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Effect of Capacitive and Resistive electric transfer on changes in muscle flexibility and lumbopelvic alignment after fatiguing exercise

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[Purpose] This study aimed to clarify the effects of Capacitive and Resistive electric transfer (CRet) on changes in muscle flexibility and lumbopelvic alignment after fatiguing exercise. [Subjects and Methods] Twenty-two healthy males were assigned into either the CRet (n=11) or control (n=11) group. Fatiguing exercise and CRet intervention were applied at the quadriceps muscle of the participants’ dominant legs. The Ely test, pelvic tilt, lumbar lordosis, and superficial temperature were measured before and after exercise and for 30 minutes after intervention. Statistical analysis was performed using one-way analysis of variance, with Tukey’s post-hoc multiple comparison test to clarify within-group changes and Student’s t-test to clarify between-group differences. [Results] The Ely test and pelvic tilt were significantly different in both groups after exercise, but there was no difference in the CRet group after intervention. Superficial temperature significantly increased in the CRet group for 30 minutes after intervention, in contrast to after the exercise and intervention in the control group. There was no significant between-group difference at any timepoint, except in superficial temperature. [Conclusion] CRet could effectively improve muscle flexibility and lumbopelvic alignment after fatiguing exercise.
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Original Article
Eect of Capacitive and Resistive electric
transfer on changes in muscle exibility and
lumbopelvic alignment after fatiguing exercise
Yuki Yokota, RPT1), takuYa Sonoda, RPT1), Yuto taShiro R P T, MS1),
YuSuke Suzuki, RPT, MS1), Yu kajiwara, RPT, MS1, 2), hala zeidan, RPT, MS1),
YaSuaki nak aYama, RPT1), mir ei kawagoe, RPT1), kanako Shimou ra, RPT1),
maSataka tatSumi, RPT1), kengo nak ai, RPT1), Yuichi niShida, RPT1),
tSubaSa bito, RPT1), SoYoka YoShimi, RPT1), tomoki aoYama, MD, PhD1)*
1) Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine,
Kyoto University: 53 Kawaharamachi Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
2) Department of Physical Therapy, Faculty of Health Science, Kio University, Japan
Abstract. [Pur pose] This study aimed to clarify the effects of Capacitive and Resistive electric transfer (CRet) on
changes in muscle exibility and lumbopelvic alignment after fatiguing exercise. [Subjects and Methods] Twenty-
two healthy males were assigned into either the CRet (n=11) or control (n=11) group. Fatiguing exercise and CRet
intervention were applied at the quadriceps muscle of the participants’ dominant legs. The Ely test, pelvic tilt,
lumbar lordosis, and supercial temperature were measured before and after exercise and for 30 minutes after in-
tervention. Statistical analysis was performed using one-way analysis of variance, with Tukey’s post-hoc multiple
comparison test to clarify within-group changes and Student’s t-test to clarif y between-group differences. [Results]
The Ely test and pelvic tilt were signicantly different in both groups after exercise, but there was no difference in
the CRet group after intervention. Supercial temperature signicantly increased in the CRet group for 30 minutes
after intervention, in contrast to after the exercise and intervention in the control group. There was no signicant
between-g roup difference at any timepoint, except in super cial temperature. [Conclusion] CRet could effectively
improve muscle exibility and lumbopelvic align ment after fatiguing exercise.
Key words: Thermotherapy, Lumbopelvic alignment, Muscle fatigue
(This article was submitted Dec. 30, 2017, and was accepted Feb. 27, 2018)
INTRODUCTION
Inappropriate lumbopelvic alignment is widely accepted as a risk factor for injuries. In particular, excessive anterior pelvic
tilt and lumbar lordosis are reported to be associated with injuries such as low back pain (LBP) and anterior cruciate ligament
(ACL) injury. Heather et al. reported that patients with LBP exhibited an increased lumbar lordosis compared with those
without LBP1). Roncarati and McMullen2) found an association between increased lumbar lordosis and anterior pelvic tilt
and LBP. Regarding ACL injury, Hertel et al.3) and Loudon et al.4) indicated that increased anterior pelvic tilt was related to a
history of ACL injury. These injuries are common in athletes and may prevent athletes from participating in sports for a long
time5, 6). Therefore, it is important to maintain the appropriate lumbopelvic alignment to prevent injuries.
Factors to dene lumbopelvic alignment include a balance between the anterior and posterior pelvic muscles. If a person
stands with an exaggerated anterior pelvic tilt and lumbar lordosis, his hip exor and lumbar extensor muscles are short-
J. Phys. Ther. Sci. 3 0: 719–725, 2018
*Corresponding author. Tomoki Aoyama (E-mail: blue@hs.med.kyoto-u.ac.jp)
©2018 The Society of Physical Therapy Science. Published by IPEC Inc.
This is an open-access ar ticle distributed under the term s of the Creative Commons Att ribution Non-Commercial No Derivatives
(by-nc-nd) License. (CC-BY-NC-ND 4.0: https://creativecommons.org /licenses/ by-nc-nd /4.0/)
The Journal of Physical Therapy Science The Journal of Physical Therapy Science
J. Phys. Ther. Sci. Vol. 30, No. 5, 2018 720
ened or tightened, whereas the abdominal muscles are
weakened7). Tashiro et al.8) revealed that anterior pelvic
tilt was signicantly greater in Japanese Keirin cyclists
than in the controls and concluded that poor exibility of
the quadriceps muscle, which includes the rectus femoris
muscle acting as a hip exor, contributed to an increase in
anterior pelvic tilt. Thus, a decrease in hip exor muscle
exibility can lead to excessive anterior pelvic tilt and
lumbar lordosis.
Muscle fatigue is one of the factors associated with de-
crease in muscle exibility. Various studies have reported
that muscle fatigue induced by intense exercise causes
an increase in muscle hardness, resulting in a decrease in
muscle exibility9–13). Therefore, muscle fatigue of the
hip exor is considered to change lumbopelvic alignment
by decreasing muscle exibility. Since poor muscle ex-
ibility itself is also related to the occurrence of injuries14–17), it is important to enhance muscle recovery after fatigue, and
maintain appropriate muscle exibility and lumbopelvic alignment.
Various modalities are utilized to facilitate muscle recovery from fatigue, including stretching18, 19), massage20, 21), active
recovery18, 22), contrast water therapy23, 24) cryotherapy25, 26), and thermotherapy27, 28). However, the effectiveness of these
modalities is controversial. Recently, Capacitive and Resistive electric transfer (CRet), which is a type of diathermy, has been
developed as a form of deep thermotherapy and applied in sports medicine29). This device delivers radiofrequency energy,
which passes between an active and inactive electrode, and generates heat within the body30, 31). Previous studies indicated
that CRet was more effective in improving blood circulation than a hot pack, which is a conventional thermotherapy modality
used frequently in clinical practice32, 33). Improving blood circulation would play an important role in the enhancement of
muscle recovery after fatigue34, 35). Thus, CRet can be an effective modality to enhance muscle recovery after fatigue, leading
to maintain and improve the appropriate muscle exibility and lumbopelvic alignment. However, there was no study indicat-
ing the effects of CRet on fatigued muscle and the changes in muscle exibility and lumbopelvic alignment after fatiguing
exercise are unknown. Therefore, the purpose of the present study was to clarify the effects of CRet on changes in muscle
exibility and lumbopelvic alignment after fatiguing exercise.
SUBJECTS AND METHODS
Twenty-two healthy males participated in the study. All participants were not active in spots and were not currently on
a regimented strenuous excessive exercise. The quadriceps muscles of their dominant legs received fatiguing exercise and
intervention. Individuals with a history of orthopedic or nervous system disease in their lower limbs or low back or who
corresponds with contraindication of the CRet intervention were excluded. Written informed consent was obtained from each
participant in accordance with the guidelines approved by Kyoto University Graduate School of Medicine and the Declara-
tion of Human Rights, Helsinki, 1975. The study was approved by the ethical committee of Kyoto University Graduate
School of Medicine (R1284).
The experimental design and time course of the measurements were summarized in Fig 1. Participants were randomly
assigned into one of two groups the CRet group or control group. The CRet group (n=11) received 15 minutes of CRet
intervention after fatiguing exercise, while the control group (n=11) was instructed to rest for 15 minutes. Measurements
were performed pre- and post- exercise (Pre-Ex and Post-Ex, respectively) and immediately, 15 minutes, and 30 minutes after
intervention (Post-In, 15 min Post-In, and 30 min Post-In, respectively).
Quadriceps muscle fatigue was induced in the participants’ dominant leg by concentric and eccentric knee extension
exercise. Participants sat on the bed with their hip joint angle at approximately 100° and their feet off the oor. From
this position, the participants were instructed to extend their knee fully over 3 seconds (concentric phase), keep their knee
extended for 1 second (isometric phase), and slowly lower the leg over 3 seconds (eccentric phase). They performed 10 sets
of 10 repetitions with a 30-second interval between sets. The resistance was set at approximately 30% of the participants’
maximum voluntary isometric contraction (MVC) force measured using a μ Tas F-1 hand-held dynamometer (Anima Corp.,
Tokyo, Japan).
Indiba® activ Pro Recovery HCR902 (Indiba S.A., Barcelona, Spain) was used for the CRet intervention. This device
operates at a frequency of 448 kHz. A rigid circular metallic electrode with a 65-mm diameter was used as the active electrode
and a large exible rectangular metallic plate (measuring 200 × 260 mm) was used as the inactive electrode. A radiofrequency
(RF) energy was delivered using in two modes: capacitive (CAP) and resistive (RES) at the active electrode. The CAP
electrode has a polyamide coating that acts as a dielectric medium, insulating its metallic body from the skin surface, and
thus it generates heat externally near the skin. The RES electrode is uncoated and the RF energy travels directly through the
body into the inactive electrode, therefore, it generates heat in deeper regions of the body. There are several contraindications
Fig. 1. The Ely test, pelvic tilt, lumbar lordosis, and supercial
temperature were measured before (Pre-Ex) and after
(Post-Ex) the fatiguing exercise. Then, the interventions
for CRet and cont rol groups were performed for 15 min-
utes. Each measu rement was performed immediately
(Post-In), 15 minutes (15-min Post-In), and 30 minutes
(30-min Post-In) after the interventions.
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to receiving CRet including pregnancy, deep vein thrombosis, hypoesthesia, damaged skin, or the presence of an implanted
pacemaker. The CRet group underwent a 15-minute intervention (5 minutes in CAP mode, and 10 minutes in RES mode).
The active electrode was continually moved in the circular motion on the skin of posterior thigh and the inactive electrode
was placed under the thigh. A manufacturer- supplied conductive cream was used as coupling medium between the active
electrode and skin surface during the intervention. The intensity was determined subjectively by a score of 6 or 7 on a
subjective analog scale, which is an 11-point scale for the participant self-reporting of thermal sensing (0, no thermal sens-
ing; 10, worst possible thermal sensing). The intensity and duration of CRet intervention were based on the manufacturer’s
recommending method, which were considered to be the most effective without feeling discomfort or pain31).
The Ely test was used to determine changes in quadriceps muscle exibility36). The participants laid prone on the bed with
their dominant leg passively bent. The knee exion angle, at which the hip rise was felt by the examiner, was measured using
a universal goniometer.
Pelvic tilt was measured using a palpation meter (PALM, Performance Attainment Associates, St Pail, MN, USA)37).
During the measurements, the participants stood with their feet aligned with their shoulders and were instructed to keep their
arms crossed over the chest and look at a xed point ahead to control for postural sway. The landmarks for measurement
were the ipsilateral anterior superior iliac spine (ASIS) and posterior superior iliac spine (PSIS). Anterior pelvic tilt was
measured by placement of the PALM caliper tips in contact with the ipsilateral ASIS and PSIS. The degree of deviation from
the horizontal was read from an inclinometer. A positive degree was used to describe anterior pelvic tilt and a negative degree
was used to describe posterior tilt in the sagittal plane. The measurements were performed two times on the participants’
dominant leg and the average value was used for analysis.
Lumbar lordosis was measured using the Spinal Mouse (Index Ltd., Tokyo, Japan)38). The Spinal Mouse is a computer-
aided electric measuring device that measures intersegmental angles in a non-invasive manner. As with PALM measurement,
the participants stood with their feet aligned with their shoulders and their arms beside the body; they were instructed to look
at a xed point ahead to control postual sway. The Spinal Mouse was guided along the midline of the spine beginning at the
spinous process of C7 and nishing at the top of the anal crease (approximately the level of S3). The lumbar lordosis angle
was calculated from the sum of six segmental angles from Th12/L1 to L5/S1. The measurements were performed three times
and the average value was used for analysis.
Supercial temperature was measured using an infrared thermometer (IT2-80, KEYENCE Co., Ltd., Japan) to estimate
the thermal effects of the CRet intervention. The measurement site was the center of the quadriceps muscle of the partici-
pants’ dominant legs.
For each measure index, the amount of change (Δ) from the rst value was calculated. The one-way analysis of variance
was used to analyze the changes at each time point within the group. The Tukey post hoc multiple comparison (Tukey-HSD)
test was performed to clarify differences within each group. The student t-test was used to compere changes at each time
point between two groups. Statistical analyses were performed using SPSS version 20.0 (IBM Corp., Armonk, NY, USA),
with a statistical threshold of 0.05.
RESU LT S
The physical characteristics of the participants in each group are shown in Table 1. There was no signicant difference in
the participants’ physical characteristics between groups. The mean resistance used in the knee extension exercise performed
by the CRet and control groups were 9.6 ± 1.4 kg and 9.2 ± 1.6 kg, respectively.
A signicant decrease in Ely test angle was observed at Post-Ex in the CRet group (p<0.05), and from Post-Ex to 30-min
Post-In in the control group (Post-Ex, Post-In, 15-min Post-In, p<0.01; 30-min Post-In, p<0.05). The pelvic tilt signicantly
increased at Post-Ex in the CRet group (p<0.01), and at Post-Ex and Post-In in the control group (p<0.01). There was no
signicant difference in lumbar lordosis in each group. Supercial temperature signicantly increased at Post-In, 15-min
Post-In, and 30-min Post-In in the CRet group (p<0.01), and at Post-Ex and Post-In in the control group (p<0.05) (Table 2).
Supercial temperature showed a signicant difference between groups from Post-Ex to 30-min Post-In (Post-Ex, 30-min
Tab le 1. Physical characteristics of the participants
CRet group (n=11) Control group (n=11)
Age (years) 23.0 ± 1.3 23.2 ± 2.3
Height (cm) 171.7 ± 5.3 168.5 ± 6.5
Weight (kg) 61.7 ± 7.8 60.0 ± 8.1
Body mass index (kg/m2)20.9 ± 2.4 21.1 ± 1.8
MVC (N) 331.5 ± 69.7 307.8 ± 57.9
Values are represented as mean ± standard deviation.
CRet: Capacitive and Resistive electric transfer; MVC: maximum voluntary
isometric contraction.
J. Phys. Ther. Sci. Vol. 30, No. 5, 2018 722
Post-In, p<0.05; Post-In, 15-min Post-In, p<0.01). There was no signicant difference in Ely test angle, pelvic tilt, and lumbar
lordosis between groups (Table 2).
DISCUSSION
In the present study, we investigated the effect of CRet intervention on changes in muscle exibility and lumbopelvic
alignment after fatiguing exercise. The results showed a signicant decrease in the angle of the Ely test and thus quadriceps
exibility, as well as a signicant increase in the angle of anterior pelvic tilt immediately after exercise in both groups. In the
control group, signicant differences in Ely test results and pelvic tilt were observed until 30 minutes after and immediately
after the intervention, respectively; while; in the CRet group, signicant differences in the Ely test and pelvic tilt were no
longer observed after CRet intervention.
Intense exercise, particularly which contains eccentric contraction, is known to induce an increase in muscle hardness9–11).
Repetitive muscle contractions frequently increase the intramuscular water content level39, 40). This exercise-induced uid
accumulation increases the intramuscular pressure, resulting in an increase in muscle hardness. Therefore, Ely test angle
signicantly decreased immediately after the knee extension exercise in both groups. This result suggests that the quadriceps
muscle exibility decreased immediately after knee extension exercise in both groups since the Ely test is an indicator of
quadriceps muscle exibility.
The results of the present study suggested that quadriceps muscle exibility returned to baseline sooner in the CRet group
than in the control group. This difference seems to be due to the thermal effects of the CRet intervention. In the present
study, the change in supercial temperature was 5.1°C immediately after CRet intervention. Our previous study showed that
the change in supercial temperature was 2.4°C immediately after CRet intervention applied at the hamstring muscles33).
Although we measured supercial temperature using a different instrument, the intervention in the present study was carried
out at the same intensity and duration using the same instrument as in this previous study. Therefore, we assumed that the
thermal effects in the present study may be equal to or higher than in the previous study.
There are three possible factors contributing to the change in quadriceps muscle exibility. The rst factor is improvement
in blood circulation to the muscle. Many studies have revealed that thermotherapy improves blood circulation34, 35, 41, 42).
Tab le 2 . Changes in the measurement value
CRet group Control group
Ely test (°) Pre-Ex 0 0
Post-Ex −6.0 ± 3.0*−6.5 ± 2.8**
Post-I n −2.6 ± 5.8 −5.8 ± 2.7**
15-min Post-In −3.2 ± 5.7 −3.9 ± 2.0**
30-min Post-In 3.4 ± 6.0 −3.1 ± 2.6*
Pelvic tilt (°) Pre-Ex 0 0
Post-Ex 1.9 ± 1.2** 1.4 ± 0.9**
Post-I n 0.5 ± 0.8 1.1 ± 0.8**
15-min Post-In −0.9 ± 0.8 0.5 ± 0.7
30-min Post-In 0.0 ± 0.9 0.4 ± 0.7
Lumbar lordosis (°) Pre-Ex 0 0
Post-Ex −1.1 ± 2.2 −1.1 ± 4.8
Post-I n −1.7 ± 2.6 −0.8 ± 4.0
15-min Post-In −0.8 ± 2.5 0.2 ± 3.7
30-min Post-In 0.3 ± 2.3 −1.4 ± 3.4
Supercial temperature (°C) Pre-Ex 0 0
Post-Ex 0.3 ± 0.70.9 ± 0.6*†
Post-I n 5.1 ± 1.3**‡ 0.9 ± 0.7*‡
15-min Post-In 2.9 ± 1.0**‡ 0.6 ± 0.8
30-min Post-In 1.7 ± 1.3**‡ 0.6 ± 0.8
Values are represented as mean ± standard deviation.
*Signicant difference from Pre-Ex value ( p<0.05, Tukey-HSD).
**Signicant difference from Pre-Ex value (p<0.01, Tukey-HSD)
Signicant difference between groups (p<0.05, Student t-test)
Signicant difference between groups (p<0.01, Student t-test)
CRet: Capacitive and Resistive electric transfer.
723
Moreover, previous studies showed that CRet intervention was more effective on the improvement in blood circulation than
hot pack application32, 33). An increase in muscle hardness is caused by an increase in intramuscular pressure resulting from
uid accumulation9). We infer that muscle hardness may decrease since the accumulated uid would be removed by the
improvement in blood circulation from CRet intervention. Muscle hardness affects muscle exibility, thus, muscle exibility
of the quadriceps could be improved by CRet intervention. The second factor is the increase in soft tissue extensibility,
including that in connective tissue composed primarily of collagen bers43–45). As temperature increases, collagen extensibil-
ity increases, and connective tissue viscosity and the viscoelasticity of muscle bers are reduced46–48). Subsequently, the
extensibility of soft tissues increases, and muscle exibility improves. The third factor is muscle relaxation. Thermal stimula-
tion decreases the activity of α motor neurons by changing the activity of group II bers, γ motor neurons and Ib bers49).
These changes in neuronal activity cause muscle relaxation. In the present study, thermal stimulation by CRet intervention
may alter nerve activity and cause muscle relaxation, resulting in improvement in quadriceps exibility based on the Ely test.
The result of the present study showed that the pelvic tilt angle signicantly increased immediately after exercise in both
groups and returned to its original value sooner in the CRet group than in the control group. These changes are considered to
be associated with the change in quadriceps muscle exibility. The position of the pelvis is determined by a balance between
the anterior and posterior pelvic muscles. Kendall et al.50) described that tightness of the hip exors led to an anterior pelvic
tilt in the standing position. The quadriceps muscle group is composed of four muscle, vastus lateralis, vastus medialis,
vastus intermedius, and rectus femoris; the rectus femoris also acts as a hip exor. Thus, it is considered that the angle of
pelvic tilt increased immediately after knee extension exercise and decreased after CRet intervention, along with a change in
quadriceps muscle exibility.
There was no signicant difference in lumbar lordosis in both groups at any time point. It is widely believed that lumbar
lordosis is associated with pelvic tilt. Levine et al.51) found that altering pelvic tilt signicantly changed the angle of lumbar
lordosis in the standing position. According to Youdas et al.52), the correlation between pelvic tilt and lumbar lordosis in the
standing position is signicant, albeit weak. We assume that the change in pelvic tilt was insufcient to affect lumbar lordosis
because the exercise and intervention were performed on participants’ dominant legs only.
Poor muscle exibility is a risk factor of various injuries14–17), thus it is important to maintain and improve muscle ex-
ibility to prevent injuries. Furthermore, inappropriate lumbopelvic alignment could cause injuries such as low back pain1, 2)
and ACL injury3, 4). The results of the present study indicated that fatiguing exercise decreased muscle exibility, resulting
in a change in pelvic alignment. Those who perform fatiguing exercise on a daily basis, for example athletes, require a faster
recovery from fatigue and enhance injury prevention through the appropriate conditioning in order for them to optimally
practice and to compete. Moreover, it is important to recover muscles after strenuous exercise in a short time because, in
many sports, situations in which athletes are not given enough time to recover their muscle fatigue are abundant; for example,
the situation in which they have to participate in a lot of games in a day. Our study results suggest that CRet could play an
important role in athletes’ conditioning.
This study had several limitations. First, we did not include female and various aged participants, and the population was
restricted to young healthy males belonging to the same university. The effects of CRet in other populations is uncertain;
therefore, further research is required in this regard. Second, we assessed the quadriceps muscle only by the Ely test. The
detailed changes caused by exercise and CRet intervention remain unclear. Third, the measurement time was limited. We
investigate the effects of CRet on changes in muscle exibility and lumbopelvic alignment before and after exercise and for
30 minutes after intervention. The lasting effects of these are unknown. Thus, studies with long-term follow up are needed.
Despite these limitations, the results of the present study provide valuable information on the effects of CRet.
The effects of CRet on changes in muscle exibility and lumbopelvic alignment after fatiguing exercise was investigated.
The results showed that the changes in quadriceps muscle exibility and anterior pelvic tilt was signicant immediately
after knee extension exercise in both groups; however, that these indexes returned to the pre-exercise value sooner in the
CRet group than after intervention. These ndings suggest that the CRet intervention is effective on improvement of muscle
exibility and pelvic tilt after fatiguing exercise. CRet could be a useful means to recover muscle fatigue and maintain the
appropriate muscle exibility and lumbopelvic alignment.
Conict of interest
None.
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... Electrophysical devices based on diathermy are one of the modalities used by many professionals to treat pain. This form of heat is used to increase blood flow and improve tissue extensibility [1][2][3][4]. ...
... And a metal plate as a passive electrode that is in contact with the patient's skin, serving as a conductor. The energy passes between the electrodes and generates heat in the tissues [1,2,5,6,[16][17][18]. The two modes of capacitive or resistive treatment induce different tissue responses depending on the resistance of the treated tissue [6,19]. ...
... The CAP electrode is coated with a polyamide material. Energy transmission generates heat in the superficial layers, with a selective action on low-impedance soft tissues (rich in water), such as adipose tissue, muscle, cartilage and lymphatic system [1,6,14,20,21]. The RES electrode does not have an insulating material, the radiofrequency energy passes directly through the body in the direction of the inactive electrode. ...
... Superficial tissues are targeted in capacitive mode, while deeper tissues such as tendons, bone and cartilage are affected in resistive mode. CRET has been shown to elicit thermal effects subsequent to the electrical resistance of tissues but will not cause overheating due to heat dissemination by circulating blood [174,[178][179][180]. Capacitiveresistive electric transfer improves blood circulation and subsequently allows for enhanced evacuation of inflammatory catabolites and tissue relaxation [180]. ...
... Superficial tissues are targeted in capacitive mode, while deeper tissues such as tendons, bone and cartilage are affected in resistive mode. CRET has been shown to elicit thermal effects subsequent to the electrical resistance of tissues but will not cause overheating due to heat dissemination by circulating blood [174,[178][179][180]. Capacitiveresistive electric transfer improves blood circulation and subsequently allows for enhanced evacuation of inflammatory catabolites and tissue relaxation [180]. ...
Article
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Osteoarthritis (OA) is a common and debilitating condition in domestic dogs. Alongside pharmaceutical interventions and weight loss, exercise and physiotherapy (PT) are important measures in maintaining patient mobility and quality of life. Physiotherapy for OA aims to reduce pain, optimize muscular function and maintain joint function. Physiotherapeutic plans typically include PT exercises combined with therapeutic modalities, lifestyle and environmental modifications to improve the patient’s overall quality of life and function. Information on therapeutic clinical efficacy of physiotherapeutic measures for canine OA is still very limited. Thus, physiotherapeutic strategies are still primarily based on evidence extrapolated from human protocols tailored to people with OA. The authors propose a simple systematic PT approach for canine OA, prioritizing measures according to simplicity, cost effectiveness and practicality. This guide (the “Physiotherapy Pyramid”) aims to provide a clear stratified approach to simplify decision making and planning for owners, veterinarians and veterinary physiotherapists, leading to more straightforward design and implementation of treatment plans. Measures are implemented starting at the base of the pyramid, subsequently progressing to the top, allowing effective and practical interventions to be prioritized. The levels of the pyramid are in ascending order: environmental modification, exercise plan, OA-specific home exercises and treatment by a veterinary physiotherapist.
... Thus, research carried out in horses by authors such as ARGÜELLES [19] and BECERO [20] demonstrated its positive influence on the increase in muscle power, as well as changes in gait patterns, with the consequent improvement in performance. CRet has been shown in both humans and horses to provide short-term relief through its thermal and electrical effects [14,17,18,20], thereby improving muscle recovery after fatigue and helping to maintain adequate muscle flexibility and correct spinal alignment [21]. ...
... The results of prior studies on CRet show that the improvement in blood circulation due to the thermal action produces an increase in soft tissue extensibility and muscle relaxation, suggesting that CRet is a beneficial treatment in post-exercise muscle recovery [14,15,21,27]. ...
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Achieving the successful recovery of sled dogs is one of the key tasks for veterinary teams involved in clinical care for middle-distance sled dog competitions. This study compares the efficacy of capacitive-resistive electrical transfer (CRet) with that of massage in the treatment of lower back pain in 40 short-haired sled dogs during a medium-distance snow sled race (LekkarodTM 2021). The dogs were divided into two groups: a CRet group (20 dogs) and a massage group (20 dogs). All subjects received a single 18 min treatment session and were evaluated one hour after the end of the treatment. A multivariate analysis of variance (MANOVA) was performed in which pre- and post-treatment pain measures were evaluated in relation to age and type of treatment. Older dogs were found to have higher significant pain scores before starting treatment. Both treatments reduce pain short-term in all cases. However, post-treatment pain values were significantly lower in dogs treated with CRet when compared to dogs treated with massage. The results show that capacitive�resistive electrical transfer has better short-term results and is beneficial in both younger and older dogs, making this technique attractive to veterinary teams working in canine sporting competitions.
... Radiofrequency can be used for ablative and non-ablative applications. Among its non-ablative effects are the induction of fibroblast proliferation [24][25][26], activation of neocollagenesis [24,26], improvement of blood circulation [27], neoangiogenesis [24], collagen remodeling and skin tightening [28,29]. Furthermore, its subthermal application (treatments that do not increase temperatures above 37 • C in the target tissues) induces anti-inflammatory and antiedematous effects [30]. ...
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Citation: Martínez-Pascual, M.A.; Sacristán, S.; Toledano-Macías, E.; Naranjo, P.; Hernández-Bule, M.L. Effects of RF Electric Currents on Hair Follicle Growth and Differentiation: A Possible Treatment for Alopecia. Int. J. Mol. Sci. 2024, 25, 7865. https:// Abstract: Androgenic alopecia (AGA) is the most common type of alopecia and its treatments involve drugs that have various adverse effects and are not completely effective. Radiofrequency-based therapies (RF) are an alternative for AGA treatment. Although there is increasing clinical evidence of the effectiveness of RF for alopecia, its effects at the tissue and cellular level have not been studied in detail. The objective of this study was to analyze ex vivo the potential effect of RF currents used in capacitive resistive electrical transfer (CRET) therapy on AGA. Hair follicles (HFs) were donated by patients with AGA and treated with CRET. AGA-HFs were exposed in vitro to intermittent 448 kHz electric current in subthermal conditions. Cell proliferation (Ki67), apoptosis (TUNEL assay), differentiation (β-catenin), integrity (collagen and MMP9), thickness of the epidermis surrounding HF, proportion of bulge cells and melanoblasts in AGA-HF were analyzed by immunohistochemistry. CRET increased proliferation and decreased death of different populations of AGA-HF cells. In addition , the melanoblasts increased in bulge and the epidermis surrounding the hair follicle thickened. These results support the effectiveness of RF-based therapies for the treatment of alopecia. However, clinical trials are necessary to know the true effectiveness of CRET therapy and other RF therapies for AGA treatment.
... According to Ribeiro et al. [13], TT reduces muscle tone and it has shown positive effects on muscle properties, improving function in different musculoskeletal disorders such as pain and tissue injury [14,15]. This is assumed to be caused by increasing intramuscular blood flow [14], hemoglobin saturation and increased temperature [16]. ...
Article
Purpose: To analyze immediate effects of TECAR therapy (TT) to reduce lower limb hypertonia and improve functionality in chronic post-stroke. Materials and methods: It is a single-blind randomized controlled clinical trial. A total of 36 chronic stroke survivors were divided into two groups. The experimental group received a single 30-minute session of TT with functional massage (FM) on lower limb. The control group received a single 30-minute session sham treatment of TT plus FM. The primary outcome measure was hypertonia (Modified Ashworth Scale, MAS). Secondary outcomes were gait speed (4-Meter Walk-Test), standing knee-flexion (Fugl-Meyer Assessment Scale IV-item), change in weight bearing ankle dorsiflexion (Ankle Lunge Test, ALT), and functional lower limb strength (5-Times Sit-to-Stand Test). All measurements were performed at baseline, immediately and 30-minutes after treatment. Results: There was a group–time interaction in MAS-knee (p = 0.044), MAS-ankle (p = 0.018) and ALT (p = 0.016) between T1 and T0 (p<.0001) and T2 and T0 (p<.0001) for the experimental group. There was a significant increase in ALT between T1 and T0 (p = 0.003) in the control group. Conclusions: A single session of TT performed at the same time as FM immediately reduces plantar-flexors and knee-extensor muscle hypertonia and increases change in weight bearing ankle dorsiflexion in chronic stroke survivors.
... However, evidence evaluating the effect of radiofrequency diathermy on the range of motion is scarce. It is possible that the increase in range of motion may be related to an increase in tissue elasticity after radiofrequency diathermy, given that soft tissues that are heated before stretching maintain elongation after stretching, as well as requiring less force from the patient to achieve elongation 25,44,51 . ...
Article
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Monopolar capacitive diathermy is a physiotherapy technique that uses high-frequency currents to generate heat in deep tissues. This heat can have several therapeutic effects, especially in the treatment of chronic low back pain (CLBP), however, until now there is little evidence of this type of diathermy. The purpose was to evaluate the efficacy of a pulsed monopolar dielectric radiofrequency diathermy (PRF)-capacitive type versus simulated treatment on symptomatology of patients with CLBP. A single-blind randomised controlled trial was conducted. Sixty patients with CLBP were randomly assigned to a PRF-capacitive or a simulated treatment group. All participants received 3 sessions per week for 3 weeks. Disability, pain intensity, movement phobia, lumbar anteflexion, quality of life, and sleep quality were assessed at baseline, after treatment, and at two months. The application of 9 sessions of PRF-capacitive showed significant improvements compared to simulated therapy during the entire follow-up for disability (F = 26.99, p < 0.001), pain intensity (F = 0.550, p < 0.001), the quality of life components of physical function (F = 0.780, p < 0.001), social function (F = 0.780, p < 0.001) and mental health (F = 0.858, p = 0.003) and for sleep duration (F = 0.863, p = 0.004).
... Consequently, CRET enables an endothermic effect when the applied intensity is moderate to high and, depending on the impedance offered by the tissues upon passage of the currents. Despite this thermal effect, tissue hyperthermia can be avoided by dissipating heat by the circulating blood towards the adjacent areas [8,9]. ...
Article
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Background It has been reported that capacitive resistive electric transfer (CRET) increases blood circulation, hemoglobin oxygenation and temperature in muscles. The attributed benefits of these changes have been linked to improved athletic performance, enhanced muscle flexibility and fastening recovery from exercise-induced fatigue. For all of this, the present research aims to investigate whether the application of CRET 24 h before exercise affects the accelerometric pattern in horses during exercise. Six sound Standardbred trotters were subjected to a CRET session of 40 min of duration, applied on both sides of the neck, back and croup, 24 h before a training session. Training sessions consisted of a warming-up (WU) for 6400 m and a training bout (TB) at their maximal training speed for 1600 m. The same protocol was followed for the device off (sham protocol), also applied 24 h before the training session. CRET and sham experiments were separated by one week, the order of application of both was randomly defined for each individual and drivers were blinded for the duration of the experiment. During the training sessions, horses wore an accelerometer fixed at the sternal level. Speed, stride frequency (SF), length (SL), regularity and symmetry and accelerometric activities were measured during WU and TB. Results CRET increased speed, mediolateral and total accelerometric activities during WU and speed, SL, dorsoventral, longitudinal and total accelerometric activities during TB, but stride regularity and symmetry decreased. Conclusion The application of CRET 24 h before exercise increased speed and accelerometric activities, results that highlight the need to evaluate the interaction between CRET and training in order to develop new methods to limit fatigue. However, the decrease in stride regularity and symmetry after CRET application could be negative effects, which could be attributed to the increased speed.
... [89][90][91][92] Finally, the thermal increase leads to an overall analgesic effect, with muscle relaxation, and an increase in the elasticity of the connective tissue. 90,[93][94][95] This is reflected in the sense of well-being perceived at the end of therapy. ...
Article
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Background The appearance of striae gravidarum (SG) during pregnancy is a common problem. The most common SG are abdominal striae, which can cause the greatest sequelae after pregnancy, and in the long term. There are several solutions to prevent and treat these striae, but not all are completely effective, and not without side effects. Aims The aim of this study was to evaluate the effectiveness of a treatment that applies an electromagnetic field under vacuum (V‐EMF therapy) on the abdominal SG. Methods A retrospective analysis was conducted on the medical records of 26 women affected by abdominal SG and treated with V‐EMF therapy. The results were evaluated using two different 5‐point Likert Scales: one administered to the treated subjects to evaluate their satisfaction, and one to the doctors who performed the treatment, to evaluate the improvement of the striae. The presence of side effects, and the effects of sun exposure after treatment were also considered. Results Only two treated subjects rated their level of satisfaction with a Score III on the Liker Scale. Everyone else expressed higher levels of satisfaction. Only one doctor rated the improvement of the striae with a Liker scale score of III. All the others reported greater improvements. No discomfort or side effects were noted either during the individual treatment sessions, or at the end of the treatment. The striae showed a newfound ability to tan. Conclusions V‐EMF therapy proves to be a valid, safe, and effective treatment modality for SG.
... Tecar therapy (TT) is another technique that reduces muscle stiffness [18] and improves flexibility [19]. TT is a modality of non-invasive diathermy that improves superficial and deep blood circulation, hemoglobin saturation, and muscle flexibility by providing high frequency to the tissues [20]. ...
Article
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Background: The aim of this study was to assess changes in muscle properties after a single session of capacitive and resistive energetic transfer (TECAR) therapy on spastic gastrocnemius and quadriceps muscles in chronic post-stroke. Methods: A total of 36 chronic stroke survivors with lower limb hypertonia were enrolled in a double-blind randomized controlled trial. The experimental group (n = 18) received a single 30 min session of TECAR therapy in combination with functional massage (FM) on the gastrocnemius and quadriceps muscles. The control group (n = 18) received a sham treatment of TECAR therapy (without electrical stimulation) in combination with real FM. The primary outcome was muscle tone of the lower limb muscles assessed with the Modified Ashworth Scale (MAS). The secondary outcomes were goniometric degrees of the MAS (goniometer), neuromuscular properties of the gastrocnemius/quadriceps (myotonometer), and passive range of motion (inclinometer). All measurements were performed at baseline (T0), immediately after treatment (T1), and at 30 min post-treatment (T2) by a blinded assessor. Results: The MAS score ankle dorsiflexion significantly decreased at T0-T1 (p = 0.046), and the change was maintained at T0-T2 (p = 0.019) in the experimental group. Significant improvements were noted in the passive range of motion for knee flexion (p = 0.012) and ankle dorsiflexion (p = 0.034) at T2. In addition, knee flexion improved at T1 (p = 0.019). Conclusion: A single session of Tecar therapy at the same time with FM on the gastrocnemius and rectus femoris immediately reduces muscle tone and increases the passive range of motion of both ankle and knee in chronic stroke survivors. There were no significant changes in the neuromuscular properties measured with myotonometer.
Conference Paper
Capacitive resistive energy transfer is a form of diathermy with lower frequency, ap-proximately 0.5 MHz. It is used in clinical practice as deep thermotherapy with capaci-tive and resistive mode. The purpose of the review is to determine the thermal effects of capacitive resistive energy transfer and two modes on tissue temperature in healthy adults. Literature review has been conducted in databases: PubMed, CINAHL and PEDro until the end of 2022. Ten studies were included. Two studies compared capacitive and resistive energy transfer to control and six studies to placebo. In three studies a compari-son was made between the capacitive and resistive modes. Capacitive and resistive en-ergy transfer in combination or alone is safe and effective as a form of thermotherapy. Participant’s subjective feeling should be that of thermal comfort. Keywords: Capacitive resistive energy transfer, CRET, Thermal effects, Temperature
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Purpose: This study aims to evaluate the effects of Capacitive and Resistive electric transfer (CRet) and hotpack (HP) on hemoglobin saturation and tissue temperature. Materials and methods: The participants were 13 healthy males (mean age 24.5 ± 3.0). They underwent three interventions on different days: (1) CRet (CRet group), (2) HP (HP group) and (3) CRet without power (sham group). The intervention and measurement were applied at the lower paraspinal muscle. Indiba® active ProRecovery HCR902 was used in the CRet group, and the moist heat method was used in the HP group. Oxygenated, deoxygenated, and total hemoglobin (oxy-Hb, deoxy-Hb, total-Hb) counts were measured before and after the 15-min interventions, together with the temperature at the skin surface, and at depths of 10mm and 20 mm (ST, 10mmDT, and 20mmDT, respectively). The hemoglobin saturation and tissue temperature were measured until 30 min after the intervention and were collected at 5-min intervals. Statistical analysis was performed for each index by using the Mann-Whitney U test for comparisons between all groups at each time point. Results: Total-Hb and oxy-Hb were significantly higher in the CRet group than in the HP group continuously for 30 min after the intervention. The 10mmDT and 20mmDT was significantly higher in the CRet group than in the HP group from 10 to 30-min after intervention. Conclusion: The effect on hemoglobin saturation was higher in the CRet group than in the HP group. In addition, the CRet intervention warmed deep tissue more effectively than HP intervention.
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To assess the effect of exercise-induced muscle damage on muscle hardness and evaluate the relationship between muscle hardness and muscle damage indicators. Seven men (mean 25.3 years; 172.7 cm; 66.8 kg) performed the single-leg ankle plantar flexion exercise involving both concentric and eccentric contractions (10 sets of 40 repetitions). The hardness of the medial gastrocnemius (MG) was evaluated using ultrasound real-time tissue elastography before, from day 1 to 4, and day 7 after exercise. The strain ratio between the MG and a reference material was calculated. Simultaneously, we evaluated the magnetic resonance T2 value (an index of edema) of the triceps surae, the ankle dorsiflexion range of motion (ROM), and calf muscle soreness. Serum creatine kinase activity was assessed before, 2 and 4 h, and from day 1 to 4 after exercise. The MG showed lower strain ratio, indicating increased muscle hardness, on day 4 post-exercise (P < 0.01) and higher T2 values on days 1-7 post-exercise (P < 0.01) relative to each pre-exercise value. The ankle dorsiflexion ROM was lower on days 2-4 post-exercise (P < 0.01). The serum creatine kinase markedly increased on days 3 and 4 post-exercise (not significant). The degree of muscle soreness among the post-exercise time points was similar. The decreased strain ratio did not correlate with the increased T2, the decreased joint ROM or muscle soreness. Muscle hardness increased after strenuous resistance exercise, but the change was not related with muscle edema, decreased joint ROM, or muscle soreness resulting from muscle damage.
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This study aimed to clarify the effects of therapeutic ultrasound on intramuscular local blood circulation (and oxygen dynamics) using near-infrared spectroscopy (NIRS). The participants were 11 healthy males. All participants performed all three trials; (1) the ultrasound (US group), (2) without powered ultrasound (placebo group), and (3) rest (control group). Ultrasound was applied at 3 MHz, 1.0 W/cm(2), and 100% duty cycle for 10 minutes. Evaluation index were oxygenated, deoxygenated, and total hemoglobin (Hb) concentrations in the intramuscular and skin surface temperature (SST). The experimental protocol was a total of 40 minutes, that is, 10 minutes before trial (rest), 10 minutes during the trial (ultrasound, placebo, and control), and 20 minutes after trial (rest). The NIRS and SST data collected before and after the trial were divided into 5 minutes intervals for further analysis. Oxygenated and total hemoglobin levels were significantly higher in the US group than in the placebo and control groups for the 20 minutes after ultrasound (p < 0.01). The SST was significantly higher in the US group than in the control for 15 minutes after ultrasound (p < 0.05), while it was significantly lower in the placebo group than in the US and control groups for 20 minutes after the trials (p < 0.01). The effects of ultrasound were maintained for 20 minutes after the trial on intramuscular blood circulation and oxygen dynamics. These effects were caused by a combination of thermal and mechanical effects of the ultrasound.
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Background/Aims: Capacitive-resistive electric transfer (CRET) is a non invasive electrothermal therapy that applies electric currents within the 400 kHz - 450 kHz frequency range to the treatment of musculoskeletal lesions. Evidence exists that electric currents and electric or magnetic fields can influence proliferative and/or differentiating processes involved in tissue regeneration. This work investigates proliferative responses potentially underlying CRET effects on tissue repair. Methods: XTT assay, flow cytometry, immunofluorescence and Western Blot analyses were conducted to asses viability, proliferation and differentiation of adipose-derived stem cells (ADSC) from healthy donors, after short, repeated (5 m On/4 h Off) in vitro stimulation with a 448-kHz electric signal currently used in CRET therapy, applied at a subthermal dose of 50 μA/mm2Results: The treatment induced PCNA and ERK1/2 upregulation, together with significant increases in the fractions of ADSC undergoing cycle phases S, G2 and M, and enhanced cell proliferation rate. This proliferative effect did not compromise the multipotential ability of ADSC for subsequent adipogenic, chondrogenic or osteogenic differentiation. Conclusions: These data identify cellular and molecular phenomena potentially underlying the response to CRET and indicate that CRET-induced lesion repair could be mediated by stimulation of the proliferation of stem cells present in the injured tissues.
Article
Introduction: The differences between Capacitive and Resistive electric transfer (CRet) and hot pack (HP) in their effects on tissue temperature, muscle flexibility, and blood circulation are unknown. This study aimed to clarify the effect of CRet and HP on tissue temperature, muscle flexibility, and blood circulation. Methods: The participants were 13 healthy adults. They randomly performed three 15-minute interventions: (1) CRet, (2) HP, and (3) without powered CRet (sham). The intervention and measurement were applied to the right hamstring muscle. INDIBA® activ ProRecovery HCR902 was used in the CRet trial. The moist heat method was used in the HP trial. The measurement indexes were superficial temperature (ST), 10-mm deep temperature (DT), and 20-mm DT; the passive straight leg raise (SLR) test; and oxygenated (oxy), deoxygenated (deoxy), and total (total) hemoglobin (Hb) concentrations. Each index was measured for 30 minutes after the intervention and the amount of change (Δ) from the pre-intervention value was calculated. Results: ΔST, Δ10 mmDT, Δ20 mmDT, Δoxy-Hb, and Δtotal-Hb were significantly higher in the CRet and HP trials than in the sham trial for 30 minutes after the intervention (p<0.05). ΔSLR was significantly higher in the CRet trial than in the HP trial from 15 to 30 minutes after the intervention (p<0.01) Conclusion: Our results indicate that CRet is an efficient method for preventing and treating musculoskeletal injuries and improve muscle flexibility. In addition, it can improve blood circulation as well as HP can.
Article
Purpose: Radiofrequency-based electrophysical agents are widely used in therapy-related clinical practice for their thermal effects, mainly relieving pain and inflammation and improving tissue extensibility. The most commonly used and researched are shortwave therapies that operate at 27.12 MHz. Although relatively new, electrophysical agents employing much lower frequencies have also emerged. Capacitive resistive monopolar radiofrequency employing 448 kHz is one such therapy. This laboratory-based study was aimed to investigate the skin thermal responses to 448 kHz radiofrequency-based therapy in healthy adults. Methods: In a two-group randomised crossover study, 15 volunteers attended two modes (capacitive and resistive) of 448 kHz radiofrequency-based therapy (using 'Indiba Activ 902') administered locally to the lower thigh region. Starting at minimum, the intensity was increased incrementally until thermal discomfort was felt. Participants reported three time points: thermal onset, definite thermal sensation, and onset of thermal discomfort. Local skin temperature was measured before, immediately post-treatment and up to 45 min post-treatment. Results: Both capacitive and resistive modes of therapy significantly increased the skin temperature and sustained it over the 45-min follow-up. There was statistically significant difference between the thermal response patterns produced by the two modes. Peak post-treatment temperatures attained were not significantly different between the two; however, the retention rate at follow-up was significantly higher for the resistive mode. Conclusions: This study confirms that radiofrequency-based therapy at 448 kHz can significantly increase and sustain skin temperature. The study also provides useful baseline data for further research in the low frequency ranges of radiofrequency-based therapy that remain largely unexplored.
Article
Background: Muscle hardness indicates muscle condition, and its measurement before and after resistance exercise is essential for preventing resistance training-induced muscle injury. Purpose: To investigate muscle hardness of the triceps brachii (TB) before and immediately after a resistance exercise session involving the elbow extensors. Material and methods: In 18 young men, muscle hardness of the long head of TB was measured at 50%, 60%, and 70% point along the length of the upper arm from the acromial process of the scapula to the lateral epicondyle of the humerus by using shear wave ultrasound elastography. At the same sites, muscle thickness of the long head of TB was also measured by ultrasonography. Resistance exercise was performed using a dumbbell with a mass adjusted to 80% of the one-repetition maximum. Results: Although the exercise-induced increase in muscle hardness was significant at all the regions, muscle hardness was significantly higher at 70% of the upper arm length than at the other regions before and after resistance exercise. The exercise-induced increase in muscle thickness was also significant, but the relative changes in muscle hardness before and after resistance exercise were not correlated with the corresponding relative changes in muscle thickness at each region. These results indicate the small effect of exercise-induced muscle swelling on exercise-induced changes in muscle hardness. Conclusion: We suggest that muscle damage and/or injury, particularly at the distal region of TB, should be carefully considered to safely perform resistance exercise.
Article
Purpose: This study aimed to clarify the effects of therapeutic ultrasound on intramuscular local blood circulation (and oxygen dynamics) using near-infrared spectroscopy (NIRS). Participants: The participants were 11 healthy males. Methods: All participants performed all three trials; (1) the ultrasound (US group), (2) without powered ultrasound (placebo group), and (3) rest (control group). Ultrasound was applied at 3 MHz, 1.0 W/cm2, and 100% duty cycle for 10 minutes. Evaluation index were oxygenated, deoxygenated, and total hemoglobin (Hb) concentrations in the intramuscular and skin surface temperature (SST). The experimental protocol was a total of 40 minutes, that is, 10 minutes before trial (rest), 10 minutes during the trial (ultrasound, placebo, and control), and 20 minutes after trial (rest). The NIRS and SST data collected before and after the trial were divided into 5 minutes intervals for further analysis. Results: Oxygenated and total hemoglobin levels were significantly higher in the US group than in the placebo and control groups for the 20 minutes after ultrasound ( p < 0.01). The SST was significantly higher in the US group than in the control for 15 minutes after ultrasound ( p < 0.05), while it was significantly lower in the placebo group than in the US and control groups for 20 minutes after the trials ( p < 0.01). Conclusion: The effects of ultrasound were maintained for 20 minutes after the trial on intramuscular blood circulation and oxygen dynamics. These effects were caused by a combination of thermal and mechanical effects of the ultrasound.