Dear Mark: Vibration Training, Missing Meniscus, and Neuromuscular Electrical Stimulation

SONY DSCFor today’s edition of Dear Mark, I’m answering three questions. First, do those whole body vibration training plates provide the kind of instability that I suggest promotes good cartilage function? Second, what can a person with degenerated or missing menisci do about it? What kind of training can work with knees that are missing cartilage? And finally, what’s my opinion of neuromuscular electric stimulation—does it work?

Let’s go:

Mark – wondering if a whole body vibration plate qualifies for unpredictable movement? I’m finding it useful for balance and rattling my lymph system loose, any impact on cartilage and tendons?

Nothing like a good lymphatic rattle, am I right?

As to your question, yes. A study from 2011 tested the effect of vibration training on cartilage in people on 14 days of full immobilization. The control group, who were immobile but did not do vibration training, lost 8% of the articular cartilage thickness at the weight-bearing part of the tibia (shin) in just 14 days. That’s scary. Meanwhile, the vibration group gained an average of 22% more cartilage thickness after 14 days.

This is remarkable. They did nothing but vibration training—literally, didn’t move their legs, just had them jiggled around a bit—and gained cartilage.

Vibration plate training also has beneficial effects on bone density and muscle strength and stability in older women. It seems legit. Maybe a larger post is in order.

But for now, it seems to work.

Mark, what about people who are missing cartilage. I am missing 75% of the meniscus in my right knee (ACL repaired) and 25% of the meniscus in my left knee.

First of all, don’t stop moving, training, and playing. Pretty much every study with people who’ve had parts of their menisci removed confirms that sticking with exercise and rehab improves outcomes.

  • One study found a 12-week exercise rehab program immediately after surgery has beneficial effects at a 1-year followup.
  • Another found that a 12-week exercise rehab program after surgery beats none at all.
  • Still another confirms that “high repetitive, high dosage” post-op rehab is efficient and effective compared to none at all.

What kind of training should you do?

This may not apply to your specific situation, but for people who are approaching surgery or just finishing it, your doctor will likely assign a physical therapy program. Just start with it. In my experience, they tend to be quite good.

Training the gluteus medius (the “outer” glute that controls hip abduction) has particularly impressive effects on post-meniscectomy knee health. Based on EMG studies (where they measure the “activity” of the muscles in response to different activities), side-lying hip abductions (think raising your leg in a side plank position), single leg squats, lateral band walk (resistance band around your ankles, walk side ways), and single leg deadlifts are the best exercises for the gluteus medius.

Do these knee circles every single day for three sets of 50-100 circles in each direction. They don’t take that long. Just do them. Go as deep as you comfortably can.

Try front squats instead of back squats. Front squats produce fewer compressive forces and knee extensor moments on both the front and back of the knee than back squats while activating just as much musculature.

Strenuous, pounding exercise may not be helpful. Research in rats with osteoarthritis finds that damaged cartilage has an imbalanced response to strenuous exercise. Whereas moderate bathes the damaged joint in both anti-inflammatory and inflammatory cytokines, strenuous exercise produces the inflammatory cytokines without enough anti-inflammatory cytokines.

A friend of mine with some missing meniscus has found that uphill sprints are both easy on the joints and more effective than flat sprints. Cycling, swimming, and rowing are other ways to get some high intensity activity without pounding the knees.

Discomfort is expected. Effort is required. Pain should be avoided. You don’t want your knee to “hurt.” That’s a sign that you’re doing something counterproductive to your ultimate goal: having healthier knees. If you can go hard and heavy without pain, keep it low volume. Think heavy singles, doubles, or triples instead of high-rep stuff.

Good luck! You can have plenty of success. And hey, there’s some cool medical tech coming down the pipeline.

There’s an active indiegogo campaign for a device called “bionic gym” that is basically a device that stimulates muscle shivering using electrical muscle stimulation (EMS) to help burn calories… genius or snake oil? I’m thinking if the science is valid, it can help many especially those who are injured or too sick to work out. If coupled with MAF method, it sounds like it’s possible to improve the base aerobic capability of a bunch of people and hopefully reduce the risk of cardiovascular disease. What do you think, too good to be true?

The Bionic Gym is a neuromuscular electrical stimulation (NMES) device.

NMES is a legitimate piece of technology. Past studies have found it can be effective in a number of capacities:

It can prevent muscle wasting in critically-ill bedridden patients and during immobilization.

It can increase muscle protein synthesis in older men with type 2 diabetes (something resistance training famously increases).

It can improve muscle thickness in older women with knee osteoarthritis.

It can improve muscle activation and reduce pain during normal physical tasks (squatting, stepping, etc) in women with knee pain.

It can improve knee flexor strength slightly more than resistance training in patients with knee osteoarthritis. No word on what that “resistance training” actually consisted of, though.

It can activate and strengthen deep abdominal stabilizers. It also works for lumbar stabilizers.

It can even coax paralyzed muscles into lifting weights.

Those are mostly patients who can’t train “normally,” though. NMES is clearly better than doing nothing at all. What about in healthy, fully-able adults?

Well, one recent study found that NMES certainly “activates” the muscle comparably to resistance training. But except for torque, which did improve, they didn’t look at many outcomes—strength gained or lost, hypertrophy, etc. On paper, it should work, but we don’t know for sure yet.

The authors of another study where NMES improved strength over resistance training concluded that healthy muscles will have the best gains with both NMES and “voluntary exercise” because they do different things. The NMES hits the largest motor units first, while voluntary exercise recruits the smaller ones first. Do both, and you theoretically have the best of both worlds.

The allure of NMES is obvious. It works to some extent, and it does the work for you. You just sit there and take it. Meanwhile, adherents to “voluntary exercise” know they have to expend effort to get results. Not everyone likes to give effort. That’s why so many people fail in the gym—they’re not willing to work hard, or they have wrong information and make poor training decisions. That’s probably why NMES compares so favorably to “exercise” in a lot of studies.

I suspect the average person loitering in the gym, puttering around with machines, watching CNN as they mindlessly cycle or row or walk without the desire to do better is the perfect candidate for NMES. They’ll see real results because their muscles will be seriously contracting, finally.

On the other hand, I suspect the average person reading this blog, doing compound exercises, running sprints, lifting heavy things, doing CrossFit, performing all the right moves doesn’t need NMES as much. But it wouldn’t surprise me if adding some NMES on top of smart training had a compound effect. That will be cool to see.

One interesting possibility is the use of NMES to target smaller muscles that people typically have trouble targeting or activating. In that study mentioned above, they used NMES to strengthen the vastus medialis, a small and oft-ignored but very important extensor muscle in the thigh. Voluntary exercise (step downs) wasn’t very effective compared to NMES. It’s just a tough muscle to hit.

I can see that kind of application working well—real training and NMES.

Anyway, that’s what I’ve got for today. Thanks for reading and be sure to chime in down below.


TAGS:  dear mark

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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