Effects of whole-body vibration on neuromuscular performance in individuals with spinal cord injury: a systematic review.

OBJECTIVE: To examine the effects of whole-body vibration on neuromuscular performance in people with spinal cord injury and evaluate the safe and effective vibration protocols. METHODS: PubMed, EMBASE, CINAHL and PEDro were mainly searched for English literatures. Other data sources were ClinicalTrials.gov , Current Controlled Trials and reference lists of all relevant articles. The PEDro scale was used to evaluate the methodological quality, and the Oxford Centre for Evidence-based Medicine level of evidence was used to assess the level of evidence. Basic information and whole-body vibration protocols were extracted by two independent researchers. Any disagreements were resolved by the third researcher. RESULTS: Of the eight included studies involving 94 individuals with spinal cord injury and 24 able-bodied participants, six of them reported beneficial effects of whole-body vibration on muscle activation and the other two on muscle spasticity. Based on the reviewed studies, an intermittent mode of whole-body vibration (frequency: 10-50 Hz; amplitude: 0.6-4 mm) is less likely to cause adverse events when applying to spinal cord injury subjects standing on platform (knees flexed at 10°-40°). CONCLUSIONS: The strength of evidence is insufficient in supporting the benefits of whole-body vibration on neuromuscular performance in individuals with spinal cord injury. The intermittent vibration (frequency: 10-50 Hz; amplitude: 0.6-4 mm; knee flexion: 10°-40°) may be the possible effective range and have good compliance.

Extracorporeal shockwave therapy as a novel and potential treatment for degenerative cartilage and bone disease: Osteoarthritis. A qualitative analysis of the literature.

Osteoarthritis (OA) is characterized with pathological changes on articular cartilage and subchondral bone, with clinical symptoms of pain and motor dysfunction in affected joints. A growing number of investigations demonstrated the therapeutic effects of extracorporeal shockwave therapy (ESWT) on joints with OA. While the partial mechanisms of action are based on cellular mechanotransduction through cytoskeleton into nuclei to regulate gene expression and cause biophysical influences, the efficacy and exact mechanisms are still under exploration. At present, a summary of the evidence regarding effectiveness of ESWT on OA is not available. The purpose of this review is thus to offer an overview of ESWT in the management of OA in the aspects of cartilage, subchondral bone, pain sensation and motor function, in hopes of eliciting further multi-disciplinary scientific investigations into this promising application as an adjunct to other modalities or surgery. The optimal frequencies, impulses, energy intensity and protocols of ESWT in the management of OA continue to be elucidated. Further studies are required to reveal its exact mechanisms and biophysical effects on cells, animals and humans prior to the clinical application.

Extracorporeal shockwave therapy promotes chondrogenesis in cartilage tissue engineering: A hypothesis based on previous evidence.

The dearth of intrinsic regenerative capacity of articular cartilage makes it a challenge to deal with the cartilage defects. Among all the recommended clinical options, cartilage tissue engineering (CTE) which is highlighted of dominant features and less drawbacks for functional cartilage restoration, has been emphasized recently. Shock waves, a mode of therapeutic mechanical forces, utilized in extracorporeal shockwave therapy (ESWT), is hypothesized to enhance proliferation, chondrogenic differentiation, and cartilage extracellular matrix production of target cells seeded on bioactive scaffolds. The hypothesis is firstly based on cellular mechanotransduction by which cells convent the shockwave mechanical signals into biochemical responses via integrins, iron channels, cytoskeletal filaments, growth factor receptors and nuclei. Secondly, by modulating gene expression and up-regulating the release of various growth factors which are of vital importance in three-dimensional cartilage culture environment, ESWT holds a promising potential to favor the cell sources (e.g. chondrocytes and stem cells) to mimic the optimal functional cartilage. In all, on the basis of cellular mechanotransduction and previous evidence, the hypothesis is developed to support the beneficial effects of ESWT on chondrogenesis in CTE. If this hypothesis is confirmed, shockwaves may allow a better success in combination with other stimulating factors for cartilage repair. There is a paucity of studies investigating the assistant role of shockwave stimulation in CTE. Further research is required to elucidate the mechanisms, and explore effectiveness and appropriate protocols of this novel stimulative factor in cartilage tissue engineering.

Effects of therapeutic ultrasound on pain, physical functions and safety outcomes in patients with knee osteoarthritis: a systematic review and meta-analysis.

OBJECTIVE: To explore the effects of therapeutic ultrasound with sham or no intervention on pain, physical function and safety outcomes in patients with knee osteoarthritis. DATA SOURCES: This systematic review was searched on CENTRAL, EMBASE, MEDLINE, CINAHL, Physiotherapy Evidence Database, Open Gray on 4 September 2015. Trials included randomized controlled trials that compared therapeutic ultrasound with a sham or no intervention in patients with osteoarthritis of the knee. REVIEW METHODS: Eligible trials and extracted data were identified by two independent investigators. Standardized mean differences (SMDs) and 95% confidence interval (CI) were calculated for pain and physical function outcomes. Heterogeneity was assessed by the I2 test and inverse-variance random-effects analysis was applied to all trials. RESULTS: Ten randomized controlled trials (645 patients) met the inclusion criteria. Therapeutic ultrasound showed a positive effect on pain (SMD = -0.93, 95%, CI = -1.22 to -0.64, p < 0.01, p for heterogeneity = 0.12, I2 = 42%). For physical function, therapeutic ultrasound was advantageous for reducingWestern Ontario and McMaster Universities physical function score (SMD = -0.37, 95% CI = -0.73 to -0.01, p = 0.04, p for heterogeneity = 0.94, I2 = 0%). In terms of safety, no occurrence of adverse events caused by therapeutic ultrasound was reported in any trial. CONCLUSION: The authors suggested that therapeutic ultrasound is beneficial for reducing knee pain and improving physical functions in patients with knee osteoarthritis and could be a safe treatment.

[Effect of Pulsed Electromagnetic Fields on Osteogenic Differentiation and Wnt/ß-catenin Signaling Pathway in Rat Bone Marrow Mesenchymal Stem Cells].

OBJECTIVE: To investigate the effect of pulsed electromagnetic tields (FEMFs) on osteogemc differentiation and Wnt/ß-catenin signaling pathway in rat bone marrow mesenchymal stem cells (BMSCs). METHODS: Rat BMSCs were isolated and the passage 3 cells were divided into 3 groups. Cells were cultured in LG-DMEM complete medium for 1 d to ensure fully adherent. Then, change the medium. Cells were maintained in complete medium (Control group) or in osteo-induction medium (OM group). The cells in PEMFs group were cultured in complete medium and exposed to 8 Hz, 3. 8 mT PEMF stimulation for 40 min/d. The intervention lasted for 21 d. Cell proliferation activity was determined by using MTT. The effects of PEMF onosteogenic differentiation were assessed by ALP and Alizarin Red S staining. Various osteoblast-relevant genes and genes of Wnt/ß-catenin signaling were analyzed by quantitative real-time RT-PCR. RESULTS: We. found that OM could significantly promote the proliferation of BMSC at 7 d, 14 d, 21 d (P<0. 05), but the effect was not obviously found in PEMFs group. For osteogenic differentiation, the positive rates of ALP or Alizarin Red S staining were detected higher in PEMFs/ OM group (P < 0. 05). Quantitative RT-PCR revealed PEMFs or OM could increase mRNA levels of Wnt1, Wnt3a, LRP5, ß-catenin, BMP-2, Runx2, ALP, OC at special time point (P<0. 05). Compared to OM group, PEMFs have a lower expression in each detection, but the trends were consistent. CONCLUSION: PEMFs (8 Hz, 3. 8 mT) could induce the osteogenic differentiation of rat BMSCs via activating Wnt/ß-catenin signaling pathway.

Effects of low-level laser therapy on joint pain, synovitis, anabolic, and catabolic factors in a progressive osteoarthritis rabbit model.

The aim of this study was to investigate the effect of low-level laser therapy (LLLT) on short-term and long-term joint pain, synovitis, anabolic, and catabolic factors in the cartilage of a rabbit model with progressive osteoarthritis (OA) induced by anterior cruciate ligament transection (ACLT). A total of 160 New Zealand white rabbits were randomly assigned into two groups (ACLT group and LLLT group). All rabbits received ACLT surgery, and 2-, 4-, 6-, and 8-week treatment after the surgery, with 20 rabbits being tested biweekly over every study period. The LLLT group received LLLT with a helium-neon (He-Ne) laser (830 nm) of 1.5 J/cm(2) three times per week, and the ACLT group received placebo LLLT with the equipment switched off. Long-term and short-term pain was tested via weight-bearing asymmetry; synovitis was assessed histologically; and knee joint cartilage was evaluated by gross morphology, histology, and gene expression analysis of anabolic and catabolic factors. The histological assessment of pain and synovitis showed that at least 6-week intermittent irradiation of LLLT could relief knee pain and control synovium inflammation. Gross morphologic inspection and histological evaluation showed that 6 weeks of LLLT could decrease cartilage damage of medical femoral condyle and 8 weeks of LLLT could decrease cartilage damage of medical and lateral femoral condyles and medical tibial plateau. Gene expression analysis revealed two results: At least 6 weeks of LLLT could decrease production of catabolic factors, for example, interleukin 1ß (IL-1ß), inducible nitric oxide synthase (iNOS), and MMP-3, and slow down the loss of anabolic factors, mainly TIMP-1. Eight weeks of LLLT treatment could slow down the loss of collagen II, aggrecan, and anabolic factors, mainly transforming growth factor beta (TGF-ß). The study suggests that LLLT plays a protective role against cartilage degradation and synovitis in rabbits with progressive OA by virtue of the regulation of catabolic and anabolic factors in the cartilage.

[Effects of whole body vibration on structural and functional remodeling of subchondral bones in rabbits with early osteoarthritis].

OBJECTIVE: To investigate the effects of whole body vibration therapy (WBVT) on structural and functional remodeling of subchondral bone in rabbits with early Osteoarthritis (OA). METHODS: Twenty-four adult rabbits received anterior cruciate ligament transaction (ACLT) to establish knee osteoarthritis model. The rabbits were randomly divided into two groups: ACLT group and WBVT+ ACLT group. The rabbits in the WBVT+ ACLT group received whole body vibration treatment (Frequency: 40 Hz; Amplitude: 2-4 mm; 40 min/d, 5 d/week, 4 weeks) two months after surgery. After interventions, the left femur and tibia of all rabbits were placed in a Micro-CT scanning system. The bone volume fraction (BVF), trabecular thickness (Tb. Th), trabecular spacing (Tb. Sp), trabecular number (Tb. N), volumetric BMD (vBMD), and tissue BMD (tBMD) of the bones of femoral condyle and tibia were analysed using three-dimensional reconstruction Micview V2.1.2 and ABA analysis software. Geomagic Studio 11.0 software were used to calculate modulus (EM), reaction force (RF) and average Von Miss stress (VMF). RESULTS: Higher levels of BVF, Tb. N, Tb. Th, EM, RF, VMF, vBMD and tBMD and lower levels of Tb. Sp were found in distal femora and tibia of the rabbits in the WBVT+ACLT group compared with the controls (P < 0.05). CONCLUSION: WBVT can effectively improve bone microstructure and mechanical properties of rabbits with early knee osteoarthritis.