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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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... CRet intervention consists of oscillating energy at specific frequencies generating therapeutic heat in body tissues [18]. Studies have shown that CRet can increase deep tissue temperature, whereas a hot pack only provides superficial thermotherapy [19], and can improve blood circulation in the muscle [20] and the peritendinous region [21]. CRet can simultaneously provide thermal stimulation and massage by moving the electrode. ...
... The heat intensity of the intervention was subjectively determined by a score of 6 or 7 on an 11-point analog scale for self-reporting of thermal sensation (0, no thermal sensation; 10, worst possible thermal sensation) to avoid burns. The intensity and duration of CRet intervention were based on the manufacturer's recommendations, which were considered the most effective levels are not causing discomfort or pain [19,21]. ...
... CRet intervention significantly improved knee flexion ROM and increased muscle strength. Yokota et al. (2018) showed that CRet intervention could increase muscle flexibility, which is believed to have increased knee flexion ROM in this study. Although no significant interaction effect was observed, CRet intervention improved muscle soreness at stretching. ...
Article
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This study aimed to investigate the acute effect of capacitive and resistive electric transfer (CRet) intervention on eccentrically damaged muscle. A total of 28 healthy and sedentary male volunteers were randomly allocated to either CRet intervention or control groups. The participants performed a bout of eccentric exercise of the knee extensors with the dominant leg and received 30 min of CRet intervention of the quadriceps 48 h after the exercise. The dependent variables for the analysis were knee flexion range of motion (ROM), muscle soreness and maximum voluntary isometric (MVC-ISO), and concentric contraction (MVC-CON) torque of the knee extensors. These were measured prior to exercise (baseline) and before and after CRet intervention (48 h after the exercise). The results showed that knee flexion ROM, muscle strength (MVC-ISO and MVC-CON), and muscle soreness significantly improved after CRet intervention. CRet intervention may improve muscle soreness and loss of muscle function in an eccentrically damaged muscle.
... The frequency range of CRet (500 Hz) reduces capacitance at the electrode-skin interface, lowering the risk of skin burn associated with traditional deep thermal and superficial thermal therapies. Previous studies reported that among individuals with non-specific LBP, CRet therapy produced vasodilation in deep local tissues and an increase in temperature, with resulting improvements in hemoglobin saturation [1][2][3][4] . These effects of CRet reduce pain and increase range of motion of the lumbar spine. ...
... It has been hypothesized that the increased fatiguability and pain of the erector spinae associated with LBP results in decreased spinal stability, causing the observed FRP 12,13) . In addition, ischemic changes in spinal tissues due to reduced local blood flow and accumulation of muscle byproducts associated with CLBP increases the stiffness of thoracolumbar muscles, further leading to loss of lumbar spine flexibility and a change in the point of maximum standing trunk flexion 3,14) . Based on this evidence, improving local blood circulation, decreasing muscle stiffness, pain, and muscle fatiguability, and increasing lumbar spine flexibility are therapeutic targets for patients with CLBP, which might normalize activity of the thoracolumbar musculature and, hence, the FRP. ...
... Based on this evidence, improving local blood circulation, decreasing muscle stiffness, pain, and muscle fatiguability, and increasing lumbar spine flexibility are therapeutic targets for patients with CLBP, which might normalize activity of the thoracolumbar musculature and, hence, the FRP. As recent studies have reported on the therapeutic benefits of CRet to improve local blood circulation and muscle fatiguability, as well as for pain relief 3,4) , we sought to evaluate the therapeutic effects of CRet therapy in improving pain and muscle stiffness as well as in normalizing muscle activity during maximum standing forward trunk flexion and the FRP among patients with CLBP. ...
Article
[Purpose] In this study, we investigated the therapeutic effects of capacitive and resistive electric transfer therapy in patients with chronic low back pain. [Participants and Methods] The study included 24 patients with chronic low back pain (12 patients each in the intervention and sham groups). Pain intensity, superficial and deep lumbar multifidus stiffness and maximum forward trunk flexion and associated activation level of the iliocostalis (thoracic and lumbar component) and lumbar multifidus muscles were measured. [Results] Post-intervention pain intensity and muscle stiffness were significantly lower than pre-intervention measurements in the intervention group. However, no between-group difference was observed in the muscle activation level at the end-point of standing trunk flexion. [Conclusion] Our findings highlight a significant therapeutic benefit of capacitive and resistive electric transfer therapy in patients with chronic low back pain and muscle stiffness.
... Therefore, we hypothesized that the application of diathermy on the Achilles tendon area warms up the superficial and deep tissues and the passage of current itself induces an electromagnetic field and these effects could increases the extensibility of the connective tissue. Researchers have studied the effects of diathermy modalities on increasing the extensibility of soft tissues and often these studies incorporate a stretching protocol following the application of heat [36,37]. Moreover, there has been conflicting evidence with studies suggesting either positive [2] or no effects [9] on tissue extensibility. ...
... Moreover, there has been conflicting evidence with studies suggesting either positive [2] or no effects [9] on tissue extensibility. Our pilot study is line with similar studies [19,37,38]. Yokota and collaborators suggested that capacitive and resistive electric transfer by means of high radiofrequency device, is an effective intervention to improve muscle flexibility [37]. ...
... Our pilot study is line with similar studies [19,37,38]. Yokota and collaborators suggested that capacitive and resistive electric transfer by means of high radiofrequency device, is an effective intervention to improve muscle flexibility [37]. However, no direct assessments on morphological and elastic properties of the tendon were performed. ...
Article
Background: Over the last 20 years, both diathermy and ultrasound have been popular choices for many clinicians in treating musculoskeletal disorders. However, there is a lack of clinical evidence of deep heating modalities to treat tendon pathology, There is no study to investigate the effects of such as physical modalities on morphological and elastic properties on the human tendons. Objective: the objective of the present study was to compare the effects of diathermy and ultrasound therapies on cross sectional area, transversal height and hardness percentage of the non-insertional region of the Achilles tendon in able-bodied subjects. Methods: healthy volunteers were divided in diathermy and ultrasound group received six 15-min treatment sessions. Before and after treatment a sonographic assessment was conducted by mean of ultrasonography and the following parameters were recorded: cross sectional area, transversal height and hardness percentage. Results: thirty-two subjects were enrolled. Between-group comparisons showed a significant change on hardness percentage (p = 0.004) after treatment in diathermy therapy group. Within-group comparison showed a significant improvement in the hardness percentage for the diathermy (p = 0.001) and ultrasound (p = 0.046) after two weeks of treatment. Conclusion: this pilot study demonstrated larger effects on morphological and elastic properties of the non-insertional region of the Achilles tendon after diathermy than ultrasound therapy in normal tendons. Diathermy may be a useful deep heat modality for treating non-insertional Achilles tendinopathy.
... Despite the limited research regarding adjuvant therapies for endometriosis, some studies have recently revealed the efficacy of radiofrequency as a treatment for other painful and chronic conditions (i.e., fibromyalgia), decreasing pain intensity and inflammation, while enhancing tissue healing [35][36][37][38][39]. The therapeutic effects of radiofrequency are mainly linked to their thermal and non-thermal mechanisms [37,38], achieving an improvement of local vascularization by increasing the oxygenated blood supply, reducing oedema and inflammation through the removal of inflammatory catabolites [40][41][42], and modulating cellular activity, resulting in the stimulation of tissue regeneration by the proliferation of stem cells [43]. Moreover, radiofrequency has shown to reduce the transmission of pain and decrease muscular hypertonus by the activation of Aβ fibres [42,44]. ...
... The therapeutic effects of radiofrequency are mainly linked to their thermal and non-thermal mechanisms [37,38], achieving an improvement of local vascularization by increasing the oxygenated blood supply, reducing oedema and inflammation through the removal of inflammatory catabolites [40][41][42], and modulating cellular activity, resulting in the stimulation of tissue regeneration by the proliferation of stem cells [43]. Moreover, radiofrequency has shown to reduce the transmission of pain and decrease muscular hypertonus by the activation of Aβ fibres [42,44]. The current treatment for endometriosis pain consists of a new radiofrequency technique that has shown beneficial outcomes in treating pelvic pain in the clinical context: the monopolar dielectric radiofrequency (MDR) [35]. ...
Article
Background and Purpose: Endometriosis-associated pain is the main cause of chronic pelvic pain in women. Endometriosis has a significant negative impact across different domains of patients’ quality of life. This study aimed to evaluate the efficacy of an intracavitary application of monopolar dielectric radiofrequency in women with endometriosis-associated pain. Patient presentation Five women with endometriosis received 25 sessions of an intracavitary application of monopolar dielectric radiofrequency within three months. Outcomes, including quality of life, sex interference (Endometriosis Health Profile [EHP]-30 + section C), myofascial pain syndrome (myofascial trigger points), pain intensity (Visual Analogue Scale), frequency and referral pattern, pressure pain thresholds, allodynia and neuropathic pain (modified DN4), were examined both during and outside menses, after intervention and six months later. Results Clinically meaningful improvements were achieved by most participants regarding pelvic pain intensity, abdominal sensitivity, and myofascial pain of the pelvic floor. Conclusion This study lays the foundation for future in-depth research, suggesting that monopolar dielectric radiofrequency could be helpful in improving the symptomatology and quality of life of women with endometriosis, also in patients who are unresponsive to medical and/or surgical treatments, or who cannot undergo them in the short term.
... In addition, the location of these reactions in the body according to the application parameters, such as the absorbed power and the position of the electrodes, continues to be based largely on the empirical experience of those who use the instrument. 23,24,27,34 Ignorance of the quantification of thermal changes and current flow is mainly due to the type of measures used in these studies. Having conducted these studies on living subjects, it is not possible to perform invasive measurements on certain structures, especially deep ones, where it is interesting to know the amount of energy that passes, and the thermal changes that occur. ...
Article
Background: Capacitive-resistive electric transfer therapy is an interesting rehabilitation treatment to use in musculoskeletal injuries. The purpose is to analyze the temperature change and current flow in superficial and deep biceps femoris and quadriceps tissues when applying different protocols of capacitive-resistive electric transfer therapy. Methods: Five cryopreserved cadavers (10 legs) were included in this study. Four interventions (high/low power) were performed for 5 minutes. Dynamic movements were performed to the biceps femoris and quadriceps. Superficial, middle, and deep temperature were recorded at 1-minute intervals and 5 minutes after the treatment using invasive temperature meters placed with ultrasound guidance. Results: Low-power applications have generated a very low thermal effect and an important current flow. The high-power capacitive application achieves a greater increase in superficial temperature compared with low power (P < .001). The high-power resistive application recorded a greater increase in superficial, middle, and deep temperatures with a greater current flow compared with the other applications (P < .001). Conclusion: This study could serve as basic science data to justify the acceleration of the processes of muscle recovery, improving cell proliferation without increasing the temperature in acute muscle injuries and increasing the temperature and viscoelasticity of the tissues in chronic processes with this therapy.
... TECAR is a diathermic method that acts on deep tissue layers. It is commonly used in human medicine for the treatment of muscle and tendon injuries [26]. Clinical effects result from increases in local blood and lymphatic flow, reduction of pain, and increase in cellular metabolism [27,28]. ...
Article
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This preliminary study has investigated the outcome of physiotherapy in 10 dogs affected by a primary lesion of the iliopsoas muscle and the potential effects of sex, age, and breed on recovery. Ten dogs with primary injury of the iliopsoas muscle were retrospectively included in this study. Dogs were submitted to a rehabilitation program, characterized by a multimodal approach, including physical therapies and modalities. After recovery, patients were submitted to a further support period of rehabilitation to promote muscle strengthening and limit injury recurrence during their return to normal functional and sports activity. Border collies were highly represented. The recovery of lameness occurred after a mean of 22.6 ± 14.7 (median 18) days with a median number of five sessions. None of the examined variables affected the recovery time, except for the border collie breed, which showed a significantly faster recovery time; however, there was no difference between the breeds with regard to the number of sessions. Multimodal rehabilitation therapy may promote lameness recovery of mild-to-moderate iliopsoas lesions within 3 weeks. This preliminary study reports a clinical approach and recovery of primary iliopsoas lesions, findings that can provide clinicians with useful prognostic information for dogs involved in sports activities.
... Although there are clinical studies that support this mechanism, the amounts of energy and current that should be transferred to obtain the desired temperature increase in structures such as the supraspinatus tendon and the joint capsule are still unknown. In addition, controlling these reactions is still based, to a great extent, on empirical experience from therapists and commercial brand protocols [9,12,17]. ...
Article
Full-text available
Background: Impingement syndrome is currently estimated to represent 60% of all shoulder pain disorders. Capacitive-Resistive electric transfer therapy is aimed to provoke temperature and current flow changes in superficial and deep tissues. This in vitro study has evaluated the variation of temperature and current flow in the shoulder tissues during two different areas of application of the movable capacitive-resistive electric transfer electrode. Methods: A cross-sectional study designed, five fresh cryopreserved cadavers (10 shoulders) were included in this study. Four interventions (capacitive and resistive modes; low- and high-power) were performed for 5 min each by a diathermy "T-Plus" device in two shoulder regions: postero-superior and antero-lateral. Supraspinatus tendon, glenohumeral capsule and superficial temperatures were recorded at 1-min intervals and 5 min after treatment. Results: A statistically significant difference was found only for the superficial area and time interaction, with high power-resistive application at the postero-superior shoulder area (P< 0.035). All the applications showed a 5 min after treatment temperature increase compared with the basal data, in all the application points. Superficial temperature in the high power-resistive application showed the greatest percent increase (42.93% ± 22.58), followed by the temperature in the tendon area with the same high power-resistive application (22.97% ± 14.70). The high power-resistive application showed the greatest percent of temperature increase in the applications, reaching 65.9% ± 22.96 at 5-min at the superficial level, and 32% ± 24.25 at 4-min at the level of the supraspinatus tendon. At the capsule level, high power-resistive was also the application that showed the greatest percent of increase, with 21.52% ± 16.16. The application with the lowest percent of temperature increase was the low power-capacitive, with a mean value of 4.86% at supraspinatus tendon level and 7.47% at capsular level. Conclusion: The shoulder postero-superior or antero-lateral areas of application of capacitive-resistive electric transfer did not cause statistically significant differences in the temperature changes in either supraspinatus tendon or glenohumeral capsule tissues in cadaveric samples. The high power-resistive application in the postero-superior area significantly increased superficial temperature compared with the same application in the antero-lateral position area.
... There are clinical publications that support the use of CRet therapy, although the amounts of energy and current that must be transferred to obtain the desired changes in temperature and current flow are unknown. Furthermore, the control of these reactions is still highly based on the empirical experience of the therapist [5,[16][17][18]. There are only two in vitro studies that analyzed changes in temperature and current flow in cadavers [13,19]. ...
Article
Full-text available
Abstract: Lateral elbow tendinopathy, or “tennis elbow,” is a pathology that affects around 1.3% of the general population. Capacitive–resistive electric transfer therapy aims to provoke temperature and current flow changes in superficial and deep tissues. The aim of this in vitro study was to analyze the thermal behavior and transmission of electric current on the superficial and deep tissues of the elbow during the application of different modalities of a capacitive–resistive electric transfer treatment protocol for chronic elbow tendinopathy. A cross-sectional study was designed; five fresh cryopreserved cadavers (10 elbows) were included in this study. A 30 min intervention was performed based on a protocol commonly used in clinics for the treatment of chronic lateral elbow tendinopathy by diathermy using the “T-Plus.” Common extensor tendon, radiohumeral capsule, and superficial temperatures were registered after each application for the duration of the 30 min treatment protocol. During all applications, we observed a current flow of over 0.03 A. The protocol showed a statistically significant increase in superficial temperature by 24% (5.02�) (p < 0.005), the common extensor tendon by 19.7% (4.36�) (p < 0.007), and the radiohumeral joint capsule by 17.5% (3.41�) (p < 0.005) at the end of the 30 min protocol compared with the baseline temperature. The different applications of the protocol showed specific effects on the temperature and current flow in the common extensor tendon and radiohumeral capsule. All applications of the protocol produced a current flow that is associated with the generation of cell proliferation. These results strengthen the hypothesis of cell proliferation and thermal changes in deep and distal structures. More studies are needed to confirm these results. Keywords: tennis elbow; cadaver; diathermy; physical therapy
... Although there are clinical studies that support this mechanism, the amounts of energy and current that should be transferred to obtain the desired temperature increase in structures such as the supraspinatus tendon and the joint capsule are still unknown. In addition, controlling these reactions is still based, to a great extent, on empirical experience from therapists and commercial brand protocols (11,15,17,24). ...
Preprint
Full-text available
Background Impingement syndrome is currently estimated to represent 60% of all shoulder pain disorders. Capacitive-Resistive electric transfer therapy is aimed to provoke temperature and current flow changes in superficial and deep tissues. This in vitro study has evaluated the variation of temperature and current flow in the shoulder tissues during two different areas of application of the movable capacitive-resistive electric transfer electrode. Methods A cross-sectional study designed, five fresh cryopreserved cadavers (10 shoulders) were included in this study. Four interventions (capacitive and resistive modes; low- and high-power) were performed for 5 minutes each by a diathermy “T-Plus” device in two shoulder regions: postero-superior and antero-lateral. Supraspinatus tendon, glenohumeral capsule and superficial temperatures were recorded at 1-min intervals and 5 min after treatment. Results A statistically significant difference was found only for the superficial area and time interaction, with high power-resistive application at the postero-superior shoulder area (P < 0.035). All the applications showed a final temperature increase compared with the basal data, in all the application points. Superficial temperature in the high power-resistive application showed the greatest percent increase (42.93% ± 22.58), followed by the temperature in the tendon area with the same high power-resistive application (22.97% ± 14.70). The high power-resistive application showed the greatest percent of temperature increase in the applications, reaching 65.9% ± 22.96 at 5-min at the superficial level, and 32% ± 24.25 at 4-min at the level of the supraspinatus tendon. At the capsule level, high power-resistive was also the application that showed the greatest percent of increase, with 21.52% ± 16.16. The application with the lowest percent of temperature increase was the low power-capacitive, with a mean value of 4.86% at supraspinatus tendon level and 7.47% at capsular level. Conclusion The shoulder postero-superior or antero-lateral areas of application of capacitive-resistive electric transfer did not cause statistically significant differences in the temperature changes in either supraspinatus tendon or glenohumeral capsule tissues in cadaveric samples. The high power-resistive application in the postero-superior area significantly increased superficial temperature compared with the same application in the antero-lateral position area.
Article
Capacitive and resistive electric transfer (CRET) therapy is used to reduce pain and improve functional disability, and the effect on low back pain remains to be investigated. This study aimed to examine the immediate effect on the onset time of the muscles after irradiating CRET therapy for non-specific chronic low back pain (NSCLBP). Thirty patients with NSCLBP were randomly divided into an intervention group (n = 15) and a sham group (n = 15). Participants and statisticians were blinded to participant allocation. The intervention group received one 15-minute session of CRET therapy on their lower back; the sham group similarly received one 15-minute session of sham therapy. Before and immediately after the intervention, the onset time of the trunk and lower limb muscles was measured during prone hip extension, and pain intensity was recorded using a visual analog scale. The intervention group showed a significant reduction in pain and a significantly earlier onset time of the thoracic part of the iliocostalis lumborum, lumbar part of the iliocostalis lumborum, lumbar multifidus, and gluteus maximus. These results showed that CRET therapy not only reduced pain, but also facilitated trunk muscle activity. Improvement in muscle activity patterns may improve activities of daily living. This study was registered at the University Hospital Medical Information Network in Japan (UMIN-CTR: 000046301).
Article
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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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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.