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Juerg Feldmann

Fortiori Design LLC
Posts: 1,530
I like to move this topic into the strength section.
 I hope to open  some  additional discussions on MOXY use  in this huge   potential field of  practical applications  from the individual athletes  to a  therapist  to personal coaches  and to team coaches  looking for   additional improvement  in individual set up   workouts .

I like to show the start discussion, where we  use  SmO2  .
 The workout  was  a  set of  squatting  exercises  to  individual subjective  limitation  followed by a set of sitting shoulder press   loads.
 MOXY was attached  on quadriceps  vastus  lateralis  and on Delta  pars  acromialis.

Dark green  is SmO2 trend of the quadriceps  muscle.  and light green is the trend of SmO2    from the delta  muscle.

What we like to show you is, that SmO2  is a great tool to see trends but if we look only on SmO2  than we   do not have a clear picture on why  we may see what we see  and why we have to speculate on the reaction.

Now  again not a critic  but  an observation. Since we use NIRS  regular in the   research  world  since    the late 1980  it is  still surprising how many new  studies  come out , where  we see that only  SmO2  is used or  HHb  or O2Hb.  What we  miss in all this great papers is the  combination of  SmO2  as a part of the trend in tHb  ( change in blood flow  /Volume).
 The idea  to leave tHb  out of the discussion is great , when we look at studies, where  blood flow is  constant     like during  arterial occlusion studies  or  during  resting situations.
 Once NIRS moved into the sport  and activity field  we  can't  ignore  changes in blood flow  and distributions  and as  such may have to rethink many ideas.

Here a short  part of that discussion  from a great product  and company.

blood flow during exercises.JPG 

Now   read carefully  and you will find one section :  tHb is assumed to stay  constant ?? including the statement, that this may be not the case  when we    move ???

In simple terms.
 tHb  has to be used  under the  idea, that during  many activities the blood flow (  volume ) in the tested area  most likely  may change.
 So a  " stable SmO2  ( TSI % ) value  as an indication of  %  O2 loaded  of the tHb  does not  mean that we have a balanced O2  use  as discussed in other sections in this forum.
 Summary :
 When reading  an increasing flood  of NIRS studies  coming out  be nearly daily  we have e to keep in mind  and critically look , whether they take this into   the  discussion or whether  conclusions  have to be critically  reviewed..
 Using a trend of HHb   or O2 Hb  alone  with out   considering tHb  reactions  can  lead to some interesting  results  and  conclusions  !!!! 

So let's look  first  just SmO2  reactions.
 Than  a great summary  and answer  by Fred

squatt  PS and elta smo2.jpg 

Juerg, hi, g'morning.

My thoughts: the torque necessary for making the 'shoulder' press movement pattern is much more dependent (isolated) on the deltoid muscle, compared to the squatting demands on the quadriceps. Plus the deltoid is comprised of smaller compartments, which creates greater demand to muscle ratio (tension) during the loading drills AND subsequently sharper de-load curve. With the deltoid, we're most likely to see more complete arteriole restrictions. So, just like you mention above, no way to shuttle in more O2 to satisfy demand. So in this instance, why would the governor bother ???

Squatting is opposite, the bar path and movement pattern are both great AND much less isolated, so a lesser restriction to inflow and greater 'systemic' ability for 'helpers' to shuttle in O2 from non-torque-generating compartments AND 'systems'. Re-load for quads is same for each set, so that's working, ensuring the start O2 load is not the issue.

Increased 'system' readiness (supply & delivery) may explain less de-load on sets 2, 3 & 4. Or increased 'fatigue' may be the reason SmO2 performance is less? To be sure, I would need to watch the performances/technique of the sets, other bio metrics, and survey the post-drill RPE.

 Now let's  add the   information of tHb  to the discussion.
smo2 thb squatt three  areas.jpg   This is a closer look at the squatting. I added  already three colors  for  further explanations.
 Red  is the perfect load , green is   still loaded and moving  but ???  and yellow  is actually no motion anymore at all.
 This is a practical example how we  design an individual strength workout depending on the goal setting for this patient  or  client. It is a SIP  ( strength intensity profile.)
 To show   an additional feedback  why we may  drop SmO2  nearly  to 0  on the delta  and  why not in the squatting read  Fred's  theoretical  ideas  and compare  to the 2  graphs . look at tHb  trends.

thb smo2 all three delta J.jpg  So if  strenght  is a are  you like to start integrating MOXY stay tuned here  over the next few  days.

Juerg Feldmann

Fortiori Design LLC
Posts: 1,530
I assume  most  readers see the  clear difference of this   2 all out  loads and Fred  explained it well, why  we see  in the delta   a very low  SmO2  situation   compared with the quadriceps. Here once more the base  picture.
smo2 thb squatt three  areas.jpg   The actual  load, so the time , where the athlete  actually did  optical squatting is  red  plus green  zone. In other words.
 The red  zone indicates a "perfect' squatting with  the suggested  sport specific knee  angle.
 The  goal was to push to  subjective exhaustion in a perfect squat position.
 The goal, a  perfect  sport specific  and therefor intermuscular  great team work  plus  an optimal intramuscular overload was done in the red  zone only.
 After the red  zone   we can see a change in SmO2  drop rate  but  as well a change in tHb ( blood flow trend)  
Describe  for yourself  the   situation on blood flow based on this trend  and why ?
 If you go back to Fred's  explanation you can see what  and why this is happening. So  we  actually, if we like to make here a perfect  squat so hard  for metabolic reasons, but perfect  for sport specific  reason in bio mechanic, we   had a terrible workout in the first set  and   most likely  would  have little  if  perhaps  even negative benefit  from  this  workout  towards the target   idea  of   the  motion.
 If we give a time or a   repetition number in any strength workout than this  is  often the end result.
 So the athlete should look optically  in front, when he looses  the target  muscle  and when he starts to compensate  to just survive the "ordered" cook book load  time or  cook book  target reps . Same with the rest period  which in this  case  was guided  by  SmO2  recovery back to base line.
Now interesting is the yellow zone. You can see  without any problem, that despite  the end of  the load  at green the SmO2 really  drops  extreme  and this  is even more extreme, when you look  that tHb  actually is increasing.
 What may be the reason of this extreme situation. ? 
Add on.
Workouts  like the above , for sure  first set , are one of the  main reasons we see  so often athletes in the therapy  and rehab. This forced  bad  reps  create  in many cases  a  muscular dysbalance  and a muscular dysharmonie.


Development Team Member
Posts: 168
Juerg, the SmO2 may drop at the end of the set due to:

Initial high quality movement PLUS forced reps create a metabolic situation the subjects VE could not balance and initial delivery to reload is reduced until that situation is OK.

As you said, probably a great subjective effort, but after the SmO2 de-load levels off, it may result in not much more than athlete hanging in there, huffing & puffing.

If the goal is maximum strength adaptation (client is stronger next session), I stop the loading when the tHb has gone in the desired direction and the lifter cannot persist to maintain the SmO2 de-load peak. As a result I literally haven't coached a # of reps or sets in almost a year.

Development Team Member
Posts: 279
I have a question with the athlete not being able to get the SmO2 de-load peak. Is there any rule that you apply. Like if the base seems 70 and if de-load doesn't go back to 70, it's over? It of course also has to do with the specific goal I guess.
Other question. Is there anything to say about cardiac output in this case? Or wasn't that measured?
Juerg Feldmann

Fortiori Design LLC
Posts: 1,530
Will be back after work on both of this great feed backs. Just to set  my confusion straight. Ruud  talks about deload    but is it that you may thing about  re  load  . Fred  I think is really talking about de loading meaning if he can see that the nice  downwards  trend in SmO2  or  the upward  trend in tHb  start to  " studder " hm is that  an English word ??
 but  may be you understand what I mean.

Development Team Member
Posts: 168
Ruud_G, hi. 

Yup, I apply the practice you mention to re-load & de-load. I keep the sets going until I see a change in either that is related to performance quality. RE: cardiac output, I may defer for more expert ideas from folks who are using the Physioflow, however my sense is that cardiac output contribution during strength performance will be load sensitive, i.e., lighter loading = greater delivery X heavier loading = lesser delivery due to effects of compression tensions. IMG_1899.PNG  IMG_1896.PNG  IMG_1898.PNG  IMG_1899.PNG


Development Team Member
Posts: 279
OK thanks Fred for your response. I asked the question about cardiac output wrt (possible?) interactions that might exist with using a certain weight - repetitions - time (constant or based on load/deload) between sets (and between reps) and stimulation of either HR or SV. Just based on some anecdote ("feeling") that I have when doing squatts 15 reps (at 60% 1 rep max) as soon as I stop, my heart start to pound hard (you feel the pounding in the chest). Maybe it's only subjective because when you're busy you don't notice it. I will start to use the Moxy with strenght training as well to share things so it does not stay subjective.

Development Team Member
Posts: 168
Depending on the overall conditioning situation, I 'think" at the load you mention (65% X 15 Reps), a CO responding at end of set will be 'normal'.

Look at the example above that we started with, note the duration of the sets (probably a gruelling experiment) and we see the tHb X SmO2 reactions from loaded to unloaded sets. From this, especially set 1, we can possibly guess who compensated in and not so easily in set 2-3. And which limiter came on heavily at end of each set to regain the last metabolic balance. Thoughts?

Development Team Member
Posts: 168
PS, Ruud_G, I think it's great you're considering fixing the MOXY on for strength work, it's very cool to work with the live feed from relative strength work through to maximal loading. Looking forward to seeing your posts,
Juerg Feldmann

Fortiori Design LLC
Posts: 1,530
We  will be on here  for many more weeks to come  as there is a wealth of information I like to share.
 So  great start into the discussion.

 Let's see how we start  and or sort this here.
 1. Feedback to  Freds   great  summary .
 What causes  the drop in SmO2  after the fact   and after we  stopped  actually " demanding " O2  for the work or performance.
 Is this a  kind of an EPOC ??  or is it  rather a  need  less  fro refueling ( what epoc  would  be.
 If we have  such a  thing like EPOC  than  we would expect , that the VO2 is  higher after  a load ( which is the case )    and  if  we would be in a O2  deficit  we  would have  a lower SmO2  . Which is the case of a few seconds  and than we  may even have the opposite , an overshoot of  SmO2.
 EPOC  got introduced when  researcher   started  to see, that the old idea of  O2  deficit  can't be really explained  by any means and that this idea  most likely  got  created  due to the lag time of  testing equipment rather  than actual physiological reality. Juts to close this  thought a  picture  you can think through  what it  may mean  or should show.

overlap VO2.jpg

So I think  like Fred  points out ,this is a  nice  example of a  drop in SmO2   to compensate  for the lack of  possible  delivery.
 The load ( red  zone) plus the   additional  load ( or perhaps not  optimal load,)  green zone [wink] created a  huge  H + production and as such a huge    CO2  pool  , and the body was not able  during the load  and  for a short moment  after the load to get rid  of it. As the load stopped , there was  an immediate attempt to  refuel  CP  and   ATP  as they  may have drop down to the critical low  level  and it  needs O2  to  refuel O2  independent  energy sources. CP    could be used  to  get a P  to refuel  ADP  to ATP ? As  such nothing is  really  O2  independent  as  O2 independent is very dependent  on O2.
We know that the  SmO2  trend   runs very similar to the CrP  trend,  so you can see, what really may happened  with a very simple tool MOXY.

Below  some additional bio markers  we used   and it will explain you a lot.

et co2  and squatting.jpg 
First number in the  square is  EtCO2  tested  with a capno meter ( Emma)  second number is  RF ( respiratory frequency )tested  with a BIO harness. Limitation. The EtCO2  is NOT  equal the  Pa  or PA  CO2  and it has a lag time reactions as well it depends  on the respiratory   ability  and level of  an athlete. How is  he  reacting. A great respiratory trained system will react over  a high RF    but as well a higher TV. A  not optimal trained  or untrained  athlete  will react mainly over  high RF  but  lower TV. As  such it will take much much longer to  re balance H +  homeostasis  and as such  much longer time needed  to refuel O2  independent energy sources.

 So the real deal  is to test this with blood sampling  ,but again  it has a lag time   . Nevertheless  we had the   great opportunity  to do this  with Per Lundstrom    in Santa Monica  red bull head quarter.
 Here  just a very  short inside  view  in a similar  idea of squatting and the reactions in numbers  for the critical reader.

So this is NOT  a  cook book and is  true only in this  case study.
2  loads   numbers only.jpg 
 What are the practical applications in  different sports.
 a)  fix the MOXY on the main  contributor  of a sport specific motion.
 Example  400 M  track athlete.
 Moxy on hip extensor. ???. Now  you plan an interval workout.
 Classical idea.  perhaps 5  x 400 m  with  3  min rest. Or  100 / 200 / 300 / 400 / 500/  400/  and so on. Any thing  which sounds  brutal and is brutal is used.
 Every thing  creates a metabolic acidosis  and as  such  an incredible demand on Ca ++ use .  It is used  to train  lactate tolerance ????
 It is  often a planned  idea  to create a stress fracture  due to this.
 We  could replace this enzymatic  goal by using a respiratory acidosis  instead ??? so no Ca ++ used in this  huge amount .
 Secondly   the risk is  increase, as    all the athletes  will  completely kill the main muscle performer  ( hip extensor)  and as the goal   seem to be finish 5  x  400 m , and not  finish a perfect load on the perfect  muscle chain    and avoid  compensatory  bad  motions  we    actually overload  not just the main muscle but  change bio mechanic  with   many  wrong loads  on tendons  and    joints ??
 . Here an alternative  option .
1 suatt to limitation.jpg  Let's stay with our example, but it can be  used  ( cook book option ) in any interval or strength  workout.
 In the above case. 
Optimal perfect   load  for vastus  lateralis in a  squat motion was  app 45 " ( red zone ).  The athlete  kept  going , but simply  used  different options to keep the squatting going . Less bending in the knees, more  motion in the hip  and so on.
 So the green load  was  just that , a load  and if the goal was to have an optimal technical load on vastus lateralis,  the 180 seconds   additional load  was not just only waste of  time  but as well of energy  and  destruction of a  perfect  coordination load   for that specific  goal
 So in a 4 00 m training you do NOT use  400 m as  the goal,  but  you use the optimal load time  for what you like to load  and where you like  to increase the time .
 So you have  1  or  2 MOXY's  on the athlete . You see live on your computer the action. You  start   what ever the  start speed is you like to  use  or go all out  and see, when the optimal motion is over  from an energy point of view  and as such    as well from a bio mechanical point of view.
 You see it , the athlete  can feel it  and you  stop the load  when you see   the SmO2  reaction and the tHb reaction. This may be  by 267 m , who cares.
 Your stop  . How long.?
 To  re bounce  to   start SmO2  or  to wait  till we have an over shut     and as soon we have the highest point of  over shoot ( possible the highest load in CrP  we go again. This may be after 1 min 56 seconds. New load  299 m. Intermediate time  by 100 and  200  or what ever  can show , whether you maintain the speed or  whether you    are even faster or much slower.
 tHb will tell you the same.  New rest  wait  for overshoot 2min 36  seconds  . And you keep going. You stop, when   times  are slower over the same distance or when you can reload  any more, or when you do not reach the same quality  contractions anymore.
 So here to end.  Destruction of quality  contraction  in the   shoulder press motion   shown by tHb.

delta overlap 1 and 3 thb.jpg 

Juerg Feldmann

Fortiori Design LLC
Posts: 1,530
Let's  go one step further.
 When we use  MOXY  in strength workouts, which is super easy as you mount  the MOXY on the target  muscle   and if you  like one on a  very little  and or non involved muscle  and you go. The client can see live on the big screen , what is going on.
 If  I have 2  or more  patients  working out,  I use a big  screen so all 4  can see   on the screen what they do and they are  super motivated as they  can see that despite  working in a group, it is all about being individual. I can have a high school student working on his ACL recovery  and a  78 year old  client working on his TKR  recovery(total knee replacement ) They work  shoulder on shoulder, have  a great interaction and can actually help each other to stay motivated and work on their individual ability to improve.
 I can guide  a  workout  on the ice   or on the snow  or where ever  and  can give  immediate feedback  to the athlete, so we have video, feeling of the athlete  and physiological feedback as we  never had before.
 For any  top coaches  we approach one by one it is  anon brain er, once they see that and they immediately understand  how they  dramatically can improve their  results  and the quality of their services.

 Here first  some ideas  and than I show you a " cook book " to start out  with,  but with the hope  you  NOT buy into a franchise  idea  but  you are motivated  to be a real chef  with your own great creations  of using MOXY
 Here a  top chef  from the eats coast. a regular reader  and great  feedback  guy . Fred  from Halifax.
 A rare,  but great view into a  top   notch fitness center  for  the  average person  of  the street, They get a better   service  and higher individual feedback  than many   multi million $  payed  pro athletes. It is  all one   by one  no matter on the  status,  it is  all   for personal best  and health.

Here  another use  from Mary Ann Kelly  MOXY  expert  on the west coast   of the USA. Live feedback during climbing in  Santa Ana  California

climbing 1.jpg

Here a great example of a  team workout in Brian Kozaks  Ice hockey  next level acceleration center. Dry land  training
Hockey Spiro.jpg 

and a  skate mill assessment
Hockey skate mill.jpg 

Now  here  what you look for  as a "cook book"
 1. SmO2  trend  as a feedback on utilization of energy.
SmO2  trend.jpg

 In theory and below in real situations
SmO2  trend. 5 1 5 examplejpg.jpg 

 Now  SmO2  is not just but   nicely used  for utilization feedback, but it is   strongly related  to  delivery feedback.
 The tool    or marker for  delivery feedback is tHb.
 See below thb  trend. 5 1 5 examplejpg.jpg

Now you can start  looking   easy and fast  at the trends  live during a workout  and or  after the  fact if you use MOXY as an assessment tool to the existing  VO2    / lactate  and other assessment equipment's
 If you like to start physiological testing ,  MOXY is  without  any doubt the cheapest  and easiest  to understand  and use  physiological assessment equipment which can be used  anywhere  any time   no  limitations  and calibration  and cost involved, once  you have it in your hands.  The main problem   we  face in the  more intellectual  world of  people  is a  simple one :
rw 1.jpg  
As usual  when we show graphs  and pictures . You add your own ideas, thoughts  and words to it. ( Smile )

mary ann

Development Team Member
Posts: 7
What a great thread!   Thanks J and Fred!  Question re; comment in #10 on how the acidosis created through excessive or exercise intensity can cause a metabolic imbalance balanced by Ca++ -  thus impacting bone health?  J, your comments "...train  lactate tolerance ???? .... planned  idea  to create a stress fracture...  We could replace this enzymatic  goal by using a respiratory acidosis  instead ??? so no Ca ++ used in this  huge amount .    So am wondering just how we might use this insight to address clients' with shin splints or prevent this (annoying) over training injury with those at risk?  
Thanks in advance!
Juerg Feldmann

Fortiori Design LLC
Posts: 1,530
I like to give an answer written by much smarter people  as overall look at his  injuries.

Overuse injuries: tendinitis,

stress fractures, compartment syndrome,

and shin splints

Robert P. Wilder, MD, FACSM*, Shikha Sethi, MD

Department of Physical Medicine and Rehabilitation, The University of Virginia,

545 Ray C. Hunt Drive, Suite 240, P.O. Box 801004, Charlottesville, VA 22908-1004, USA

Approximately 50% of all sports injuries are secondary to overuse [1]. The

frequency of overuse injuries evaluated in primary care sports medicine clinics is

even greater, reportedly up to twice the frequency of acute injuries [2]. The majority

of injuries evaluated in running injury clinics are related to overuse [3,4], and

approximately half of these involve the lower leg (20%), ankle (15%), and foot

(15%) [5,6].

Overuse injuries result from repetitive microtrauma that leads to local tissue

damage in the form of cellular and extracellular degeneration, and are most likely to

occur when an athlete changes the mode, intensity, or duration of training—

a phenomenon described as the ‘‘principle of transition’’ [7,8]. Physical training

uses prescribed periods of intense activity to induce the desired goal of ‘‘supercompensation’’

or performance improvement. A mismatch between overload and

recovery can lead to breakdown on a cellular, extracellular, or systemic level,

however.At the cellular level, repetitive overload on tissues that fail to adapt to new

or increased demands can lead to tissue breakdown and overuse injury. It is

important to realize that, in theory, this subclinical tissue damage can accumulate

for some time before the person experiences pain and becomes symptomatic. On

the systemic level, rapid increases in training load without adequate recovery may

cause a global ‘‘overtraining syndrome.’’ Strong predictors of overuse musculoskeletal

injury include a previous history of injury as well as walking or running

more than 20 miles per week [9].

Both intrinsic and extrinsic factors contribute to overuse injuries. Intrinsic

factors are biomechanical abnormalities unique to a particular athlete and include

such features as malalignments, muscle imbalance, inflexibility, weakness, and

instability. High arches, for example, have been demonstrated to predispose to a

greater risk of musculoskeletal overuse injury than low arches (‘‘flat feet’’) in

military recruits [10]. Extrinsic (avoidable) factors that commonly contribute to

overload include poor technique, improper equipment, and improper changes in the

duration or frequency of activity. These improper changes in activity duration/

frequency or ‘‘training errors’’ are the most common causes of overuse injuries in

recreational athletes. Vulnerability to extrinsic overload varies with the intrinsic

risk factors of an individual athlete [7].

Sports-acquired deficiencies, categorized as an extrinsic risk factor, actually

represent the product of biomechanical abnormalities and training errors. Because

sports activity can overload an athlete’s musculoskeletal system in predictable

ways, athletic repetition without proper conditioning can propagate muscular

imbalance and flexibility deficits.

Injuries are often related to biomechanical abnormalities removed from the

specific site of injury, underscoring the importance of evaluation of the entire

kinetic chain [11].

Common overuse injuries of the lower leg, ankle, and foot include tendinopathies,

stress fractures, chronic exertional compartment syndrome, and shin



Fortiori Design LLC
Posts: 65
I wanted to add a few points to this thread, as it is very active.

First, I wanted to quickly give Ruud an input on this point made earlier in the thread:

Just based on some anecdote ("feeling") that I have when doing squatts 15 reps (at 60% 1 rep max) as soon as I stop, my heart start to pound hard (you feel the pounding in the chest). Maybe it's only subjective because when you're busy you don't notice it.

Nicely presented by Fred's images, and we have all seen seen the effect of occlusions in tHb with the Moxy, when we do strength training we often have a limited return of blood to the heard for a short moment due to poor circulation from muscle pressure. Once this muscle pressure is released, we have a sudden rush of blood back to the heart, and with it many biomarkers communicating what is going on in the muscles. Firstly this rush of blood back to the heart will increase preload and cardiac output, and the peripheral feedback will relay a demand for increased energy substrates, and the elimination of metabolites. This would all very logically explain the high central demand post strength bouts.

Secondly, we have been working with some elite strength trainers in Switzerland who are very interested and the application of Moxy during strength training. How and where can we use it, something to discuss.

At the moment (this could all change based on your persuasive arguments [wink] ), I see SmO2 as a bioenergetic signal, and therefore useful for longer duration sets of multiple reps, or longer time frame (5s-10s+). Of course, as we all see oxygen is used immediately for energy production, so it is not that we dont need oxygen for shorter maximum bouts, that is not my point just to be clear. The question is, during a 1 or 2 rep maximum effort, is our performance limited by bioenergetics? I would argue it is limited by CNS, motor-muscle control/coordination, and muscle contraction potential. Therefore for max strength/power I dont see SmO2 as a control of intensity to be super useful. Recovery is again a different story and using SmO2 overshoot in my experience has worked nicely. THB on the other hand does give use some indication of muscular force being produced, but again for max strength I would suggested that the usefulness may be limited. Thoughts?

For hypertrophy based or "endurance based" resistance training, I think Moxy is an excellent tool to gauge much like Fred describes both intensity and recovery. Not only that you can now decide if you want the intensity to last in a mostly oxygen dependent zone, or push on to maximize oxygen independent production.
Juerg Feldmann

Fortiori Design LLC
Posts: 1,530
Interesting reading.
 Here a suggestion  to all  discussing MOXY  and maximal strength.
 Make  some  workouts  and combine SEMG  and MOXY  and sent the info back in. Try to combine  theory  and  real practical feed backs  . So  the challenge is out there. 1  or  2  rep  max  contraction  combined  with MOXY  and SEMG  on the same    muscle  under the same tape.
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