Photobiomodulation does not provide incremental benefits to patients with knee osteoarthritis who receive a strengthening exercises program: a randomized controlled trial.

BACKGROUND: There is lack of agreement in the literature about the effectiveness of photobiomodulation (PBM) for reducing pain-related symptoms in patients with knee osteoarthritis (OA). OBJECTIVE: To evaluate whether PBM, when combined to exercises, provides incremental therapeutic benefits for pain, physical function, and quality of life (QoL) in patients with knee OA. METHODS: A six-month double-blind placebo-controlled randomized trial was conducted. Patients with knee OA were randomly assigned to one of three treatment groups: Exercise, Exercise plus Active PBM, or Exercise plus Placebo PBM. Treatment was provided over an eight-week period, three times per week. The primary outcomes were pain at rest and upon movement, assessed by a visual analogue scale (VAS). WOMAC global score, QoL, and a core-set of performance-based tests were measured as secondary outcomes. All outcomes were collected at baseline, immediately after treatment, and after three- and six-month post-treatment. RESULTS: 127 participants were allocated as follows: Exercise, N = 41; Exercise plus Active PBM, N = 44; and Exercise plus Placebo PBM, N = 42. There was no between-groups difference in improvement in pain, physical function, and QoL for all follow-up times. However, all groups presented significant, clinically relevant improvements in pain, physical function, and QoL immediately and three months after treatment compared with baseline measures. CONCLUSION: Patients with knee OA who received a strengthening exercises program did not experience incremental benefits regarding pain, physical function, or QoL when adding PBM to their therapeutic exercises.

Knee osteoarthritis: key treatments and implications for physical therapy.

BACKGROUND: Knee osteoarthritis (OA) is a chronic progressive disease that imparts a substantial socioeconomic burden to society and healthcare systems. The prevalence of knee OA has dramatically risen in recent decades due to consistent increases in life expectancy and obesity worldwide. Patient education, physical exercise, and weight loss (for overweight or obese individuals) constitute the first-line knee OA treatment approach. However, less than 40% of patients with knee OA receive this kind of intervention. There is an unmet need for healthcare professionals treating individuals with knee OA to understand the current recommended treatment strategies to provide effective rehabilitation. OBJECTIVE: To guide physical therapists in their clinical decision making by summarizing the safest and most efficacious treatment options currently available, and by delineating the most traditional outcome measures used in clinical research for knee OA. CONCLUSION: There is a need for healthcare providers to abandon low-quality and ineffective treatments and educate themselves and their patients about the current best evidence-based practices for knee OA.

Short-term cryotherapy did not substantially reduce pain and had unclear effects on physical function and quality of life in people with knee osteoarthritis: a randomised trial.

OBJECTIVE: Does short-term cryotherapy improve pain, function and quality of life in people with knee osteoarthritis (OA)? DESIGN: Randomised controlled trial with concealed allocation, blinded assessment of some outcomes, and intention-to-treat analysis. PARTICIPANTS: People living in the community with knee OA. INTERVENTIONS: The experimental group received cryotherapy, delivered as packs of crushed ice applied to the knee with mild compression. The control group received the same regimen but with sham packs filled with sand. The interventions were applied once a day for 4 consecutive days. OUTCOME MEASURES: Participants were assessed at baseline and on the day after the 4-day intervention period. The primary outcome was pain intensity according to a visual analogue scale. Secondary outcomes were baseline to post-intervention changes according to the Western Ontario and McMaster Universities Osteoarthritis, Knee injury and Osteoarthritis Outcome; Timed Up and Go test; and 30-Second Chair to Stand test. RESULTS: Sixty participants were randomised into the experimental group (n = 30) or the control group (n = 30). Twenty-nine participants from each group completed the trial. The mean between-group difference in change in pain severity was -0.8 cm (95% CI -1.6 to 0.1), where negative values favour the experimental group. This result did not reach the nominated smallest worthwhile effect of 1.75 cm. The secondary outcomes had less-precise estimates, with confidence intervals that spanned worthwhile, trivial and mildly harmful effects. CONCLUSION: Short-term cryotherapy was not superior to a sham intervention in terms of relieving pain or improving function and quality of life in people with knee OA. Although cryotherapy is considered to be a widely used resource in clinical practice, this study does not suggest that it has an important short-term effect, when compared with a sham control, as a non-pharmacological treatment for people with knee osteoarthritis. REGISTRATION: NCT02725047.

Correlation between eccentric training and functional tests in subjects with reconstructed acl / Correlação entre treino excêntrico e testes funcionais em sujeitos com lca reconstruído / Correlación entre entrenamiento excéntrico y pruebas funcionales en sujetos con lca reconstruido

INTRODUCTION: Eccentric training and jump tests are widely used to recover and measure deficits in knee strength and functionality after anterior cruciate ligament (ACL) reconstruction. OBJECTIVE: To correlate knee extension and flexion torque generated by eccentric isokinetic training, with functional jump tests in subjects with reconstructed ACL. METHOD: Sixteen men with unilateral ACL reconstruction were assessed before and after 12 weeks of eccentric isokinetic training of knee flexors and extensors (3×10 MVC, 2x/week) at 30°/s for extension and flexion torque (isometric; concentric and eccentric at 30 and 120°/s) and functional jump tests (single, triple, cross and figure of 8). Inter- and intra-limb pre- and post-training mean peak torque (MPT), distance and jump test times were compared along with the correlations between these variables, considering P<0.05. RESULTS: The affected limb (AL) showed significant gain of extension and flexion torque (P<0.01) in the different test categories and velocities evaluated. In the non-affected limb (NAL), this only occurred in the eccentric category (30 and 120°/s), in the extension (P<0.01) and flexion (P<0.05 and P<0.01) torques, respectively. In the jumps, there was an increase in distance (single and triple; P<0.05) and a decrease in time (crossed and figure of 8; P<0.01), however, MPT x Jump correlations were weak (r<0.3) in the pre and post-training period in both limbs. CONCLUSION: Despite the gain in knee extension and flexion torque and jumping performance, the expected correlation was not satisfactory, suggesting that knee functionality involves other variables inherent to motor control. Level of Evidence IV; Type of study: Case series.

INTRODUÇÃO: O treino excêntrico e testes de saltos são muito utilizados para recuperar e aferir déficits de força e funcionalidade do joelho, após reconstrução do ligamento cruzado anterior (LCA). OBJETIVO: Correlacionar o torque extensor e flexor do joelho, gerados pelo treino isocinético excêntrico, com testes funcionais de saltos em sujeitos com LCA reconstruído. MÉTODO: Foram avaliados 16 homens, com reconstrução unilateral do LCA, antes e depois de 12 semanas de treino isocinético excêntrico de extensores e flexores do joelho (3 × 10 CEVM, 2x/semana) a 30°/s, quanto ao torque extensor e flexor (isométrico; concêntrico e excêntrico a 30°/s e 120°/s) e aos testes funcionais de saltos (simples, triplo, cruzado e figura em 8). As médias dos picos de torque (MPT), a distância e os tempos dos testes de salto inter e intramembros, pré e pós-treino foram comparados, além das correlações entre essas variáveis, considerando P< 0,05. RESULTADOS: O membro acometido (MA) mostrou ganho significativo de torque extensor e flexor (P< 0,01) nos modos e velocidades avaliados. No membro não acometido (MNA), isso ocorreu apenas para o modo excêntrico (30°/s e 120°/s), do torque extensor (P< 0,01) e flexor (P< 0,05 e P<0,01), respectivamente. Nos saltos, houve aumento da distância (simples e triplo; P< 0,05) e diminuição do tempo (cruzado e figura em 8; P< 0,01), porém, as correlações entre MPT e saltos mostraram-se fracas nos dois membros (r< 0,3) antes e depois do treino. CONCLUSÃO: Apesar do ganho no torque extensor e flexor do joelho e no rendimento dos saltos, a correlação esperada não foi satisfatória, sugerindo que a funcionalidade do joelho envolve outras variáveis inerentes ao controle motor. Nível de evidência IV; Tipo de estudo: Série de casos.

INTRODUCCIÓN: El entrenamiento excéntrico y las pruebas de saltos son muy utilizados para recuperar y medir los déficits de fuerza y funcionalidad de la rodilla, después de la reconstrucción del ligamento cruzado anterior (LCA). OBJETIVO: Correlacionar el torque extensor y flexor de la rodilla, generados por el entrenamiento isocinético excéntrico, con pruebas funcionales de saltos en sujetos con LCA reconstruido. MÉTODO: Fueron evaluados 16 hombres, con reconstrucción unilateral del LCA, antes y después de 12 semanas de entrenamiento isocinético excéntrico de extensores y flexores de la rodilla (3x10 CEVM, 2x/semana) a 30°/s, cuanto al torque extensor y flexor (isométrico, concéntrico y excéntrico a 30 y 120°/s) y a las pruebas funcionales de saltos (simple, triple, cruzado y figura en 8). Se compararon promedios de los picos de torque (MPT), distancia y tiempos de las pruebas de salto, inter e intra-miembros, pre y post-entrenamiento, además de las correlaciones entre estas variables, considerando P<0,05. RESULTADOS: El miembro acometido (MA) mostró aumento significativo del torque extensor y flexor (P<0,01) en los modos y velocidades evaluados. En el miembro no acometido (MNA), eso ocurrió sólo para el modo excéntrico (30 y 120°/s), del torque extensor (P<0,01) y flexor (P<0,05 y P<0,01), respectivamente. En los saltos, hubo aumento en la distancia (simple y triple; P<0,05) y disminución del tiempo (cruzado y figura en 8; P<0,01), sin embargo, las correlaciones MPT x saltos se mostraron débiles (r<0,3) en el pre y post-entrenamiento, en los dos miembros. CONCLUSIÓN: A pesar del aumento en el torque extensor y flexor de la rodilla y en el rendimiento de los saltos, la correlación esperada no fue satisfactoria, sugiriendo que la funcionalidad de la rodilla involucra otras variables inherentes al control motor. Nivel de evidencia IV; Tipo de estudio: Serie de casos

Insulin treatment reverses the increase in atrogin-1 expression in atrophied skeletal muscles of diabetic rats with acute joint inflammation.

BACKGROUND: The aim of this study was to evaluate the changes in biomarkers of skeletal muscle proteolysis (atrogin-1, muscle RING finger-1 protein [MuRF-1]) and inflammation (nuclear factor kappa-B) in skeletal muscles of rats under two catabolic conditions, diabetes mellitus (DM) and acute joint inflammation, and the effects of insulin therapy. MATERIALS AND METHODS: Male Wistar rats were divided into groups without diabetes - normal (N), saline (NS), or ι-carrageenan (NCa) injection into the tibiotarsal joint - and groups with diabetes - diabetes (D), plus insulin (DI), saline (DS), or ι-carrageenan (DCa) injection into the tibiotarsal joint, or ι-carrageenan injection and treatment with insulin (DCaI). Three days after ι-carrageenan injection (17 days after diabetes induction), tibialis anterior (TA) and soleus (SO) skeletal muscles were used for analysis. RESULTS: DM alone caused a significant decrease in the mass of TA and SO muscles, even with low levels of atrogenes (atrogin-1, MuRF-1), which could be interpreted as an adaptive mechanism to spare muscle proteins under this catabolic condition. The loss of muscle mass was exacerbated when ι-carrageenan was administered in the joints of diabetic rats, in association with increased expression of atrogin-1, MuRF-1, and nuclear factor kappa-B. Treatment with insulin prevented the increase in atrogin-1 (TA, SO) and the loss of muscle mass (SO) in diabetic-carrageenan rats; in comparison with TA, SO muscle was more responsive to the anabolic actions of insulin. CONCLUSION: Acute joint inflammation overcame the adaptive mechanism in diabetic rats to prevent excessive loss of muscle mass, worsening the catabolic state. The treatment of diabetic-carrageenan rats with insulin prevented the loss of skeletal muscle mass mainly via atrogin-1 inhibition. Under the condition of DM and inflammation, muscles with the prevalence of slow-twitch, type 1 fibers were more responsive to insulin treatment, recovering the ability to grow.

The effects of 12 weeks Pilates-inspired exercise training on functional performance in older women: A randomized clinical trial.

BACKGROUND: Recent scientific evidence supports the benefits of Pilates exercises on postural balance and muscle strength of older persons. However, their effects on other aspects of physical fitness, which are also important for independent living in older age, are still unknown. OBJECTIVE: To investigate the effects of a 12-week Pilates-inspired exercise program on the functional performance of community-dwelling older women. METHODS: Forty community-dwelling older women were randomly enrolled in a Pilates-inspired exercise training (2 times/week, 60 min/session) (PG, n = 21, 66.0 ± 1.4yrs) or kept in the control group (CG; n = 19, 63.3 ± 0.9yrs). The Pilates exercises were conducted in small groups and performed on mats (using accessories such as exercise rubber bands, swiss and exercise balls). The functional performance on one-leg stance (OLS), timed up and go (TUG), five-times-sit-to-stand (STS) and 6-min walk (6 MW) tests was evaluated before and after the 12-week Pilates training or control follow-up period. RESULTS: After 12 weeks, time effects were observed for STS (p = 0.03) and 6 MW tests (p < 0.01). Only among PG subjects did the time spent to rise from a chair and return to a seated position decrease significantly (2.0 s faster, p = 0.02) and the distance walked in 6 min increase (∼30 m, p < 0.01). OLS and TUG performance remained unaltered in both groups. CONCLUSION: Pilates-inspired exercises improved dynamic balance, lower-extremity strength and aerobic resistance in community-dwelling older women. Therefore, it may be a potentially effective exercise regimen to maintain physical fitness in old age.

Multiple cryotherapy applications attenuate oxidative stress following skeletal muscle injury.

OBJECTIVES: To investigate the effects of multiple cryotherapy applications after muscle injury on markers of oxidative stress. METHODS: Following cryolesion-induced skeletal muscle injury in rats, ice was applied at the injured site for 30 minutes, three times per day, on the day of injury, and for 2 days after injury. To determine the effect of the cryotherapy treatment on markers of oxidative stress, biochemical analyses were performed 3, 7, and 14 days after injury. RESULTS: Compared with non-treated animals, cryotherapy reduced dichlorofluorescein at 7 and 14 days post-injury and thiobarbituric acid reactive substances levels at 3 and 7 days post-injury (P < 0.05). Additionally, cryotherapy maintained methyl thiazol tetrazolium reduction levels compared to the control group at all analyzed time points (P > 0.05), whereas non-treated groups demonstrated lower levels than the control group (P < 0.05). Superoxide dismutase activity at 7 and 14 days post-injury and catalase activity at 3 days post-injury were lower in cryotherapy groups compared with non-treated groups (P < 0.05). Cryotherapy prevented the reduction of non-protein thiol levels and maintained within control group level, at 3 days post-injury (P = 0.92). DISCUSSION: Cryotherapy reduced the production of reactive oxygen species after muscle injury, resulting in an attenuated response of the antioxidant system. These findings suggest that using multiple cryotherapy applications is efficient to reduce oxidative stress.

Cryotherapy Reduces Inflammatory Response Without Altering Muscle Regeneration Process and Extracellular Matrix Remodeling of Rat Muscle.

The application of cryotherapy is widely used in sports medicine today. Cooling could minimize secondary hypoxic injury through the reduction of cellular metabolism and injury area. Conflicting results have also suggested cryotherapy could delay and impair the regeneration process. There are no definitive findings about the effects of cryotherapy on the process of muscle regeneration. The aim of the present study was to evaluate the effects of a clinical-like cryotherapy on inflammation, regeneration and extracellular matrix (ECM) remodeling on the Tibialis anterior (TA) muscle of rats 3, 7 and 14 days post-injury. It was observed that the intermittent application of cryotherapy (three 30-minute sessions, every 2 h) in the first 48 h post-injury decreased inflammatory processes (mRNA levels of TNF-α, NF-κB, TGF-ß and MMP-9 and macrophage percentage). Cryotherapy did not alter regeneration markers such as injury area, desmin and Myod expression. Despite regulating Collagen I and III and their growth factors, cryotherapy did not alter collagen deposition. In summary, clinical-like cryotherapy reduces the inflammatory process through the decrease of macrophage infiltration and the accumulation of the inflammatory key markers without influencing muscle injury area and ECM remodeling.

Effects of isokinetic eccentric training on knee extensor and flexor torque and on gait of individuals with long term ACL reconstruction: a controlled clinical trial / Efeitos do treinamento isocinético excêntrico de extensores de joelho e torque flexor na marcha de indivíduos com reconstrução do LCA: um ensaio clínico controlado / Efectos del entrenamiento excéntrico isocinético en extensor de la rodilla y el par flexor y sobre la marcha de las personas con reconstrucción ACL: un ensayo clínico controlado

This study investigated the effects of the isokinetic eccentric training (IET) on the knee extensor and flexor torque and kinematic gait parameters in individuals with ACL reconstruction. Sixteen men with ACL reconstructed (ACLr) whose torque and the gait were evaluated, before and after 12 weeks of IET, was compared to a control group (14 individuals). Student t, MANOVA and ANOVA tests were performed with 5% of significance. The training increased the isometric, concentric at 30 and 120º/s (p < .05) and eccentric at 30º/s (p < .01) extensor torque on the affected limb (AL), and eccentric at 30 and 120º/s (p < .01), on the non-affected limb (NAL). In the flexors, there was an increase on the torque: isometric, concentric at 30º/s and eccentric at 30 and 120º/s (p < .01) in AL and in eccentric at 30 (p < .05) and 120º/s (p < .01) in NAL. With respect to the angular and spatio-temporal variables gait, there was no difference between pre-and post-training in LCAr group. Compared to control group, the cycle time, in two members, was lower in LCAr group, and stride length and cadence were higher in the AL of the LCAr (p < .05). Moreover, the knee flexion-extension angles (minimum and maximum) remained lower in LCAr, pre- and post-training (p < .01). The torque gain associated with eccentric isokinetic training did not affect the kinematic parameters of gait in patients undergoing ACL reconstruction...

"Efeitos do treinamento isocinético excêntrico de extensores de joelho e torque flexor na marcha de indivíduos com reconstrução do LCA: Um ensaio clínico controlado." Este estudo investigou os efeitos do treinamento isocinético excêntrico (TIE) sobre o torque extensor e flexor do joelho e parâmetros cinemáticos da marcha de indivíduos com reconstrução do LCA. Dezesseis homens com LCA reconstruído (LCAr), foram avaliados quanto ao torque e marcha, antes e após 12 semanas de TIE e comparados com um grupo controle (14 indivíduos). Testes t Student, MANOVA e ANOVA foram realizados com 5% de significância. O treinamento aumentou o torque extensor isométrico, concêntrico a 30 e 120º/s (p < 0,05) e excêntrico a 30º/s (p < 0,01) no membro afetado (MA), e excêntrico a 30 e 120º/s (p < 0,01), no membro não afetado (MNA). Nos flexores, houve um aumento no torque: isométrico, concêntrico a 30º/s e excêntrico a 30 e 120º/s (p < 0,01) no MA, e excêntrico a 30 (p < 0,05) e 120º/s (p < 0,01) no MNA. Com relação às variáveis espaço-temporais e angulares da marcha, não houve diferença entre as avaliações pré e pós-treino no grupo LCAr. Comparado ao controle, a duração do ciclo, nos dois membros, foi menor no LCAr, e comprimento da passada e cadência foram maiores no MA do grupo LCAr (p < 0,05). Além disso, os ângulos (mínimo e máximo) de flexão-extensão do joelho permaneceram menores no LCAr, pré e pós-treino (p < 0,01). O ganho de torque associado ao treinamento isocinético excêntrico não modificou os parâmetros cinemáticos da marcha nos indivíduos submetidos à reconstrução do LCA...

"Efectos del entrenamiento excéntrico isocinético en extensor de la rodilla y el par flexor y sobre la marcha de las personas con reconstrucción ACL: Un ensayo clínico controlado." Este estudio investigó los efectos del entrenamiento isocinético excéntrico (EIE) en el torque del extensor y del flexor de la rodilla y parámetros cinemáticos de la marcha de personas con la reconstrucción del LCA. Dieciséis hombres con LCA reconstruido (LCAr), fueron evaluados para el par y la marcha antes y después de 12 semanas de EIE y se compararon con un grupo control (14 personas). Prueba t Student, ANOVA y MANOVA se realizaron con 5 % de significación. La formación aumentó extensor torque isométrico, concéntrico 30 y 120°/s (p < 0,05) y la excéntrica 30°/s (p < 0,01) en el miembro afectado (MA), y la excéntrica 30 y 120°/s (p < 0,01) en el miembro no afectado (MNA). Flexor, hubo un aumento en el par motor: isométrica , concéntrica 30°/s excéntrica 30 y 120°/s (p < 0,01) en MA, excéntrico y 30 (p < 0,05 ) y 120°/ s (p < 0,01) en el MNA. Con respecto a las variables angulares y espacio-temporal de andar, no hubo diferencia entre pre y post-entrenamiento en grupo LCAr. En comparación con el grupo control, el tiempo de ciclo, em los dos miembros, fue menor en LCAr, y la longitud del paso y cadencia fueron mayores en el LCAr del MA (p < 0,05). Por otra parte, los ángulos de flexión-extensión de la rodilla (mínimo y máximo) se mantuvieron bajos en LCAr, pre y post-entrenamiento (p < 0,01). El aumento del torque asociado con el entrenamiento isocinético excéntrico no afectó los parámetros cinemáticos de la marcha en las personas sometidas a la reconstrucción del LCA...

Muscle atrophy, voluntary activation disturbances, and low serum concentrations of IGF-1 and IGFBP-3 are associated with weakness in people with chronic stroke.

BACKGROUND: The muscle weakness that is exhibited poststroke is due to a multifactorial etiology involving the central nervous system and skeletal muscle changes. Insulinlike growth factor 1 (IGF-1) and IGF binding protein 3 (IGFBP-3) have been described as biomarkers of neuromuscular performance in many conditions. However, no information about these biomarkers is available for people with chronic hemiparesis. OBJECTIVE: The purpose of this study was to investigate possible factors involved in muscle weakness, such as IGF-1 and IGFBP-3 serum concentrations, muscle volume, and neuromuscular performance of the knee flexors and extensors, in people with chronic hemiparesis poststroke. DESIGN: This was a cross-sectional study. METHODS: A cross-sectional study was performed on 14 individuals poststroke who were paired with healthy controls. Mobility, function, balance, and quality of life were recorded as outcome measures. Knee flexor and extensor muscle volumes and neuromuscular performance were measured using nuclear magnetic resonance imaging, dynamometry, and electromyography. The serum concentrations of IGF-1 and IGFBP-3 were quantified by enzyme-linked immunosorbent assay (ELISA). RESULTS: The hemiparetic group had low serum concentrations of IGF-1 (25%) and IGFBP-3 (40%); reduced muscle volume in the vastus medialis (32%), vastus intermedius (29%), biceps femoris (16%), and semitendinosus and semimembranosus (12%) muscles; reduced peak torque, power, and work of the knee flexors and extensors; and altered agonist and antagonist muscle activation compared with controls. CONCLUSIONS: Low serum concentrations of IGF-1 and IGFBP-3, deficits in neuromuscular performance, selective muscle atrophy, and decreased agonist muscle activation were found in the group with chronic hemiparesis poststroke. Both hemorrhagic and ischemic stroke were considered, and the data reflect a chronic poststroke population with good function.

Sit-to-stand movement in children with hemiplegic cerebral palsy: relationship with knee extensor torque and social participation.

This study aimed to investigate the relationship between sit-to-stand (STS) movement, knee extensor torque and social participation in children with cerebral palsy (CP). Seven spastic hemiplegic CP patients (8.0 ± 2.2 years), classified by the Gross Motor Function Classification System as I and II, and 18 typical children (8.4 ± 2.3 years) participated in this study. Trunk, hips, knees, and ankles angles and temporal variables of STS movement were obtained by means of kinematics evaluation. Isokinetic evaluation was performed at 60°/s in the concentric passive mode to measure knee extensors torque. Social participation was assessed by the Assessment of Life Habits for Children (LIFE-H) scale. Results showed that children with spastic hemiplegic CP have lower knee extensor torque in the affected limb and restriction in social participation in dimensions related with fine motor control and language skills when compared to their typical peers. Except for ankle excursion in frontal plane, and ankle excursion and range in transverse plane, patients were similar to typical children regarding the strategies adopted to perform the STS movement, as well as in the participation dimensions related with gross motor function. Moreover, we found a significant non-linear correlation between knee extensors torque and some lower limb and trunk angles for children with CP. Therefore, during evaluation and rehabilitation processes, impairments in body functions and structures should be related with how much they affect a child's ability to perform functional activities, so rehabilitation protocols could be focused on individual needs.

The effect of intermittent cryotherapy on the activities of citrate synthase and lactate dehydrogenase in regenerating skeletal muscle

This study examined the effect of three sessions of cryotherapy (three sessions of 30 minutes applied each 2 h) and muscle compression in the regenerating skeletal muscle of the rats. The middle belly of tibialis anterior muscle was injured by a frozen iron bar and received one of the following intervention: injury + cryotherapy (treated with cryotherapy); injury + placebo (sand pack), and injury (I).The enzymatic activities of citrate synthase (CS) and lactate dehydrogenase (LDH) were measured in the presence of 1mM or 10mM pyruvate. The ANOVA and Tukey's test (p<0.05) were performed for the statistical analysis. In summary, the intermittent sessions of cryotherapy, associated to muscle compression and applied immediately after the primary muscle injury minimized the CS and LDH activity at 4h30 and 24h periods post-lesion, which could be related to the reduction in the secondary muscle injury inherent to cryotherapy treatment.

Non-invasive ventilation improves peripheral oxygen saturation and reduces fatigability of quadriceps in patients with COPD.

BACKGROUND AND OBJECTIVE: Non-invasive ventilation (NIV) might improve peripheral muscle function and exercise capacity in severely disabled patients. This study evaluated the physiological impact of NIV on isokinetic concentric strength and endurance of lower limb muscles in patients with severe COPD. METHODS: This clinical trial tested COPD patients (n = 24) and healthy subjects (n = 18). Subjects underwent isokinetic dynamometry tests while given either bi-level positive airway pressure ventilation (BV) or sham ventilation (SV), in a randomized order with 30 min of rest prior to each intervention. The inspiratory level of BV was set up to 14 cm H(2)O and expiratory pressure up to 6 cm H(2)O. Peripheral oxygen saturation (SpO(2)), heart rate (HR), systolic (SBP) and diastolic blood pressure (DBP) at the peak of exercise were measured for each intervention. RESULTS: Compared with controls, COPD patients had lower values of SpO(2) and HR (P < 0.01) during both BV and SV and lower values of DBP (P < 0.01) during BV. BV improved SpO(2) (P < 0.01), and reduced SBP in both COPD (P < 0.01) and control groups (P < 0.05) and reduced DBP in COPD patients (P < 0.01). BV also reduced the fatigue index in COPD patients when compared with SV (P = 0.003). Variation (BV-SV) of total work at the peak of the test was higher in the control group than in the COPD group (P < 0.05). CONCLUSIONS: BV improved SpO(2) and reduced the fatigability of the quadriceps muscle in patients with severe COPD. These results support the need for further evaluation of BV as adjunct during high-intensity strength exercise training in these patients.

Estimulacao eletrica neuromuscular do tibial anterior nao altera a morfologia dos musculos soleo(antagonista) e extensor digital longo(sinergista) do rato / Neuromuscular electrical stimulation of tibialis anterior do not change the morphology of soleus(antagonistic) and extensor digitorum longus(synergistic) muscles of rat

A estimulacao eletrica neuromuscular(EENM) e um recurso fisioterapico muito utilizado para produzir fortalecimento e hipertofia muscular. O objetivo deste trabalho foi analisar os efeitos morfologicos da EENM na musculatura sinergista e antagonista ao musculo diretamente estimulado. O musculo tibial anterior(TA) direito de seis ratos (Wistar)foi submetido a eletroestimulacao e os musculos extensor digital longo(EDL) e soleo, sinergista e antagonista ao TA, repectivamente, foram analisados. A EENM foi realizada em uma frequencia de 52 Hz., com ciclo ON-OFF na proporcao de 1/1, rampa de subida de trens de pulso de 2,2 seg. e intensidade de aproximadamente 0,5 mA. Foram produzidas 20 contracoes em cada sessao, 3 vezes por semana, durante 8 semanas. Posteriormente os animais foram anestesiados,e os musculos EDL e soleo direito e esquerdo foram removidos, pesados, congelados, seccionados e corados com Azul de Toluidina, para avaliacao morfologica das fibras musculares. Estudo previo, realizado no TA diretamente estimulado, nao revelou alteracoes morfologicas significativas no peso, area media das fibras e incidencia de sinais de lesao no EDL e no soleo, quando comparados com os musculos da pata controle nao estimulada. Esses resultados indicam que o protocolo utilizado para EENM, nao produziu alteracoes morfologicas significantes nos musculos EDL(sinergista) e soleo(antagonista) apos estimulacao do TA

Anatomical correlation between the venter of the soleus muscle and rat leg lenght

An equipment was previously developed in our laboratory to produce a non-invasive contusion in the soleus muscle of the rat. In order to produce the trauma it is also necessary to non-invasively identify the calfof the soleus muscle. The aim of the present study was to identify the calf of the soleus muscle using a correlation between the lenght of the rat leg and the middle region of the muscle. Nine rats were anaesthetised and the lenghts of the animals'legs were then measured with a pachymeter. As an anatomical reference we used the plantar surface of the calcaneus, immediately cranial to its tuberosity, and the cranial face of the distal third of the femoral diaphysis, next to the femoral patellar face, with the articulation of the knee and ankle maintained at 90(degree) of flexion. After dissection and exposure of the soleus muscle, the region where the diameter of the muscular venter was maximal was identified and the distance from this point to the plantar surface of the calcaneus was then measured. Considering this correlation, it was observed that the venter of the rat Soleus muscle is located at a distance from the plantar surface of the calcaneus equal to 44ñ1(per cent) of the rat leg length. This percentage correlation was identified in rats with different body weights and occurred in all of the animals. Subsequent tests, for the induction of a non-invasive trauma, using this correlation, confirmed the efficacy of this methodology for locating the belly of the soleus in a non-invasive way. Three days after trauma, acute signs of injury such as myonecrosis, celular infiltration and muscle fiber basophilia were observed in the ventral face of the soleus muscle.