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Muscle Rehabilitation Techniques and Prevention of Injury
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Background
Low load exercise training with blood flow restriction (BFR) has become increasingly used by human physical therapists to prescribe controlled exercise following orthopaedic injury; its effects on the equine superficial digital flexor tendon (SDFT), however, are unknown.
Objective
To investigate outcomes of pressure specific BFR walking exercise on uninjured equine SDFT biomechanics and histomorphology.
Study design
Controlled in vivo experiment.
Methods
Four forelimbs of four horses were exposed to 40 BFR‐walk sessions (10‐min interval walking) on a treadmill over a 56‐day study period with their contralateral forelimbs serving as untreated controls. Similarly, four forelimbs of four control horses were exposed to 40 sham cuff walk sessions. On study Day 56, all horses (n = 8) were humanely euthanised and forelimb SDFTs underwent non‐destructive biomechanical testing and corresponding histomorphological analysis. Significance in biomechanical parameters between treatment groups was analysed using a mixed‐effects ANOVA with Tukey's post‐hoc tests.
Results
Statistically significant differences in SDFT stiffness for both first (p = 0.02) and last cycles (p = 0.03) were appreciated within the BFR treated group only, with BFR exposed forelimbs being significantly stiffer than the contralateral unexposed forelimbs. When normalised to cross‐sectional area, no significant differences were appreciated among treatment groups in elastic modulus for the first (p = 0.5) or last cycles (p = 0.4). No histological differences were appreciated among treatment groups according to Bonar, Movin, or musculotendinous junction evaluation criteria.
Main limitations
Short‐term comparisons were performed in a small sample population without correlation to performance outcome measures. Optimal occlusion percentages and walk protocols remain unknown.
Conclusions
This study demonstrated no negative impact of BFR on mechanical strength of the equine SDFT; however, evidence suggests that BFR results in increased tendon stiffness based on biomechanical testing and subsequent calculations. No consistent detrimental histomorphological changes were seen.
Background
Blood flow restriction (BFR) has become a key rehabilitative tool for human orthopaedic conditions. With modernised technology and evolution of clinical application, patient‐specific delivery of occlusion percentages is now considered the standard of care in human patients due to improved therapeutic outcomes and minimised safety risks. Safety validation and limb occlusion pressure (LOP) data for horses, however, are lacking.
Objective
(1) To determine if BFR exposure resulted in forelimb biomechanical gait dysfunction as safety validation and (2) to investigate inter‐horse and inter‐limb LOP differences.
Study design
Controlled in vivo experiment.
Methods
Daily unilateral forelimb BFR was performed in four horses over 56 days. Clinical examinations and objective gait analyses were performed on Days 0, 28 and 56. Daily LOP values were determined by Doppler evaluation to deliver 80% vascular occlusion at a walk. A linear mixed model evaluated for differences in lameness, kinetic and kinematic gait parameters.
Results
There were no significant differences in forelimb lameness (range of Grades 0–2 across all forelimbs), kinematic or kinetic gait parameters over time or between BFR‐exposed and control (contralateral) limbs (p > 0.05). Clinically apparent complications related to BFR such as thrombosis or dermatitis were not appreciated. Significant differences in mean LOP values between various horses (p < 0.001) and measured left (204.48 mmHg) and right (173.78 mmHg) forelimbs (p < 0.001) were observed. Mean LOP and standard deviation across all readings was 189.1 ± 22.2 mmHg.
Main limitations
Optimal BFR occlusion percentages and protocols with documented clinical efficacy are unknown. Small study population.
Conclusions
Exposure to BFR did not result in forelimb biomechanical dysfunction in four horses. Applied pressures of 75–151 mmHg would likely simulate a range of 50%–80% vascular occlusion in horses, but inherent physiological variation between horses and forelimbs warrants incorporation of individual pressures.
Background
Neck pain and stiffness are increasingly recognized in horses and often treated using multimodal pharmaceutical and rehabilitation approaches. In humans, deep tissue heating is reported to reduce neck pain and increase flexibility.
Objectives
The objective of this project was to determine the effects of capacitive-resistive electrical therapy on neck pain and stiffness in horses.
Study Design
A blinded, randomized, controlled clinical trial with 10 horses assigned to active and 10 horses assigned to sham treatment groups.
Methods
Neck pain, stiffness, and muscle hypertonicity were assessed by manual palpation. Forelimb postural stability was evaluated using a portable media device with built-in inertial sensing components. All outcome parameters were recorded once weekly for 4 weeks. Using manufacturer recommendations, the treatment group received active capacitive-resistive electrical therapy to the lower cervical region (C4-C7), twice weekly for a total of 6 treatments, while the control group received a sham (inactive) treatment. Data was analyzed using a mixed model that was fit separately for each response variable.
Results
There were no significant differences noted over time or between groups for any outcome parameter evaluated. While neck pain and stiffness decreased by week 3 in both groups, the improvement was not significant.
Main limitations
Limitations include the lack of a definitive pathoanatomic diagnosis of cervical pathology and in-vivo temperature measurements.
Conclusions
Capacitive-resistive electrical therapy was ineffective in reducing neck pain and dysfunction using the recommended treatment protocols. No short-term adverse effects were noted. Specific clinical applications and effective treatment parameters need further evaluation.
Thoracolumbar pain has been identified in both human and equine patients. Rehabilitation and conditioning programs have focused specifically on improving trunk and abdominal muscle function (1–5). Equine exercise programs routinely incorporate ground poles and training devices for the similar goals of increasing spinal and core stability and strength (6–8). The multifidus muscle has been an area of focus due to atrophy associated with disease (9). To date, there have been no reports on the activity of the multifidus muscle in horses in relation to therapeutic exercises. Our objectives were to use electromyography to determine the average work performed and peak muscle activity of the multifidus in horses trotting, trotting over ground poles, trotting while wearing a resistance band-based training device and trotting while wearing the training device over ground poles. We hypothesized that ground poles and the training device would each increase average work performed and peak multifidus muscle activity. Right and left cranial thoracic locations showed significant increased muscle work and peak activation when horses were trotted over ground poles versus without. The peak activation was significantly greater in horses trotting over poles in both lumbar regions, but there was no significant change in peak activation in either location due to the training device. When the influence of the training device was investigated without ground poles, left caudal thoracic muscle work and peak activity, and right lumbar muscle work were significantly lower when using the training device, as compared to without. When the training device was combined with trotting over ground poles, both left and right caudal thoracic regions showed significantly lower muscle work and peak activity when the device was used. There was no significant difference between with and without the device in either left or right lumbar muscle work. In conclusion, implementing ground poles can be an effective strategy to increase the activation of the multifidus muscle, however, caution should be taken when incorporating the use of a resistance band training device as muscle work and peak activation were significantly reduced in most locations. Further study should be performed in regards to the training device to determine its effects on epaxial musculature.
Asymmetry of the multifidi has been correlated with scoliosis and back pain in humans and has been investigated as a factor in equine back pain as well. The purpose of this study was to determine if FES would affect the symmetry of equine thoracolumbar multifidi when compared to controls. Twelve horses received 24 FES treatments bilaterally over the thoracolumbar region for 8 weeks. Twelve additional control horses received no FES treatments. Ultrasonographic measurements of the cross-sectional area (CSA) of the multifidi of the treatment horses at seven thoracolumbar levels were compared to determine the change in left and right asymmetry post-FES. The same measurements during the same period were also taken in the control group. All measurements were blinded for evaluation. Statistical significance was assessed utilizing two-sided, matched-pairs t-tests, and Welch’s (unequal variances) t-test (alpha = 0.05). Multiple comparisons were accounted for using the Sidak correction. A significant improvement in multifidi asymmetry was observed, post-FES, at all seven thoracolumbar levels, with no evidence of asymmetry improvement in the control group. The difference between mean improvements of the treatment and control groups was statistically significant (P < .001). FES significantly improved the symmetry of equine multifidi, and evidence was provided for the effectiveness of FES at each of seven thoracolumbar levels. The improvement in symmetry appeared to result from increases, decreases, and maintenance of the CSA of the left and right multifidi in various combinations. The FES protocol used in this study has the potential to improve spinal function and assist in reducing back pain in horses.
Rehabilitation has become an important aspect of equine practice. Unfortunately, there is limited knowledge or awareness of the general principles and methods used to develop safe and effective rehabilitation programmes. By following a few basic principles, appropriate rehabilitation programmes can be developed for individual horses with a wide range of injuries and sources of musculoskeletal pain or dysfunction. This article provides an outline of general guidelines to help practitioners interested in developing rehabilitation programmes or working with sports medicine and rehabilitation experts to provide the best possible treatment for individual horses with injuries at different stages of healing.
Background: Calf muscle strain and Achilles tendon injuries are common in many sports. For the treatment of
muscular and tendinous injuries, one of the newer approaches in sports medicine is capacitive-resistive electric
transfer therapy. Our objective was to analyze this in vitro, using invasive temperature measurements in cadaveric
specimens.
Methods: A cross-sectional study designed with five fresh frozen cadavers (10 legs) were included in this study.
Four interventions (capacitive and resistive modes; low- and high-power) was performed for 5 min each by a
diathermy “T-Plus” device. Achilles tendon, musculotendinous junction and superficial temperatures were recorded
at 1-min intervals and 5 min after treatment.
Results: With the low-power capacitive protocol, at 5 min, there was a 25.21% increase in superficial temperature, a
17.50% increase in Achilles tendon temperature and an 11.27% increase in musculotendinous junction temperature,
with a current flow of 0.039 A ± 0.02.
With the low-power resistive protocol, there was a 1.14% increase in superficial temperature, a 28.13% increase in
Achilles tendon temperature and an 11.67% increase in musculotendinous junction temperature at 5 min, with a
current flow of 0.063 A ± 0.02. With the high-power capacitive protocol there was an 88.52% increase in superficial
temperature, a 53.35% increase in Achilles tendon temperature and a 39.30% increase in musculotendinous
junction temperature at 5 min, with a current flow of 0.095 A ± 0.03. With the high-power resistive protocol, there
was a 21.34% increase in superficial temperature, a 109.70% increase in Achilles tendon temperature and an 81.49%
increase in musculotendinous junction temperature at 5 min, with a current flow of 0.120 A ± 0.03.
Conclusion: The low-power protocols resulted in only a very slight thermal effect at the Achilles tendon and
musculotendinous junction, but current flow was observed. The high-power protocols resulted in a greater
temperature increase at the Achilles tendon and musculotendinous junction and a greater current flow than
the low-power protocols. The high-power resistive protocol gave the greatest increase in Achilles tendon and
musculotendinous junction temperature. Capacitive treatments (low- and high-power) achieved a greater
increase in superficial temperature.
Background:
Tecar therapy (TT) is an endogenous thermotherapy used to generate warming up of superficial and deep tissues. TT capability to affect the blood flow is commonly considered to be the primary mechanism to promote tissue healing processes. Despite some preliminary evidence about its clinical efficacy, knowledge on the physiologic responses induced by TT is lacking.
Objective:
The aim of this quantitative randomized pilot study was to determinate if TT, delivered in two modes (resistive and capacitive), affects the perfusion of the skin microcirculation (PSMC) and intramuscular blood flow (IMBF).
Design:
A randomized controlled pilot feasibility study.
Subjects:
Ten healthy volunteers (n = 4 females, n = 6 males; mean age 35.9 ± 10.7 years) from a university population were recruited and completed the study.
Intervention:
All subjects received three different TT applications (resistive, capacitive, and placebo) for a period of 8 min.
Outcome measures:
PSMC, IMBF, and the skin temperature (ST) were measured pre- and post-TT application using power Doppler sonography, laser speckle contrast imaging (LSCI), and infrared thermography.
Results:
Compared with placebo application, statistically significant differences in PSMC resulted after both the resistive (p = 0.0001) and the capacitive (p = 0.0001) TT applications, while only the resistive modality compared with the placebo was capable to induce a significant change of IMBF (p = 0.013) and ST (p = 0.0001).
Conclusions:
The use of power Doppler sonography and LSCI enabled us to evaluate differences in PSMC and IMBF induced by TT application.
Lactate is a metabolic substrate mainly produced in muscles, especially during exercise. Recently, it was reported that lactate affects myoblast differentiation; however, the obtained results are inconsistent and the in vivo effect of lactate remains unclear. Our study thus aimed to evaluate the effects of lactate on myogenic differentiation and its underlying mechanism. The differentiation of C2C12 murine myogenic cells was accelerated in the presence of lactate and, consequently, myotube hypertrophy was achieved. Gene expression analysis of myogenic regulatory factors showed significantly increased myogenic determination protein (MyoD) gene expression in lactate-treated cells compared with that in untreated ones. Moreover, lactate enhanced gene and protein expression of myosin heavy chain (MHC). In particular, lactate increased gene expression of specific MHC isotypes, MHCIIb and IId/x, in a dose-dependent manner. Using a reporter assay, we showed that lactate increased promoter activity of the MHCIIb gene and that a MyoD binding site in the promoter region was necessary for the lactate-induced increase in activity. Finally, peritoneal injection of lactate in mice resulted in enhanced regeneration and fiber hypertrophy in glycerol-induced regenerating muscles. In conclusion, physiologically high lactate concentrations modulated muscle differentiation by regulating MyoD-associated networks, thereby enhancing MHC expression and myotube hypertrophy in vitro and, potentially, in vivo.
In response to sudden postural perturbations, the posture control system uses anticipatory and compensatory postural adjustments (APAs and CPAs) to maintain balance and equilibrium. APAs strengthen as the perturbation magnitude increases, while CPAs remain constant because APAs make the necessary adjustments. However, the magnitude of a postural perturbation cannot always be fully known. This research focused on postural adjustments in response to perturbations with unknown magnitude. Participants caught falling sandbags of three weights on a tray held in their hands. Participants were told about the weight used for the upcoming trial in the KNOWN condition and not told in the UNKNOWN condition. Surface electromyography (sEMG) of the lumbar muscles and displacement of the center of pressure (COP) were recorded synchronously. The results showed that APAs and CPAs were stronger in the UNKNOWN condition than in the KNOWN condition. Meanwhile, in the UNKNOWN condition, the activity of the lumbar muscles and displacements of the COP showed no difference between weight levels. The lumbar erector spinae (LES) and lumbar multifidus (LMF) activated earlier in the UNKNOWN condition than for the heaviest weight in the KNOWN condition. The outcome of this study indicates that APAs and CPAs of lumbar muscles and displacements of the COP are affected by the knowledge of postural perturbations. The central nervous system (CNS) coped with load perturbations of unknown magnitude with redundancy response strategy, based on the maximum assumption of perturbation magnitude.
Equine acupuncture and herbal medicine are increasingly popular and have been anecdotally used in the treatment of a number of conditions. There is, however, a lack of data on the most commonly treated conditions in horses. The medical records of 164 horses presented exclusively for acupuncture and herbal therapy over a three-year period from October 2012 to October 2015 were evaluated from a mixed animal integrative medicine service at a veterinary academic teaching hospital. Horses were presented primarily for musculoskeletal conditions (62.0%), gastrointestinal disorders (9.5%), and anhydrosis (6.1%). Nearly half of all treated horses were geldings and the mean age of treatment was 10.7±6.5 years. The most common breeds were Warmbloods (28.2%), Quarter horses (20.2%), Thoroughbreds (17.8%), and Arabians (8.0%). Treatments included acupuncture (90.2%), herbal supplements (79.8%), electroacupuncture (69.9%), B12 injections (aqua-acupuncture, 29.4%) or administration of autologous blood at acupuncture points (8.0%). Thirty eight (38) different herbal formulas were recommended during the study period. Horses which were not provided herbal recommendations were more likely to present with gastrointestinal complaints (Odds Ratio=11.2). Sex, breed, and presenting complaint had no or minimal impact on the types of treatments performed during the visit. However, data regarding patient characteristics and presenting complaints provides novel information which can be used to design prospective clinical trials.
Pulsed electromagnetic field (PEMF) therapy can non-invasively treat a variety of pathologies by delivering electric and magnetic fields to tissues via inductive coils. The electromagnetic fields generated by these devices have been found to affect a variety of biological processes and basic science understanding of the underlying mechanisms of action of PEMF treatment has accelerated in the last 10 years. Accumulating clinical evidence supports the use of PEMF therapy in both animals and humans for specific clinical indications including bone healing, wound healing, osteoarthritis and inflammation, and treatment of post-operative pain and edema. While there is some confusion about PEMF as a clinical treatment modality, it is increasingly being prescribed by veterinarians. In an effort to unravel the confusion surrounding PEMF devices, this article reviews important PEMF history, device taxonomy, mechanisms of action, basic science and clinical evidence, and relevant trends in veterinary medicine. The data reviewed underscore the usefulness of PEMF treatment as a safe, non-invasive treatment modality that has the potential to become an important stand-alone or adjunctive treatment modality in veterinary care.
The present study aimed to compare the early metabolic response between high-load resistance exercise (HL-RE) and low-load resistance exercise with blood flow restriction (LL-BFR). Nine young, well-trained men participated in a randomized crossover design in which each subject completed LL-BFR, HL-RE, or condition control (no exercise) with a 1-week interval between them. Blood samples were taken immediately before and 5 min after the exercise sessions. Nuclear magnetic resonance spectroscopy identified and quantified 48 metabolites, 6 of which presented significant changes among the exercise protocols. The HL-RE promoted a higher increase in pyruvate, lactate, and alanine compared with the LL-BFR and the control. HL-RE and LL-BFR promoted a higher increase in succinate compared with the control; however, there was no difference between HL-RE and LL-BFR. Also, while there was no difference in acetoacetate between HL-RE and LL-BFR, a greater decrease was observed in both compared with the control. Finally, LL-BFR promoted a greater decrease in choline compared with the control. In conclusion, this study provides by metabolomics a new insight in metabolic response between LL-BFR and HL-RE by demonstrating a distinct response to some metabolites that are not commonly analyzed.
In this randomized study involving 50 amateur athletes with severe injury to thigh or calf muscles, a return to full activity was more rapid when the rehabilitation program was started 2 days rather than 9 days after injury.
It is well known that endurance training is effective to attenuate skeletal muscle atrophy. Succinate is a typical TCA metabolite, of which exercise could dramatically increase the content. The present study aimed to investigate the effect of succinate on protein synthesis in skeletal muscle, and try to delineate the underlying mechanism. The in vitro study revealed that succinate dose‑dependently increased protein synthesis in C2C12 myotube along with the enhancement of phosphorylation levels of AKT Serine/Threonine Kinase 1(Akt), mammalian target of rapamycin, S6, eukaryotic translation initiation factor 4E, 4E binding protein 1 and forkhead box O (FoxO) 3a. Furthermore, it was demonstrated that 20 mM succinate markedly increased [Ca2+]i. Then, the phospho‑extracellular regulated kinase (Erk), ‑Akt level and the crosstalk between Erk and Akt were elevated in response to succinate. Notably, the Erk antagonist (U0126) or mTOR inhibitor (rapamycin) abolished the effect of succinate on protein synthesis. The in vivo study verified that succinate dose‑dependently increased the protein synthesis, in addition to phosphorylation levels of Erk, Akt and FoxO3a in gastrocnemius muscle. In summary, these findings demonstrated that succinate promoted skeletal muscle protein deposition via Erk/Akt signaling pathway.
Anti-inflammatory modalities are commonly used for the treatment of various musculoskeletal injuries. Although inflammation was originally believed to interfere with skeletal muscle regeneration, several recent studies have highlighted the beneficial effects of inflammatory cells on muscle healing. This discrepancy is attributable to an evolving understanding of the complex inflammatory process. To better appreciate the paradoxical roles of inflammation, clinicians must have a better comprehension of the fundamental mechanisms regulating the inflammatory response. In this perspective article, cellular, animal, and human studies were analyzed to summarize recent knowledge regarding the impact of inflammation on muscle regeneration in acute or chronic conditions. The effect of anti-inflammatory drugs on the treatment of various muscle injuries was also considered. Overall, this work aims to summarize the current state of the literature on the inflammatory process associated with muscle healing in order to give clinicians the necessary tools to have a more efficient and evidence-based approach to the treatment of muscle injuries and disorders.
Introduction:
Quadriceps strength after arthroscopic knee procedures is frequently diminished several years postoperation. Blood flow restriction (BFR) training uses partial venous occlusion while performing submaximal exercise to induce muscle hypertrophy and strength improvements. The purpose of this study was to evaluate BFR as a postoperative therapeutic intervention after knee arthroscopy.
Methods:
A randomized controlled pilot study comparing physical therapy with and without BFR after knee arthroscopy was conducted. Patients underwent 12 sessions of supervised physical therapy. Subjects followed the same postoperative protocol with the addition of 3 additional BFR exercises. Outcome measures included thigh girth, physical function measures, Knee Osteoarthritis Outcome Score (KOOS), Veterans RAND 12-Item Health Survey (VR12), and strength testing. Bilateral duplex ultrasonography was used to evaluate for deep venous thrombosis preintervention and postintervention.
Results:
Seventeen patients completed the study. Significant increases in thigh girth were observed in the BFR group at 6-cm and 16-cm proximal to the patella (P = 0.0111 and 0.0001). All physical outcome measures significantly improved in the BFR group, and the timed stair ascent improvements were greater than conventional therapy (P = 0.0281). The VR-12 and KOOS subscales significantly improved in the BFR group, and greater improvement was seen in VR-12 mental component score (P = 0.0149). The BFR group displayed approximately 2-fold greater improvements in extension and flexion strength compared with conventional therapy (74.59% vs 33.5%, P = 0.034). No adverse events were observed during the study.
Conclusions:
This study suggests that BFR is an effective intervention after knee arthroscopy. Further investigation is warranted to elucidate the benefits of this intervention in populations with greater initial impairment.
The aim of the study was to investigate the effect of high-intensity laser therapy (HILT) in treatment of patients with chronic neck pain (CNP) on cervical range of motion (ROM), pain, and functional activity. Sixty male patients participated in this study with mean (SD) age of 35.47 (4.18) years. Patients were randomly assigned into two groups and treated with HILT plus exercise (HILT + EX) and placebo laser plus exercise (PL + EX) in groups 1 and 2, respectively. The outcomes measured were cervical ROM, pain level by visual analog scale (VAS), and functional activity by neck disability index (NDI) score. Statistical analyses were performed to compare the differences between baseline and post-treatment. The level of statistical significance was set as p < 0.05. Cervical ROM significantly increased after 6 weeks of treatment in all groups. VAS and NDI results showed significant decrease post-treatment in both groups. HILT + EX effectively increased cervical ROM and decreased VAS and NDI scores after 6 weeks of treatment compared to PL + EX. HILT + EX is an effective physical therapy modality for patients with CNP compared to PL + EX therapy. The combination of HILT + EX effectively increased cervical ROM, functional activity, and reduced pain after 6 weeks of treatment.
Purpose
The present study aimed to investigate the effects of low-intensity resistance training with blood flow restriction (BFR resistance training) on vascular endothelial function and peripheral blood circulation.
Methods
Forty healthy elderly volunteers aged 71 ± 4 years were divided into two training groups. Twenty subjects performed BFR resistance training (BFR group), and the remaining 20 performed ordinary resistance training without BFR. Resistance training was performed at 20 % of each estimated one-repetition maximum for 4 weeks. We measured lactate (Lac), norepinephrine (NE), vascular endothelial growth factor (VEGF) and growth hormone (GH) before and after the initial resistance training. The reactive hyperemia index (RHI), von Willebrand factor (vWF) and transcutaneous oxygen pressure in the foot (Foot-tcPO2) were assessed before and after the 4-week resistance training period.
Results
Lac, NE, VEGF and GH increased significantly from 8.2 ± 3.6 mg/dL, 619.5 ± 243.7 pg/mL, 43.3 ± 15.9 pg/mL and 0.9 ± 0.7 ng/mL to 49.2 ± 16.1 mg/dL, 960.2 ± 373.7 pg/mL, 61.6 ± 19.5 pg/mL and 3.1 ± 1.3 ng/mL, respectively, in the BFR group (each P < 0.01). RHI and Foot-tcPO2 increased significantly from 1.8 ± 0.2 and 62.4 ± 5.3 mmHg to 2.1 ± 0.3 and 68.9 ± 5.8 mmHg, respectively, in the BFR group (each P < 0.01). VWF decreased significantly from 175.7 ± 20.3 to 156.3 ± 38.1 % in the BFR group (P < 0.05).
Conclusions
BFR resistance training improved vascular endothelial function and peripheral blood circulation in healthy elderly people.
Functional electrical stimulation (FES) has proven to be advantageous in reducing muscle hypertonicity and reeducating muscle memory in the human population and has recently been used in horses. Six horses ranging in age from 10 to 17 years were selected for the study. Still photographs and clinical evaluations using the Modified Ashworth Scale to characterize muscle hypertonicity were performed on all horses pre- and post-FES. Functional electrical stimulation treatments were performed over a period of 8 weeks, resulting in a total of 22 treatments per horse. Biopsies pre- and post-FES treatments were obtained from the longissimus lumborum muscle of each horse. Mitochondrial density and distribution of the blinded samples pre- and post-FES were determined, and a two-sided Welch's t test was used to analyze the results. The results of the clinical evaluations and of morphometric analyses comparing pre- to post-FES muscle biopsies found: (1) a significant increase (P < .001) in the pooled mean mitochondrial density of both glycolytic and oxidative muscle fibers, (2) a significant increase (P < .001) in the subsarcolemmal mitochondrial high-density patches in oxidative muscle fibers, and (3) a significant increase (P < .001) in the subsarcolemmal mitochondrial high-density area percentages. In summary, the clinical improvements in the reduction of hypertonicity are, conceivably, related to the daily increased muscle contraction and perfusion induced by FES training. Thus, the FES protocol used in this study produced a positive effect on mitochondrial density and distribution, which in turn may help create healthier muscle tissue that is better able to function during exercise.
There is something in our genome that dictates life expectancy and there is nothing that can be done to avoid this; indeed, there is not yet any record of a person who has cheated death. Our physical prowess can vacillate substantially in our lifetime according to our activity levels and nutritional status and we may fight aging, but we will inevitably lose. We have presented strong evidence that the atrophy which accompanies aging is to some extent caused by loss of innervation. We compared muscle biopsies of sedentary seniors to those of life long active seniors, and show that these groups indeed have a different distribution of muscle fiber diameter and fiber type. The senior sportsmen have many more slow fiber-type groupings than the sedentary people which provides strong evidence of denervation-reinnervation events in muscle fibers. It appears that activity maintains the motoneurons and the muscle fibers. Premature or accelerated aging of muscle may occur as the result of many chronic diseases. One extreme case is provided by irreversible damage of the Conus and Cauda Equina, a spinal cord injury (SCI) sequela in which the human leg muscles may be completely and permanently disconnected from the nervous system with the almost complete disappearance of muscle fibers within 3-5 years from SCI. In cases of this extreme example of muscle degeneration, we have used 2D Muscle Color CT to gather data supporting the idea that electrical stimulation of denervated muscles can retain and even regain muscle. We show here that, if people are compliant, atrophy can be reversed. A further example of activity-related muscle adaptation is provided by the fact that mitochondrial distribution and density are significantly changed by functional electrical stimulation in horse muscle biopsies relative to those not receiving treatment. All together, the data indicate that FES is a good way to modify behaviors of muscle fibers by increasing the contraction load per day. Indeed, it should be possible to defer the muscle decline that occurs in aging people and in those who have become unable to participate in physical activities. Thus, FES should be considered for use in rehabilitation centers, nursing facilities and in critical care units when patients are completely inactive even for short periods of time.
Low-level laser therapy (LLLT) continues to receive much attention in many clinical fields. Also, LLLT has been used to enhance the proliferation of various cell lines, including stem cells. This study investigated the effect of LLLT on human adipose-derived stem cells (ADSCs) through in vitro and in vivo studies.
Low-level laser irradiation of cultured ADSCs was performed using a 830 nm Ga-Al-As (gallium-aluminum-arsenide) laser. Then, proliferation of ADSCs was quantified by a cell counting kit-8. In the in vivo study, irradiated ADSCs or non-irradiated ADSCs were transplanted, and then, low-level laser irradiation of each rat was performed as per the protocol. Cell viability was quantified by immunofluorescent staining using the human mitochondria antibody.
In the in vitro study, the laser-irradiated groups showed an increase in absorbance compared to the control group. Also, in the in vivo study, there was a significant increase in the number of human ADSCs in the laser-irradiated groups compared to the control group (p < 0.001).
Our study showed that LLLT could enhance the proliferation and viability of ADSCs. The ADSCs enhanced by LLLT could be applied in various clinical fields. With the use of LLLT, the proliferation and viability of various cells can be enhanced, besides ADSCs.
This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .
Background. This study evaluates the effect of adjuvant BEMER therapy in patients with knee arthrosis and chronic low back pain in a randomized double blind design. Methods. A total of 50 patients with chronic low back pain and 50 patients with osteoarthritis of knee took part in this study and were randomized into 4 groups. Hospitalized patients received a standardized physiotherapy package for 3 weeks followed by BEMER therapy or placebo. Results. In patients with low back pain, the comparison of the results obtained at the first and second visit showed a significant improvement in resting VAS scores and Fatigue Scale scores. The Oswestry scores and Quality of Life Scale scores showed no change. In patients with knee arthrosis, the comparison of the first and second measurements showed no significant improvement in the abovementioned parameters, while the comparison of the first and third scores revealed a significant improvement in the Fatigue Scale scores and in the vitality test on the Quality of Life Scale. Conclusions. Our study showed that BEMER physical vascular therapy reduced pain and fatigue in the short term in patients with chronic low back pain, while long-term therapy appears to be beneficial in patients with osteoarthritis of knee.
Functional Electrical Stimulation (FES) has been used extensively over several decades to reverse muscle atrophy during rehabilitation for spinal cord injury patients. The benefits of the technology are being expanded into other areas, and FES has been recently utilized for injury rehabilitation and performance enhancement in horses. Six retired horses (age from 10 to 17 yrs) that had been previously used mainly for dressage riding were selected for this study. Clinical evaluation found epaxial muscle spasms in all horses with minimal to no pelvic extension when manually palpated. FES treatments were performed on the sacral/lumbar region 3 times per week for a period of 8 weeks, obtaining a total of 22 treatments per horse. The Modified Ashworth Scale for grading muscle spasms found a one grade improvement after approximately four FES treatments, indicating improved functional movement of the sacral/lumbar region, supporting the evidence by clinical palpations that a reduction in epaxial muscle spasms occurred. Skeletal muscle biopsies Pre and Post FES treatments were obtained from the longissimus lumborum muscle. Cryosections were stained with a Hemotoxylin-Eosin (H-E), and nicotinamide adenine dinucleotide tetrazolium reductase reaction (NADH-TR). The eventual size change of the muscle fibers were evaluated by morphometry in the H-E and NADH-TR stained cryosections, while in the NADH-TR slides the histochemical density and distribution of mitochondria were also determined. The main results of the morphometric analyses were: 1) As expected for the type of FES treatment used in this study, only a couple of horses showed significant increases in mean muscle fiber size when Pre- vs Post-FES biopsies were compared; 2) In the older horses, there were sparse (or many in one horse) very atrophic and angulated muscle fibers in both Pre- and Post-FES samples, whose attributes and distribution suggests that they were denervated due to a distal neuropathy; 3) The hypothesis of generalized FES-induced muscle fiber damage during epaxial muscle training is not supported by our data since: 3.1) Denervated muscle fibers were also present in the Pre-FES biopsies and 3.2) Only one horse presented with several long-term denervated muscles fibers Post-FES; 4) Preliminary data indicate an increased density and distribution of mitochondria in Post-FES biopsies, suggesting that the clinical improvements in the FES treated horses may be related to daily increased muscle contraction and perfusion induced by FES training. In conclusion, FES in horses is a safe treatment that provides clinical improvements in equine epaxial muscle spasms.
Objective:
The aim of this preliminary study was to investigate the effect of Multiwave Locked System (MLS(®)), a particular model of low-level laser, in the acute phase of collagenase-induced tendon lesions in six adult sheep randomly assigned to two groups.
Background data:
Tendon injuries are common among human athletes and in sport horses, require a long recovery time, and have a high risk of relapse. Many traditional treatments are not able to repair the injured tendon tissue correctly. In recent years, the use of low-level laser therapy (LLLT) produced interesting results in inflammatory modulation in different musculoskeletal disorders.
Methods:
Group 1 received 10 treatments of MLS laser therapy at a fluence of 5 J/cm(2) on the left hindlimb. Group 2 received 10 treatments of MLS laser therapy at a fluence of 2.5 J/cm(2) on the left hindlimb. In every subject in both groups, the right hindlimb was considered as the control leg.
Results:
Clinical follow-up and ultrasonography examinations were performed during the postoperative period, and histological examinations were performed at day 30 after the first application of laser therapy. In particular, results from histological examinations indicate that both treatments induced a statistically significant cell number decrease, although only in the second group did the values return to normal. Moreover, the MLS laser therapy dose of 2.5 J/cm(2) (group 2) caused a significant decrease of vessel area.
Conclusions:
In this study, clinical and histological evaluation demonstrated that a therapeutic dose <5 J/cm(2) furnished an anti-inflammatory effect, and induced a decrease of fibroblasts and vessel area. Overall, our results suggest that MLS laser therapy was effective in improving collagen fiber organization in the deep digital flexor tendon.
Given the clinical practice of prescribing physical rehabilitation for the treatment of VML injuries, the present study examined the functional and histomorphological adaptations in the volumetric muscle loss (VML) injured muscle to physical rehabilitation.
Tibialis anterior muscle VML injury was created in Lewis rats (n = 32), and were randomly assigned to either sedentary (SED) or physical rehabilitation (RUN) group. After 1 week, RUN rats were given unlimited access to voluntary running wheels either 1 or 7 weeks (2 or 8 weeks post-injury). At 2 weeks post-injury, TA muscles were harvested for molecular analyses. At 8 weeks post-injury, the rats underwent in vivo function testing. The explanted tissue was analyzed using histological and immunofluorescence procedures.
The primary findings of the study are that physical rehabilitation in the form of voluntary wheel running promotes ~ 17% improvement in maximal isometric torque, and a ~ 13% increase in weight of the injured muscle, but it did so without significant morphological adaptations (e.g., no hypertrophy and hyperplasia). Wheel running up-regulated metabolic genes (SIRT-1, PGC-1α) only in the uninjured muscles, and a greater deposition of fibrous tissue in the defect area of the injured muscle preceded by an up-regulation of pro-fibrotic genes (Collagen I, TGF-β1). Therefore, it is plausible that the wheel running related functional improvements were due to improved force transmission and not muscle regeneration.
This is the first study to demonstrate improvement in functional performance of non-repaired VML injured muscle with physical rehabilitation in the form of voluntary wheel running. This study provides information for the first time on the basic changes in the VML injured muscle with physical rehabilitation, which may aid in the development of appropriate physical rehabilitation regimen(s).
Objective:
To evaluate the effect of low-level laser irradiation on the proliferation and possible nuclear morphological changes of mouse mesenchymal stem cells.
Methods:
Mesenchymal stem cells derived from bone marrow and adipose tissue were submitted to two applications (T0 and T48 hours) of low-level laser irradiation (660 nm; doses of 0.5 and 1.0 J/cm2). The trypan blue assay was used to evaluate cell viability, and growth curves were used to analyze proliferation at zero, 24, 48, and 72 hours. Nuclear alterations were evaluated by staining with DAPI (4'-6-diamidino-2-phenylindole) at 72 hours.
Results:
Bone marrow-derived mesenchymal stem cells responded to laser therapy in a dose-dependent manner. Higher cell growth was observed when the cells were irradiated with a dose of 1.0 J/cm2, especially after 24 hours (p<0.01). Adipose-derived mesenchymal stem cells responded better to a dose of 1.0 J/cm2, but higher cell proliferation was observed after 48 hours (p<0.05) and 72 hours (p<0.01). Neither nuclear alterations nor a significant change in cell viability was detected in the studied groups.
Conclusion:
Low-level laser irradiation stimulated the proliferation of mouse mesenchymal stem cells without causing nuclear alterations. The biostimulation of mesenchymal stem cells using laser therapy might be an important tool for regenerative therapy and tissue engineering.
Clinical practice CPGs (CPGs) have been developed to summarize evidence related to the management of osteoarthritis (OA). CPGs facilitate uptake of evidence-based knowledge by consumers, health professionals, health administrators and policy makers. The objectives of the present review were: 1) to assess the quality of the CPGs on non-pharmacological management of OA; using a standardized and validated instrument - the Appraisal of Guidelines Research and Evaluation (AGREE II) tool - by three pairs of trained appraisers; and 2) to summarize the recommendations based on only high-quality existing CPGs. Scientific literature databases from 2001 to 2013 were systematically searched for the state of evidence, with 17 CPGs for OA being identified. Most CPGs effectively addressed only a minority of AGREE II domains. Scope and purpose was effectively addressed in 10 CPGs on the management of OA, stakeholder involvement in 12 CPGs, rigour of development in 10 CPGs, clarity/presentation in 17 CPGs, editorial independence in 2 CPGs, and applicability in none of the OA CPGs. The overall quality of the included CPGs, according to the 7-point AGREE II scoring system, is 4.8±0.41 for OA. Therapeutic exercises, patient education, transcutaneous electrical nerve stimulation, acupuncture, orthoses and insoles, heat and cryotherapy, patellar tapping, and weight control are commonly recommended for the non-pharmacological management of OA by the high-quality CPGs. The general clinical management recommendations tended to be similar among high-quality CPGs, although interventions addressed varied. Non-pharmacological management interventions were superficially addressed in more than half of the selected CPGs. For CPGs to be standardized uniform creators should use the AGREE II criteria when developing CPGs. Innovative and effective methods of CPG implementation to users are needed to ultimately enhance the quality of life of arthritic individuals.
The aim of this article was to review current evidence about cryotherapy in inflammatory rheumatic diseases (therapeutic and biological effects). For therapeutic effects, we performed a systematic review (PubMed, EMBASE, Cochrane Library, LILACS databases, unpublished data) and selected studies including non-operated and non-infected arthritic patients treated with local cryotherapy or whole-body cryotherapy. By pooling 6 studies including 257 rheumatoid arthritis (RA) patients, we showed a significant decrease in pain visual analogic scale (mm) and 28-joint disease activity score after chronic cryotherapy in RA patients. For molecular pathways, local cryotherapy induces an intrajoint temperature decrease, which might downregulate several mediators involved in joint inflammation and destruction (cytokines, cartilage-degrading enzymes, proangiogenic factors), but studies in RA are rare. Cryotherapy should be included in RA therapeutic strategies as an adjunct therapy, with potential corticosteroid and nonsteroidal anti-inflammatory drug dose-sparing effects. However, techniques and protocols should be more precisely defined in randomized controlled trials with stronger methodology.
Equine back pain can potentially initiate an unstable intervertebral situation that results in atrophy and dysfunction of the epaxial muscles even after back pain has resolved. Several physiotherapy approaches are advocated to promote the strengthening of the multifidus muscle. This study aimed to asses and compare the effect of dynamic mobilization exercises (DME) and neuromuscular electrical stimulation (NMES) in 8 adult horses (4 individuals by group) to increase the cross-sectional area (CSA) of this muscle after a 7-weeks period treatment. The epaxial muscles of NMES group were electrical stimulated during 10 minutes per session, 4 days a week for 7 weeks, yielding a total of 28 sessions per individual. Horses included in DME group were trained to move the chin to a specific position (three different cervical flexions, one cervical extension and three different lateral bending exercises) to the left and right sides, repeated 5 times per session, completing 28 sessions. Ultrasonographic images of the left and right multifidus muscle were acquired at 3 different spinal locations (T12, T16 and L2) at the initial and the end of the experiment. Significant increases (P < .050) in its CSA were obtained at all levels considered (except at T16), consistent with a 18.65% and 13.41% increase after NMES and DME, respectively. These results suggest that a 7-week period of DME or NMES treatments are useful to increase the CSA of the multifidus muscle in horses, and hence, these two therapies could be combined during a back-rehabilitation program to improve the spine stabilization in horses.
Background:
Back pain and inflammation of the epaxial musculature is a significant problem in all equine athletes. Treatment of back pain can be challenging and often requires a multimodal approach. In humans, bio-electromagnetic energy regulation therapy (BEMER) has been reported to be effective in pain modulation. With its increased use in people comes a similar robust application in veterinary medicine unfortunately, there is unsubstantiated evidence for this type of therapy in horses.
Objectives:
Objectives of this study were to assess analgesic responses and biomechanical outcome variables using a bio-electromagnetic energy regulation therapy blanket, and to evaluate serum biomarkers as a method to monitor the treatment effects in horses with thoracolumbar epaxial muscle pain.
Study design:
Cohort study of eight horses treated for 3 consecutive days.
Methods:
Horses with naturally-occurring thoracolumbar epaxial muscle pain were used in this study. Objective outcome variables were recorded daily for five days, which included spinal evaluation, mechanical nociceptive thresholds, electromyography, kinematics, kinetics, and serum biomarkers.
Results:
BEMER blanket therapy significantly improved thoracolumbar epaxial muscle nociceptive thresholds. Center of pressure displacement as a measure of postural stability was significantly improved as well as significant gains in spinal flexibility were demonstrated at study completion. A significant treatment effect was not appreciated in measures of muscle tone, ground reaction forces or serum biomarkers.
Main limitations:
Limitations include the lack of a control group and a definitive structural diagnosis of thoracolumbar epaxial muscle pain.
Conclusions:
The BEMER blanket produced significant clinical and biomechanical effects in horses with back pain.
Capacitive and resistive electric transfer (CRET) therapy is a physical treatment modality commonly used to treat musculoskeletal pain. It normally uses a longwave radiofrequency of ~0.5 MHz. The system consists of a neutral plate and two different electrodes that can transfer energy in two modalities: capacitive and resistive. The aim of this systematic review was to identify and summarize the available data in the literature on this physical modality. From a search of articles published before December 2019 in MEDLINE and Scopus indexed journals, we retrieved 276 articles, 13 of which met the inclusion criteria for this review. Most articles dealt with musculoskeletal disorders, mainly spine disorders and knee osteoarthritis. More than 75% of the studies used a similar range of frequency (440-600 KHz). Almost all described an improvement in strength and function and reduced pain intensity after the treatment. Although nine of the 13 studies (70%) were randomized controlled trials, only two had a low risk of bias according to the Cochrane library assessment tool. CRET seems to be an effective therapy to decrease pain, and improve the quality of life and disability of patients affected by musculoskeletal disorders. There is no study on symptoms of patients with neurological disorders. Further research is necessary to standardize the therapeutic protocols across different orthopedic diseases, and to assess the benefits of CRET in other fields such as neurological or rheumatologic disorders.
Postural stability maintains balance, protects the spinal column, and allows accurate responses to destabilizing forces. The musculus multifidus (m. multifidus) is the major postural muscle located adjacent to the vertebrae along the length of the spinal column. Increased cross-sectional area (CSA) of the m. multifidus has been demonstrated in horses following a rehabilitation strengthening exercises program, however, correlation with functional postural stability has not been shown. The objective of the current study is to evaluate the relationship of the thoracolumbar m. multifidus cross-sectional area and measures of postural sway performance in lame horses undergoing rehabilitation exercises in clinical cases. Seven client-owned horses admitted to the Equine Rehabilitation service were included in the study. M. multifidus CSA was measured via ultrasonography at the start of a rehabilitation program (initial evaluation) and after 12 weeks of rehabilitation exercises (final evaluation). Postural sway data was also measured at initial and final evaluation. A significant increase in m. multifidus CSA was seen from initial to final evaluation. A moderate to strong correlation was present between m. multifidus CSA and postural sway variables. These results suggest that there is an association between postural stability and m. multifidus hypertrophy in lame horses undergoing individualized rehabilitation programs. However, more research is needed to provide a definitive answer on the nature of this relationship. Ideally, specific performance tests would better define and examine the relationship in which to guide clinicians in rehabilitation protocol development.
Muscle strain injuries disrupt the muscle‐tendon unit, early rehabilitation is associated with a faster return to sports (RTS), but the time course of tissue healing remains sparsely described. The purpose was to examine tissue regeneration and the effectiveness of early versus delayed rehabilitation onset on functional and structural recovery after strain injuries. 50 recreational athletes with a severe acute strain injury in their thigh or calf muscles were randomized to early or delayed rehabilitation onset. Magnetic resonance imaging (MRI) was obtained initially, 3 and 6 months post injury and dynamic contrast‐enhanced MRI (DCE‐MRI) estimated tissue inflammation initially and after 6 months. Muscle strength was determined 5 weeks, 3 and 6 months post injury and a questionnaire determined soreness, pain and confidence. DCE‐MRI microvascular perfusion was higher in the injured compared to an uninjured muscle acutely (p< 0.01) and after 6 months (p< 0.01), for both groups (p> 0.05) and unrelated to RTS (p> 0.05). Total volume of the injured muscle decreased from the acute to the 3 months scan, and to the 6 months scan (p< 0.01) in both groups. Muscle strength was similar in both groups at any time. There was a non‐significant trend (p≤ 0.1) towards less pain and higher confidence with early rehabilitation. One re‐injury was recorded. In conclusion, our data showed prolonged tissue repair with the initial response linked to muscle atrophy but did not explain why early rehabilitation onset accelerated recovery considering that structural and functional recovery was similar with early and delayed rehabilitation.
This article is protected by copyright. All rights reserved.
Optimal function of skeletal muscle is essential for successful athletic performance. Even minor derangements in locomotor muscle function will impact power output, coordination, stamina, and desire to work during exercise. In this review, the presenting clinical signs, differential diagnoses, approach to diagnostic testing and treatment of muscle atrophy and weakness, focal muscle strain, and exertional myopathies are discussed. Exertional myopathies include polysaccharide storage myopathies, recurrent exertional rhabdomyolysis, malignant hyperthermia, and myofibrillar myopathy.
Blood flow restriction (BFR) training is a technique shown to be safe and effective at increasing muscular strength and endurance in healthy fitness populations and is under study for its use in postinjury rehabilitation. BFR stimulates muscular strength and hypertrophy gains at much lower loads than traditional methods, allowing patients to begin the rehabilitation process much sooner. We report on 2 patients who incorporated BFR training into their traditional rehabilitation program after Achilles tendon ruptures. Patient 1 was a 29-year-old active duty soldier who sustained a left Achilles tendon rupture while playing competitive football. After operative repair and traditional rehabilitative measures, he was unable to ambulate without assistive devices owing to persistent weakness. The patient subsequently started a 5-week "return to run" program using BFR training. He experienced plantarflexion peak torque improvements of 522% and 108.9% and power gains of 4475% and 211% at 60°/s and 120°/s, respectively. He was able to ambulate without assistive devices at the 5-week follow-up examination. Patient 2 was a 38-year-old male soldier who experienced a complete left Achilles tendon rupture while exercising. After nonoperative treatment with an accelerated rehabilitation program, the patient still experienced significant strength and functional deficits. He was subsequently enrolled in a 6-week course of BFR training. He experienced plantarflexion strength improvements of 55.8% and 47.1% and power gains of 68.8% and 78.7% at 60°/s and 120°/s, respectively. He was able to return to running and sports on completion of 6 weeks of BFR-assisted therapy. Incorporating tourniquet-assisted blood flow restriction with rehabilitation programs can improve strength, endurance, and function after Achilles tendon rupture.
Spinal cord injury (SCI) due to acute intervertebral disc extrusions (IVDE) is common in dogs and is treated by surgical decompression. Dogs with sensorimotor complete injuries have an incomplete recovery. Pulsed electromagnetic fields (PEMF) reduce postoperative pain through anti-inflammatory effects and there is growing evidence for neuroprotective effects. This randomized, controlled clinical trial evaluated the effect of PEMF on post-operative pain and neurologic recovery in dogs with surgically treated sensorimotor complete SCI due to acute IVDE. Sixteen dogs with surgically treated complete thoracolumbar SCI were randomized to receive PEMF (15 minutes every 2 hours for 2 weeks then twice daily for 4 weeks) or placebo starting immediately after diagnosis. The primary outcome was gait score at 2 weeks. Secondary measures of gait, pain perception and proprioceptive function were evaluated at 2 and 6 weeks. Plasma GFAP concentration was measured as a SCI biomarker. Post-operative pain was quantified by measuring mechanical sensory thresholds (MST) at control and surgical sites. There was no significant difference in demographics or GFAP concentration between the 2 groups at trial entry. There was no difference in primary outcome or in secondary measures of gait, but proprioceptive placing was significantly better at 6 weeks and GFAP concentrations were significantly lower at 2 weeks in the PEMF group. MSTs were significantly higher in the PEMF treated group. We conclude that PEMF reduced incision-associated pain in dogs following surgery for IVDE and may reduce extent of spinal cord injury and enhance proprioceptive placing. Larger clinical trials are warranted.
Objective:
This study aimed to examine the influence of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser irradiation on equine bone marrow-derived mesenchymal stem cell (MSC) viability, proliferation, and cytokine expression in vitro.
Background:
Photobiomodulation of cells using monochromatic light is a technique designed to influence cellular processes. Previous studies have shown dose-dependent effects of low-level laser irradiation on cell proliferation and cytokine expression in a range of cell types and species. Evidence for the influence of 1064 nm wavelength near-infrared irradiation on MSCs is sparse, and high-energy doses have shown inhibitory effects.
Methods:
MSC cultures from six horses were exposed to 1064 nm irradiation with an energy density of 9.77 J/cm(2) and a mean output power of 13.0 W for 10 sec. MSC viability and proliferation were evaluated through flow cytometry and real-time live cell analysis. Gene expression and cytokine production in the first 24 h after irradiation were analyzed through polymerase chain reaction (PCR), multiplex assay, and enzyme-linked immunosorbent assay.
Results:
No difference in viability was detected between irradiated and control MSCs. Irradiated cells demonstrated slightly lower proliferation rates, but remained within 3.5% confluence of control cells. Twenty-four hours after irradiation, irradiated MSCs demonstrated a significant increase in expression of interleukin (IL)-10 and vascular endothelial growth factor (VEGF) compared with control MSCs.
Conclusions:
Under these irradiation parameters, equine MSCs remained viable and expressed increased concentrations of IL-10 and VEGF. IL-10 has an anti-inflammatory action by inhibiting the synthesis of proinflammatory cytokines at the transcriptional level. This response to 1064 nm irradiation shows promise in the photobiomodulation of MSCs to enhance their therapeutic properties.
Reasons for performing study:
Training and rehabilitation techniques aiming at improving core muscle strength may result in increased dynamic stability of the equine vertebral column. A system of elastic resistance bands is suggested to provide proprioceptive feedback during motion to encourage recruitment of core abdominal and hindquarter musculature for improved dynamic stability.
Objectives:
To quantify the effects of a specific resistance band system on back kinematics during trot in-hand and during lungeing at beginning and end of a 4-week exercise programme.
Study design:
Quantitative analysis of back movement before/after a 4-week exercise programme.
Methods:
Inertial sensor data were collected from seven horses at week 1 and 4 of an exercise protocol with elastic resistance bands. Translational (dorsoventral, mediolateral) and rotational (roll, pitch) range of motion of six landmarks from poll to coccygeal region were quantified during trot in-hand (hard surface) and during lungeing (soft surface, both reins) with/without elastic exercise bands. A mixed model (p<0.05) evaluated the effects of exercise bands, time (week) and movement direction (straight, left, right).
Results:
The bands reduced roll, pitch and mediolateral displacement in the thoracolumbar region (all p<0.04). At week 4, independent of band usage, rotational movement (withers, thoracic) was reduced while dorsoventral movement (thoracic, coccygeal) increased. Increased back movement was measured in 80% of back movement parameters during lungeing.
Main limitations:
Comparing each horse without and with bands without a control group does not distinguish whether the differences measured between week 1 and 4 are related to use of the bands, or only to the exercise regimen.
Conclusion:
Results suggest that the elastic resistance bands reduce mediolateral and rotational movement of the thoracolumbar region (increase dynamic stability) in trot. Further studies should investigate the underlying mechanism with reference to core abdominal and hindquarter muscle recruitment and study the long-term effects. This article is protected by copyright. All rights reserved.
Exercise therapy is a key component in rehabilitation in both human and equine physiotherapy, however in relation to the equine athlete only limited evidence is available for the use of exercises in rehabilitation. The aim of this review is to analyse studies that have evaluated trunk and hindlimb muscle activation and therefore provide an evidence base for the selection of exercises. Isolating activity to specific muscle groups or positioning to preferentially activate specific muscles is challenging for physiotherapists in horses, however surface electromyography (EMG) data of muscular activity during locomotion could be applied to support selection of rehabilitation exercises employed for this goal. The literature consistently reports the positive effect of increasing speed and slope on activity of longissimus dorsi, gluteus medius, tensor fascia latae, biceps femoris, vastus lateralis and the abdominal muscles. However, there is still a lack of investigation into muscular activity during movements used for rehabilitation, despite exercises using training aids, poles and stretches being reported as therapeutic and strengthening. The use of EMG within the current studies does suggest relative patterns of muscle activity may be useful in comparing activity of one exercise to another and are worthy of further investigation in relation to rehabilitation exercise.
The Kinesio taping method was developed in Japan for use in humans in 1979. The use of complementary therapies is becoming common in equine athletes and the discovery of Kinesio taping potential brought it into the animal world. Kinesio taping can be used to treat a wide range of clinical conditions, from tendon injuries to neurologic disorders and from muscle contractures to postural insufficiencies. Its use in veterinary medicine is promising, but relies heavily on evidence-based clinical reports. Further scientific research is needed to fully understand the real effectiveness of application.
As part of a placebo-controlled study series, a random sample of 50-year-old rehabilitation patients was examined to determine whether the complementary use of a physical treatment method to stimulate arteriolar vasomotion would improve the therapeutic success of established measures for the purposes of physical conditioning. The result showed that both the microcirculatory blood-flow regulation and the (cellular) immune response could be affected in a therapy-relevant manner through additional physical vasomotion stimulation.
As part of a placebo-controlled study, high-resolution measurement methods were used to examine, on the basis of representative functional characteristics of microcirculation, whether and to what extent six different, commercially available, physical treatment devices were suitable for influencing, through complementary therapy, deficient blood-flow regulation. Of the six commercially available devices tested, two proved to be ineffective and three not effective enough to be therapeutically relevant. Only in one device was it possible to show a complementary-therapeutic effect: the device uses a specific, biorhythmically defined stimulus for vasomotion.
This crossover study aimed to determine whether a single high-velocity, low-amplitude manipulation of the cervical spine would affect postural sway in adults with nonspecific neck pain.Methods
Ten participants received, in random order, 7 days apart, a high-velocity, low-amplitude manipulation applied to a dysfunctional spinal segment and a passive head-movement control. Four parameters of postural sway were measured before, immediately after, and at 5 and 10 minutes after each procedure.ResultsResults showed no differences between interventions in change in any of the parameters. When changes before and immediately after each procedure were analyzed separately, only the control showed a significant change in the length of center of pressure path (an increase from median, 118 mm; interquartlie range, 93-137 mm to an increase to 132 mm; 112-147; P = .02).Conclusion
This study failed to show evidence that single manipulation of the cervical spine influenced postural sway. Given the ability of the postural control system to reweight the hierarchy of sensory information to compensate for inadequacies in any 1 component, it is possible that any improvements in the mechanisms controlling postural sway elicited by the manipulative intervention may have been concealed.
Myofascial pain syndrome (MPS) of the trapezius muscle is one of the main causes of neck pain. In this randomized, double-blind study, we evaluated the effects of high-intensity laser therapy (HILT) in female patients with chronic MPS of the trapezius muscle. The patients were assigned to two groups. The HILT group was treated with HILT and exercise, and the sham therapy group was treated with placebo HILT and exercise. The patients were assessed for pain, cervical active range of motion, disability, and quality of life. Evaluations were performed before treatment (week 0) and after treatment (weeks 4 and 12). Both groups showed significant improvement in all parameters at weeks 4 and 12. However, in a comparison of the percentage changes in the parameters at weeks 4 and 12 relative to pretreatment values, the HILT group showed greater improvement in pain scores, the neck disability index, and several subparts of the short-form 36 health survey (SF-36) (physical functioning, role limitations due to physical functioning, bodily pain, general health perceptions, social functioning, and role limitations due to emotional problems) than did the sham therapy group. We conclude that HILT is an effective therapeutic method in the treatment of patients with chronic MPS of the trapezius muscle.
Development of core muscle strength is important for training and during rehabilitation following injury. A Pessoa training aid (PTA) is a system of ropes and pulleys which is commonly used during equine training and rehabilitation, but there is limited information on its effectiveness. The objective of the study was to determine the effect of the PTA on the temporal, linear and angular kinematics of the working trot. Influence of testing order on effect of a PTA was assessed in four horses. Twelve riding horses were lunged at working trot on a 16m diameter circle without (WO) and with a PTA (WP) that was set level with the shoulder. Objective measurements were carried out using high-speed motion capture (125Hz) and inertial measurement units. Subjective video assessment was also undertaken. When a PTA was applied there was a significant reduction in speed, stride length, head angle (P<0.0001 for all) and lumbosacral angle at maximal hindlimb retraction (P=0.0028), but no effect on limb joint angles. The highest point of the horse was significantly different between conditions (WO, poll; WP, crest) (P=0.0010). Dorsoventral displacement of the middle of the back (P⩽0.0001) and overall impression grade (P=0.0002) were significantly greater WP compared with WO. These findings indicated that a PTA may be beneficial for general training and rehabilitation as a method of improving posture, stimulating core muscle activation and improving overall way of going, without increasing the loading of forelimb and hindlimb structures. Further work is warranted to understand the mechanism which induces these changes.