What is KAATSU?€¦ · would resume. • The extremity would remain maximally vasodilated. If I...
Transcript of What is KAATSU?€¦ · would resume. • The extremity would remain maximally vasodilated. If I...
WhatisKAATSU?
Dr.JimStray-Gundersen,MDChiefMedicalOfficer
KAATSUGlobal
KAATSUis:
Asafe,effecFve,efficientmethodforimprovingspecificstrengthinsport,leadingtoimprovedperformanceonthepitch.
Asafe,effecFve,efficientmethodtoreturnaninjuredplayerbacktothepitchquickly.
Asafe,effecFve,efficientmethodforsFmulaFngrecovery.
HowdoesKAATSUwork?
• Byimpeding(butnotoccluding)bloodflow,simpleeasyexercisesbecomeunsustainable.ThisdisturbanceofhomeostasisistransmiUedtothebrain,whichinturn,releasesananabolic/healingneuro-humoralcascade.SinceliUledamagewasactuallydone,improvementinmusculo-skeletalstructureandfuncFonensuesrapidly.
IsKAATSUsafe?
1. Approximately,300,000KAATSUsessionsperdayforyearsinJapan.NoreportsofcomplicaFons.
2. NaFonalSurvey a.6casesofDVTin12,642people undergoing~32,000KAATSUsessions. i.1/100,000ingeneralpopulaFon ii.1/100inhospitalizedpopulaFon b.1caseofrhabdomyolysisin~32,000KAATSU
sessions.
CoagulaFonStudies
Effectsoflow-intensityresistanceexercisewithbloodflowrestric7ononcoagula7onsysteminhealthysubjects.
MadarameH1,KuranoM,TakanoH,IidaH,SatoY,OhshimaH,AbeT,IshiiN,MoritaT,NakajimaT.
ClinPhysiolFunctImaging.2010May;30(3):210-3.
IsKAATSUEfficacious?
HowdoesKAATSUwork?
• BycreaFnganimpeded(notoccluded)circulaFon,simpleexercisebecomesunsustainable.
• Thisproduces2localmechanismsofvasculardistension/emptyinganddisturbanceofhomeostasisinexercisingmuscle,bothwhichpromptup-regulaFonofanabolicprocesseslikeangiogenesisandmusclehypertrophy.
• ThesedisturbancesarecommunicatedtotheCNSandtheCNSrespondsbyreflexincreasesinheartrateandvenFlaFonalongwithiniFaFonofananabolicneuro-humoralcascade.
IfIweretoclampthefemoralvein…Femoralvenousouhlowwouldstop.
Distalvenouschannelsandcapillarybedswoulddilateanddistend.
Thefemoralarterywouldkeeppumpingbloodintotheextremity.
Soon(5-10seconds),thelimitoftheouterfascialcompartmentswouldbereachedandthelimbwouldbecomecongestedandswollen.
Arterialinflowwouldslowandeventuallystop.
Now,ifIremovedtheclamp…
• Thefemoralveinwouldrapidlyempty,returningbloodtotheheartandcollapsingthevenous/capillaryvessels.
• Arterialinflowtotheextremitywouldresume.
• Theextremitywouldremainmaximallyvasodilated.
IfIweretorepeatedlyapplytheclampfor20secondsandthenremoveitfor5seconds,wewouldhavecreatedan
impeded,butpulsaFle,venouscirculaFon.
• ThatiswhatwedowithKAATSUCycle,onlyweuseanarrowbandofairpressuretodoso.
• AndtheblockageofflowisincompleteandhasgradaFonstoit.
• WithKAATSUbandsproperlyapplied,wecreateanimpeded,pulsaFlevenouscirculaFonwiththearterypushingbloodintotheextremitywhenitcan.
Youusepressuresof300-400mmHg?!?
• Imaginethatthepressureofthesurgicalclampisinfinite.Novenousbloodgetsbyit.
• Imaginethatthe300mmHgofairpressureinthebandisontheoutsideoftheextremity.
• Imaginethatblood(anon-compressableliquid)forcesitselfpasttheblockageandcompressesairintheband.
• Imaginethatthebandofpressureproducedinthebandreducesrapidlyasitgoesdeeperintotheextremity.
• Imaginethatthebandpressurestartsoutsomewhatnarrowerthanthecuffandthatwidthnarrowsasitgoesdeeperintotheextremity.
KAATSUat300mmHg13.1mls/min
ThisshowsthepulseofarterialbloodandOnecanseesomeretrogradeflow
Herewehavethepatentarteryandveinaboveit
KAATSUpressurehasliUletodowiththeathlete’s
arterialbloodpressure.
• KAATSUpressureisappliedtotheveinsandmoderatesvenousouhlow.
• ModeraFngvenousouhloweventuallymodifiesarterialinflow.
• Bloodflowintoanextremitymustsoonmatchbloodflowoutoftheextremity.However,thereissomecapacitanceforholdingextrabloodintheextremity,butoncethatcapacitanceisreached,bloodflowinmustmatchbloodflowout.
Mechanismandcharacterofbloodflowinan
extremitywithKAATSU• Whenamusclecontracts,pressuresinthatmusclecanreachhighlevels.
• Theysqueezeanybloodinthemuscleorvesselsinthemuscle,backintothemajorarteriesandveins.
• Veinshavevalves,whichcausesbloodtoflowonlyinonedirecFon,backtotheheart.
• WithKAATSU,theveinsareholdinglotsofbloodandwithmusclecontracFonthatbloodissqueezedpastthepressureblockageoftheband.
Mechanismandcharacterofbloodflowinan
extremitywithKAATSU• SomeFmes,ifthepressuredifferenFalsareinfavorofthis,whenthemusclecontracts,inaddiFontorobustvenousouhlow,thereisretrogradearterialflow.
• WithKAATSUTraining,andmusclecontracFonhappeningevery1-2seconds,animpeded,pulsaFlebloodflowintheextremityisestablished.
Mechanismandcharacterofbloodflowinan
extremitywithKAATSU
• WithKAATSUCycle(pressureonandoffwithnoexercise),bandinflaFonoccurringevery20-60seconds,followedbydeflaFonfor5-20seconds,similarly,animpeded,pulsaFlecirculaFonisestablished,includingandistendedvasculaturedistaltotheband,followedbyanemptyingofthecapillariesandveins.
KAATSUversustourniquets,
elasFcbands• IthastakenDr.Sato,over30yearstofindjusttherightwaytoproducethisimpededcirculaFoninasafe,controlledandreliableway.
• ThisiswhytheKAATSUMasterisnecessarytoproduceandmonitorthisimpairedcirculaFon.
• OthermethodsandequipmentarenotcapableofreproduciblycreaFngthesecondiFons.
KAATSUexerciseleadstoa“disturbanceofhomeostasis”
inworkingmuscle
• Whenlight,easyexercisesareaddedtothisimpededcirculaFon,theexercisequicklybecomesunsustainable.
• pO2,pH,droptocriFcallevelswithevenmildexercise(e.g.unweightedarmcurls).
• Highlevelsoflactatearegenerated.• ATPlevelsdrop,asADPandPilevelsrise.• ATPdependantElectrolytepumps(e.g.Ca++)cannotmaintainproperelectrolytegradients.
Mechanism(s)ofKAATSU
• Localvascularmechanism:ThereisalternaFngdistensionandemptyingofthevenous/capillaryvascularspace.
• Localmusclemechanism:Thereis“disturbanceofhomeostasis”inthemuscle.
• ThesedisturbancesarecommunicatedtotheCNS.
• Systemicmechanism:TheCNSreflexsFmulatescardiovascularresponsesandreleasesananabolicneuro-humoralcascade.
TheCNSreacts
• ThereisareflexiniFaFonofaneuro-humoral-immunoanabolic/healing/adaptaFoncascade.
• AllvascularFssuesthathavehadthisdistension/emptyingflowcharacterisFcssFmulateanangiogenicresponse.
• Allmuscular-tendon-boneunitsthathavebeenexercisingenjoyananabolicgrowthresponse.
• Anycurrentinjuriesareaugmented/aided/acceleratedbythehealing,anabolicmilieu.
Hemodynamicandhormonalresponsestoashort-term,lowintensity,resistanceexercisewiththereduc7onofmusclebloodflow
ToddLodwick37y/o,6-FmeNordicCombinedOlympian
• January3rd2014wonNaFonalChampionship,qualifyingfor6thOlympicGames.
• January10th2014Fellskijumping,mulFplecomminutedfractureofLhumerus,labraltear,disruptedrotatorcuff,brokenrib.
• Challenge:maintainfitnessandhealLshouldersufficientlytomeaningfullycompetein2014SochiOlympicGames(OpeningCeremoniesFebruary7th).
• OnJanuary13th,iniFatednormalKAATSUTrainingon3uninjuredextremiFesandmodifiedKAATSUCycleandTrainingonLarm,2X/day.
• InaddiFontoKAATSU,uphilltreadmillwalking,rollerskiingwithonepole,staFonarycycling.
Todd’sInjury1/10/14
USAFlagbearerNote:carryingflaginLerhand4weekspostinjury
OlympicTeamEvent40dayspostinjury
ToddLodwick37y/o,6FmeNordicCombinedOlympian
• Jan28th,firstrundownlandinghill;firstcrosscountryskiing.
• Feb7th,carriedUSflaginOpeningCeremonies• Feb10th,firstskijumpingpracFce,normalhill• Feb13th,firstXCintervalsession• Feb20th,OlympicNCTeamcompeFFon(40dayspostinjury).– Normal,expectedjumpingperformance– 95%typicalperformancein5kmXCskiing(12:28)– Teamfinishedrespectable6thplace.
BodeMiller36y/oOlympicandWorldChampionAlpine
Racer• BronzemedalSuperG,SochiOlympicGamesFeb2014• ChronicbackandkneepainprevenFngnormaltraininginthesummerandfallof2014.
• Oct.->IntroducFontoKAATSUTraining• Dec.->MicrodisectomyL4-L5• PostOp:KAATSUTrainingtwiceperday.• InlateDec/Jan,someeasyalpineskiingplusafewtrainingrunsonracecourses.
• Feb9thSuperGCompeFFon,VailWorldChampionships.• Result:crashandDNF.However,skiingreallywellandleadingtheraceattheFme,likelymedalperformance,possiblygold.TwoseverelaceraFonstobackofkneeandgastrocnemiusprevenFngfurthercompeFFon.
• file:///.file/id=6571367.3079744
BodeMillerOlympicandWorldChampionAlpineRacer
Bode,SuperG,Vail20152monthspostopmicrodisectomy
Bode,SuperG,Vail2015laceratedsemi-tendinosis
JoshSaunders32y/oKeeperfor
LAGalaxy,RealSaltLakeandNYCFC• July132013:ToreLACLduringamatch• July23,2013:LACLreconstrucFonusingLhamstringgrar.
• Aug3,4,7th‘13Grar/joint/boneinfecFonrequiringmulFplere-operaFon,grarremoval,debridementandlongtermanFbioFctreatment.
• Duetodisuse,infecFonandmulFplesurgicalprocedures,quadricepsandassociatedmusculatureweremarkedlyatrophied.
• Sept13,‘13StartedAlter-GandKAATSUtrainingdaily.• Oct15,’13Re-operated,bonegrarusedforsealingpreviouscanals.
JoshSaundersKeeperforLAGalaxy,RealSaltLakeandNYCFC• Jan6th,‘14LACLreconstrucFonwithRhamstringgrar.
• Alter-GandKAATSUprotocolsre-startedwithinfirstpost-opweek.
• 12weekspost-op;gait,girthandstrengthofquadricepsnormalandsymmetrictocontra-lateralside.InsFtuteddrillsonthepitch.
• 18-24weeks.Returntonormaltraining/pracFce.• Firstgame,23weekspostop.• March’15MLSplayerofthemonth
Josh8weekspostLACLrepairEqualquadgirths
JoshSaunderskeepinggoal
JoshSaunders,100%
rehabilitated1yearpostLACLrepair
ConclusionofCaseReports
• Inall3cases,KAATSUCycleandTrainingweretheprimaryandcriFcalrehabilitaFontoolinreturningtheseeliteathletestotheirsport.
• Inall3cases,theathleteswerecompeFngmuchearlierthanexpected.
• Inall3cases,thewholeathletewasre-condiFonedforthedemandsoftheirsport,withminimallossoffitness.
Conclusions
• KAATSUissafe,whenproperequipmentisusedandDr.Sato’sprotocolsareproperlyapplied.
• KAATSUisefficaciousat:– Buildingstrengthwithshortworkouts(30minutes)andinasfewas10sessions.
– ImprovingperformancewherespecificstrengthisacriFcalparameter
• KAATSUacceleratesreturntosport.
Conclusions
• KAATSUsimplytricksthebrainintothinkingahuge,horrendousworkouthasoccurredanditmustrepairthedamage,whereinreality,liUledamagehasbeendoneandrebuildingjustmakesstructureandfuncFonbeUerrapidly.
• KAATSUallowssignificantmaximalintensitytrainingwhileinjuredjoints,bones,andmuscleshealexpediously.
WhenKAATSUisusedwithDr.Sato’s
equipmentandprotocols
Asafe,effecFve,efficientmethodforimprovingspecificstrengthinsport,leadingtoimprovedperformanceonthepitch.
Asafe,effecFve,efficientmethodtoreturnaninjuredplayerbacktothepitchquickly.
Asafe,effecFve,efficientmethodforsFmulaFngrecovery.