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Yelvington M, Whitehead C, Turgeon L. Special Considerations for Pediatric Burn Injuries. Phys Med Rehabil Clin N Am 2023; 34:825-837. [PMID: 37806700 DOI: 10.1016/j.pmr.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Burns are the fifth leading cause of non-fatal childhood injuries. Physiological differences between children and adults lead to unique considerations when treating young burn survivors. In addition to the physical and psychological concerns which must be considered in adult burn rehabilitation, pediatric burn rehabilitation must also consider the developmental stage of the child, preexisting developmental delays, and the impact of scaring on growth and motor skill attainment. Treatment of pediatric burn survivors requires a multidisciplinary approach centered around caring for not only the child but also for their parents, siblings, and other caregivers. For children who sustain burns early in life, long-term follow-up is essential and should be conducted under the guidance of a burn center for the early identification of needed interventions during periods of growth and development. This article considers pediatric-specific factors, which may present during the rehabilitation of a child with a burn injury.
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Affiliation(s)
- Miranda Yelvington
- Arkansas Children's Hospital, 1 Children's Way, Slot 104, Little Rock, AR 72202, USA.
| | | | - Lori Turgeon
- Shriners Children's Boston, 51 Blossom Street, Boston, MA 02114, USA
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Geusebroek G, van Dieën JH, Hoozemans MJM, Noort W, Houdijk H, Maas H. Constant force muscle stretching induces greater acute deformations and changes in passive mechanical properties compared to constant length stretching. J Biomech 2023; 154:111594. [PMID: 37182406 DOI: 10.1016/j.jbiomech.2023.111594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/27/2023] [Accepted: 04/17/2023] [Indexed: 05/16/2023]
Abstract
Stretching is applied to lengthen shortened muscles in pathological conditions such as joint contractures. We investigated (i) the acute effects of different types of stretching, i.e. constant length (CL) and constant force (CF) stretching, on acute deformations and changes in passive mechanical properties of medial gastrocnemius muscle (MG) and (ii) the association of acute muscle-tendon deformations or changes in mechanical properties with the impulse or maximal strain of stretching. Forty-eight hindlimbs from 13 male and 12 female Wistar rats (13 weeks old, respectively 424.6 ± 35.5 and 261.8 ± 15.6 g) were divided into six groups (n = 8 each). The MG was initially stretched to a length at which the force was 75%, 95%, or 115% of the force corresponding to estimated maximal dorsiflexion and held at either CF or CL for 30 min. Before and after the stretching protocol, the MG peak force and peak stiffness were assessed by lengthening the passive muscle to the length corresponding to maximal ankle dorsiflexion. Also, the muscle belly length and tendon length were measured. CF stretching affected peak force, peak stiffness, muscle belly length, and tendon length more than CL stretching (p < 0.01). Impulse was associated only with the decrease in peak force, while maximal strain was associated with the decrease in peak force, peak stiffness, and the increase in muscle belly length. We conclude that CF stretching results in greater acute deformations and changes in mechanical properties than CL stretching, which appears to be dependent predominantly on the differences in imposed maximal strain.
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Affiliation(s)
- G Geusebroek
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - J H van Dieën
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - M J M Hoozemans
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - W Noort
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - H Houdijk
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, The Netherlands
| | - H Maas
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands.
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Tanikawa H, Mukaino M, Itoh S, Kondoh H, Fujimura K, Teranishi T, Ohtsuka K, Hirano S, Kagaya H, Saitoh E, Otaka Y. Development of a simple mechanical measurement method to measure spasticity based on an analysis of a clinical maneuver and its concurrent validity with the modified Ashworth scale. Front Bioeng Biotechnol 2022; 10:911249. [PMID: 36046668 PMCID: PMC9420860 DOI: 10.3389/fbioe.2022.911249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/18/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Despite recent developments in the methodology for measuring spasticity, the discriminative capacity of clinically diagnosed spasticity has not been well established. This study aimed to develop a simple device for measuring velocity-dependent spasticity with improved discriminative capacity based on an analysis of clinical maneuver and to examine its reliability and validity. Methods: This study consisted of three experiments. First, to determine the appropriate motion of a mechanical device for the measurement of velocity-dependent spasticity, the movement pattern and the angular velocity used by clinicians to evaluate velocity-dependent spasticity were investigated. Analysis of the procedures performed by six physical therapists to evaluate spasticity were conducted using an electrogoniometer. Second, a device for measuring the resistance force against ankle dorsiflexion was developed based on the results of the first experiment. Additionally, preliminary testing of validity, as compared to that of the Modified Ashworth Scale (MAS), was conducted on 17 healthy participants and 10 patients who had stroke with spasticity. Third, the reliability of the measurement and the concurrent validity of mechanical measurement in the best ankle velocity setting were further tested in a larger sample comprising 24 healthy participants and 32 patients with stroke. Results: The average angular velocity used by physical therapists to assess spasticity was 268 ± 77°/s. A device that enabled the measurement of resistance force at velocities of 300°/s, 150°/s, 100°/s, and 5°/s was developed. In the measurement, an angular velocity of 300°/s was found to best distinguish patients with spasticity (MAS of 1+ and 2) from healthy individuals. A measurement of 300°/s in the larger sample differentiated the control group from the MAS 1, 1+, and 2 subgroups (p < 0.01), as well as the MAS 1 and 2 subgroups (p < 0.05). No fixed or proportional bias was observed in repeated measurements. Conclusion: A simple mechanical measurement methodology was developed based on the analysis of the clinical maneuver for measuring spasticity and was shown to be valid in differentiating the existence and extent of spasticity. This study suggest possible requirements to improve the quality of the mechanical measurement of spasticity.
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Affiliation(s)
- Hiroki Tanikawa
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Masahiko Mukaino
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
- *Correspondence: Masahiko Mukaino,
| | - Shota Itoh
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan
| | - Hikaru Kondoh
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan
| | - Kenta Fujimura
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Toshio Teranishi
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Kei Ohtsuka
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Satoshi Hirano
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Hitoshi Kagaya
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
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Wang L, Cui JB, Xie HM, Zuo XQ, He JL, Jia ZS, Zhang LN. Effects of Different Static Progressive Stretching Durations on Range of Motion, Myofibroblasts, and Collagen in a Posttraumatic Knee Contracture Rat Model. Phys Ther 2022; 102:6481179. [PMID: 34972861 DOI: 10.1093/ptj/pzab300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 07/24/2021] [Accepted: 10/19/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the effects of different durations of static progressive stretching (SPS) on posttraumatic knee contracture in rats, including range of motion (ROM), gait analysis, myofibroblast proliferation, and collagen regulation. METHODS The posttraumatic knee contracture model was established, and male Wistar rats were randomly divided into the 20-minute SPS treatment, 30-minute SPS treatment (S30), 40-minute SPS treatment, untreated, immobilization, and control groups. At Week 1, 2, and 4 of treatment intervention, joint ROM and gait were measured and compared. Knee joint samples stained with hematoxylin and eosin and Masson trichrome were used to observe alterations in pathological structures. Collagen density and cell numbers in the posterior joint capsule were used to assess joint capsule fibrosis and inflammation. Immunohistochemistry was used to detect type I collagen and α-smooth muscle actin expression. RESULTS The S30 group improved the most; ROM, stance, mean intensity, print area, and stride length were 115 (SD = 5) degrees, 0.423 (SD = 0.074) seconds, 156.020 (SD = 7.952), 2.116 (SD = 0.078) cm2, and 11.758 (SD = 0.548) cm, respectively. The numbers of myofibroblasts, fibroblasts, and inflammatory cells decreased, and collagen proliferation was significantly suppressed in the S30 group compared with the other groups. CONCLUSION S30 significantly improved posttraumatic knee contracture in rats, with reduced type I collagen and α-smooth muscle actin expression, decreased the numbers of myofibroblasts and inflammatory cells, suppressed fibrotic and inflammatory changes in the joint capsule, and increased joint mobility. This study provided basic evidence for an optimal standard-of-care treatment approach for posttraumatic knee joint contracture in rats, which may have significance for humans.
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Affiliation(s)
- Lu Wang
- Department of Rehabilitation Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, China.,Graduate School, Medical School of Chinese PLA, Beijing, China.,Department of Rehabilitation Medicine, Beijing Tongren Hospital, Beijing, China
| | - Jian-Bo Cui
- Department of Rehabilitation Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Hui-Min Xie
- Department of Rehabilitation Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiu-Qin Zuo
- Department of Rehabilitation Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jia-Le He
- Department of Rehabilitation Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, China.,Graduate School, Medical School of Chinese PLA, Beijing, China
| | - Zi-Shan Jia
- Department of Rehabilitation Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Li-Ning Zhang
- Department of Rehabilitation Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, China
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Monson JK, Schoenecker J, Matheson JW, O'Keefe J, Schwery N, Hickmann A. Modern Principles for Rehabilitation for Medial and Lateral Knee Ligament Surgery: How to Optimize Outcomes. OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Paul RW, Sheridan S, Reuther KE, Kelly JD, Thomas SJ. The Contribution of Posterior Capsule Hypertrophy to Soft Tissue Glenohumeral Internal Rotation Deficit in Healthy Pitchers. Am J Sports Med 2022; 50:341-346. [PMID: 35019758 DOI: 10.1177/03635465211062598] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The relationship between posterior capsule adaptations and soft tissue glenohumeral internal rotation deficit (GIRD) in healthy pitchers remains unclear. PURPOSE/HYPOTHESIS This study aimed to identify if posterior capsule thickness (PCT) was associated with soft tissue GIRD in healthy pitchers. We hypothesized that there would be a positive relationship between soft tissue GIRD and PCT in the dominant arm, no relationship between soft tissue GIRD and PCT in the nondominant arm, and a strong positive relationship between soft tissue GIRD and the bilateral difference in PCT (posterior capsule hypertrophy [PCH]). STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 45 healthy collegiate and professional pitchers were included. Glenohumeral internal rotation and external rotation range of motion, humeral retroversion, and PCT were measured bilaterally. PCT was determined for unilateral posterior capsule measurements, and PCH of the throwing shoulder was calculated as the bilateral difference in PCT. Soft tissue GIRD was calculated as the sum of clinical GIRD and the bilateral difference in humeral retroversion. Pearson correlation coefficients were determined to evaluate the relationships between dominant arm PCT, nondominant arm PCT, and PCH and soft tissue GIRD. RESULTS Pearson correlations showed that both dominant arm PCT (R = -0.13; P = .378) and nondominant arm PCT (R = 0.21; P = .165) were not related to soft tissue GIRD. However, Pearson correlations did show that the amount of PCH was moderately related to soft tissue GIRD (R = 0.40; P = .007). Therefore, as the posterior capsule hypertrophied, soft tissue GIRD moderately increased. CONCLUSION Increased PCH was associated with an increase in soft tissue GIRD in healthy pitchers. If PCT measurements are feasible, clinicians should consider performing bilateral ultrasound assessments to isolate posterior capsule adaptations (ie, PCH). This will allow clinicians to identify pitchers with potentially maladaptive structural adaptations and optimize management strategies throughout the season to counteract them.
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Affiliation(s)
- Ryan W Paul
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Scott Sheridan
- Major League Baseball Umpires Association, New York, New York, USA
| | - Katherine E Reuther
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John D Kelly
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephen J Thomas
- College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Mao D, Mi J, Pan X, Li F, Rui Y. Suppression of TGF-beta activity with remobilization attenuates immobilization-induced joint contracture in rats. Injury 2021; 52:434-442. [PMID: 33408055 DOI: 10.1016/j.injury.2020.12.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Joint contracture is a common complication of joint injury. This study aimed to assess the effect of inhibiting the transforming growth factor-β (TGF-β) signaling during joint immobilization and remobilization on immobilization-induced joint contracture in rats. METHODS The knees of rats were immobilized using Kirschner wires following trauma to the femoral condyles to generate joint contracture. After immobilization, levels of TGF-β and passive extension range of motion (ROM) were measured at different time points, joints were histologically analyzed by hematoxylin and eosin (H&E) and Masson trichrome staining, and the expression of inflammatory or fibrosis-related mediators, including interleukin-1β (IL-1β), phosphorylated Smad2/3 (p-Smad2/3), α-smooth muscle actin (α-SMA) and collagen types I (Col 1) and III (Col 3), were examined in joint capsules using immunohistochemistry and quantitative real-time polymerase chain reaction (qRT-PCR). Rats were also treated with LY2157299, a TGF-β receptor I kinase inhibitor, at different stages of immobilization and remobilization. RESULTS TGF-β1 levels in the serum and the number of p-Smad2/3+ cells in the joint capsule were significantly elevated after immobilization. ROM decreased during the 6 weeks of immobilization and partly recovered after remobilization. After treatment with LY2157299 during immobilization, the restricted ROM moderately increased, but this effect was stronger when combined with active motion. Mechanistically, the expression of IL-1β, TGF-β, fibrosis-related factors, and the density of collagen significantly decreased after treatment with LY2157299. CONCLUSIONS Inhibiting TGF-β signaling paired with active motion effectively attenuated the formation of immobilization-induced joint contracture in rats.
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Affiliation(s)
- Dong Mao
- Orthopaedic Institute, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, 214062, China
| | - Jingyi Mi
- Department of Sports Medicine, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, 214062, China
| | - Xiaoyun Pan
- Orthopaedic Institute, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, 214062, China
| | - Fengfeng Li
- Department of Orthopedics, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China.
| | - Yongjun Rui
- Department of Orthopedics, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, 214062, China
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Inoue S, Moriyama H, Wakimoto Y, Li C, Hatakeyama J, Wakigawa T, Sakai Y, Akisue T. Transcutaneous application of carbon dioxide improves contractures after immobilization of rat knee joint. Phys Ther Res 2021; 23:113-122. [PMID: 33489648 DOI: 10.1298/ptr.e10023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/13/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Joint contractures are a major complication following joint immobilization. However, no fully effective treatment has yet been found. Recently, carbon dioxide (CO2) therapy was developed and verified this therapeutic application in various disorders. We aimed to verify the efficacy of transcutaneous CO2 therapy for immobilization-induced joint contracture. METHOD Twenty-two Wistar rats were randomly assigned to three groups: caged control, those untreated after joint immobilization, and those treated after joint immobilization. The rats were treated with CO2 for 20 min once a daily either during immobilization, (prevention) or during remobilization after immobilization (treatment). Knee extension motion was measured with a goniometer, and the muscular and articular factors responsible for contractures were calculated. We evaluated muscle fibrosis, fibrosis-related genes (collagen Type 1α1 and TGF-β1) in muscles, synovial intima's length, and fibrosis-related proteins (Type I collagen and TGF-β1) in the joint capsules. RESULTS CO2 therapy for prevention and treatment improved the knee extension motion. Muscular and articular factors decreased in rats of the treatment group. The muscular fibrosis of treated rats decreased in the treatment group. Although CO2 therapy did not repress the increased expression of collagen Type 1α1, the therapy decreased the expression of TGF-β1 in the treatment group. CO2 therapy for treatment improved the shortening of the synovial membrane after immobilization and decreased the immunolabeling of TGF-β1 in the joint capsules. CONCLUSIONS CO2 therapy may prevent and treat contractures after joint immobilization, and appears to be more effective as a treatment strategy for the deterioration of contractures during remobilization.
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Affiliation(s)
- Shota Inoue
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University
| | - Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University
| | - Yoshio Wakimoto
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University
| | - Changxin Li
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University
| | - Junpei Hatakeyama
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University
| | - Taisei Wakigawa
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University
| | - Yoshitada Sakai
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine
| | - Toshihiro Akisue
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University
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Satkunskiene D, Khair RM, Muanjai P, Mickevicius M, Kamandulis S. Immediate effects of neurodynamic nerve gliding versus static stretching on hamstring neuromechanical properties. Eur J Appl Physiol 2020; 120:2127-2135. [PMID: 32728819 DOI: 10.1007/s00421-020-04422-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/15/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE We investigated the immediate effects of neurodynamic nerve gliding (ND) on hamstring flexibility, viscoelasticity, and mechanosensitivity, compared with traditional static stretching (ST). METHODS Twenty-two physically active men aged 21.9 ± 1.9 years were divided randomly into two equal intervention groups using ST or ND. An isokinetic dynamometer was used to measure the active knee joint position sense, perform passive knee extension, record the passive extension range of motion (ROM) and the passive-resistive torque of hamstrings. Stiffness was determined from the slope of the passive torque-angle relationship. A stress relaxation test (SRT) was performed to analyze the viscoelastic behavior of the hamstrings. The passive straight leg raise (SLR) test was used to evaluate hamstring flexibility. RESULTS A significant interaction was observed for ROM and passive ultimate stiffness, reflected by an increase in these indicators after ND but not after SD. SLR increased significantly in both groups. After ST, a significantly faster initial stress relaxation was observed over the first 4 s. than after ND. There was no significant change in the active knee joint position sense. CONCLUSIONS ND provided a slightly greater increase in hamstring extensibility and passive stiffness, possibly by decreasing nerve tension and increasing strain in connective tissues than ST. The ST mostly affected the viscoelastic behavior of the hamstrings, but neither intervention had a significant impact on proprioception.
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Affiliation(s)
- Danguole Satkunskiene
- Institute of Sports Science and Innovation, Lithuanian Sports University, Sporto g. 6, 44221, Kaunas, Lithuania
| | - Ra'ad M Khair
- Institute of Sports Science and Innovation, Lithuanian Sports University, Sporto g. 6, 44221, Kaunas, Lithuania
| | - Pornpimol Muanjai
- Faculty of Allied Health Sciences, Burapha University, Chonburi, Thailand
| | - Mantas Mickevicius
- Institute of Sports Science and Innovation, Lithuanian Sports University, Sporto g. 6, 44221, Kaunas, Lithuania.
| | - Sigitas Kamandulis
- Institute of Sports Science and Innovation, Lithuanian Sports University, Sporto g. 6, 44221, Kaunas, Lithuania
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Kaneguchi A, Ozawa J, Yamaoka K. Intra-articular injection of mitomycin C prevents progression of immobilization-induced arthrogenic contracture in the remobilized rat knee. Physiol Res 2020; 69:145-156. [PMID: 31852201 DOI: 10.33549/physiolres.934149] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This study tested whether cell cycle inhibitor mitomycin C (MMC) prevents arthrogenic contracture progression during remobilization by inhibiting fibroblast proliferation and fibrosis in the joint capsule. Rat knees were immobilized in a flexed position to generate flexion contracture. After three weeks, the fixation device was removed and rat knees were allowed to freely move for one week. Immediately after and three days after fixator removal, rats received intra-articular injections of MMC or saline. The passive extension range of motion (ROM) was measured before and after myotomy of the knee flexors to distinguish myogenic and arthrogenic contractures. In addition, both cellularity and fibrosis in the posterior joint capsule were assessed histologically. Joint immobilization significantly decreased ROMs both before and after myotomy compared with untreated controls. In saline-injected knees, remobilization increased ROM before myotomy, but further decreased that after myotomy compared with that of knees immediately after three weeks of immobilization. Histological analysis revealed that hypercellularity, mainly due to fibroblast proliferation, and fibrosis characterized by increases in collagen density and joint capsule thickness occurred after remobilization in saline-injected knees. Conversely, MMC injections were able to prevent the remobilization-enhanced reduction of ROM after myotomy by inhibiting both hypercellularity and joint capsule fibrosis. Our results suggest that joint capsule fibrosis accompanied by fibroblast proliferation is a potential cause of arthrogenic contracture progression during remobilization, and that inhibiting fibroblast proliferation may constitute an effective remedy.
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Affiliation(s)
- A Kaneguchi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Hiroshima, Japan.
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11
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Wang F, Zhang QB, Zhou Y, Chen S, Huang PP, Liu Y, Xu YH. The mechanisms and treatments of muscular pathological changes in immobilization-induced joint contracture: A literature review. Chin J Traumatol 2019; 22:93-98. [PMID: 30928194 PMCID: PMC6488749 DOI: 10.1016/j.cjtee.2019.02.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 10/15/2018] [Accepted: 01/26/2019] [Indexed: 02/04/2023] Open
Abstract
The clinical treatment of joint contracture due to immobilization remains difficult. The pathological changes of muscle tissue caused by immobilization-induced joint contracture include disuse skeletal muscle atrophy and skeletal muscle tissue fibrosis. The proteolytic pathways involved in disuse muscle atrophy include the ubiquitin-proteasome-dependent pathway, caspase system pathway, matrix metalloproteinase pathway, Ca2+-dependent pathway and autophagy-lysosomal pathway. The important biological processes involved in skeletal muscle fibrosis include intermuscular connective tissue thickening caused by transforming growth factor-β1 and an anaerobic environment within the skeletal muscle leading to the induction of hypoxia-inducible factor-1α. This article reviews the progress made in understanding the pathological processes involved in immobilization-induced muscle contracture and the currently available treatments. Understanding the mechanisms involved in immobilization-induced contracture of muscle tissue should facilitate the development of more effective treatment measures for the different mechanisms in the future.
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Affiliation(s)
- Feng Wang
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, Hefei, 230601, China
| | - Quan-Bing Zhang
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, Hefei, 230601, China
| | - Yun Zhou
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, Hefei, 230601, China,Corresponding author.
| | - Shuang Chen
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, Hefei, 230601, China
| | - Peng-Peng Huang
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, Hefei, 230601, China
| | - Yi Liu
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, Hefei, 230601, China
| | - Yuan-Hong Xu
- Department of Clinical Laboratory, The First Hospital of Anhui Medical University, Hefei, 230601, China
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12
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Martínez TC, Lluch E, Torres-Cueco R, Pecos-Martín D, McConnell J. Concurrent Criterion-related Validity, Reliability, and Responsiveness to Treatment of the Figure-of-Four Position for Measurement of Anterior Hip Joint Structures Tightness. J Manipulative Physiol Ther 2019; 41:780-788. [PMID: 30791995 DOI: 10.1016/j.jmpt.2018.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/31/2018] [Accepted: 04/02/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study was to examine the intra- and intertester reliability, concurrent criterion-related validity, and responsiveness to treatment of the "figure-of-four" position. METHODS A total of 52 asymptomatic male soccer players participated in this study. The intraclass correlation coefficient (2, 1) was used to determine intra- and intertester reliability of the figure-of-four position. Pearson product moment correlation coefficients examining the association between the figure-of-four position and goniometric measurements of hip extension and external rotation were used to establish concurrent validity. To evaluate responsiveness to treatment, the figure-of-four position was assessed by a blinded examiner before and immediately after the application of a stretching technique or control intervention. RESULTS Excellent reliability (intraclass correlation coefficient > 0.75) was obtained for both intra- and intertester reliability of the figure-of-four position. Overall, the figure-of-four position and goniometric measurements of both hip extension and external rotation were significantly correlated. However, no significant treatment effects were observed for the figure-of-four position. CONCLUSION The results of this study demonstrated that the figure-of-four position is a reliable and valid way to obtain information on tightness of anterior hip joint structures in male soccer players. However, responsiveness to treatment of the figure-of-four position should be questioned.
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Affiliation(s)
| | - Enrique Lluch
- Department of Physical Therapy, University of Valencia, Valencia, Spain.
| | | | - Daniel Pecos-Martín
- Department of Physical Therapy, Universidad de Alcalá, Alcalá de Henares, Spain
| | - Jenny McConnell
- Centre for Sports Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Lim W. Easy method for measuring stretching intensities in real clinical settings and effects of different stretching intensities on flexibility. J Back Musculoskelet Rehabil 2018; 32:BMR181243. [PMID: 30530964 DOI: 10.3233/bmr-181243] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Flexibility changes according to stretching intensity have been rarely investigated. I aimed to assess the effect of different stretching intensities on hamstring flexibility by measuring them in a setting similar to real clinical settings. METHODS Stretching intensities were quantified using an easy method, and participants were grouped according to intensity: 100% (P100), 70% (P70), 40% (P40), and 10% (P10) of maximum voluntary isometric contraction. Proprioceptive neuromuscular facilitation stretching intensities were measured using a sling system and tension dynamometer. Hamstring flexibility was measured (before; immediately after; and 3, 6, 9, 12, and 15 min after stretching) using the active knee extension test. Flexibility was compared between subgroups, and longitudinal changes in flexibility were additionally observed in each group. RESULTS At identical time points, no significant difference in hamstring flexibility was found between the high-intensity (P100) and moderate-intensity (P70, P40) groups. A significant difference was found between P100 and P10 immediately after and 12 and 15 min after stretching. Increased flexibility was maintained until the end in P100 and P70 but not P40 and P10. CONCLUSIONS High-intensity and moderate-intensity stretching increases flexibility compared with low-intensity stretching. Furthermore, high-intensity stretching was superior to moderate-intensity stretching in terms of maintaining flexibility over time.
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Affiliation(s)
- Wootaek Lim
- Department of Physical Therapy, College of Health and Welfare, Woosong University, Daejeon, Korea
- Advanced Institute of Convergence Sports Rehabilitation, Woosong University, Daejeon, Korea Tel.: +82 10 9769 1515; Fax: +82 42 630 4611; E-mail:
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Effect of Stretching Combined With Ultrashort Wave Diathermy on Joint Function and Its Possible Mechanism in a Rabbit Knee Contracture Model. Am J Phys Med Rehabil 2018; 97:357-363. [DOI: 10.1097/phm.0000000000000873] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kaneguchi A, Ozawa J, Minamimoto K, Yamaoka K. Active exercise on immobilization-induced contractured rat knees develops arthrogenic joint contracture with pathological changes. J Appl Physiol (1985) 2018; 124:291-301. [DOI: 10.1152/japplphysiol.00438.2017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
This study investigated the effects of treadmill walking during remobilization on range of motion (ROM) and histopathology in rat knee joints, which were immobilized for 3 wk in a flexed position. After fixator removal, rats were divided into a no-intervention (RM) group and a group forced to walk on a treadmill daily at 12 m/min for 60 min (WALK group). Passive knee extension ROMs were measured before (m-ROM) and after (a-ROM) knee flexor myotomy on the first and last day of a 7-day remobilization period, with m-ROM mainly reflecting myogenic factors and a-ROM reflecting arthrogenic factors. Knee joints were histologically analyzed and gene expression of inflammatory or fibrosis-related mediators in the posterior joint capsule were examined. m-ROM and a-ROM restrictions were established after immobilization. m-ROM significantly increased following the remobilization period both in RM and WALK groups compared with that of immobilized (IM) group. Conversely, a-ROM decreased following the remobilization period in both RM and WALK groups compared with that of IM group. Importantly, a-ROM was smaller in the WALK group than the RM group. Remobilization without intervention induced inflammatory and fibrotic reactions in the posterior joint capsule after 1 and 7 days. Treadmill walking promoted these reactions and also increased the expression of fibrosis-related TGF-β1 and collagen type I and III genes. While free movement after immobilization improved myogenic contracture, arthrogenic contracture worsened. Treadmill walking further aggravated arthrogenic contracture through amplified inflammatory and fibrotic reactions. Thus active exercise immediately after immobilization may not improve immobilization-induced joint contracture. NEW & NOTEWORTHY In clinical practice, it is widely accepted that facilitation of joint movements is effective in improving immobilization-induced joint contracture. However, whether active exercises improve arthrogenic contracture is not known. In this study, we revealed that treadmill walking further promoted remobilization-induced progression of arthrogenic contracture. To our knowledge, this is the first study demonstrating no favorable effect of active exercise on immobilization-induced arthrogenic contracture.
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Affiliation(s)
- Akinori Kaneguchi
- Department of Rehabilitation, Mori Orthopaedic Clinic, Hiroshima, Japan
| | - Junya Ozawa
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Hiroshima, Japan
| | - Kengo Minamimoto
- Major in Medical Engineering and Technology, Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, Hiroshima, Japan
| | - Kaoru Yamaoka
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Hiroshima, Japan
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Abstract
Treatment sequelae such as trismus, shoulder dysfunction syndrome resulting from spinal accessory nerve palsy, and radiotherapy-induced neck fibrosis are often overlooked when in the management of head and neck cancer patients. This chapter examines these underappreciated issues and their corresponding physical therapy intervention based on current evidence. Head and neck cancer survivors must contend with these disabilities for years after treatment has been concluded. A few quit their jobs which puts a tremendous burden on them and their families with a diminished quality of life. The physical rehabilitative needs of head and neck cancer patients and useful interventions to help meet them are addressed.
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Muanjai P, Jones DA, Mickevicius M, Satkunskiene D, Snieckus A, Skurvydas A, Kamandulis S. The acute benefits and risks of passive stretching to the point of pain. Eur J Appl Physiol 2017; 117:1217-1226. [PMID: 28391391 DOI: 10.1007/s00421-017-3608-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 04/04/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE This study evaluated the acute effects of two different stretch intensities on muscle damage and extensibility. METHODS Twenty-two physically active women (age 20 ± 1.0 years) were divided into two matched groups and undertook eight sets of 30-s passive hamstring stretching. One group stretched to the point of discomfort (POD) and the other to the point of pain (POP). Hamstring passive torque, sit and reach (S&R), straight leg raise (SLR), and markers of muscle damage were measured before, immediately after stretching and 24 h later. RESULTS S&R acutely increased and was still increased at 24 h with median (interquartile range) of 2.0 cm (0.5-3.75 cm) and 2.0 cm (0.25-3.0 cm) for POP and POD (p < 0.05), respectively, with no difference between groups; similar changes were seen with SLR. Passive stiffness fully recovered by 24 h and there was no torque deficit. A small, but significant increase in muscle tenderness occurred at 24 h in both groups and there was a very small increase in thigh circumference in both groups which persisted at 24 h in POP. Plasma CK activity was not raised at 24 h. CONCLUSION Stretching to the point of pain had no acute advantages over stretching to the discomfort point. Both forms of stretching resulted in very mild muscle tenderness but with no evidence of muscle damage. The increased ROM was not associated with changes in passive stiffness of the muscle but most likely resulted from increased tolerance of the discomfort.
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Affiliation(s)
- Pornpimol Muanjai
- Institute of Sport Science and Innovations, Lithuanian Sports University, Sporto 6, 44221, Kaunas, Lithuania.
| | - David A Jones
- School of Healthcare Science, Manchester Metropolitan University, Manchester, England, UK
| | - Mantas Mickevicius
- Institute of Sport Science and Innovations, Lithuanian Sports University, Sporto 6, 44221, Kaunas, Lithuania
| | - Danguole Satkunskiene
- Institute of Sport Science and Innovations, Lithuanian Sports University, Sporto 6, 44221, Kaunas, Lithuania
| | - Audrius Snieckus
- Institute of Sport Science and Innovations, Lithuanian Sports University, Sporto 6, 44221, Kaunas, Lithuania
| | - Albertas Skurvydas
- Institute of Sport Science and Innovations, Lithuanian Sports University, Sporto 6, 44221, Kaunas, Lithuania
| | - Sigitas Kamandulis
- Institute of Sport Science and Innovations, Lithuanian Sports University, Sporto 6, 44221, Kaunas, Lithuania
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Iwasawa H, Nomura M, Sakitani N, Watanabe K, Watanabe D, Moriyama H. Stretching After Heat But Not After Cold Decreases Contractures After Spinal Cord Injury in Rats. Clin Orthop Relat Res 2016; 474:2692-2701. [PMID: 27530397 PMCID: PMC5085939 DOI: 10.1007/s11999-016-5030-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 08/08/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Contractures are a prevalent and potentially severe complication in patients with neurologic disorders. Although heat, cold, and stretching are commonly used for treatment of contractures and/or spasticity (the cause of many contractures), the sequential effects of these modalities remain unclear. QUESTIONS/PURPOSES Using an established rat model with spinal cord injury with knee flexion contracture, we sought to determine what combination of heat or cold before stretching is the most effective for treatment of contractures derived from spastic paralyses and investigated which treatment leads to the best (1) improvement in the loss of ROM; (2) restoration of deterioration in the muscular and articular factors responsible for contractures; and (3) amelioration of histopathologic features such as muscular fibrosis in biceps femoris and shortening of the joint capsule. METHODS Forty-two adolescent male Wistar rats were used. After spasticity developed at 2 weeks postinjury, each animal with spinal cord injury underwent the treatment protocol daily for 1 week. Knee extension ROM was measured with a goniometer by two examiners blinded to each other's scores. The muscular and articular factors contributing to contractures were calculated by measuring ROM before and after the myotomies. We quantitatively measured the muscular fibrosis and the synovial intima length, and observed the distribution of collagen of skeletal muscle. The results were confirmed by a blinded observer. RESULTS The ROM of heat alone (34° ± 1°) and cold alone (34° ± 2°) rats were not different with the numbers available from that of rats with spinal cord injury (35° ± 2°) (p = 0.92 and 0.89, respectively). Stretching after heat (24° ± 1°) was more effective than stretching alone (27° ± 3°) at increasing ROM (p < 0.001). Contrastingly, there was no difference between stretching after cold (25° ± 1°) and stretching alone (p = 0.352). Stretching after heat was the most effective for percentage improvement of muscular (29%) and articular (50%) factors of contractures. Although quantification of muscular fibrosis in the rats with spinal cord injury (11% ± 1%) was higher than that of controls (9% ± 0.4%) (p = 0.01), no difference was found between spinal cord injury and each treatment protocol. The total synovial intima length of rats with spinal cord injury (5.9 ± 0.2 mm) became shorter than those of the controls (7.6 ± 0.2 mm) (p < 0.001), and those of stretching alone (6.9 ± 0.4 mm), stretching after heat (7.1 ± 0.3 mm), and stretching after cold (6.7 ± 0.4 mm) increased compared with rats with spinal cord injury (p = 0.01, p = 0.001, and p = 0.04, respectively). The staining intensity and pattern of collagen showed no difference among the treatment protocols. CONCLUSIONS This animal study implies that heat or cold alone is ineffective, and that stretching is helpful for the correction of contractures after spinal cord injury. In addition, we provide evidence that heat is more beneficial than cold to increase the effectiveness of stretching. CLINICAL RELEVANCE Our findings tend to support the idea that stretching after heat can improve the loss of ROM and histopathologic features of joint tissues. However, further studies are warranted to determine if our findings are clinically applicable.
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Affiliation(s)
- Hiroyuki Iwasawa
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Tomogaoka 7-10-2, Suma-ku, Kobe, 654-0142 Japan ,Department of Rehabilitation, St Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki, Japan
| | - Masato Nomura
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Tomogaoka 7-10-2, Suma-ku, Kobe, 654-0142 Japan
| | - Naoyoshi Sakitani
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Tomogaoka 7-10-2, Suma-ku, Kobe, 654-0142 Japan
| | - Kosuke Watanabe
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Tomogaoka 7-10-2, Suma-ku, Kobe, 654-0142 Japan
| | - Daichi Watanabe
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Tomogaoka 7-10-2, Suma-ku, Kobe, 654-0142 Japan
| | - Hideki Moriyama
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Tomogaoka 7-10-2, Suma-ku, Kobe, 654-0142 Japan
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Ozawa J, Kaneguchi A, Tanaka R, Kito N, Moriyama H. Cyclooxygenase-2 inhibitor celecoxib attenuates joint contracture following immobilization in rat knees. BMC Musculoskelet Disord 2016; 17:446. [PMID: 27776498 PMCID: PMC5078937 DOI: 10.1186/s12891-016-1303-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 10/17/2016] [Indexed: 12/31/2022] Open
Abstract
Background The aim of this study is to clarify the following two points: First, whether a cyclooxygenase-2 mediated pathway is involved in the formation of immobilization-induced joint contracture and, second, the effectiveness of oral administration of non-steroidal anti-inflammatory drug celecoxib (CBX) for the prevention of myogenic and arthrogenic contracture following immobilization in a rat model. Methods Thirty male rats were randomly divided into three groups: immobilization (Im), Im + CBX, and control (n = 10 each). External fixation immobilized the right knee joint of Im and Im + CBX groups in flexion for 3 weeks. 50 mg/kg of CBX was administrated daily to the Im + CBX group during this period. The passive range of motion (ROM) of knee joints was measured before and after transection of knee flexor muscles and myogenic and arthrogenic ROM restrictions were calculated. The semitendinosus muscles and knee joints were investigated histologically to elucidate factors responsible for contracture. Results Myogenic ROM restrictions were exhibited both in Im and Im + CBX groups (44 ± 5 and 36 ± 8 °, respectively), but restrictions significantly decreased in the Im + CBX group compared to the Im group. Significant reductions of the muscle length ratios (Rt/Lt) and sarcomere number ratios (Rt/Lt) in knee flexor semitendinosus muscle, which are responsible for myogenic contracture, were also seen both in Im group (92 ± 5 and 92 ± 4 %, respectively) and Im + CBX group (97 ± 3 and 97 ± 3 %, respectively), but were inhibited by CBX administration (P < 0.05). Im and Im + CBX groups exhibited arthrogenic ROM restrictions with no significant differences (82 ± 3 and 83 ± 5 °, respectively). Posterior synovial length shortening and pathological changes (hemorrhage in joint cavities and capsule edema) in the knee joints were comparable between Im and Im + CBX groups. Conclusions Oral administration of celecoxib partially reduced myogenic ROM restriction concomitantly with knee flexor muscle shortening following immobilization. These results imply that inflammation and nociception are involved in myogenic contracture formation independently of joint immobilization, and that CBX is effective in preventing joint contracture following immobilization in rats.
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Affiliation(s)
- Junya Ozawa
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose- Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, 739-2695, Japan.
| | - Akinori Kaneguchi
- Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, Higashi-Hiroshima, Hiroshima, Japan
| | - Ryo Tanaka
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose- Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, 739-2695, Japan
| | - Nobuhiro Kito
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose- Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, 739-2695, Japan
| | - Hideki Moriyama
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Tomogaoka 7-10-2, Suma-ku, Kobe, Hyogo, Japan
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Nagai M, Ito A, Tajino J, Iijima H, Yamaguchi S, Zhang X, Aoyama T, Kuroki H. Remobilization causes site-specific cyst formation in immobilization-induced knee cartilage degeneration in an immobilized rat model. J Anat 2016; 228:929-39. [PMID: 26989984 PMCID: PMC5341580 DOI: 10.1111/joa.12453] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2016] [Indexed: 12/13/2022] Open
Abstract
An understanding of the articular cartilage degenerative process is necessary for the prevention and treatment of joint disease. The present study aimed to examine how long‐term immobilization‐induced cartilage degeneration is aggravated by remobilization. Sixty 8‐week‐old male Wistar rats were used in this study. The unilateral knee joint was immobilized using an external fixator for 8 weeks. The rats were killed at 0 and 3 days, and at 1, 2, 4 and 8 weeks after removing the fixator. After the rats were killed, the maximum knee extension angles were measured. Histological sections at the medial mid‐condylar region (non‐contact, transitional and contact regions of the femur and tibia) were prepared and scored. The cartilage thickness and number of chondrocytes were measured, and CD44 and Col2‐3/4c expression levels were assessed immunohistochemically. The histological assessment revealed progressive aggravation of cartilage degeneration in the transitional region, with a decreased number of chondrocytes and CD44‐positive chondrocytes as well as poor scoring over time, particularly in the tibia. Cyst formation was confirmed in the transitional region of the tibia at 8 weeks post‐remobilization. The cartilage thickness in the transitional region was thicker than that in the contact region, particularly in the tibia. Col2‐3/4c expression was observed in the non‐contact and transitional regions, and the knee extension angle was recovered. In conclusion, immobilization‐induced cartilage degeneration was aggravated by remobilization over time in the transitional region, followed by observations of a decreased number of chondrocytes and morphological disparity between different cartilage regions.
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Affiliation(s)
- Momoko Nagai
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Congenital Anomaly Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akira Ito
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Junichi Tajino
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hirotaka Iijima
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shoki Yamaguchi
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Xiangkai Zhang
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomoki Aoyama
- Department of Development and Rehabilitation of Motor Function, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Kuroki
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Dynasplint Trismus System exercises for trismus secondary to head and neck cancer: a prospective explorative study. Support Care Cancer 2016; 24:3315-23. [PMID: 26956713 PMCID: PMC4917584 DOI: 10.1007/s00520-016-3131-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/09/2016] [Indexed: 10/28/2022]
Abstract
PURPOSE The Dynasplint Trismus System (DTS) can be used to treat trismus secondary to head and neck cancer. We conducted a prospective study with the following aims: (1) to determine the effects of DTS exercises on changes in mouth opening, pain, mandibular function, quality of life (QoL), and symptomatology and (2) to analyze the patients' perception on DTS exercises, including user satisfaction, experiences, comfort, and compliance. METHODS The patients were instructed to exercise with the DTS for at least 16 weeks. Changes in mouth opening, pain, mandibular function, QoL, and symptomatology were evaluated, as well as the patients' perception of DTS exercises. RESULTS Eighteen consecutive patients were included. Baseline mouth opening was 22.6 mm (sd 7.6). After the patients completed the DTS exercise program, mouth opening increased (7.1 mm, sd 4.7) and perceived difficulty of opening the mouth improved significantly (p < 0.05). No significant effects were found in mandibular function, QoL, and overall symptomatology. The patients' perception was diverse. They reported effectiveness and positive feelings of the results and would recommend DTS exercises to other patients. About half of them thought DTS exercises were burdensome. CONCLUSIONS Mouth opening increased significantly after the DTS exercise program, relative to baseline. About one third of the gained increase was lost in the follow-up period. In general, the patients were satisfied about the effects and the DTS exercise program.
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Gait cycle analysis: parameters sensitive for functional evaluation of peripheral nerve recovery in rat hind limbs. Ann Plast Surg 2015; 73:405-11. [PMID: 24317246 DOI: 10.1097/sap.0000000000000008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Video-assisted gait kinetics analysis has been a sensitive method to assess rat sciatic nerve function after injury and repair. However, in conduit repair of sciatic nerve defects, previously reported kinematic measurements failed to be a sensitive indicator because of the inferior recovery and inevitable joint contracture. OBJECTIVE This study aimed to explore the role of physiotherapy in mitigating joint contracture and to seek motion analysis indices that can sensitively reflect motor function. METHODS Data were collected from 26 rats that underwent sciatic nerve transection and conduit repair. Regular postoperative physiotherapy was applied. Parameters regarding step length, phase duration, and ankle angle were acquired and analyzed from video recording of gait kinetics preoperatively and at regular postoperative intervals. RESULTS Stride length ratio (step length of uninjured foot/step length of injured foot), percent swing of the normal paw (percentage of the total stride duration when the uninjured paw is in the air), propulsion angle (toe-off angle subtracted by midstance angle), and clearance angle (ankle angle change from toe off to midswing) decreased postoperatively comparing with baseline values. The gradual recovery of these measurements had a strong correlation with the post-nerve repair time course. CONCLUSIONS Ankle joint contracture persisted despite rigorous physiotherapy. Parameters acquired from a 2-dimensional motion analysis system, that is, stride length ratio, percent swing of the normal paw, propulsion angle, and clearance angle, could sensitively reflect nerve function impairment and recovery in the rat sciatic nerve conduit repair model despite the existence of joint contractures.
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Freitas SR, Andrade RJ, Larcoupaille L, Mil-homens P, Nordez A. Muscle and joint responses during and after static stretching performed at different intensities. Eur J Appl Physiol 2015; 115:1263-72. [PMID: 25585964 DOI: 10.1007/s00421-015-3104-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 01/07/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE We investigated the effects of plantarflexor static stretching of different intensities on the medial gastrocnemius (GAS) shear elastic modulus, GAS fascicle length and ankle passive torque-angle responses during and after stretching. METHODS Participants performed three stretching sessions of different intensities: 40 % (R40) of maximal dorsiflexion range of motion (ROM), 60 % (R60) of ROM, and 80 % (R80) of ROM. Each stretching lasted 10 min. The GAS architecture, GAS shear elastic modulus, ankle passive torque-angle, and muscle activity were assessed before, during, and after the stretching. RESULTS The absolute and relative (i.e., normalized to the static stretching start value) GAS shear elastic modulus relaxation varied across stretching intensities. The absolute passive torque relaxation varied across intensities (p < 0.05) but not when normalized to the stretching start value. No significant changes were observed in GAS fascicle length during the stretching (p = 0.93). After stretching, passive torque at a given angle was significantly decreased for R60 [-0.99 ± 0.59 Nm (-6.5 ± 3.8 %), p < 0.001] and R80 [-1.05 ± 1.12 Nm (-6.8 ± 6.3 %), p = 0.004], and GAS shear elastic modulus decreased only for the R80 [-9.3 ± 7.2 kPa (-14.1 %), p = 0.003]. No significant correlations were found between the magnitude of relaxation during stretching and post-stretching effect in the GAS shear elastic modulus or ankle passive torque variables. No significant relation was found between the shear elastic modulus and the ankle passive torque responses during and after stretching. CONCLUSION The effects of stretching on joint passive torque do not reflect changes in the medial gastrocnemius shear elastic modulus, and these responses to stretching depend on its intensity.
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Affiliation(s)
- Sandro R Freitas
- Faculdade de Motricidade Humana, Universidade de Lisboa, CIPER, Estrada da Costa, 1499-002, Cruz Quebrada, Dafundo, Portugal
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Marcellin-Little DJ, Levine D. Principles and application of range of motion and stretching in companion animals. Vet Clin North Am Small Anim Pract 2014; 45:57-72. [PMID: 25440753 DOI: 10.1016/j.cvsm.2014.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Optimal function after injury, surgery, or in patients with chronic conditions requires adequate motion in joints, muscles, tendon, fascia, and skin. Range of motion and stretching exercises are commonly used in companion animal rehabilitation programs to maintain or improve motion of musculoskeletal tissues. Range of motion exercises and stretching prevent adhesions from forming, help scar tissue remodeling, may improve muscle tone, and prevent future injury from occurring. Stretching is used to avoid loss of motion or to regain lost joint motion. Stretching is done manually, using external coaptation, or using therapeutic exercises. Careful documentation of range of motion is necessary.
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Affiliation(s)
- Denis J Marcellin-Little
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, NCSU CVM VHC #2563, 1052 William Moore Drive, Raleigh, NC 27607-4065, USA.
| | - David Levine
- Department of Physical Therapy, 615 McCallie Avenue, Chattanooga, TN 37403-2598, USA
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25
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Trudel G, Uhthoff HK, Goudreau L, Laneuville O. Quantitative analysis of the reversibility of knee flexion contractures with time: an experimental study using the rat model. BMC Musculoskelet Disord 2014; 15:338. [PMID: 25294116 PMCID: PMC4289348 DOI: 10.1186/1471-2474-15-338] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 09/29/2014] [Indexed: 11/19/2022] Open
Abstract
Background Knee flexion contractures prevent the full extension of the knee joint and cause disability. The etiology is not well defined. Extended periods of immobilization of joints lead to contractures difficult to completely reverse by rehabilitation treatments. Recovery of the complete range of motion without intervention has not been studied but is of importance to optimize clinical management. This study was designed to quantify the spontaneous reversibility of knee flexion contractures over time. Methods Knee flexion contractures of increasing severities were induced by internally fixing one knee of 250 adult male rats for 6 increasing durations. The contractures were followed for four different durations of spontaneous recovery up to 48 weeks (24 groups, target n = 10 per group). The angle of knee of extension at a standardized torque was measured. Contralateral knees constituted controls. Results Full reversibility characterized by knee extension similar to controls was only measured in the lowest severity group where 4 weeks of spontaneous recovery reversed early-onset contractures. Spontaneous recovery of 2, 4 and 8 weeks caused partial gain of knee extension in longer-lasting contractures (P ≤ 0.05; all 4 comparisons). Extending the durations of spontaneous recovery failed to further improve knee extension (P > 0.05, all 12 comparisons). No reversal occurred in the highest severity group (32 week; P > 0.05). Conclusions Reversibility of knee flexion contractures was dependent on their severity. Full spontaneous recovery was limited to the least severe contractures. While contractures initially improved, a plateau was reached beyond which additional durations of spontaneous recovery led to no additional gain of knee extension. These results support our view that without treatment, permanent losses in knee mobility must be anticipated in immobility-induced contractures. Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-338) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Guy Trudel
- Department of Medicine, Faculty of Medicine, University of Ottawa, 451 Smyth Rd,, Ottawa, ON K1H 8M5, Canada.
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Godoy-Santos AL, Diniz Fernandes T, Luzo C, Ortiz RT, Sakaki M, Weil L. Effectiveness of the dorsal thermoplastic locking orthosis to prevent floating toes in postoperative follow-up of Weil osteotomies: pilot study. Foot Ankle Spec 2014; 7:356-62. [PMID: 24793064 DOI: 10.1177/1938640014532131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Weil oblique distal metatarsal osteotomy is regularly used in the treatment of primary metatarsalgia. The most frequent complication is the floating toe, which occurs in up to 36% of postoperative follow-up. The theory of reducing the plantar flexor mechanism tension associated with the retraction of the dorsal structures during the healing process of the surgical procedure may explain this negative evolution. OBJECTIVE This study aimed at assessing the effectiveness of the Tucade dorsal thermoplastic locking orthosis in the prevention of floating toe after Weil osteotomy. METHODS In all, 30 patients with metatarsalgia diagnosis submitted to Weil osteotomy were treated in the postoperative period with the Tucade dorsal thermoplastic locking orthosis. RESULTS The floating toe was not observed in this case series. There was 1 case of superficial wound irritation at the dorsal surgical incision and 1 case that evolved with transfer metatarsalgia. Statistical analyses were performed-American Orthopaedic Foot and Ankle Society Scale for lateral toes and extension of the lateral toes-using the t test, and P < .0001 was obtained for comparison of the preoperative and postoperative periods in the population studied. CONCLUSION The Tucade dorsal thermoplastic locking orthosis during the postoperative period of Weil osteotomy proved to be effective in the prevention of floating toes. LEVEL OF EVIDENCE Therapeutic Level IV: Case Series.
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Affiliation(s)
- Alexandre Leme Godoy-Santos
- Department of Orthopedic Surgery, University of São Paulo, Sao Paulo, Brazil (ALGS, TDF, CL, RTO, MS)Weil Foot and Ankle Institute, Des Plaines, IL (LW)
| | - Tulio Diniz Fernandes
- Department of Orthopedic Surgery, University of São Paulo, Sao Paulo, Brazil (ALGS, TDF, CL, RTO, MS)Weil Foot and Ankle Institute, Des Plaines, IL (LW)
| | - Candida Luzo
- Department of Orthopedic Surgery, University of São Paulo, Sao Paulo, Brazil (ALGS, TDF, CL, RTO, MS)Weil Foot and Ankle Institute, Des Plaines, IL (LW)
| | - Rafael Trevisan Ortiz
- Department of Orthopedic Surgery, University of São Paulo, Sao Paulo, Brazil (ALGS, TDF, CL, RTO, MS)Weil Foot and Ankle Institute, Des Plaines, IL (LW)
| | - Marcos Sakaki
- Department of Orthopedic Surgery, University of São Paulo, Sao Paulo, Brazil (ALGS, TDF, CL, RTO, MS)Weil Foot and Ankle Institute, Des Plaines, IL (LW)
| | - Lowell Weil
- Department of Orthopedic Surgery, University of São Paulo, Sao Paulo, Brazil (ALGS, TDF, CL, RTO, MS)Weil Foot and Ankle Institute, Des Plaines, IL (LW)
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Freitas SR, Vilarinho D, Rocha Vaz J, Bruno PM, Costa PB, Mil-homens P. Responses to static stretching are dependent on stretch intensity and duration. Clin Physiol Funct Imaging 2014; 35:478-84. [PMID: 25164268 DOI: 10.1111/cpf.12186] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 07/03/2014] [Indexed: 11/29/2022]
Abstract
Information regarding the effects of stretching intensity on the joint torque-angle response is scarce. The present study examined the effects of three static stretching protocols with different intensities and durations on the passive knee extension torque-angle response of seventeen male participants (age ± SD: 23.9 ± 3.6 years, height: 177.0 ± 7.2 cm, BMI: 22.47 ± 1.95 kg · m(2)). The stretching intensity was determined according to the maximal tolerable torque of the first repetition: fifty per cent (P50), seventy-five per cent (P75) and the maximum intensity without pain (P100). Five repetitions were performed for each protocol. The stretch duration of each repetition was 90, 135 and 180 s for P100, P75 and P50, respectively. The rest period between repetitions was 30 s. Passive torque at a given angle, angle, stress relaxation, area under the curve, surface electromyography activity and visual analogue scale score were compared. The significant (P < 0.05) results found were as follows: (i) the P50 and P75 did not increase the angle and passive peak torque outcomes, despite more time under stretch; (ii) only the P100 increased the angle and passive peak torque outcomes; (iii) the perception of stretching intensity mainly changed depending on knee angle changes, and not passive torque; (iv) the P50 induced a higher passive torque decrease; (v) when protocols were compared for the same time under stretch, the torque decrease was similar; (vi) the change in torque-angle curve shape was different depending on the stretching protocol. In conclusion, higher stretch duration seems to be a crucial factor for passive torque decrease and higher stretch intensity for maximum angle increase.
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Affiliation(s)
- Sandro R Freitas
- Fac Motricidade Humana, Universidade de Lisboa, CIPER, Lisbon, Portugal
| | - Daniel Vilarinho
- Fac Motricidade Humana, Universidade de Lisboa, CIPER, Lisbon, Portugal
| | - João Rocha Vaz
- Fac Motricidade Humana, Universidade de Lisboa, CIPER, Lisbon, Portugal
| | - Paula M Bruno
- Fac Motricidade Humana, Universidade de Lisboa, CIPER, Lisbon, Portugal
| | - Pablo B Costa
- Exercise Physiology Laboratory, Department of Kinesiology, California State University-Fullerton, CA, USA
| | - Pedro Mil-homens
- Fac Motricidade Humana, Universidade de Lisboa, CIPER, Lisbon, Portugal
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Moriyama H, Tobimatsu Y, Ozawa J, Kito N, Tanaka R. Amount of torque and duration of stretching affects correction of knee contracture in a rat model of spinal cord injury. Clin Orthop Relat Res 2013; 471:3626-36. [PMID: 23893364 PMCID: PMC3792286 DOI: 10.1007/s11999-013-3196-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 07/17/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Joint contractures are a common complication of many neurologic conditions, and stretching often is advocated to prevent and treat these contractures. However, the magnitude and duration of the stretching done in practice usually are guided by subjective clinical impressions. QUESTIONS/PURPOSES Using an established T8 spinal cord injury rat model of knee contracture, we sought to determine what combination of static or intermittent stretching, varied by magnitude (high or low) and duration (long or short), leads to the best (1) improvement in the limitation in ROM; (2) restoration of the muscular and articular factors leading to contractures; and (3) prevention and treatment of contracture-associated histologic alterations of joint capsule and articular cartilage. METHODS Using a rat animal model, the spinal cord was transected completely at the level of T8. The rats were randomly assigned to seven treatment groups (n = 4 per group), which were composed of static or intermittent stretching in combination with different amounts of applied torque magnitude and duration. We assessed the effect of stretching by measuring the ROM and evaluating the histologic alteration of the capsule and cartilage. RESULTS Contractures improved in all treated groups except for the low-torque and short-duration static stretching conditions. High-torque stretching was effective against shortening of the synovial membrane and adhesions in the posterosuperior regions. Collagen Type II and VEGF in the cartilage were increased by stretching. CONCLUSIONS High-torque and long-duration static stretching led to greater restoration of ROM than the other torque and duration treatment groups. Stretching was more effective in improving articular components of contractures compared with the muscular components. Stretching in this rat model prevented shortening and adhesion of the joint capsule, and affected biochemical composition, but did not change morphologic features of the cartilage. CLINICAL RELEVANCE This animal study tends to support the ideas that static stretching can influence joint ROM and histologic qualities of joint tissues, and that the way stretching is performed influences its efficacy. However, further studies are warranted to determine if our findings are clinically applicable.
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Affiliation(s)
- Hideki Moriyama
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Tomogaoka 7-10-2, Suma-ku, Kobe, Hyogo, 654-0142, Japan,
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Furia JP, Willis FB, Shanmugam R, Curran SA. Systematic review of contracture reduction in the lower extremity with dynamic splinting. Adv Ther 2013; 30:763-70. [PMID: 24018464 PMCID: PMC3779086 DOI: 10.1007/s12325-013-0052-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Indexed: 11/26/2022]
Abstract
Introduction Joint contractures are relatively common disorders that can result in significant, long-term morbidity. Initial treatment is non-operative and often entails the use of mechanical modalities such as dynamic and static splints. Although widely utilized, there is a paucity of data that support the use of such measures. The purpose of this systematic review was to evaluate the safety and efficacy of dynamic splinting as it is used to treat joint contracture in lower extremities, and to determine if duration on total hours of stretching had an effect on outcomes. Methods Reviews of PubMed, Science Direct, Medline, AMED, and EMBASE websites were conducted to identify the term ‘contracture reduction’ in manuscripts published from January 2002 to January 2012. Publications selected for inclusion were controlled trials, cohort studies, or case series studies employing prolonged, passive stretching for lower extremity contracture reduction. A total of 354 abstracts were screened and eight studies (487 subjects) met the inclusion criteria. The primary outcome measure was change in active range of motion (AROM). Results The mean aggregate change in AROM was 23.5º in the eight studies examined. Dynamic splinting with prolonged, passive stretching as home therapy treatment showed a significant direct, linear correlation between the total number of hours in stretching and restored AROM. No adverse events were reported. Discussion Dynamic splinting is a safe and efficacious treatment for lower extremity joint contractures. Joint specific stretching protocols accomplished greater durations of end-range stretching which may be considered to be responsible for connective tissue elongation.
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Affiliation(s)
- John P. Furia
- SUN Orthopedic Group, 900 Buffalo Road, Lewisburg, PA 17837 USA
| | - F. Buck Willis
- McMurry University, Abilene, TX 79697 USA
- Present Address: Galveston Clinical Research Foundation, PO Box 1582, Galveston, TX 77553 USA
| | - Ram Shanmugam
- School of Health Administration, Texas State University, 601 University Drive, Health Professions Building #256, San Marcos, TX 78666 USA
| | - Sarah A. Curran
- Wales Centre for Podiatric Studies, Cardiff Metropolitan University, Western Avenue, Cardiff, CF5 2YB UK
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McKee P, Hannah S, Priganc VW. Orthotic considerations for dense connective tissue and articular cartilage--the need for optimal movement and stress. J Hand Ther 2012; 25:233-42; quiz 243. [PMID: 22507215 DOI: 10.1016/j.jht.2011.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 12/11/2011] [Accepted: 12/13/2011] [Indexed: 02/03/2023]
Abstract
Orthotic intervention is an essential component of hand rehabilitation, addressing biological factors that affect activity and participation. Functional, pain-free joint mobility requires skeletal stability, healthy articular cartilage, and appropriate extensibility of periarticular dense connective tissues (DCTs). This article addresses basic science underlying clinical reasoning when considering orthoses to maintain or restore structural integrity, mobility and function of DCT structures, and articular cartilage. However, these tissues often have different and sometimes conflicting requirements for the maintenance and restoration of integrity and health. The duration of immobilization, especially at end range, should be carefully considered, as it impairs nutrition of tissues and adversely compresses articular cartilage, causing injury that may not be reversible. Immobilization also reduces extensibility of DCT. Thus, an intermittent orthotic wearing schedule is suggested, allowing movement wherever possible to promote tissue health. To optimize benefits and minimize harmful effects of orthotic intervention, further research on physiological responses of human tissues to immobilization and tension is needed.
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Affiliation(s)
- Pat McKee
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada.
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Moriyama H, Kanemura N, Brouns I, Pintelon I, Adriaensen D, Timmermans JP, Ozawa J, Kito N, Gomi T, Deie M. Effects of aging and exercise training on the histological and mechanical properties of articular structures in knee joints of male rat. Biogerontology 2012; 13:369-81. [PMID: 22526371 DOI: 10.1007/s10522-012-9381-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 04/12/2012] [Indexed: 02/07/2023]
Abstract
The impact of aging on joints can have a profound effect on an individual's functioning. Our objectives were to assess the histological and mechanical properties of the knee joint capsule and articular cartilage with aging, and to examine the effects of exercise on age-related changes in the knee joint. 2-year-old Wistar rats were divided into a sedentary control group and an exercise-trained group. 10-week-old animals were used to investigate the changes with aging. The joint capsule and cartilage were evaluated with histological, histomorphometric, immunohistochemical, and mechanical analyses. Severe degenerative changes in articular cartilage were observed with aging, whereas exercise apparently did not have a significant effect. The articular cartilage of aged rats was characterized by damage to the cartilage surface, cell clustering, and an abnormal cartilage matrix. Histomorphometric analysis further revealed changes in cartilage thickness as well as a decreased number of chondrocytes. Aging led to stiffness of the articular cartilage and reduced the ability to dissipate the load and distribute the strain generated within the joint. Joint stiffness with aging was independent of capsular stiffness and synovitis was not a characteristic feature of the aging joint. This study confirms that aging alone eventually leads to joint degeneration in a rat model. The lack of recovery in aging joint changes may be due to several factors, such as the duration of the intervention and the regeneration ability of the cartilage.
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Affiliation(s)
- Hideki Moriyama
- Graduate School of Health Sciences, Hiroshima University, Hiroshima, 734-8551, Japan.
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Menzes M, Willis FB. Dynamic splinting for paediatric contracture reduction of the upper limb. HAND THERAPY 2011. [DOI: 10.1258/ht.2011.011019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background This report is based on a case of ‘shaken baby syndrome,’ and clinical manifestations of this injury often include hypertonicity, spasticity and joint contracture. Shaken baby syndrome affects over 1 million children and resembles symptoms of traumatic brain injury. Methods The patient was a five-year-old boy who had suffered a traumatic brain injury with right spastic hemiplegia. Over the course of treatment, multiple modalities were used to manage his tone, spasticity and to reduce wrist and elbow contractures, which included Botox® (Allergan Co., Irvine, CA, USA), manual therapy and dynamic splinting as home therapy. The main outcome measured was change in maximal range of motion(s) (ROMs) in the elbow and wrist. Results After dynamic splinting was initiated, the child's passive ROM increased by 65° in wrist extension and 45° in elbow extension. Ulnar deviation progressed by 15–30°. Conclusion Dynamic splinting contributed over 900 hours of end-range, home therapy for wrist extension and 700 hours in end-range home therapy for elbow extension. It is hypothesized that this prolonged duration of passive stretching at the end-range is responsible for the substantial gains in ROM.
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Affiliation(s)
- Melissa Menzes
- Dell Children's Medical Center of Central Texas, Austin, TX, USA
| | - F Buck Willis
- University of Phoenix: Axia College, Phoenix, AZ, USA
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Radiation Fibrosis Syndrome: Neuromuscular and Musculoskeletal Complications in Cancer Survivors. PM R 2011; 3:1041-54. [DOI: 10.1016/j.pmrj.2011.08.535] [Citation(s) in RCA: 125] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 07/13/2011] [Accepted: 08/18/2011] [Indexed: 11/16/2022]
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Lee S, Sakurai T, Ohsako M, Saura R, Hatta H, Atomi Y. Tissue stiffness induced by prolonged immobilization of the rat knee joint and relevance of AGEs (pentosidine). Connect Tissue Res 2010; 51:467-77. [PMID: 20604714 DOI: 10.3109/03008201003686941] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Joints, connective tissues consisting of extracellular matrix (ECM) with few blood vessels, transfer tension to the skeleton in response to environmental demand. Therefore, joint immobilization decreases active and passive mechanical stress, resulting in increased joint stiffness and tissue degeneration; however, the cause of joint stiffness is obscure. Using a rat knee immobilization model, we examined the relationship between range of motion (ROM) and cell numbers and ECM cross-links by accumulation of advanced glycation end products, pentosidine, in the posterior joint capsule of immobilized joints during 16 weeks of immobilization. The left knee joint was immobilized by internal fixation and compared with the non-immobilized right leg. As early as 2 weeks of immobilization, joint ROM and torque significantly decreased and in parallel, disordered alignment of collagen fiber bundles significantly increased, compared with non-immobilized joints. Those changes continued until 16 weeks of immobilization. Significant increases in pentosidine-positive areas after 8 weeks and significantly decreased cell numbers after 16 weeks of immobilization were also observed compared to the contralateral side. A significant negative correlation between tissue stiffness measured by restriction of ROM and accumulation of pentosidine was observed. This study is the first to show that immobilization of knee joints induces articular contracture associated with sequential changes of ECM alignment, influencing ROM and later pentosidine accumulation and decreased cell numbers during the 16-week immobilization period. Pentosidine appears to be an indicator toward a chronic tissue stiffness leading to decreased cell number rather than a cause of ROM restriction induced by joint immobilization.
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Affiliation(s)
- Sachiko Lee
- Department of Life Sciences, Graduate School of Arts and Sciences, University of Tokyo, Tokyo, Japan
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Stubblefield MD, Manfield L, Riedel ER. A preliminary report on the efficacy of a dynamic jaw opening device (dynasplint trismus system) as part of the multimodal treatment of trismus in patients with head and neck cancer. Arch Phys Med Rehabil 2010; 91:1278-82. [PMID: 20684911 DOI: 10.1016/j.apmr.2010.05.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 05/21/2010] [Accepted: 05/21/2010] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To examine the effectiveness of a dynamic jaw opening device as part of a multimodal treatment strategy for trismus in patients with head and neck cancer. DESIGN Retrospective cohort study. SETTING Tertiary care cancer center. PARTICIPANTS Patients with head and neck cancer and trismus (N=20). INTERVENTION All patients underwent assessment by a board-certified physiatrist and were referred to physical therapy for delivery of the DTS and instructed to progress use of the DTS to 30 minutes 3 times a day. Additional modalities for the treatment of trismus including pain medications and botulinum toxin injections were prescribed as clinically indicated. MAIN OUTCOME MEASURES Change in maximal interincisal distance (MID) as documented in the medical record. RESULTS The use of the DTS as part of multimodal therapy including physical therapy, pain medications, and botulinum toxin injections as deemed clinically appropriate resulted in an overall improvement of the MID from 16.5mm to 23.5mm (P<.001). Patients who could comply with the treatment recommendations for DTS treatment did better than those who could not, with an improvement of the MID from 16 mm to 27 mm (P<.001) versus 17 mm to 22 mm (P=.88). CONCLUSIONS The DTS is a safe and effective component of a multimodal strategy for improving trismus associated with head and neck cancer and its treatment. Further investigation is needed to determine the relative efficacy of the treatment modalities available for trismus including physical therapy and other jaw stretching devices.
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Dynamic splinting in wrist extension following distal radius fractures. J Orthop Surg Res 2010; 5:53. [PMID: 20691093 PMCID: PMC2924302 DOI: 10.1186/1749-799x-5-53] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Accepted: 08/06/2010] [Indexed: 11/20/2022] Open
Abstract
Background Wrist flexion contracture is a common pathology which presents secondary to distal radius fractures. Joint stability, restoration and early mobilization are frequently achieved through surgical treatment after such an injury. The purpose of this retrospective study was to evaluate the initial effect of dynamic splinting on wrist extension (active range of motion), in both surgical and non-surgical patients following distal radius fractures. Methods
Records were obtained from 133 patients who were treated with a Wrist Extension Dynasplint (WED) following distal radius fractures, between May 2007 and May 2009. Forty-two of these patients received surgical treatment for their fractures. This study specifically examined the initial usage of the WED as a home therapy. The retrospective analysis included categorization of patients who received the WED exclusively vs. patients who received WED treatment with concurrent hand therapy; surgical categorization included surgical patients vs. nonsurgical patients. Results There was a significant improvement in maximal active range of motion (AROM) for all patients (P < 0.0001) after a mean duration of 3.9 weeks of dynamic splinting. Patients showed a mean 62% increase in active extension. There was not a significant difference between patients who had received surgical treatment for the fracture vs. nonsurgical. Conclusion This dynamic splinting modality contributed 138 to 185 hours of stretching at the end range of motion for these patients in their first month following fracture. This unique regime is considered directly responsible for significant gains in AROM.
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Trudel G, Zhou J, Uhthoff HK, Laneuville O. Four weeks of mobility after 8 weeks of immobility fails to restore normal motion: a preliminary study. Clin Orthop Relat Res 2008; 466:1239-44. [PMID: 18299947 PMCID: PMC2311487 DOI: 10.1007/s11999-008-0181-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Accepted: 02/05/2008] [Indexed: 01/31/2023]
Abstract
Prolonged immobilization reduces passive range of motion of joints creating joint contractures. Whether and to what extent these iatrogenic contractures can be reduced is unknown. We raised three questions using an animal model: What degree of contracture remains at the end of a defined remobilization period? Do contractures in sham-operated and immobilized joints differ? What is the contribution of the posterior knee capsule in limiting knee extension? We immobilized one knee of 11 adult male rats in flexion to induce a joint contracture; 10 control animals underwent a sham operation. After 8 weeks, the internal fixation device was removed, and the animals were allowed to resume unrestricted activity for 4 weeks at the end of which the knee range of motion was measured with standardized torques. The mean flexion contracture was higher in the immobilized group (51.9 degrees +/- 2.8 degrees ) than in the sham-operated group (18.9 degrees +/- 2.1 degrees ). Eighty-eight percent of the contractures remained in the immobilized group after dividing skin and muscle, suggesting an important contribution of the posterior knee capsule in limiting knee mobility. Based on our preliminary study the range of motion of rat knees immobilized for 8 weeks remained substantially reduced after a 4-week period of unassisted remobilization.
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Affiliation(s)
- Guy Trudel
- Bone and Joint Laboratory, University of Ottawa, Ottawa, ON Canada ,Division of Physical Medicine and Rehabilitation, University of Ottawa, Ottawa, ON Canada
| | - Jian Zhou
- Bone and Joint Laboratory, University of Ottawa, Ottawa, ON Canada
| | - Hans K. Uhthoff
- Bone and Joint Laboratory, University of Ottawa, Ottawa, ON Canada
| | - Odette Laneuville
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON Canada K1H 8M5
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