$$ & make $$$

4. MBODY REAL-TIME AND POST-EXERCISE ANALYSIS
”KNOW YOUR MUSCLES”
GO
BLUETOOTH
GET SET
SHORTS + MCELL
SEE THE RESULTS
SMART PHONE APP
MOVESCOUNT (WEB)
MUSCLE MONITOR (PC)

5. MBODY REAL-TIME AND POST-EXERCISE ANALYSIS
4-CHANNEL EMG
QUADRICEPS & HAMSTRINGS
MUSCLE LOAD & BALANCE
HEART RATE
CADENCE, SPEED, DISTANCE…

6. ADVANTAGES OF MUSCLE MONITORING
THE MORE INFORMATION – THE MORE KNOWLEDGE (AND QUESTIONS)
-Inside feedback from the movement – ”heart rate of the muscles”
-Muscle balance, LT/RT – Q/H
-Quality of the movement
-Muscle activation – relaxation
>> running analysis >>> sports spesific in real action
-Athlete profilation & screening
-Athletes like to see how the muscles are working -> learning & motivation
-Athletes self monitoring – self confidence
-Real time analysis – post exercise analysis & documentation
-Fast feedback for athlete & coach/physio
-”Long distance” control for coach/physio
-Co-operation between coach & physio
-Easier program progression with EMG feedback
-Sports spesific use

7. CASE STUDY BY PUUSTINEN, J., PT, M.SC. STUDENT,
JYLÄNKI. P. M.SC. TECHNOLOGY & SPORTS SCIENCE
4 ACL/PCL OPERATED FOOTBALL PLAYERS IN FINLAND
We selected four male adult professional football players after ACL or PCL reconstruction. Players followed
a sport-specific rehabilitation protocol for soccer. We followed criterion based rehabilitation practice
guidelines, soreness rules, running progression, return to sport criteria (Adams et al. 2012, Della Villa et al.
2012), so called traffic light concept as described by (Tsapralis 2014) and rehabilitation program succession
of 5 phases, each characterised by the achievement of clinical and functional goals (Tencone 2012).
Together with traditional rehabilitation monitoring we included EMG monitoring as a new way to monitor
muscle re-training. Monitoring was done using Myontec Mbody EMG shorts measuring quadriceps and
hamstrings muscle groups.
Tests
Players performed same tests as tolerated at that time, consisting measurements and tests for range of
motion, muscle atrophy, isometric muscle strength testing of m.quadriceps and m.hamstring, 1 hop test,
triple hop test, Yo-Yo Intermittent Recovery Test Levels 1-2 and Knee injury and Osteoarthritis Outcome
Score parts Function, daily living and Function, sports and recreational activities. Myontec Mbody EMG
smart shorts were used in isometric strength tests, leg press endurance test, drop jump test, Yo-Yo
Intermittent Recovery Test and treadmill running test at 1 degree incline and 3 minutes steps and 2 km/h
increase in the level starting from 5 km/h and ending to 13 km/h speed if tolerated.

8. CASE 1 TREADMILL BALANCE SUMMAY (ACL left, LT hamstring graft)
80
70
60
50
40
30
20
Treadmill 5km/h – Balance %
3kk 4kk 5kk 6kk
L Quads R Quads
L Hams R Hams
80
70
60
50
40
30
20
Treadmill 7km/h – Balance %
3kk 4kk 5kk 6kk
L Quads R Quads
L Hams R Hams
80
70
60
50
40
30
20
Treadmill 9km/h – Blance %
3kk 4kk 5kk 6kk
L Quads R Quads
L Hams R Hams
80
70
60
50
40
30
20
Treadmill 11km/h – Blance %
3kk 4kk 5kk 6kk
L Quads R Quads
L Hams R Hams
80
70
60
50
40
30
20
Treadmill 13km/h – Balance %
5kk 6kk
L Quads R Quads
L Hams R Hams

9. 3 months 4 months 5 months 6 months
L Quads
R Quads
L Hams
R Hams
L Quads
R Quads
L Hams
R Hams
L Quads
R Quads
L Hams
R Hams
L Quads
R Quads
L Hams
R Hams
CASE 1 TREADMILL RUNNING TEST 9km/h (ACL left, LT hamstring graft)
LT/RT BALANCE

10. Case2–Left leg ACL+PLC, 5 months post op; muscle distribution view
Running on treadmill with increacing speed, incline 1 degree
5km/h 7 km/h 9km/h 11 km/h 13 km/h

11. CONCLUSIONS & ACTIONS TREADMILL RUNNING TEST
Case 1 training method was changed 5 months
after operation to power training (Force –
Velocity). The decision was made based on EMG
data and strength measurement results. EMG
data indicated the diffrence between muscle firing
and relaxation on right and left hamstring.
6 months after operation strength levels between
right and left hamstring was identical. Subject was
able to finnish the season without symptoms.
Total activation level could give ”wrong”
information, need to check
Activation – relaxation
L Quads
R Quads
L Hams
R Hams
5 months

12. CASE LEGG PRESS
Case1 leg press balance %
Muscle activation balance during leg press exercise in all cases.
Results clearly indicates that muscle activation balance is
improved during rehabilitation process.
56 54 53 57
44 47
46 43
100
80
60
40
20
0
3kk 4kk 5kk 6kk
L Quads % R Quads% L Hams % R Hams %
Case 2 leg press balance %
43
57 52 55
55 51 50
49 50
45 48 45
100
80
60
40
20
0
3kk 4kk 5kk 6kk
L Quads % R Quads% L Hams% R Hams%
62
Case3 Leg press balance %
64 60
49 47
38
51 53
46
36 40
54
100
80
60
40
20
0
4kk 5kk 6kk
L Quads % R Quads% L Hams% R Hams%
Case4 leg press balance %
60 55
46 50 54 50
40 45
100
80
60
40
20
0
3kk 4kk 5kk 6kk
L Quads % R Quads% L Hams% R Hams%

13. CASE YO-YO
4 Months after operation 5 Months after operation
Relaxation problem with
Left Hamstring?
Running balance:
Left/Right:
• Balance ok close 50/50
H/Q:
• Hamstring acitivity level high 75/25

14. CASE SKICROSS
18 yrs old Europa Cup skicross racer
Broke ACL 15.1.2013
Operated 5.2.2013, hamstring graft
Back on skis 8/13
Back on podium 12/13
Re-injury 17.12.2012, partial tear ACL
Rehab 4 weeks
Back racing 17.1.2014 w/ Ortema knee brace
Re-op 5.5.2014 -> MBody
Back on skis 8/14

15. ISOKINETIC TESTING 60/60 DEG/SEC 5 REPS

16. ISOKINETIC TESTING 240/240 DEG/SEC 30 REPS

17. ISOKINETIC ECCENTRIC 90/90 DEG/SEC 5 REPS
-BIGGER DIFFERENCE IN ECCENTRIC MOVEMENT, ESPECIALLY HAMSTRINGS > change training more eccentric

18. ACCELERATION SPRINTS 5x 50m, speed increasing

19. MUSCLE BALANCE Hurdle jumps, slow vs fast

20. SQUAT normal & w/ Low Back Pain
Squat
5 RM
normal
Squat
w/ LBP
Front
Squat

21. SPORTS SPECIFIC MBody on skis

22. THE FUTURE…
REHBILITATION PROCESS
& TRAINING
OPTIMIZATION
-how to use the new info
HAMSTRING SCREENING
-find the problems before injuries
-activation - relaxation
-fatigue?
-eccentric measurements “Nordics”?
VIDEO + REAL TIME DATA TOGETHER
MONITORING IS GREAT TOOL, BUT WE NEED MORE EXPERIENCE TO GET THE
MAXIMUM OUT OF THE NEW MEASUREMENTS & INFORMATION

23. “IF YOU WANT TO GET SOMETHING OTHERS DON’T HAVE
YOU NEED TO DO SOMETHING OTHERS DON’T DO”
THANK YOU!
DANKE!
PETRI LEHIKOINEN
PHYSIO1 INC.
+41 79 7904042
PETRI@FYSIO.FI
TWITTER @FYSIO1
WWW.MYONTEC.COM
WWW.KNOWYOURMUSCLES.COM