High-energy dose of therapeutic ultrasound in the treatment of patellar tendinopathy: protocol of a randomized placebo-controlled clinical trial.

BACKGROUND: Patellar tendinopathy is an extremely debilitating condition and its treatment usually requires a combination of clinical approaches. Therapeutic ultrasound (TUS) is one of the most available electrophysical agent in rehabilitation settings; however, there is also a lack of high-quality studies that test different dosimetric aspects of TUS. Thus, the purpose of this study is to evaluate the short-, medium-, and long-term effects of the combination of high-energy TUS with a rehabilitation program for patellar tendinopathy. METHODS: This will be a randomized, placebo-controlled trial with blinding of patients, assessors, and therapist. The setting is an outpatient physical therapy clinic. We will recruit 66 participants (male and female) aged between 18 and 40 years and presenting with patellar tendinopathy. A treatment combining high-energy dose TUS and a rehabilitation program for patellar tendinopathy will be delivered twice a week for 8 weeks. The control group will receive the same treatment, but with a placebo TUS. The effectiveness of the intervention will be measured at the beginning (baseline), midpoint (4 weeks), and end of treatment (8 weeks), as well as at 3- and 6-months post-treatment. Primary outcomes will be pain intensity (visual analogue scale, VAS), and VISA-P questionnaire and primary time points will be baseline (T0) and the end of the program (T2). Also, IPAQ-short form questionnaire, muscle strength (manual dynamometry), 2D kinematics, pain pressure threshold (PPT) algometry, thermography, and magnetic resonance imaging (MRI) will be collected. DISCUSSION: TUS will be applied in an attempt to enhance the results obtained with the rehabilitation program proposed in this study, as well as stimulate some repair responses in individuals undergoing treatment for patellar tendinopathy, which in turn may optimize and improve treatment programs for patellar tendinopathy as well as to establish new guidelines for the application of TUS. TRIAL REGISTRATION: This study was prospectively registered at April-3rd-2018 and updated at September-1st-2019 in the Brazilian Registry of Clinical Trials (REBEC) under the registration number: RBR-658n6w.

Low-level laser therapy in IL-1ß, COX-2, and PGE2 modulation in partially injured Achilles tendon.

This study evaluated IL-1ß, COX-2, and PGE2 modulation in partially injured Achilles tendons treated with low-level laser therapy (LLLT). Sixty-five male Wistar rats were used. Sixty were submitted to a direct injury on Achilles tendon and then distributed into six groups: LASER 1 (a single LLLT application), LASER 3 (three LLLT applications), and LASER 7 (seven LLLT applications) and Sham 1, 3, and 7 (the same injury but LLLT applications were simulated). The five remaining animals were allocated at control group (no procedure performed). LLLT (780 nm) was applied with 70 mW of mean power and 17.5 J/cm(2) of fluency for 10 s, once a day. The tendons were surgically removed and assessed immunohistochemically for IL-1ß, COX-2, and PGE2. In comparisons with control (IL-1ß: 100.5 ± 92.5 / COX-2: 180.1 ± 97.1 / PGE2: 187.8 ± 128.8) IL-1ß exhibited (mean ± SD) near-normal level (p > 0.05) at LASER 3 (142.0 ± 162.4). COX-2 and PGE2 exhibited near-normal levels (p > 0.05) at LASER 3 (COX-2: 176.9 ± 75.4 / PGE2: 297.2 ± 259.6) and LASER 7 (COX-2: 259.2 ± 190.4 / PGE2: 587.1 ± 409.7). LLLT decreased Achilles tendon's inflammatory process.

Infrared low-level diode laser on serum chemokine MCP-1 modulation in mice.

The effect of the low-level laser therapy (LLLT) in the modulation of cells related to inflammatory processes has been widely studied, with different parameters. The objective was to investigate the immediate and cumulative effect of infrared LLLT on chemokine monocyte chemotactic protein-1 (MCP-1) modulation in mice. Fifty-two isogenic mice were distributed in seven groups: control (n = 10, no surgical procedure), laser I (n = 7, surgical procedure and a single LLLT exposure 12 h after the surgery), laser II (n = 7, surgery followed by two LLLT exposures, 12 and 36 h after surgery), and laser III (n = 7, surgery followed by three LLLT exposures, 12, 36, and 60 h after surgery). For each group, a sham group (n = 21) underwent surgery without laser application. The animals in the laser groups received an infrared diode continuous laser exposure (AsGaAl, 780 nm wavelength, power of 20 mW, energy density of 10 J/cm(2), spot size of 0,04 cm(2)) on three points (20 s per point), and a final energy of 0.4 J. The animals were sacrificed 36 h (laser I and sham I groups), 60 h (laser II and sham II), and 84 h (laser III and sham III groups) after surgery. The MCP-1 concentrations were measured by cytometric bead array. There was no significant difference between the three periods in the sham group (p = 0.3). There was a lower concentration of MCP-1 in the laser III group compared to the laser I group (p = 0.05). The infrared LLLT showed a cumulative effect in the modulation of chemokine MCP-1 concentration. Three LLLT exposures were necessary to achieve the MCP-1 modulation.

THE EFFECTS OF VARIED TENSIONS OF KINESIOLOGY TAPING ON QUADRICEPS STRENGTH AND LOWER LIMB FUNCTION.

BACKGROUND: Kinesiology Taping (KT) may promote changes in muscle strength and motor performance, topics of great interest in the sports-medicine sciences. These characteristics are purported to be associated with the tension generated by the KT on the skin. However, the most suitable tension for the attainment of these strength and performance effects has not yet been confirmed. HYPOTHESIS/PURPOSE: The purpose of the present study was to analyze the effects of different tensions of KT on the isometric contraction of the quadriceps and lower limb function of healthy individuals over a period of seven days. STUDY DESIGN: Blind, randomized, clinical trial. METHODS: One hundred and thirty healthy individuals were distributed into the following five groups: control (without KT); KT0 (KT without tension); KT50; KT75 and KT100 (approximately 50%, 75% and 100% tension applied to the tape, respectively). Assessments of isometric quadriceps strength were conducted using a hand held dynamometer. Lower limb function was assessed through Single Hop Test for Distance, with five measurement periods: baseline; immediately after KT application; three days after KT; five days after KT; and 72h after KT removal (follow-up). RESULTS: There were no statistically significant differences (p > 0.05) at any of the studied periods on participants' quadriceps strength nor in the function of the lower dominant limb, based on comparisons between the control group and the experimental groups. CONCLUSION: KT applied with different tensions did not produce modulations, in short or long-term, on quadriceps' strength or lower limb function of healthy individuals. Therefore, this type of KT application, when seeking these objectives, should be reconsidered. LEVEL OF EVIDENCE: 1b.

Low-Level Laser Therapy (780 nm) on VEGF Modulation at Partially Injured Achilles Tendon.

OBJECTIVE: The aim of this study was to analyze the modulatory effects of near infrared (780 nm) low-level laser therapy (LLLT) on the presence of the vascular endothelial growth factor (VEGF) in the partially injured Achilles tendons of rats. BACKGROUND: LLLT stimulates the healing process for Achilles tendon injuries, although the extent of the modulatory effect of LLLT on the VEGF levels found in the injured tendons remains unclear. METHODS: Sixty-five male Wistar rats were distributed in the following seven groups: LASER 1, 3, and 7 (10 partially injured Achilles tendons in each group, which were treated with LLLT for 1, 3, and 7 days, respectively); Sham 1, 3, and 7 (same injury, with simulated LLLT); Control group containing the five remaining animals and in which no procedures were performed. LLLT was applied once a day for 10 sec, with a mean power of 70 mW and fluency of 17.5 J/cm(2). After euthanasia, all of the Achilles tendons were surgically removed and the VEGF levels were analyzed using immunohistochemistry. RESULTS: The VEGF levels remained close to normal (p > 0.05) when comparing the experimental groups (LASER and Sham: 1, 3, and 7) with the Control group. CONCLUSION: LLLT did not stimulate the expression of VEGF in the treated Achilles tendons.

Low-level laser therapy on tissue repair of partially injured achilles tendon in rats.

OBJECTIVE: The aim of this study was to assess the alignment and type of collagen (I and III) in partially injured Achilles tendons of rats treated with low-level laser therapy (LLLT). BACKGROUND: Achilles tendons present high indices of injury and their regeneration process may take a long time. LLLT has been used to accelerate and enhance injured Achilles tendon repair. METHODS: Sixty-five male Wistar rats were distributed into seven groups: LASER 1, 3, and 7 (the rat's Achilles tendons were partially injured and submitted to treatment for 1, 3, or 7 days, respectively); a Sham group 1, 3, and 7 for each of LASER group (same injury, but the LLLT was only simulated), and five remaining animals were allocated to the control group (no procedures were performed). The 780 nm LLLT was applied once a day, with 70 mW of mean power, fluence of 17.5 J/cm(2) for 10 sec. After the rats were euthanized, the tendons were surgically removed and assessed by birefringence technique (collagen alignment) and picrosirius red (collagen I and III). RESULTS: Sham versus LASER analysis did not show differences (p>0.05) for collagen alignment. The collagen composition (median) was significantly different (p<0.05) for LASER 3 (I: 16.5; III: 83.5) versus Sham 3 (I: 12.5; III: 87.5) and LASER 7 (I: 20.2; III: 79.8) versus Sham 7 (I: 10.2; III: 89.8). LASER groups exhibited a higher percentage of type I collagen and a lower percentage of type III collagen. CONCLUSIONS: LLLT stimulated collagen I proliferation, improving the injured Achilles tendons' healing process.