Combined regenerative rehabilitation improves recovery following volumetric muscle loss injury in a rat model.

Volumetric muscle loss (VML) injury causes irreversible deficits in muscle mass and function, often resulting in permanent disability. The current standard of care is physical therapy, but it is limited in mitigating functional deficits. We have previously optimized a rehabilitation technique using electrically stimulated eccentric contraction training (EST) that improved muscle mass, strength, and size in VML-injured rats. A biosponge scaffold composed of extracellular matrix proteins has previously enhanced muscle function postVML. This study aimed to determine whether combining a regenerative therapy (i.e., biosponge) with a novel rehabilitation technique (i.e., EST) could enhance recovery in a rat model of VML. A VML defect was created by removing ~20% of muscle mass from the tibialis anterior muscle in adult male Lewis rats. Experimental groups included VML-injured rats treated with biosponge with EST or biosponge alone (n = 6/group). EST was implemented 2 weeks postinjury at 150 Hz and was continued for 4 weeks. A linear increase in eccentric torque over 4 weeks showed the adaptability of the VML-injured muscle to EST. Combining biosponge with EST improved peak isometric torque by ~52% compared with biosponge treatment alone at 6 weeks postinjury. Application of EST increased MyoD gene expression and the percentage of large (>2000 µm2) type 2B myofibers but reduced fibrotic tissue deposition in VML-injured muscles. Together, these changes may provide the basis for improved torque production. This study demonstrates the potential for combined regenerative and rehabilitative therapy to improve muscle recovery following VML.

Steroid myopathy and rehabilitation in patients with cancer.

Steroids are broadly used in oncology, despite known adverse events such as glucocorticosteroid-induced myopathy (SM). To date there are no accepted guidelines on the diagnosis and treatment of SM. The purpose of this review is to provide up-to-date information regarding SM with emphasis on neuro-oncology and hematopoietic stem cell transplant patients, given they are at high risk of experiencing SM following routine treatment with steroids. Our work is a combination of a comprehensive narrative review regarding etiology, pathogenesis, incidence, clinical presentation and treatment options for SM and a scoping review on exercise therapy for SM. We have identified 24 in vivo studies of different exercise modalities in the settings of glucocorticosteroid treatment. Twenty of 24 studies demonstrated decreased muscle catabolism with exercise training. Both endurance and resistance exercises at mild to moderate intensity were beneficial. The value of high-intensity activities remains questionable as it may worsen muscle atrophy. Rehabilitation interventions, along with pharmacologic and dietary considerations, may be beneficial in preventing or reversing SM. Potential adverse events of some of these interventions and expected caveats in translating findings in preclinical models to human settings warrant caution and demand controlled clinical studies.

Muscle injury and sports rehabilitation management in endurance training oriented to winter sports / Lesão muscular e gerenciamento da reabilitação esportiva no treinamento de resistência direcionado aos esportes de inverno / Gestión de las lesiones musculares y de la rehabilitación deportiva en el entrenamiento de resistencia dirigido a los deportes de invierno

ABSTRACT Introduction: Muscle injury in ski sports training has gradually increased, greatly impairing performance in ice and snow sports competitions. Objective: To study muscle injury and muscle movement during ice and snow sports training and the rehabilitation of muscle injuries. Methods: Thirty skiers with knee muscle injuries were selected as subjects and underwent rehabilitation training for six weeks, and the indicators were statistically evaluated. Results: The ski injuries were mainly muscle strain, muscle or ligament strain, and ligament rupture. The indices after treatment were significantly different from those before treatment (P < 0.05); compared with the three rehabilitation programs, the improvement of each index in group C was significantly different from that in the other two groups (P < 0.05), while there was no significant difference in the improvement of each index between the multi-angle isometric training treatment in group A and the proprioceptive neuromuscular stimulation technique in group B (P>0.05). Conclusion: The influence of recovery training technology on knee muscle re-education was proposed, and a rehabilitation plan for skiing was presented. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: O quadro de lesão muscular no treinamento esportivo de esqui tem aumentado gradualmente, prejudicando muito o desempenho das competições esportivas de gelo e neve. Objetivo: Estudar a lesão muscular e o movimento muscular durante o treinamento esportivo no gelo e na neve, bem como a reabilitação das lesões musculares. Métodos: Trinta esquiadores com lesão muscular no joelho foram selecionados como sujeitos e submetidos a treinamento de reabilitação por um total de 6 semanas, tendo os indicadores sido avaliados estatisticamente. Resultados: Os tipos de lesões no esqui foram principalmente tensão muscular, tensão muscular ou ligamentar e ruptura ligamentar. Os índices após o tratamento foram significativamente diferentes daqueles antes do tratamento (P < 0,05); comparado com os três programas de reabilitação, a melhora de cada índice no grupo C foi significativamente diferente da dos outros dois grupos (P < 0,05), enquanto não houve diferença significativa na melhora de cada índice entre o tratamento de treinamento isométrico multiangular no grupo A e a técnica de estimulação neuromuscular proprioceptiva no grupo B (P>0,05). Conclusão: A influência da tecnologia de treinamento de recuperação na reeducação muscular do joelho foi proposta, e foi apresentado um plano de reabilitação para a prática de esqui. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: El cuadro de lesiones musculares en el entrenamiento de los deportes de esquí ha ido aumentando progresivamente, lo que perjudica en gran medida el rendimiento en las competiciones de deportes de hielo y nieve. Objetivo: Estudiar las lesiones musculares y el movimiento muscular durante el entrenamiento de los deportes de hielo y nieve, así como la rehabilitación de las lesiones musculares. Métodos: Se seleccionaron como sujetos treinta esquiadores con lesiones musculares en la rodilla y se sometieron a un entrenamiento de rehabilitación durante un total de 6 semanas, y se evaluaron estadísticamente los indicadores. Resultados: Los tipos de lesiones de esquí fueron principalmente la distensión muscular, la distensión muscular o de ligamentos y la rotura de ligamentos. Los índices después del tratamiento fueron significativamente diferentes de los anteriores (P < 0,05); en comparación con los tres programas de rehabilitación, la mejora de cada índice en el grupo C fue significativamente diferente de la de los otros dos grupos (P < 0,05), mientras que no hubo diferencias significativas en la mejora de cada índice entre el tratamiento de entrenamiento isométrico multiángulo en el grupo A y la técnica de estimulación neuromuscular propioceptiva en el grupo B (P>0,05). Conclusión: Se propuso la influencia de la tecnología de entrenamiento de recuperación en la reeducación muscular de la rodilla y se presentó un plan de rehabilitación para el esquí. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Guidelines of the Brazilian Society of Rheumatology for the treatment of systemic autoimmune myopathies

Abstract Background: Recommendations of the Myopathy Committee of the Brazilian Society of Rheumatology for the management and therapy of systemic autoimmune myopathies (SAM). Main body: The review of the literature was done in the search for the Medline (PubMed), Embase and Cochrane databases including studies published until June 2018. The Prisma was used for the systematic review and the articles were evaluated according to the levels of Oxford evidence. Ten recommendations were developed addressing the management and therapy of systemic autoimmune myopathies. Conclusions: Robust data to guide the therapeutic process are scarce. Although not proven effective in controlled clinical trials, glucocorticoid represents first-line drugs in the treatment of SAM. Intravenous immunoglobulin is considered in induction for refractory cases of SAM or when immunosuppressive drugs are contra-indicated. Consideration should be given to the early introduction of immunosuppressive drugs. There is no specific period determined for the suspension of glucocorticoid and immunosuppressive drugs when individually evaluating patients with SAM. A key component for treatment in an early rehabilitation program is the inclusion of strengthbuilding and aerobic exercises, in addition to a rigorous evaluation of these activities for remission of disease and the education of the patient and his/her caregivers.

Incidencia de lesiones deportivas en un equipo de futbol profesional / Sports injury incidence in a professional soccer team

Se evaluaron 267 jugadores de futbol profesional del Monagas Sport Club de Primera División, durante cinco temporadas (diez torneos cortos), comprendidas entre 2005 y 2010. Se estudiaron las diversas lesiones producidas en este deporte. El promedio de edad de los jugadores correspondió a 24,64 años, oscilando las edades entre 16 y 36 años. En las cinco temporadas de estudio, las horas de exposición fueron 3136 horas de partidos y 70689 horas de entrenamientos. La incidenciade lesiones encontradas en este estudio fue de 3,81 por cada 1000 horas de exposición por jugador. Las lesiones musculares representaron el mayor porcentaje 41,1%, siendo la extremidad inferior mayormente afectada. La mayoría de las lesiones ocurrieron durante el entrenamiento, siendo la defensa la más susceptible a presentar una lesión 41,1%. Se destaca la diferencia entre lesión aguda y por sobrecarga; se agruparon de acuerdo a su severidad en cuatro grupos, manteniendo la prevalencia las lesiones moderadas (grado II) 58,6%. El tratamiento médico prevalece sobre el quirúrgico. De acuerdo a las condiciones deportivas del grupo estudiadojunto a los resultados obtenidos de este estudio, se establecen conclusiones que servirán para regir directivasen el campo de la prevención de lesiones.

267 professional soccer players of Monagas Sport Club First Division were evaluated, for five seasons between (ten short tournament) 2005 and 2010. We studied the different injuries that take place in this sport. The averageage of players was 24.64 years, ranging between the ages of 16 and 36 years. In the five seasons of study, exposure times were 3136 hours of games and 70,689 hours of training. The incidence of lesions found in this study was 3.81 per 1000 hours of exposure per player. Muscle injury represented the highest percentage 41.1%, being the most affected the lower extremity. Most injuries occurred during training, the defense being the most susceptible to a lesion 41.1%. It highlights the difference between acute and overuse injuries were grouped according to their severity into four groups, keeping the prevalence of moderate injuries (grade II) 58.6%. The medical treatment outweighs the surgery. According to the conditions of the studied group, with the results of this study, findings will set guidelines to govern in the field of injury prevention.

Torcicolo muscular congênito: resultado do tratamento cirúrgico / Congenital torticollis: results of surgical management

Sao apresentados três casos de uma mesma família. portadores de osteólise idiopática com padrao de herança do tipo dominante autossômico e expressividade variável. Fazem-se comentários sobre os vários tipos de osteólises conhecidos e de outras afecçoes do esqueleto que devem entrar no diganóstico diferencial. Um dos pacientes. devido à gravidade do acomentimento nos quadris, necessitou de ressecçao das cabeças femorais. É descrito o resultado anatomopatológico das peças removidas.

Lesoes osteomioarticulares no programa de condicionamento fisico / Musculoskeletal injuries in a physical conditioning program

A partir do acompanhamento de cento e trinta pacientes em programa de condicionamento fisico durante o periodo de um ano, observou-se lesoes parcialmente incapacitantes com queixas clinicas preliminares ao inicio do programa em treze pacientes, e intercorrencias durante o desenvolvimento do mesmo em dezenove pacientes. No primeiro grupo, quatro pacientes foram afastados do programa, dois temporariamente e dois definitivamente. No segundo grupo, cinco pacientes tiveram programa interrompido por periodos que variaram de vinte dias a dois meses. Em ambos os grupos foram propostas medidas terapeuticas envolvendo o uso de meios fisicos, cinesioterapia e medicamentos. Ausencias no programa de condicionamento fisico por periodos superiores a tres semanas provocam perdas expressivas dos beneficios cardiovasculares. O medico clinico deve estar atento ao fato de que pacientes sedentarios do ponto de vista cardiovascular tambem o sao do ponto de vista mioarticular. A consulta fisiatrica deve ser incluida na avaliacao destes pacientes visando prevenir e/ou tratar as lesoes incapacitantes.

Miopatia centronuclear (miotubular): relato de caso / Centronuclear myopathy (myotubular): a case report

Os autores apresentam o caso de uma menina de cinco meses de idade com retardo acentuado do desenvolvimento neuromotor, tetraparesia flacida, hiporreflexia e semiptose palpebral bilateral, cuja biopsia muscular demonstrou grande numero de fibras com nucleos centrais, permitindo o diagnostico de miopatia centronuclear (miotubular). Sao analisadas e discutidas a dificuldade de caracterizacao histologica e a variabilidade do quadro clinico deste tipo de miopatia que admite formas de diferente gravidade.

Distrofia muscular progresiva: a propósito de un caso clínico de miopatía tipo Duchenne / Progressive muscular dystrophy: to purpose of a clinic case of Duchenne myophaty

Reportamos el caso de un niño de 8 años de edad, con un cuadro de déficit motor de 2 años de evolución. Al exámen se encontró una disminución de la fuerza muscular a predominio de los miembros inferiores, marcha parapética. Se planteó el diagnóstico de Distrofia Muscular Tipo Duchenne, el cual fue confirmado con los exámenes auxiliares practicados