Everyone has a plan until they get punched in the mouth, or, in my case, get a *wince* back injury.
In my 20s I ran to and from work for fun, did an Ironman and my first 50-mile trail race, and generally couldn’t be bothered to talk about things like plantar fasciitis, which seemed to me to be something you got by not taking running seriously enough. Years and a handful of injuries later (some quite severe), I find myself taking a very different approach to health and my body in particular. There isn’t a one-size-fits-all approach to wellness; for me, it almost meant getting my L5 and S1 vertebrae fused. But then a very wise doctor suggested I chill out for a while and try meditating before jumping into back surgery, and that lump of advice led me down the winding path of health and recovery that I’m on today.
One significant element of that has been to construct a mini physical therapy studio in my home. Rubber bands, foam rollers, a yoga mat, an exercise ball were just the beginning — there are books about the relationship between back pain and anger as well as the positive benefits of relaxing herbal teas and motivational quotes. There’s a new way of thinking about the body and the stresses I put on mine. And then there are several pricey devices that raise eyebrows at TSA, as well as those of some science-minded people who aren’t yet impressed by the clinical evidence. As anyone who has been injured will tell you, feeling good in your body has no price, and a little belief (plus a little science) can go a long way.
During recent months I’ve tried three supposedly cutting-edge recovery devices — the Marc Pro Plus, Theragun G2 Pro (the G3 has since come out), and the Terraquant TQ Solo cold laser — each of which is available for use at home and has some degree of therapeutic value. I tested them out and did some research about the science behind them, so what you have below is my experience and a brief look at what clinical evidence exists.
A word of caution about considering whether something “works”: It’s always important to ask, for what exactly? The companies selling these products typically make either very narrow or very broad claims about their potential, depending on how much science there is and whether the FDA approves them for specific treatments. Broad claims tend to be easily defensible, while narrow claims will get you in trouble with regulatory bodies if they’re not true. Remember, while pharmaceutical companies might invest billions into a blockbuster drug in the hopes that it will produce equally large returns, it makes less sense for a company to put money into expensive clinical trials for something like a personal massager, which people like because it feels good.
As somebody who has found himself at both of the opposing ends on a scale of physical activity (endurance athlete at one, barely sitting up in bed at the other — my experience with these tools yields the following wisdom:
Be patient and compassionate with yourself. Injuries often erase years of “base” you’ve built up, and trying to get back to who you once were is often counterproductive. Create a new path.
Read the research yourself. Studies can be complex, but you can usually understand the gist of it by reading them over twice.
Be safe. Read the manuals and check in with a doctor and physical therapist to get their opinions before trying to deal with an injury at home. Ideally you’d do as I did and add at-home treatment to an existing routine with a doctor and physical therapist. (Remember that if you’re not injured, there are places you do not want to point a Theragun at or stimulate with electricity.)
Try everything. Read all the books, try different movement techniques, and if a product makes you feel better and it’s safe, then buy it — even if the science isn’t all there.
Marc Pro Plus
What It Is: The Marc Pro Plus is an electrical muscle stimulation device intended for pain relief and muscle recovery. You’ve probably heard of electrical muscle stimulation or used it in physical therapy, and there are a few other consumer-facing machines out there from Compex and Power Dot that occupy a similar space. This is not to be confused with TENS, or transcutaneous electrical nerve stimulation, which stimulates the nerves and tries to confuse the brain into ignoring sensations of pain. Instead, the primary function of Marc Pro is to cause the muscles to contract using what they describe as “unique, non-fatiguing muscle contractions that allow your body to recover faster and reduce pain.”
The voice of Marc Pro, in addition to a handful of athletes and trainers like CrossFit athlete Noah Ohlsen and mobility expert Kelly Starrett is Gary Reinl, director of National Accounts and Professional Athletic Teams for Marc Pro. He’s also known as @TheAntiIceMan on Twitter, and wrote Iced! The Illusory Treatment Option and has taken a strong stance against RICE (rest, ice, compression, elevation), which was conventional wisdom for the better part of three decades and now appears to be bogus. (Gabe Mirkin, the doctor who invented it, wrote the intro to Reinl’s anti-ice book.)
Reinl is worth mentioning because he likes electric stimulation for the same reason he dislikes ice: Whereas ice and rest cause stressed or overused muscles to congest and, in the case of injury, atrophy, activating the muscles sets off what he calls a “muscle activated recovery cascade,” which includes increasing circulation and angiogenesis (the creation of new blood vessels). The pre-RICE advice of “walking it off” is actually the right idea.
“It’s the muscle activation — the ‘walking it off’ — that solves the problem,” Reinl says. “Stim lets you do it without stressing the damaged tissue without control. Say you rolled your ankle. How do you walk it off without stressing the damaged site? That’s why stim wins the contest of muscle activation.”
The Marc Pro Plus has both a low frequency, which through muscle contractions is meant to improve circulation and angiogenesis for everyday recovery, and a high frequency, which offers pain relief by disrupting a particular function within the nerve.
What The Science Says: The science on Marc Pro and electrical muscle stimulation is the best of the three devices on this list, with evidence suggesting that it does what it says it does in both trials that support the effectiveness of electrical muscle stimulation as a treatment as well as a trial specifically with the Marc Pro.
For example, one study showed that electrical muscle stimulation improved muscle thickness and knee extension strength after surgery in patients with acute ACL tears. In a study specifically on the Marc Pro, subjects who combined exercise (calf presses) with electrical stimulation had improved strength and reduced feelings of fatigue compared to groups that did not use the device.
My Take: I use the low setting frequently on muscle groups near the low back. My general function and range of motion have increased, but I’ve also been working on posture and movement with the Alexander Technique and other physical therapy methods, so it’s harder to pinpoint one specific type of therapy as the sole cause of progress. The high setting on the Marc Pro Plus offers exceptional pain relief, but my primary focus is improving movement and range of motion, not relieving pain.
Overview: You may recognize Theragun from the slow motion Instagram videos of tanned flesh bouncing in concentric waves beneath the gun’s massage heads. These clips are everywhere. The updated version is supposed to be 50 percent quieter, but the one I have is deafening — it’s like the 20-year-old air compressor I keep in the back of my Jeep in case of a flat. But the noise is not without purpose: the motor drives the arm, mounted with one of the various attachments that come with the gun, against your body. It creates what Dr. Jason Wersland, DC, founder of Theragun, calls percussive therapy, or “a deep muscle treatment using rapid and long vertical strokes into the muscle tissue causing a neuromuscular response.”
Wersland developed the Theragun after a disc-related injury to his neck in a motorcycle accident. He used it on muscles affected by the injury, for instance, his right trap, right tricep, and right bicep. He recommends using it before a workout, during a workout, and after a workout.
In brief, this thing is basically a badass personal massage gun with 16 millimeters of amplitude (that figure refers to how much it moves up and down), delivering up to 60 pounds of force at up to 40 percussions per second.
What the Science Says: The style of treatment in question is “percussive massage therapy,” which is a new category created by Theragun, Hyperice, and a handful of lesser-known brands. (New-ish: Who among us hasn’t, while giving a massage, used the “hacking” style of tapotement from Swedish massage?) The intended outcome, according to Theragun, is to “improve performance and recovery” and offer “natural pain relief.”
So does it do that? There aren’t any clinical trials on the Theragun itself, but there is a body of literature about massage, generally, and what it points to is that scientifically-proven benefits are mostly about reducing anxiety and depression — because massage is relaxing and being touched feels good. Part of the reason for this — and this is important for the Theragun — is that vibration has a relaxing effect on muscles because it overwhelms the nervous system with lots of stimuli. This is relaxing, feels good, and offers pain relief. To try it on for size, point the Theragun at a tight calf muscle and leave it there: it hurts for a second or two, and then the muscle totally gives up.
My Take: It’s ridiculous and very loud, but I love this thing. I use it twice a day — in the morning when I wake up and a few hours before bed — and find that it’s super relaxing. I like to think of my at-home physical therapy practice as teaching my body to relax after several years of injuries. The more I do it, the more it comes naturally. This tool helps.
Terraquant TQ Solo Cold Laser
Overview: I first came across cold laser, or low-level laser therapy (LLLT), or photobiomodulation, when a friend at my office with a similar low back disc injury brought a black case over to my desk, opened it up and asked if wanted to try a $2,000 handheld laser for pain relief. Of course I did.
The TQ Solo is a handheld laser producing radiation at wavelengths of 640, 875, and 905 nanometers, which includes both visible and infrared light. It’s called “cold” laser because the light it’s emitting is at energy densities low enough that they won’t heat up, or in extreme cases, cut through, tissue.
For a thorough explanation of how it works, read this paper from the Annals of Biomedical Engineering, which, be warned, is extremely complicated. The paper covers the origins of laser research for health purposes, which dates back to an experiment in the 1960s in which a scientist in Hungary used a helium-neon laser to stimulate hair growth and wound healing in mice. As the paper points out, what’s happening when the light hits your body isn’t known for sure, but it’s certainly doing a lot at the level of molecules, cells, and tissues. Lab research suggests that it may heal by acting on the mitochondria, increasing the production of ATP (adenosine triphosphate), and setting in motion a variety of other cellular processes that are useful for bringing health back to a damaged area. Applying these learnings in the lab to actual human conditions remains the challenge today for cold laser (more on that later).
I spoke with John Bruno, manager of the Sports Medicine Division at Multi Radiance Medical, the company that makes the product. He says that most people buy the laser to control their pain. “They’re using it for pain associated with inflammation, pain associated with arthritis,” he says. “When you look at the indications for laser therapy, it’s for the temporary relief of muscle and joint pain, arthritis, relieving stiffness, promoting the relaxation of muscle tissue, and increasing local blood circulation.” Bruno is pretty careful about what he says about the laser because the FDA governs his claims.
What The Science Says: A complicating factor, as the same paper points out, is that “wavelength, fluence, power density, pulse structure, and timing of the applied light” are all factors in whether the treatment seems to work, which means you need a great deal of expertise and precisely the right application to get a positive outcome.
This is an issue in the human studies on cold laser, which show that while it may have some anti-inflammatory effects and may help with short-term pain relief, the results of the studies are very much mixed, with it working and not working in some cases, and being counterproductive in others. (Animal studies, on the other hand, have shown promise with the short-term treatment of skeletal muscle injuries.) Overall, there’s probably a bright future where laser is used to treat a wide variety of issues, but right now there seem to be a lot of reasons to question whether clinicians have enough knowledge to use it effectively.
My Take: I’m a sucker for really cool explanations of the mechanism of action, so I find laser exciting and think the results in animals are promising. When I used it, I did notice some pain relief in the low back, but I wouldn’t line up to be a brand ambassador.
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