What is KAATSU?€¦ · would resume. • The extremity would remain maximally vasodilated. If I...

transcript

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.

extremitywithKAATSU• SomeFmes,ifthepressuredifferenFalsareinfavorofthis,whenthemusclecontracts,inaddiFontorobustvenousouhlow,thereisretrogradearterialflow.

• WithKAATSUTraining,andmusclecontracFonhappeningevery1-2seconds,animpeded,pulsaFlebloodflowintheextremityisestablished.

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.

What is KAATSU?€¦ · would resume. • The extremity would remain maximally vasodilated. If I...

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