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Muñoz-Vergara D, Grabowska W, Yeh GY, Khalsa SB, Schreiber KL, Huang CA, Zavacki AM, Wayne PM. A systematic review of in vivo stretching regimens on inflammation and its relevance to translational yoga research. PLoS One 2022; 17:e0269300. [PMID: 35648793 PMCID: PMC9159623 DOI: 10.1371/journal.pone.0269300] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 05/18/2022] [Indexed: 12/09/2022] Open
Abstract
OBJECTIVE To conduct a systematic review evaluating the impact of stretching on inflammation and its resolution using in vivo rodent models. Findings are evaluated for their potential to inform the design of clinical yoga studies to assess the impact of yogic stretching on inflammation and health. METHODS Studies were identified using four databases. Eligible publications included English original peer-reviewed articles between 1900-May 2020. Studies included those investigating the effect of different stretching techniques administered to a whole rodent model and evaluating at least one inflammatory outcome. Studies stretching the musculoskeletal and integumentary systems were considered. Two reviewers removed duplicates, screened abstracts, conducted full-text reviews, and assessed methodological quality. RESULTS Of 766 studies identified, 25 were included for synthesis. Seven (28%) studies had a high risk of bias in 3 out of 10 criteria. Experimental stretching protocols resulted in a continuum of inflammatory responses with therapeutic and injurious effects, which varied with a combination of three stretching parameters--duration, frequency, and intensity. Relative to injurious stretching, therapeutic stretching featured longer-term stretching protocols. Evidence of pro- and mixed-inflammatory effects of stretching was found in 16 muscle studies. Evidence of pro-, anti-, and mixed-inflammatory effects was found in nine longer-term stretching studies of the integumentary system. CONCLUSION Despite the overall high quality of these summarized studies, evaluation of stretching protocols paralleling yogic stretching is limited. Both injurious and therapeutic stretching induce aspects of inflammatory responses that varied among the different stretching protocols. Inflammatory markers, such as cytokines, are potential outcomes to consider in clinical yoga studies. Future translational research evaluating therapeutic benefits should consider in vitro studies, active vs. passive stretching, shorter-term vs. longer-term interventions, systemic vs. local effects of stretching, animal models resembling human anatomy, control and estimation of non-specific stresses, development of in vivo self-stretching paradigms targeting myofascial tissues, and in vivo models accounting for gross musculoskeletal posture.
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Affiliation(s)
- Dennis Muñoz-Vergara
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
- Osher Center for Integrative Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
- * E-mail:
| | - Weronika Grabowska
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Gloria Y. Yeh
- Osher Center for Integrative Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Sat Bir Khalsa
- Osher Center for Integrative Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Kristin L. Schreiber
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Christene A. Huang
- The Department of Surgery, School of Medicine, University of Colorado, Denver, CO, United States of America
| | - Ann Marie Zavacki
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Peter M. Wayne
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
- Osher Center for Integrative Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
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Sikes KJ, Andrie KM, McConnell A, Wist S, Smith S, Cole B, Frisbie DD, Santangelo KS. Clinical and Histologic Manifestations of a Novel Rectus Femoris Myotendinous Junction Injury in Rats. Muscles Ligaments Tendons J 2021; 11:600-613. [PMID: 38111789 PMCID: PMC10726684 DOI: 10.32098/mltj.04.2021.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background Animal models of muscle injury have primarily relied on methods which do not mimic the chronic scarring that typically occurs adjacent to the myotendinous junction (MTJ). The goal of this study was three-fold: (i) to create a strain-induced in vivo model of rectus femoris MTJ injury in rats; (ii) to document clinical manifestations of injury using longitudinal tracking of individual animals via voluntary and compulsory (treadmill) mobility analyses and (iii) to validate and assess the model for persistent scarring through serial histologic assessment and development of a semi-quantitative grading scheme to characterize injury response over time. Methods Strain-induced MTJ injury was generated in male Sprague Dawley rats via needle tension directed along the transverse axis between the rectus femoris muscle and distal tendon that attaches to the patella. Animals received mobility assessments (gait analysis using a DigiGait Treadmill System and weight bearing using a Tekscan Rodent Walkway System) at days 0, 1, 3, 6, 13, 20, and 27 of the experimental protocol. Rats were euthanized at 1, 3, 7, 14, and 28 days post-injury (n = 6 rats per time-point) and hindlimbs were processed for histology. Results Significant changes in locomotor parameters included injured and contralateral limb paw area, max dA/dt (limb deceleration/breaking time), stride time, stance time, force time impulse, and fore/hind symmetry, and injured limb maximum force. The most significant and consistent histologic finding was a pathologic fibrotic adhesive lesion at the muscle and tendon interface along the proximal aspect of the patella just distal to the injury site. This lesion was composed of reactive fibroblasts, disorganized collagen fibers, vascular profiles, and a myxomatous ground substance stroma. Conclusions This work is the first to characterize the clinical and pathologic development of a chronic model of rectus femoris MTJ injury, which resulted in altered mobility likely caused by a strain-induced fibrotic scar along the anterior patella. Notably, both the functional and pathologic changes recapitulated the course of injury progression similar to what is described in humans. This work provides a unique model to study MTJ injury mechanisms for the identification of enhanced treatment options for patients who suffer from activity-related muscle conditions.
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Affiliation(s)
- K J Sikes
- Department of Clinical Sciences, Colorado State University, Fort Collins (CO), U.S.A
| | - K M Andrie
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins (CO), U.S.A
| | - A McConnell
- Department of Clinical Sciences, Colorado State University, Fort Collins (CO), U.S.A
| | - S Wist
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins (CO), U.S.A
| | - S Smith
- Department of Clinical Sciences, Colorado State University, Fort Collins (CO), U.S.A
| | - B Cole
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago (IL), U.S.A
| | - D D Frisbie
- Department of Clinical Sciences, Colorado State University, Fort Collins (CO), U.S.A
| | - K S Santangelo
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins (CO), U.S.A
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