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

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What is KAATSU? Dr. Jim Stray-Gundersen, MD Chief Medical Officer KAATSU Global
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Page 1: What is KAATSU?€¦ · would resume. • The extremity would remain maximally vasodilated. If I were to repeatedly apply the clamp for 20 seconds and then remove it for 5 seconds,

WhatisKAATSU?

Dr.JimStray-Gundersen,MDChiefMedicalOfficer

KAATSUGlobal

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KAATSUis:

Asafe,effecFve,efficientmethodforimprovingspecificstrengthinsport,leadingtoimprovedperformanceonthepitch.

Asafe,effecFve,efficientmethodtoreturnaninjuredplayerbacktothepitchquickly.

Asafe,effecFve,efficientmethodforsFmulaFngrecovery.

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HowdoesKAATSUwork?

•  Byimpeding(butnotoccluding)bloodflow,simpleeasyexercisesbecomeunsustainable.ThisdisturbanceofhomeostasisistransmiUedtothebrain,whichinturn,releasesananabolic/healingneuro-humoralcascade.SinceliUledamagewasactuallydone,improvementinmusculo-skeletalstructureandfuncFonensuesrapidly.

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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.

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CoagulaFonStudies

Effectsoflow-intensityresistanceexercisewithbloodflowrestric7ononcoagula7onsysteminhealthysubjects.

MadarameH1,KuranoM,TakanoH,IidaH,SatoY,OhshimaH,AbeT,IshiiN,MoritaT,NakajimaT.

ClinPhysiolFunctImaging.2010May;30(3):210-3.

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IsKAATSUEfficacious?

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HowdoesKAATSUwork?

•  BycreaFnganimpeded(notoccluded)circulaFon,simpleexercisebecomesunsustainable.

•  Thisproduces2localmechanismsofvasculardistension/emptyinganddisturbanceofhomeostasisinexercisingmuscle,bothwhichpromptup-regulaFonofanabolicprocesseslikeangiogenesisandmusclehypertrophy.

•  ThesedisturbancesarecommunicatedtotheCNSandtheCNSrespondsbyreflexincreasesinheartrateandvenFlaFonalongwithiniFaFonofananabolicneuro-humoralcascade.

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IfIweretoclampthefemoralvein…Femoralvenousouhlowwouldstop.

Distalvenouschannelsandcapillarybedswoulddilateanddistend.

Thefemoralarterywouldkeeppumpingbloodintotheextremity.

Soon(5-10seconds),thelimitoftheouterfascialcompartmentswouldbereachedandthelimbwouldbecomecongestedandswollen.

Arterialinflowwouldslowandeventuallystop.

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Now,ifIremovedtheclamp…

•  Thefemoralveinwouldrapidlyempty,returningbloodtotheheartandcollapsingthevenous/capillaryvessels.

•  Arterialinflowtotheextremitywouldresume.

•  Theextremitywouldremainmaximallyvasodilated.

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IfIweretorepeatedlyapplytheclampfor20secondsandthenremoveitfor5seconds,wewouldhavecreatedan

impeded,butpulsaFle,venouscirculaFon.

•  ThatiswhatwedowithKAATSUCycle,onlyweuseanarrowbandofairpressuretodoso.

•  AndtheblockageofflowisincompleteandhasgradaFonstoit.

•  WithKAATSUbandsproperlyapplied,wecreateanimpeded,pulsaFlevenouscirculaFonwiththearterypushingbloodintotheextremitywhenitcan.

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Youusepressuresof300-400mmHg?!?

•  Imaginethatthepressureofthesurgicalclampisinfinite.Novenousbloodgetsbyit.

•  Imaginethatthe300mmHgofairpressureinthebandisontheoutsideoftheextremity.

•  Imaginethatblood(anon-compressableliquid)forcesitselfpasttheblockageandcompressesairintheband.

•  Imaginethatthebandofpressureproducedinthebandreducesrapidlyasitgoesdeeperintotheextremity.

•  Imaginethatthebandpressurestartsoutsomewhatnarrowerthanthecuffandthatwidthnarrowsasitgoesdeeperintotheextremity.

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KAATSUat300mmHg13.1mls/min

ThisshowsthepulseofarterialbloodandOnecanseesomeretrogradeflow

Herewehavethepatentarteryandveinaboveit

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KAATSUpressurehasliUletodowiththeathlete’s

arterialbloodpressure.

•  KAATSUpressureisappliedtotheveinsandmoderatesvenousouhlow.

•  ModeraFngvenousouhloweventuallymodifiesarterialinflow.

•  Bloodflowintoanextremitymustsoonmatchbloodflowoutoftheextremity.However,thereissomecapacitanceforholdingextrabloodintheextremity,butoncethatcapacitanceisreached,bloodflowinmustmatchbloodflowout.

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Mechanismandcharacterofbloodflowinan

extremitywithKAATSU•  Whenamusclecontracts,pressuresinthatmusclecanreachhighlevels.

•  Theysqueezeanybloodinthemuscleorvesselsinthemuscle,backintothemajorarteriesandveins.

•  Veinshavevalves,whichcausesbloodtoflowonlyinonedirecFon,backtotheheart.

•  WithKAATSU,theveinsareholdinglotsofbloodandwithmusclecontracFonthatbloodissqueezedpastthepressureblockageoftheband.

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Mechanismandcharacterofbloodflowinan

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

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

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Mechanismandcharacterofbloodflowinan

extremitywithKAATSU

• WithKAATSUCycle(pressureonandoffwithnoexercise),bandinflaFonoccurringevery20-60seconds,followedbydeflaFonfor5-20seconds,similarly,animpeded,pulsaFlecirculaFonisestablished,includingandistendedvasculaturedistaltotheband,followedbyanemptyingofthecapillariesandveins.

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KAATSUversustourniquets,

elasFcbands•  IthastakenDr.Sato,over30yearstofindjusttherightwaytoproducethisimpededcirculaFoninasafe,controlledandreliableway.

•  ThisiswhytheKAATSUMasterisnecessarytoproduceandmonitorthisimpairedcirculaFon.

•  OthermethodsandequipmentarenotcapableofreproduciblycreaFngthesecondiFons.

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KAATSUexerciseleadstoa“disturbanceofhomeostasis”

inworkingmuscle

• Whenlight,easyexercisesareaddedtothisimpededcirculaFon,theexercisequicklybecomesunsustainable.

•  pO2,pH,droptocriFcallevelswithevenmildexercise(e.g.unweightedarmcurls).

•  Highlevelsoflactatearegenerated.•  ATPlevelsdrop,asADPandPilevelsrise.•  ATPdependantElectrolytepumps(e.g.Ca++)cannotmaintainproperelectrolytegradients.

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Mechanism(s)ofKAATSU

•  Localvascularmechanism:ThereisalternaFngdistensionandemptyingofthevenous/capillaryvascularspace.

•  Localmusclemechanism:Thereis“disturbanceofhomeostasis”inthemuscle.

•  ThesedisturbancesarecommunicatedtotheCNS.

•  Systemicmechanism:TheCNSreflexsFmulatescardiovascularresponsesandreleasesananabolicneuro-humoralcascade.

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TheCNSreacts

•  ThereisareflexiniFaFonofaneuro-humoral-immunoanabolic/healing/adaptaFoncascade.

•  AllvascularFssuesthathavehadthisdistension/emptyingflowcharacterisFcssFmulateanangiogenicresponse.

•  Allmuscular-tendon-boneunitsthathavebeenexercisingenjoyananabolicgrowthresponse.

•  Anycurrentinjuriesareaugmented/aided/acceleratedbythehealing,anabolicmilieu.

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Hemodynamicandhormonalresponsestoashort-term,lowintensity,resistanceexercisewiththereduc7onofmusclebloodflow

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ToddLodwick37y/o,6-FmeNordicCombinedOlympian

•  January3rd2014wonNaFonalChampionship,qualifyingfor6thOlympicGames.

•  January10th2014Fellskijumping,mulFplecomminutedfractureofLhumerus,labraltear,disruptedrotatorcuff,brokenrib.

•  Challenge:maintainfitnessandhealLshouldersufficientlytomeaningfullycompetein2014SochiOlympicGames(OpeningCeremoniesFebruary7th).

•  OnJanuary13th,iniFatednormalKAATSUTrainingon3uninjuredextremiFesandmodifiedKAATSUCycleandTrainingonLarm,2X/day.

•  InaddiFontoKAATSU,uphilltreadmillwalking,rollerskiingwithonepole,staFonarycycling.

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Todd’sInjury1/10/14

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USAFlagbearerNote:carryingflaginLerhand4weekspostinjury

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OlympicTeamEvent40dayspostinjury

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ToddLodwick37y/o,6FmeNordicCombinedOlympian

•  Jan28th,firstrundownlandinghill;firstcrosscountryskiing.

•  Feb7th,carriedUSflaginOpeningCeremonies•  Feb10th,firstskijumpingpracFce,normalhill•  Feb13th,firstXCintervalsession•  Feb20th,OlympicNCTeamcompeFFon(40dayspostinjury).– Normal,expectedjumpingperformance– 95%typicalperformancein5kmXCskiing(12:28)– Teamfinishedrespectable6thplace.

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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.

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•  file:///.file/id=6571367.3079744

BodeMillerOlympicandWorldChampionAlpineRacer

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Bode,SuperG,Vail20152monthspostopmicrodisectomy

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Bode,SuperG,Vail2015laceratedsemi-tendinosis

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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.

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JoshSaundersKeeperforLAGalaxy,RealSaltLakeandNYCFC•  Jan6th,‘14LACLreconstrucFonwithRhamstringgrar.

•  Alter-GandKAATSUprotocolsre-startedwithinfirstpost-opweek.

•  12weekspost-op;gait,girthandstrengthofquadricepsnormalandsymmetrictocontra-lateralside.InsFtuteddrillsonthepitch.

•  18-24weeks.Returntonormaltraining/pracFce.•  Firstgame,23weekspostop.•  March’15MLSplayerofthemonth

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Josh8weekspostLACLrepairEqualquadgirths

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JoshSaunderskeepinggoal

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JoshSaunders,100%

rehabilitated1yearpostLACLrepair

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ConclusionofCaseReports

•  Inall3cases,KAATSUCycleandTrainingweretheprimaryandcriFcalrehabilitaFontoolinreturningtheseeliteathletestotheirsport.

•  Inall3cases,theathleteswerecompeFngmuchearlierthanexpected.

•  Inall3cases,thewholeathletewasre-condiFonedforthedemandsoftheirsport,withminimallossoffitness.

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Conclusions

•  KAATSUissafe,whenproperequipmentisusedandDr.Sato’sprotocolsareproperlyapplied.

•  KAATSUisefficaciousat:– Buildingstrengthwithshortworkouts(30minutes)andinasfewas10sessions.

– ImprovingperformancewherespecificstrengthisacriFcalparameter

•  KAATSUacceleratesreturntosport.

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Conclusions

•  KAATSUsimplytricksthebrainintothinkingahuge,horrendousworkouthasoccurredanditmustrepairthedamage,whereinreality,liUledamagehasbeendoneandrebuildingjustmakesstructureandfuncFonbeUerrapidly.

•  KAATSUallowssignificantmaximalintensitytrainingwhileinjuredjoints,bones,andmuscleshealexpediously.

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WhenKAATSUisusedwithDr.Sato’s

equipmentandprotocols

Asafe,effecFve,efficientmethodforimprovingspecificstrengthinsport,leadingtoimprovedperformanceonthepitch.

Asafe,effecFve,efficientmethodtoreturnaninjuredplayerbacktothepitchquickly.

Asafe,effecFve,efficientmethodforsFmulaFngrecovery.


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