Erratum: Petrofsky, J., et al. Greater Postural Sway and Tremor during Balance Tasks in Patients with Plantar Fasciitis Compared to Age-Matched Controls. Healthcare 2020, 8, 219.

Some details of the author affiliations should be corrected in the article [...].

Greater Postural Sway and Tremor during Balance Tasks in Patients with Plantar Fasciitis Compared to Age-Matched Controls.

Plantar fasciitis (PF) is a common condition found in men and women and can reoccur throughout life. PF is commonly diagnosed by prolonged foot pain lasting more than 3 months and a plantar fascia over 0.4 mm thick, as measured using ultrasound imaging. This study examined the ability to balance and the occurrence of muscle tremor during different balance tasks in patients with PF compared to their control counterparts. Fifty subjects (25 patients with PF and 25 control subjects) participated in this study. Subjective pain (measured with a visual analog scale (VAS)), pressure pain threshold (PPT), and postural sway and tremor during eight different balance tasks were measured. Postural sway was measured by a balance platform, while tremor was measured as the mechanical movement of the platform in the 8 Hz frequency range. Thickness of plantar fascia, subjective pain, and PPT were significantly greater in the PF group compared to the controls (p < 0.001). Postural sway and 8 Hz tremor were significantly greater in the PF group compared to the control group for all eight balance tasks (p < 0.01). These results indicate that the lack of plantar fascia elasticity is probably the cause of the reduced balance and increased muscle tremor.

Local heating of trigger points reduces neck and plantar fascia pain.

BACKGROUND: Heating the skin and muscles is a commonly accepted method of pain relief and a modality to increase relaxation in muscles and increase tissue blood flow. OBJECTIVE: The purpose of the present study was to examine the effect of local heat applied to trigger points and to determine if there was pain relief in the neck and plantar fascia. METHODS: Forty adults were divided into 2 different groups according to their pain; twenty subjects had plantar foot pain and the other 20 had nonspecific neck pain. The 20 subjects in each group were randomly subdivided into a heat and a sham group. Sensitivity to pressure was measured with an algometer. A stopwatch was given to the subject and started when either the heat patch or placebo was applied. Heat cells were applied at trigger points on the pain area. RESULTS: Subjective pain significantly decreased in both sham and heat group patients with neck pain (p< 0.05), however, the change was greater in the heat group and there was a significant difference between the heat and sham groups (p= 0.002, d= 0.81). For the plantar pain group, a significant decrease in subjective pain was found in the heat group but not in the sham group. Pressure pain threshold significantly decreased in the heat group patients both with neck and plantar pain but for the sham group there was an increase in the pressure after sham treatment. Pain relief during the intervention was also significantly different between the heat and sham group in both patients with neck and plantar pain. CONCLUSION: The effect of local heat on trigger points of the body on pain relief was significantly better in the heat groups than in the sham groups. This finding is significant because using heat on trigger points could be an alternative to dry needling performed by healthcare professionals. This modality can be alternative for home use and avoids opioids.

The influence of ageing and diabetic peripheral neuropathy on posture sway, tremor, and the time to achieve balance equilibrium.

BACKGROUND: It is well recognized that ageing and diabetes are associated with reduced balance and impaired gait. However, one important factor may be not just balance, but how long it takes to achieve balance equilibrium after a balance challenge. This study examined the relationship between balance, tremor, and time to achieve balance after a challenge to stability in young and old individuals without and without diabetes. METHODS: Twenty-four of the subjects were young controls, 22 were older controls, 23 were individuals with diabetes, and 21 were young people with diabetes. Posture sway, tremor, and time to achieve stability were assessed on a force plate during 8 progressively challenging balance tasks. RESULTS: For postural sway, tremor and time to reach postural stability, there was a significant difference in all groups with the increased balance challenge of the 8 tests (P<0.01). However, ageing and diabetes made balance, tremor and time to reach stability worse. In general, the young group with diabetes, for example, had similar responses to the old group without diabetes. CONCLUSIONS: In the subjects with diabetes, balance was poorer than the non-diabetes groups. The young subjects with diabetes showed similar results to the older subjects without diabetes. Diabetes subjects had more muscle tremor and a slower response time of the body to a balance challenge. This may account for increased falls in individuals with diabetes.

Use of low level of continuous heat and Ibuprofen as an adjunct to physical therapy improves pain relief, range of motion and the compliance for home exercise in patients with nonspecific neck pain: A randomized controlled trial.

BACKGROUND: It has been well documented at heat reduces pain and increases healing by increasing blood flow in tissue. OBJECTIVE: The purpose of this study was to see if the use of low level continuous heat (LLCH) and Ibuprofen used as a home therapy between physical therapy sessions at a clinic resulted in better therapy outcomes in people with chronic neck pain. METHODS: Ninety-two patients with chronic nonspecific neck pain were randomly divided into 4 groups; LLCH group, LLCH with Ibuprofen (IP) group, sham LLCH with sham IP group, and controls. All subjects underwent 45 minutes of conventional physical therapy twice a week for 2 weeks. the neck disability index (NDI), subjective pain, range of motion (ROM), strength of the neck, and home exercise compliance were measured. RESULTS: Both LLCH and IP significantly reduced pain and NDI score, and increased ROM (p< 0.01). Home exercise compliance in LLCH and LLCH with IP group was significantly higher than the placebo and control groups (p < 0.05). CONCUSION: The use of LLCH alone and LLCH with IP as an adjunct to conventional physical therapy for chronic neck pain significantly improved pain attenuation and it causes greater compliance for home.

The Efficacy of Sustained Heat Treatment on Delayed-Onset Muscle Soreness.

OBJECTIVE: To assess the impact of heat applied for 8 hours immediately after or 24 hours after exercise on delayed-onset muscle soreness (DOMS) in large skeletal muscle groups measured by subjective and objective means. DESIGN: Cross-sectional repeated measure design study. SETTING: Research laboratory. SUBJECTS: Three groups of 20 subjects, age range 20 to 40 years. INTERVENTION: Squats were conducted in three 5-minute bouts to initiate DOMS; 3 minutes of rest separated the bouts. One group had heat applied immediately after exercise, and a second group had heat applied 24 hours after exercise. A third group was the control group where no heat was applied. MAIN OUTCOME MEASURES: Visual analog pain scales, muscle strength of quads, range of motion of quads, stiffness of quads (Continuous Passive Motion machine), algometer to measure quadriceps soreness, and blood myoglobin. RESULTS: The most significant outcome was a reduction in soreness in the group that had low-temperature heat wraps applied immediately after exercise (P < 0.01). There was benefit to applying heat 24 hours after exercise, but to a smaller extent. This was corroborated by myoglobin, algometer, and stiffness data. CONCLUSIONS: Low-level continuous heat wraps left for 8 hours just after heavy exercise reduced DOMS in the population tested as assessed by subjective and objective measures. CLINICAL RELEVANCE: Although cold is commonly used after heavy exercise to reduce soreness, heat applied just after exercise seems very effective in reducing soreness. Unlike cold, it increases flexibility of tissue and tissue blood flow. For joint, it is still probably better to use cold to reduce swelling.

Use of Low Level of Continuous Heat as an Adjunct to Physical Therapy Improves Knee Pain Recovery and the Compliance for Home Exercise in Patients With Chronic Knee Pain: A Randomized Controlled Trial.

Petrofsky, JS, Laymon, MS, Alshammari, FS, and Lee, H. Use of low level of continuous heat as an adjunct to physical therapy improves knee pain recovery and the compliance for home exercise in patients with chronic knee pain: a randomized controlled trial. J Strength Cond Res 30(11): 3107-3115, 2016-This study examined if the use of low level continuous heat (LLCH) wraps at home between physical therapy sessions at a clinic resulted in better therapy outcomes in patients with chronic knee pain. Fifty individuals with chronic nonspecific knee pain was randomly allocated to 2 groups: the LLCH group and the placebo group. All subjects underwent 1 hour of conventional physical therapy twice per week for 2 weeks at the outpatient clinic and they were asked to accomplish 1 hour of therapeutic exercise at home each day between sessions. The LLCH group applied LLCH knee wraps for 6 hours at home before home exercise while placebo group took a placebo ibuprofen. (This was done since placebo heat is impossible to use since subjects would notice that the wraps were cold) Before, during, and after intervention, pain intensity, active range of motion of the knee (AROM), knee strength, and home exercise compliance were measured. The LLCH group showed pain attenuation after 2 weeks of therapy sessions (p ≤ 0.05). AROM and strength of the knee significantly improved over time compared to the placebo group. Home exercise compliance was significantly higher in the LLCH group than placebo group (p ≤ 0.05). These results indicated that the use of LLCH as an adjunct to conventional physical therapy for chronic knee pain significantly improved pain attenuation and recovery of strength and movement in patients with chronic knee pain.

Effect of ThermaCare HeatWraps and Icy Hot Cream/Patches on Skin and Quadriceps Muscle Temperature and Blood Flow.

OBJECTIVES: The purpose of this study was to compare the effects of over-the-counter treatments-ThermaCare HeatWraps (chemical reaction to produce heat above the skin), Icy Hot Patch, and Icy Hot Cream (topically applied menthol)-on skin and deep tissue temperature. METHODS: This was a longitudinal crossover study. On each of 3 days, a ThermaCare HeatWrap, Icy Hot Cream, or Icy Hot Patch was applied randomly over the quadriceps muscle in 15 healthy volunteers with normal body mass. Skin and muscle temperature and blood flow were measured by laser flowmetry every 15 minutes for 2 hours. RESULTS: After 2 hours, mean temperature decreased by 2.1°C (7.0%; P = .02) in skin and 1.0°C (2.9%; P = .01) in muscle with Icy Hot Cream. Icy Hot Patch decreased skin and muscle temperature by 1.7°C (5.4%; P = .03) and 1.3°C (3.8%; P = .01), respectively. In contrast, ThermaCare raised skin and muscle temperature by 7.8°C (25.8%; P = .001) and 2.7°C (7.7%; P = .002), respectively; both were significantly warmer with ThermaCare vs either Icy Hot product (all P < .007). Icy Hot products produced a net decrease in skin blood flow (Cream: 56.7 flux [39.3%; P = .003]; Patch: 19.1 flux [16.7%; P = .045]). Muscle blood flow decreased with the Patch (6.7 flux [7.0%; P = .02]). After a period of fluctuations, Icy Hot Cream produced a net increase vs baseline of 7.0 flux (16.9%; P = .02). ThermaCare more than doubled blood flow in skin (83.3 flux [109.7%; P = .0003]) and muscle (25.1 flux [148.5%; P = .004]). CONCLUSIONS: In this group of 15 healthy volunteers, ThermaCare HeatWraps provided the greatest degree of tissue warming and increase in tissue blood flow.

Synergistic Effects of Continuous Low Level Heat Wraps and Vitamins in Improving Balance and Gait in Adults.

Ageing is associated with a loss of balance and mobility. This study was conducted to determine if the use of heat, vitamins alone or heat with vitamins could increase mobility and balance in adults with mobility impairments. Eighty adults in the age range between 55 and 64 were randomly divided into 4 different groups; low level continues heat (LLCH), vitamins (VT) alone, vitamins combined with heat (VT + H), and control group. Subjects were sedentary individuals that were not participating in any balance or walking exercises regularly and were not taking vitamins for at least 1 year. 4000 units vitamin D, 1000 units vitamin E, 300mg CoQ10, 600 mg Calcium, 1 tablet multivitamin were taken each day in the VT and VT + H groups. LLCH was applied with a dry chemical heat wrap, average temperature 42°C for 4 hours per day over the upper leg. The outcome was assessed through postural sway and tremor during standing, tremor, gait speed, symmetry, ground reaction force, and muscle activity during gait. All experimental groups showed significant improvement in balance and walking ability after 4 months of interventions (p < 0.05) but no significant changes were found in the control group. The difference between the control group and all other groups was significant (p < 0.05). The greatest improvements were found in VT + H group after 4 months. This is evidenced by better balance, less muscle tremor and faster and more stable gait, especially with the heat and vitamins used together. Heat and vitamins used together were synergistic.

Effect of monophasic pulsed current on heel pain and functional activities caused by plantar fasciitis.

BACKGROUND: Plantar fasciitis (PF) is a soft tissue disorder considered to be one of the most common causes of inferior heel pain. The aim of this study was to investigate the effect of monophasic pulsed current (MPC) and MPC coupled with plantar fascia-specific stretching exercises (SE) on the treatment of PF. MATERIAL AND METHODS: Forty-four participants (22 women and 22 men, with a mean age of 49 years) diagnosed with PF were randomly assigned to receive MPC (n=22) or MPC coupled with plantar fascia-specific SE (n=22). Prior to and after 4 weeks of treatment, participants underwent baseline evaluation; heel pain was evaluated using a visual analogue scale (VAS), heel tenderness threshold was quantified using a handheld pressure algometer (PA), and functional activities level was assessed using the Activities of Daily Living subscale of the Foot and Ankle Ability Measure (ADL/FAAM). RESULTS: Heel pain scores showed a significant reduction in both groups compared to baseline VAS scores (P<0.001). Heel tenderness improved significantly in both groups compared with baseline PA scores (P<0.001). Functional activity level improved significantly in both groups compared with baseline (ADL/FAAM) scores (P<0.001). However, no significant differences existed between the 2 treatment groups in all post-intervention outcome measures. CONCLUSIONS: This trial showed that MPC is useful in treating inferior heel symptoms caused by PF.

Effect of heat, cold, and pressure on the transverse carpal ligament and median nerve: a pilot study.

BACKGROUND: This study quantified the effects of heat, cold, and pressure on the median nerve and transverse carpal ligament in subjects without carpal tunnel syndrome. MATERIAL AND METHODS: Subjects were individuals ages 20-50 who had no symptoms of carpal tunnel disease. Imaging ultrasound was used to measure the clearance around the median nerve, transverse ligament elasticity, nerve conduction velocity, thickness of the carpal ligament, and area of the median nerve. Pressure was applied to the carpal ligament to assess the effects of increasing pressure on these structures. On 3 separate days, 10 subjects had ThermaCare heat or cold packs applied, for either 60 or 120 minutes for heat or 20 minutes for cold, to the palmer surface of the hand. RESULTS: Tissue changes were recorded as a response to pressure applied at 0, 5, 10, and 20 N. The size of the nerve and ligaments were not significantly altered by pressure with the hand at room temperature and after cold exposure. After heat, the nerve, ligaments, and tendons showed significantly more elasticity. CONCLUSIONS: Application of cold to the hand may reduce compression of the carpal ligament and nerve.

Tactile intervention as a novel technique in improving body stability in healthy elderly and elderly with diabetes.

BACKGROUND: Body sway increases in the elderly because of normal aging and high incidence of disease such as diabetes. Prevalence of sway is greater in the elderly with diabetes because of damage to the central and peripheral nervous systems. Increase in body sway is associated with an elevated risk of falling. Falling is one of the major causes of morbidity and mortality in the elderly. The purpose of this study was to develop a new technique to improve body stability and decrease body sway in the elderly people with or without diabetes. SUBJECTS AND METHODS: Twenty-two subjects--12 elderly (mean age, 75.5±7.3 years) and 10 age-matched elderly with diabetes (mean age, 72.5±5.3 years)--were recruited for this study. Subjects received tactile feedback as a tingling sensation resulting from electrical stimulation triggered by body sway. RESULTS: The results showed a significant reduction in body sway in the elderly while standing on foam with eyes open (1.0±0.31 vs. 1.9±0.8; P=0.006) and eyes closed (1.8±0.7 vs. 3.3±1.5; P=0.001). In the group with diabetes, there was a significant reduction in body sway while standing on foam with eyes closed (1.4±0.5 vs. 2.3±0.8; P=0.045) but not with eyes open. CONCLUSIONS: In this small study, this technique offers a new tool for training people with diabetes and elderly people to improve body stability and balance.

Differences in anterior cruciate ligament elasticity and force for knee flexion in women: oral contraceptive users versus non-oral contraceptive users.

Eighty-two percent of sexually active women aged 15-44 have used oral contraceptive pills (OCP) in the United States. The OCP, an exogenous source of synthetic forms of steroid hormones, prevents ovulation. Hormone changes during the menstrual cycle (MC) are believed to have an impact on anterior cruciate ligament (ACL) laxity due to estrogen. Because the estrogen receptor ß resides on human connective tissue, OCP may have potential impact on tendon and ligament synthesis, structure, and biomechanical properties. Temperature has also been known to have an effect on tissue elasticity. Therefore, the purpose of this study was to investigate the differences in ACL elasticity, force to flex the knee (FFK), and knee flexion-extension hysteresis (KFEH) between OCP users and non-OCP users. To investigate these changes, two different knee temperatures were measured. Nineteen young females were divided into two groups: OCP users and non-OCP users. Blood for estradiol serum concentration (E2) was taken before beginning the tests. ACL elasticity, FFK, and KFEH were assessed both at ambient temperature (22 °C) and after 38 °C warming of the leg to stabilize tissue temperature. Assessments were performed four times during the MC. Throughout the MC, ACL elasticity, FFK, and KFEH fluctuated in non-OCP users, but not in OCP users. At ambient temperature, ACL elasticity was significantly lower and FFK and KFEH were significantly higher in OCP users than non-OCP users (p < 0.05). But, no significant differences in FFK and KFEH between the two groups were found after warming to 38 °C.

A greater reduction of anterior cruciate ligament elasticity in women compared to men as a result of delayed onset muscle soreness.

Women have a higher risk for anterior cruciate ligament (ACL) injuries compared to men. ACL elasticity and muscle flexibility are major risk factors for knee injuries. The presence of estrogen receptors in connective tissue allows estrogen to change the mechanical properties of muscles and ligaments. Delayed onset muscle soreness (DOMS) happened when begin unaccustomed levels of exercise. Thus, the purpose of this study was to examine ACL elasticity after exercise meant to produce DOMS. As a measure of DOMS, visual analog pain scale and quadriceps strength were measured. One hundred forty healthy students (age: 25.2 ± 2.4 years, height: 165.9 ± 8.0 cm, weight: 62.5 ± 10.5 kg, BMI: 22.6 ± 3.1) participated in this investigation and were divided into two groups: men (n = 70) and women (n = 70). Visual analog pain scale, ACL elasticity, and quadriceps strength were measured before and after the intervention. Subjects participated in the same exercise to induce DOMS. To provoke DOMS, subjects accomplished squats for 5 minutes for 3 rounds. Greater ACL elasticity, greater pain on the subjective pain scale and less muscle strength were found (p < 0.001) in women compared to men before and after exercise. A greater reduction of ACL elasticity (p < 0.05) was found as a result of DOMS in women compared to men. Women are likely to have the damage to the ACL and recover slower compared to men after exercise. Thus, we suggest that women should have more time for musculoskeletal recovery after heavy exercise.

Effect of heat and cold on tendon flexibility and force to flex the human knee.

BACKGROUND: It is commonly believed in medicine that using heat will increase the distensability and flexibility of soft tissue. If true, increased flexibility would be a positive factor to reduce injuries in sports. However, cold should have the opposite effect and is often used to treat sports injuries. This study was accomplished to quantify the effect of heat and cold on the force needed to flex the knee and laxness of the anterior and posterior cruciate ligaments. MATERIAL AND METHODS: The present study examined 20 male and female subjects to determine if heat would increase extensibility of the anterior and posterior cruciate ligaments of the knee and reduce the force needed to flex the knee. Cold exposure was examined to see if it would have the opposite effect. There were 4 experiments in the series: The first was a room temperature series; the second was a series where cold was applied with an ice pack for 20 minutes; in the third, hydrocollator heat packs were applied for 20 minutes; and in the fourth, ThermaCare heat wraps were applied for 4 hours on the quadriceps and knee. Tendon extensibility was measured with a KT2000. The force for flexing the knee was measured by passive movement being applied (CPM) to the knee through 30° and the force required to move the leg was measured. RESULTS: The results show that the anterior and posterior cruciate ligament flexibility increased and the force needed to move the knee decreased with heat by about 25% compared to cold application. CONCLUSIONS: Heat is beneficial in increasing muscle and ligament flexibility and may help reduce athletic injuries, but cold treatment may have the opposite effect.

CoQ10 and endothelial function in Asians from Korea compared to Asians born in the United States and US born Caucasians.

BACKGROUND: The vascular endothelium is the interface between the blood and vascular smooth muscle in arteries. It is easily damaged by oxidative stress. Recent studies show that Asians are more susceptible than Caucasians to impairment of endothelial function. This study examined endothelial function in US-born Caucasians, Asians from Korea, and US-born Asians (almost all Korean decent) and examined the effect of coenzyme Q10 (CoQ10) on endothelial function. MATERIAL AND METHODS: Twenty Caucasians and 30 Asians participated (<35 years old, males and females). Endothelial function was assessed by the skin blood flow response to local heat using a thermode for 6 minutes at 44°C and by vascular occlusion for 4 minutes followed by release and measurement of skin blood flow for 2 minutes. In the US-born subjects, the experiments were repeated after 2-week administration of CoQ10 or a placebo. RESULTS: When applying 6 minutes of local heat at 44°C, the skin blood flows were significantly higher in Caucasians than both Asian groups Asians. Likewise after vascular occlusion, the blood flow response was greater in Caucasians compared to Asians. Asians born in Asia had the lowest response of the 3 groups of subjects. Administering CoQ10 for 2 weeks eliminated much of the difference between the groups, whereas there was no difference with a placebo. CONCLUSIONS: These findings suggest that Asians either born in Asia or the US may have lower endothelial function than Caucasians. This may be explained, in part, by genetic variations causing increased oxidative stress from westernized diets in Asians. Co enzyme Q10 administration narrows the difference between the groups.

Postural sway and rhythmic electroencephalography analysis of cortical activation during eight balance training tasks.

BACKGROUND: The purpose of this study was to investigate the changes in the Power Spectrum Density (PSD) of the electroencephalography (EEG) in common sensorimotor balance training tasks of varying difficulty. Sensorimotor balance exercises including alteration of vision, base of support or surface compliance are used to improve postural control. These exercises are presumed to induce supraspinal adaptation, however, there were no studies that investigated the power changes of the cortical activity in these static balance tasks. Our objective was to provide evidence in the cortical involvement with the static balance tasks frequently used in sensorimotor training. MATERIAL AND METHODS: Postural sway and EEG changes of alpha, beta and sigma wave bands were measured in seventeen participants during eight balance tasks of varying difficulty with eyes open and closed, feet in tandem or apart and on foam or a firm surface. RESULTS: The power of beta and sigma bands increased significantly at the parietal and central area of the brain in tasks with eyes open together with one sensory factor (base of support or surface compliance) or two sensory factors (base of support and surface compliance) altered, and in task with three sensory factors (vision, base of support and surface compliance) altered from the control task. CONCLUSIONS: This study demonstrated the cortical involvement in the sensorimotor balance tasks, suggesting that these exercises may induce cortical adaptation for postural control. The results support subcortical control with increased task difficulty and the increase in cortical processing when task became extremely challenging.

The use of thermal infra-red imaging to detect delayed onset muscle soreness.

Delayed onset muscle soreness (DOMS), also known as exercise induced muscle damage (EIMD), is commonly experienced in individuals who have been physically inactive for prolonged periods of time, and begin with an unexpected bout of exercise, but can also occur in athletes who exercise beyond their normal limits of training. The symptoms associated with this painful phenomenon can range from slight muscle tenderness, to severe debilitating pain. The intensity of these symptoms and the related discomfort increases within the first 24 hours following the termination of the exercise, and peaks between 24 to 72 hours post exercise. For this reason, DOMS is one of the most common recurrent forms of sports injury that can affect an individual's performance, and become intimidating for many. For the last 3 decades, the DOMS phenomenon has gained a considerable amount of interest amongst researchers and specialists in exercise physiology, sports, and rehabilitation fields. There has been a variety of published studies investigating this painful occurrence in regards to its underlying mechanisms, treatment interventions, and preventive strategies. However, it is evident from the literature that DOMS is not an easy pathology to quantify, as there is a wide amount of variability between the measurement tools and methods used to quantify this condition. It is obvious that no agreement has been made on one best evaluation measure for DOMS, which makes it difficult to verify whether a specific intervention really helps in decreasing the symptoms associated with this type of soreness or not. Thus, DOMS can be seen as somewhat ambiguous, because many studies depend on measuring soreness using a visual analog scale (VAS), which is a subjective rather than an objective measure. Even though needle biopsies of the muscle, and blood levels of myofibre proteins might be considered a gold standard to some, large variations in some of these blood proteins have been documented, in addition to the high risks sometimes associated with invasive techniques. Therefore, in the current investigation, we tested a thermal infra-red (IR) imaging technique of the skin above the exercised muscle to detect the associated muscle soreness. Infra-red thermography has been used, and found to be successful in detecting different types of diseases and infections since the 1950's. But surprisingly, near to nothing has been done on DOMS and changes in skin temperature. The main purpose of this investigation was to examine changes in DOMS using this safe and non-invasive technique.

The use of thermal infrared imaging to assess the efficacy of a therapeutic exercise program in individuals with diabetes.

BACKGROUND: Exercise is of great value for individuals with diabetes in helping to control their hemoglobin A1c levels and in increasing their insulin sensitivity. Delayed-onset muscle soreness (DOMS) is a common problem in healthy individuals and in people who have diabetes. People with diabetes are also faced with metabolic and endothelial impairments, which could make DOMS even worse. But because they usually have neuropathies, they may not feel this soreness appropriately, leading to premature return to exercise and causing further injuries. RESEARCH DESIGN: One hundred eighteen subjects participated in this study and were divided into four groups. Two groups (healthy and diabetes) performed a series of abdominal exercises, and the other two groups (healthy and diabetes) performed a series of arm exercises to induce DOMS. Skin temperature above the muscle was assessed using a thermal infrared camera, and perceived soreness of the exercised muscle was assessed using a 100-mm visual analog scale. Serum myoglobin concentrations were also measured. RESULTS: There was a significant increase in skin temperature 24 h post-exercise for all four exercise groups (P<0.05), where the combined average increase in skin temperature for all four groups was approximately 0.65°C from baseline. Also, 24 h post-exercise, all four groups were significantly sorer than they were at baseline (P<0.05). Serum myoglobin levels were also significantly higher on day 3 compared with day 1 (P<0.05). CONCLUSION: Infrared thermal imaging may be a valuable technique of seeing which muscles are sore hours or even days after the exercise is over. Thus, thermal imaging would be an efficient and painless way of looking at DOMS in both healthy individuals and individuals who have diabetes, even if they are facing neurological problems.

Estimation of the distribution of intramuscular current during electrical stimulation of the quadriceps muscle.

Electrical stimulation is commonly used for strengthening muscle but little evidence exists as to the optimal electrode size, waveform, or frequency to apply. Three male and three female subjects (22-40 years old) were examined during electrical stimulation of the quadriceps muscle. Two self adhesive electrode sizes were examined, 2 cm x 2 cm and 2 cm x 4 cm. Electrical stimulation was applied with square and sine waveforms, currents of 5, 10 and 15 mA, and pulse widths of 100-500 micros above the quadriceps muscle. Frequencies of stimulation were 20, 30, and 50 Hz. Current on the skin above the quadriceps muscle was measured with surface electrodes at five positions and at three positions with needle electrodes in the same muscle. Altering pulse width in the range of 100-500 micros, the frequency over a range of 20-50 Hz, or current from 5 to 15 mA had no effect on current dispersion either in the skin or within muscle. In contrast, the distance separating the electrodes caused large changes in current dispersion on the skin or into muscle. The most significant finding in the present investigation was that, while on the surface of the skin current dispersion was not different between sine and square wave stimulation, significantly more current was transferred deep in the muscle with sine versus square wave stimulation. The use of sine wave stimulation with electrode separation distances of less then 15 cm is recommended for electrical stimulation with a sine wave to achieve deep muscle stimulation.