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Kalli M, Stylianopoulos T. Toward innovative approaches for exploring the mechanically regulated tumor-immune microenvironment. APL Bioeng 2024; 8:011501. [PMID: 38390314 PMCID: PMC10883717 DOI: 10.1063/5.0183302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
Within the complex tumor microenvironment, cells experience mechanical cues-such as extracellular matrix stiffening and elevation of solid stress, interstitial fluid pressure, and fluid shear stress-that significantly impact cancer cell behavior and immune responses. Recognizing the significance of these mechanical cues not only sheds light on cancer progression but also holds promise for identifying potential biomarkers that would predict therapeutic outcomes. However, standardizing methods for studying how mechanical cues affect tumor progression is challenging. This challenge stems from the limitations of traditional in vitro cell culture systems, which fail to encompass the critical contextual cues present in vivo. To address this, 3D tumor spheroids have been established as a preferred model, more closely mimicking cancer progression, but they usually lack reproduction of the mechanical microenvironment encountered in actual solid tumors. Here, we review the role of mechanical forces in modulating tumor- and immune-cell responses and discuss how grasping the importance of these mechanical cues could revolutionize in vitro tumor tissue engineering. The creation of more physiologically relevant environments that better replicate in vivo conditions will eventually increase the efficacy of currently available treatments, including immunotherapies.
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Affiliation(s)
- Maria Kalli
- Cancer Biophysics Laboratory, Department of Mechanical and Manufacturing Engineering, University of Cyprus, Nicosia, Cyprus
| | - Triantafyllos Stylianopoulos
- Cancer Biophysics Laboratory, Department of Mechanical and Manufacturing Engineering, University of Cyprus, Nicosia, Cyprus
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2
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Berrueta L, Muñoz-Vergara D, Martin D, Thompson R, Sansbury BE, Spite M, Badger GJ, Langevin HM. Effect of stretching on inflammation in a subcutaneous carrageenan mouse model analyzed at single-cell resolution. J Cell Physiol 2023; 238:2778-2793. [PMID: 37909412 PMCID: PMC10773986 DOI: 10.1002/jcp.31133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 11/03/2023]
Abstract
Understanding the factors that influence the biological response to inflammation is crucial, due to its involvement in physiological and pathological processes, including tissue repair/healing, cancer, infections, and autoimmune diseases. We have previously demonstrated that in vivo stretching can reduce inflammation and increase local pro-resolving lipid mediators in rats, suggesting a direct mechanical effect on inflammation resolution. Here we aimed to explore further the effects of stretching at the cellular/molecular level in a mouse subcutaneous carrageenan-inflammation model. Stretching for 10 min twice a day reduced inflammation, increased the production of pro-resolving mediator pathway intermediate 17-HDHA at 48 h postcarrageenan injection, and decreased both pro-resolving and pro-inflammatory mediators (e.g., PGE2 and PGD2 ) at 96 h. Single-cell RNA sequencing analysis of inflammatory lesions at 96 h showed that stretching increased the expression of both pro-inflammatory (Nos2) and pro-resolution (Arg1) genes in M1 and M2 macrophages at 96 h. An intercellular communication analysis predicted specific ligand-receptor interactions orchestrated by neutrophils and M2a macrophages, suggesting a continuous neutrophil presence recruiting immune cells such as activated macrophages to contain the antigen while promoting resolution and preserving tissue homeostasis.
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Affiliation(s)
- Lisbeth Berrueta
- Connective Tissue Section, National Institute of Dental and Craniofacial Research, National Institute of Health, Bethesda, Maryland, USA
| | - Dennis Muñoz-Vergara
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Martin
- Connective Tissue Section, National Institute of Dental and Craniofacial Research, National Institute of Health, Bethesda, Maryland, USA
| | - Rebecca Thompson
- Connective Tissue Section, National Institute of Dental and Craniofacial Research, National Institute of Health, Bethesda, Maryland, USA
| | - Brian E Sansbury
- Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Matthew Spite
- Department of Anesthesiology, Perioperative and Pain Medicine, Center for Experimental Therapeutics and Reperfusion Injury, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Gary J Badger
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont, USA
| | - Helene M Langevin
- Connective Tissue Section, National Institute of Dental and Craniofacial Research, National Institute of Health, Bethesda, Maryland, USA
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Harris-Hayes M, Zorn P, Steger-May K, Burgess MM, DeMargel RD, Kuebler S, Clohisy J, Haroutounian S. Comparison of Joint Mobilization and Movement Pattern Training for Patients With Hip-Related Groin Pain: A Pilot Randomized Clinical Trial. Phys Ther 2023; 103:pzad111. [PMID: 37606253 PMCID: PMC10683042 DOI: 10.1093/ptj/pzad111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 04/19/2023] [Accepted: 06/10/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE The objective of this study was to assess the feasibility of completing a randomized clinical trial (RCT) and examine the preliminary effects of 2 interventions for hip-related groin pain (HRGP). METHODS In this pilot RCT, patients with HRGP, who were 18 to 40 years old, were randomized (1:1 ratio) to a joint mobilization (JtMob) group or a movement pattern training (MoveTrain) group. Both treatments included 10 supervised sessions and a home exercise program. The goal of JtMob was to reduce pain and improve mobility through peripherally and centrally mediated pain mechanisms. The key element was physical therapist-provided JtMob. The goal of MoveTrain was to reduce hip joint stresses by optimizing the biomechanics of patient-specific tasks. The key element was task-specific instruction to correct abnormal movement patterns displayed during tasks. Primary outcomes were related to future trial feasibility. The primary effectiveness outcome was the Hip Disability and Osteoarthritis Outcome Score. Examiners were blinded to group; patients and treatment providers were not. Data collected at baseline and immediately after treatment were analyzed with analysis of covariance using a generalized linear model in which change was the dependent variable and baseline was the covariate. The study was modified due to the coronavirus disease 2019 (COVID-19) pandemic. RESULTS The COVID-19 pandemic affected participation; 127 patients were screened, 33 were randomized (18 to the JtMob group and 15 to the MoveTrain group), and 29 (88%) provided posttreatment data. Treatment session adherence was 85%, and home exercise program component adherence ranged from 71 to 86%. Both groups demonstrated significant mean within-group improvements of ≥5 points on Hip Disability and Osteoarthritis Outcome Score scales. There were no between-group differences in effectiveness outcomes. CONCLUSIONS A large RCT to assess the effects of JtMob and MoveTrain for patients with HRGP may be feasible. Preliminary findings suggested that JtMob or MoveTrain may result in improvements in patient-reported pain and activity limitations. IMPACT The COVID-19 pandemic interfered with participation, but a randomized controlled trial may be feasible. Modification may be needed if the trial is completed during future pandemics.
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Affiliation(s)
- Marcie Harris-Hayes
- Program in Physical Therapy, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Patricia Zorn
- Patricia Zorn Center for Physical Therapy and Spine Rehabilitation, St. Louis, Missouri, USA
| | - Karen Steger-May
- Center for Biostatistics and Data Science, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Megan M Burgess
- Program in Physical Therapy, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rebecca D DeMargel
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Suzanne Kuebler
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
| | - John Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Simon Haroutounian
- Department of Anesthesiology and Washington University Pain Center, Washington University School of Medicine, St. Louis, Missouri, USA
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Kodama Y, Masuda S, Ohmori T, Kanamaru A, Tanaka M, Sakaguchi T, Nakagawa M. Response to Mechanical Properties and Physiological Challenges of Fascia: Diagnosis and Rehabilitative Therapeutic Intervention for Myofascial System Disorders. Bioengineering (Basel) 2023; 10:bioengineering10040474. [PMID: 37106661 PMCID: PMC10135675 DOI: 10.3390/bioengineering10040474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Damage to the fascia can cause significant performance deficits in high-performance sports and recreational exercise and may contribute to the development of musculoskeletal disorders and persistent potential pain. The fascia is widely distributed from head to toe, encompassing muscles, bones, blood vessels, nerves, and internal organs and comprising various layers of different depths, indicating the complexity of its pathogenesis. It is a connective tissue composed of irregularly arranged collagen fibers, distinctly different from the regularly arranged collagen fibers found in tendons, ligaments, or periosteum, and mechanical changes in the fascia (stiffness or tension) can produce changes in its connective tissue that can cause pain. While these mechanical changes induce inflammation associated with mechanical loading, they are also affected by biochemical influences such as aging, sex hormones, and obesity. Therefore, this paper will review the current state of knowledge on the molecular level response to the mechanical properties of the fascia and its response to other physiological challenges, including mechanical changes, innervation, injury, and aging; imaging techniques available to study the fascial system; and therapeutic interventions targeting fascial tissue in sports medicine. This article aims to summarize contemporary views.
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Affiliation(s)
- Yuya Kodama
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, 1-10-25 Midorimachi, Minamiku, Okayama 702-8055, Japan
| | - Shin Masuda
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, 1-10-25 Midorimachi, Minamiku, Okayama 702-8055, Japan
| | - Toshinori Ohmori
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, 1-10-25 Midorimachi, Minamiku, Okayama 702-8055, Japan
| | - Akihiro Kanamaru
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, 1-10-25 Midorimachi, Minamiku, Okayama 702-8055, Japan
| | - Masato Tanaka
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, 1-10-25 Midorimachi, Minamiku, Okayama 702-8055, Japan
| | - Tomoyoshi Sakaguchi
- Department of Central Rehabilitation, Okayama Rosai Hospital, 1-10-25 Midorimachi, Minamiku, Okayama 702-8055, Japan
| | - Masami Nakagawa
- Department of Central Rehabilitation, Okayama Rosai Hospital, 1-10-25 Midorimachi, Minamiku, Okayama 702-8055, Japan
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Mavropalias G, Boppart M, Usher KM, Grounds MD, Nosaka K, Blazevich AJ. Exercise builds the scaffold of life: muscle extracellular matrix biomarker responses to physical activity, inactivity, and aging. Biol Rev Camb Philos Soc 2023; 98:481-519. [PMID: 36412213 DOI: 10.1111/brv.12916] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 11/23/2022]
Abstract
Skeletal muscle extracellular matrix (ECM) is critical for muscle force production and the regulation of important physiological processes during growth, regeneration, and remodelling. ECM remodelling is a tightly orchestrated process, sensitive to multi-directional tensile and compressive stresses and damaging stimuli, and its assessment can convey important information on rehabilitation effectiveness, injury, and disease. Despite its profound importance, ECM biomarkers are underused in studies examining the effects of exercise, disuse, or aging on muscle function, growth, and structure. This review examines patterns of short- and long-term changes in the synthesis and concentrations of ECM markers in biofluids and tissues, which may be useful for describing the time course of ECM remodelling following physical activity and disuse. Forces imposed on the ECM during physical activity critically affect cell signalling while disuse causes non-optimal adaptations, including connective tissue proliferation. The goal of this review is to inform researchers, and rehabilitation, medical, and exercise practitioners better about the role of ECM biomarkers in research and clinical environments to accelerate the development of targeted physical activity treatments, improve ECM status assessment, and enhance function in aging, injury, and disease.
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Affiliation(s)
- Georgios Mavropalias
- Centre for Human Performance, School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, and Centre for Healthy Aging, Health Futures Institute, Murdoch University, Murdoch, WA, 6150, Australia
- Discipline of Exercise Science, Murdoch University, Murdoch, WA, 6150, Australia
| | - Marni Boppart
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 1206 South Fourth St, Urbana, IL, 61801, USA
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana- Champaign, 405 N. Mathews Avenue, Urbana, IL, 61801, USA
| | - Kayley M Usher
- School of Biomedical Sciences, University of Western Australia (M504), 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - Miranda D Grounds
- School of Human Sciences, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - Kazunori Nosaka
- Centre for Human Performance, School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Anthony J Blazevich
- Centre for Human Performance, School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
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Monteiro BP, Lascelles BDX, Murrell J, Robertson S, Steagall PVM, Wright B. 2022
WSAVA
guidelines for the recognition, assessment and treatment of pain. J Small Anim Pract 2022. [DOI: 10.1111/jsap.13566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- B. P. Monteiro
- Department of Clinical Sciences, Faculty of Veterinary Medicine Université de Montréal 3200 rue Sicotte, Saint‐Hyacinthe Quebec Canada
| | - B. D. X. Lascelles
- Comparative Pain Research Laboratory and Surgery Section North Carolina State University 4700 Hillsborough Street Raleigh NC USA
| | - J. Murrell
- Highcroft Veterinary Referrals 615 Wells Rd, Whitchurch Bristol BS149BE UK
| | - S. Robertson
- Senior Medical Director Lap of Love Veterinary Hospice 17804 N US Highway 41 Lutz FL 33549 USA
| | - P. V. M. Steagall
- Department of Clinical Sciences, Faculty of Veterinary Medicine Université de Montréal 3200 rue Sicotte, Saint‐Hyacinthe Quebec Canada
| | - B. Wright
- Mistral Vet 4450 Thompson Pkwy Fort Collins CO 80534 USA
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Peng J, Yang J, Feng J, Zhou G, Dong L, Lin R, Wang D. The Effect of Fu's Subcutaneous Needling Combined with Reperfusion Approach on Surface Electromyography Signals in Patients with Cervical Spondylosis and Neck Pain: A Clinical Trial Protocol. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1761434. [PMID: 36193322 PMCID: PMC9526609 DOI: 10.1155/2022/1761434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/06/2022] [Accepted: 08/18/2022] [Indexed: 11/18/2022]
Abstract
Background Neck pain is one of the most common musculoskeletal diseases. Fu's subcutaneous needling therapy is a special acupuncture method that targets muscle trigger points. It has been proven to have a positive effect on the treatment of neck pain. The access to its curative effect may be related to the improvement of muscle and soft tissue condition. The purpose of this study is to evaluate the outcome of Fu's subcutaneous needling therapy for patients with neck pain by collecting changes in the sEMG of the patient's neck muscles and related data from evaluation scales and explore the feasibility and safety of Fu's subcutaneous needling therapy for neck pain. Methods 72 patients meeting the inclusion criteria were randomly divided into FSN group and acupuncture group for corresponding treatment. FSN group was treated once every other day for 5 consecutive treatments; the acupuncture group was treated once a day for 10 consecutive treatments. Result Outcome indicators were measured at baseline, after the first treatment and the end of the treatment. Primary outcome indicators: average EMG (AEMG) and (mean power frequency) MPF of sternocleidomastoid muscle and superior trapezius muscle. Secondary outcome indicators: Mc Gill pain questionnaire (MPQ), neck disability index (NDI), and adverse reactions. Conclusions This study will explore the efficacy, safety, and possible mechanism of Fu's subcutaneous needling therapy for patients with neck pain, thus to provide more evidence support for clinical decision-making. This trial is registered with Chinese Clinical Trial Register Center (registration number ChiCTR2100043529).
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Affiliation(s)
- Junliang Peng
- Department of Rehabilitation Medicine, Affiliated TaiHe Hospital of Hubei University of Medicine, Shiyan, 442000 Hubei, China
| | - Jiaen Yang
- Department of TCM Rehabilitation Medicine, Affiliated Foshan Gaoming Hospital of Guangdong Medical University, Foshan, 528000 Guangdong, China
| | - Jiaqi Feng
- Department of TCM Rehabilitation Medicine, Affiliated Foshan Gaoming Hospital of Guangdong Medical University, Foshan, 528000 Guangdong, China
| | - Guangjin Zhou
- Department of TCM Rehabilitation Medicine, Affiliated Foshan Gaoming Hospital of Guangdong Medical University, Foshan, 528000 Guangdong, China
| | - Li Dong
- Department of Rehabilitation Medicine, Affiliated Hospital of Chengdu University, Chengdu, 610000 Sichuan, China
| | - Rong Lin
- Department of Rehabilitation Medicine, The Second People's Hospital of Longquanyi District, Chengdu, 610000 Sichuan, China
| | - Dong Wang
- Department of Rehabilitation Medicine, Affiliated Hospital of Chengdu University, Chengdu, 610000 Sichuan, China
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Król M, Kupnicka P, Bosiacki M, Chlubek D. Mechanisms Underlying Anti-Inflammatory and Anti-Cancer Properties of Stretching-A Review. Int J Mol Sci 2022; 23:ijms231710127. [PMID: 36077525 PMCID: PMC9456560 DOI: 10.3390/ijms231710127] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 02/07/2023] Open
Abstract
Stretching is one of the popular elements in physiotherapy and rehabilitation. When correctly guided, it can help minimize or slow down the disabling effects of chronic health conditions. Most likely, the benefits are associated with reducing inflammation; recent studies demonstrate that this effect from stretching is not just systemic but also local. In this review, we present the current body of knowledge on the anti-inflammatory properties of stretching at a molecular level. A total of 22 papers, focusing on anti-inflammatory and anti-cancer properties of stretching, have been selected and reviewed. We show the regulation of oxidative stress, the expression of pro- and anti-inflammatory genes and mediators, and remodeling of the extracellular matrix, expressed by changes in collagen and matrix metalloproteinases levels, in tissues subjected to stretching. We point out that a better understanding of the anti-inflammatory properties of stretching may result in increasing its importance in treatment and recovery from diseases such as osteoarthritis, systemic sclerosis, and cancer.
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Affiliation(s)
- Małgorzata Król
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wlkp. 72, 70-111 Szczecin, Poland
| | - Patrycja Kupnicka
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wlkp. 72, 70-111 Szczecin, Poland
- Correspondence:
| | - Mateusz Bosiacki
- Chair and Department of Functional Diagnostics and Physical Medicine, Pomeranian Medical University, Żołnierska 54, 71-210 Szczecin, Poland
| | - Dariusz Chlubek
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wlkp. 72, 70-111 Szczecin, Poland
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Kaya M, Gokce E, Demırturk F. The effect of two different stretching exercises on the muscle tendon unit and range of motion. ISOKINET EXERC SCI 2022. [DOI: 10.3233/ies-210172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Stretching is commonly used for clinical and sports reason but the effects vary on time and the technique used. PURPOSE: To determine the acute effects of static and dynamic stretching of gastrocnemius muscle on muscle-tendon unit (MTU) and dorsiflexion range of motion (ROM) in the same individuals; to find out how long the stretching effects endure. METHODS: Twenty-eight males (mean age: 22.18 ± 2.58 years) were included in the study. A 45-s static stretching (SS) exercise was applied to the right leg 5 times and dynamic stretching (DS) of same duration to the other leg. Change in MTU was assessed by ultrasonography and active and passive ROM was measured with goniometer. All evaluations were performed before, immediately following, 5-min, 15-min and 30-min after stretching. RESULTS: Muscle thickness and pennation angle did not change over time with either techniques (p> 0.05). A significant muscle-tendon junction (MTJ) displacement occurred after the techniques (p< 0.05); the highest change was achieved after DS (p< 0.05). Both techniques improved active ROM values similarly (p< 0.05), but only dynamic stretching increased passive ROM significantly (p< 0.05). Active and passive ROM and MTJ displacement values at 30th – min were still higher than the baseline ones on the DS side (p< 0.05). However, SS increased active ROM angle immediately after application but this increment declined until the final measurement. CONCLUSION: We recommend using the dynamic stretching technique to achieve greater and longer lasting increases in tendon length and range of motion.
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Affiliation(s)
- Mustafa Kaya
- Department of Movement and Training Sciences, Faculty of Sports Sciences, Sivas Cumhuriyet University, Sivas, Turkey
| | - Erkan Gokce
- Department of Radiology, Faculty of Medicine, Tokat Gaziosmanpasa University, Tokat, Turkey
| | - Funda Demırturk
- Physiotherapy and Rehabilitation Department, Faculty of Health Sciences, Tokat Gaziosmanpasa University, Tokat, Turkey
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Bruce J, Mazuquin B, Mistry P, Rees S, Canaway A, Hossain A, Williamson E, Padfield EJ, Lall R, Richmond H, Chowdhury L, Lait C, Petrou S, Booth K, Lamb SE, Vidya R, Thompson AM. Exercise to prevent shoulder problems after breast cancer surgery: the PROSPER RCT. Health Technol Assess 2022; 26:1-124. [PMID: 35220995 DOI: 10.3310/jknz2003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Upper limb problems are common after breast cancer treatment. OBJECTIVES To investigate the clinical effectiveness and cost-effectiveness of a structured exercise programme compared with usual care on upper limb function, health-related outcomes and costs in women undergoing breast cancer surgery. DESIGN This was a two-arm, pragmatic, randomised controlled trial with embedded qualitative research, process evaluation and parallel economic analysis; the unit of randomisation was the individual (allocated ratio 1 : 1). SETTING Breast cancer centres, secondary care. PARTICIPANTS Women aged ≥ 18 years who had been diagnosed with breast cancer and were at higher risk of developing shoulder problems. Women were screened to identify their risk status. INTERVENTIONS All participants received usual-care information leaflets. Those randomised to exercise were referred to physiotherapy for an early, structured exercise programme (three to six face-to-face appointments that included strengthening, physical activity and behavioural change strategies). MAIN OUTCOME MEASURES The primary outcome was upper limb function at 12 months as assessed using the Disabilities of Arm, Hand and Shoulder questionnaire. Secondary outcomes were function (Disabilities of Arm, Hand and Shoulder questionnaire subscales), pain, complications (e.g. wound-related complications, lymphoedema), health-related quality of life (e.g. EuroQol-5 Dimensions, five-level version; Short Form questionnaire-12 items), physical activity and health service resource use. The economic evaluation was expressed in terms of incremental cost per quality-adjusted life-year and incremental net monetary benefit gained from an NHS and Personal Social Services perspective. Participants and physiotherapists were not blinded to group assignment, but data collectors were blinded. RESULTS Between 2016 and 2017, we randomised 392 participants from 17 breast cancer centres across England: 196 (50%) to the usual-care group and 196 (50%) to the exercise group. Ten participants (10/392; 3%) were withdrawn at randomisation and 32 (8%) did not provide complete baseline data. A total of 175 participants (89%) from each treatment group provided baseline data. Participants' mean age was 58.1 years (standard deviation 12.1 years; range 28-88 years). Most participants had undergone axillary node clearance surgery (327/392; 83%) and 317 (81%) had received radiotherapy. Uptake of the exercise treatment was high, with 181 out of 196 (92%) participants attending at least one physiotherapy appointment. Compliance with exercise was good: 143 out of 196 (73%) participants completed three or more physiotherapy sessions. At 12 months, 274 out of 392 (70%) participants returned questionnaires. Improvement in arm function was greater in the exercise group [mean Disabilities of Arm, Hand and Shoulder questionnaire score of 16.3 (standard deviation 17.6)] than in the usual-care group [mean Disabilities of Arm, Hand and Shoulder questionnaire score of 23.7 (standard deviation 22.9)] at 12 months for intention-to-treat (adjusted mean difference Disabilities of Arm, Hand and Shoulder questionnaire score of -7.81, 95% confidence interval -12.44 to -3.17; p = 0.001) and complier-average causal effect analyses (adjusted mean difference -8.74, 95% confidence interval -13.71 to -3.77; p ≤ 0.001). At 12 months, pain scores were lower and physical health-related quality of life was higher in the exercise group than in the usual-care group (Short Form questionnaire-12 items, mean difference 4.39, 95% confidence interval 1.74 to 7.04; p = 0.001). We found no differences in the rate of adverse events or lymphoedema over 12 months. The qualitative findings suggested that women found the exercise programme beneficial and enjoyable. Exercise accrued lower costs (-£387, 95% CI -£2491 to £1718) and generated more quality-adjusted life years (0.029, 95% CI 0.001 to 0.056) than usual care over 12 months. The cost-effectiveness analysis indicated that exercise was more cost-effective and that the results were robust to sensitivity analyses. Exercise was relatively cheap to implement (£129 per participant) and associated with lower health-care costs than usual care and improved health-related quality of life. Benefits may accrue beyond the end of the trial. LIMITATIONS Postal follow-up was lower than estimated; however, the study was adequately powered. No serious adverse events directly related to the intervention were reported. CONCLUSIONS This trial provided robust evidence that referral for early, supported exercise after breast cancer surgery improved shoulder function in those at risk of shoulder problems and was associated with lower health-care costs than usual care and improved health-related quality of life. FUTURE WORK Future work should focus on the implementation of exercise programmes in clinical practice for those at highest risk of shoulder problems. TRIAL REGISTRATION This trial is registered as ISRCTN35358984. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Julie Bruce
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Bruno Mazuquin
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Pankaj Mistry
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Sophie Rees
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Alastair Canaway
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Anower Hossain
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
- Institute of Statistical Research and Training (ISRT), University of Dhaka, Dhaka, Bangladesh
| | - Esther Williamson
- Centre for Rehabilitation Research, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Emma J Padfield
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Ranjit Lall
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Helen Richmond
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada
| | - Loraine Chowdhury
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Clare Lait
- Gloucestershire Care Services NHS Trust, Gloucester, UK
| | - Stavros Petrou
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Katie Booth
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Sarah E Lamb
- College of Medicine and Health, University of Exeter, Exeter, UK
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12
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Muñoz-Vergara D, Schreiber KL, Langevin H, Yeh GY, Zhu Y, Rist P, Wayne PM. The Effects of a Single Bout of High- or Moderate-Intensity Yoga Exercise on Circulating Inflammatory Mediators: A Pilot Feasibility Study. Glob Adv Health Med 2022; 11:2164957X221145876. [PMID: 36583069 PMCID: PMC9793102 DOI: 10.1177/2164957x221145876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/04/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
Background There is a knowledge gap in the physiological effects of short-term yoga exercise interventions. Objective To evaluate the feasibility of a randomized controlled trial (RCT) assessing the acute effects of a yoga exercise protocol practiced at 2 intensities (high or moderate) on temporal responses of a battery of systemic circulatory cytokines in healthy yoga-naïve adults. Methods This study was a three-arm, pre-post pilot-RCT employing a single bout of yoga exercise intervention. Groups were high-intensity yoga (HY, n = 10), moderate-intensity yoga (MY, n = 10), and a sedentary, no-intervention control group (CON, n = 10). Blood samples were collected at baseline and post-intervention at 6 timepoints (0-, 30-, 60-, 120-, 180-minutes, and 24-hours post-intervention) and were processed with a pre-defined inflammatory panel of 13 cytokines. Heart rate (HR) was assessed with a Polar H10® device. The PROMIS Pain intensity Questionnaire was used to assess body soreness. Results We demonstrate feasibility of recruitment, randomization, and retention of participants based upon predetermined metrics, including: proportion of eligible to enrolled participants (55%); recruitment period (11-months); participant retention (97%); completion rate for questionnaires (99%); completion of physiological measures (98%); and adherence to the yoga exercise protocol (88%). Cytokine levels over time were heterogeneous within and between groups. Responses of a subset of cytokines were positively correlated with 1 another in high- and moderate-intensity yoga exercise groups but not in the control group. Median values for HR were 91 (IQR: 71-95) in the HY, 95 (IQR: 88-100) in the MY, and 73 (IQR: 72-75) in the CON. Pre-post changes in body soreness after the yoga exercise intervention were most evident in the HY group. Conclusion Along with observed trends in select cytokines, findings encourage a more definitive trial aimed at understanding the short-term effects of yoga exercise on inflammatory immune markers and pain in sedentary healthy adults. Clinicaltrials.gov ID# NCT04444102.
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Affiliation(s)
- Dennis Muñoz-Vergara
- Osher Center for Integrative
Medicine, Harvard Medical School, Brigham and Women’s
Hospital, Boston, MA, USA
- Division of Preventive Medicine,
Harvard Medical School, Brigham and Women’s
Hospital, Boston, MA, USA
- Dennis Muñoz-Vergara, DVM, MS, MPH,
Division of Preventive Medicine, Brigham and Women’s Hospital, 900 Commonwealth
Ave, Boston, MA 02215, USA.
| | - Kristin L. Schreiber
- Department of Anesthesiology,
Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women’s
Hospital, Boston, MA, USA
| | - Helene Langevin
- National Center for Complementary
and Integrative Health (NCCIH), National Institute of Health
(NIH), Bethesda, MD, USA
| | - Gloria Y. Yeh
- Osher Center for Integrative
Medicine, Harvard Medical School, Brigham and Women’s
Hospital, Boston, MA, USA
- Division of General Medicine and
Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Yehui Zhu
- Department of Radiology, A. A.
Martinos Center for Biomedical Imaging, Harvard Medical School, Massachusetts General
Hospital, Boston, MA, USA
| | - Pamela Rist
- Osher Center for Integrative
Medicine, Harvard Medical School, Brigham and Women’s
Hospital, Boston, MA, USA
- Division of Preventive Medicine,
Harvard Medical School, Brigham and Women’s
Hospital, Boston, MA, USA
| | - Peter M. Wayne
- Osher Center for Integrative
Medicine, Harvard Medical School, Brigham and Women’s
Hospital, Boston, MA, USA
- Division of Preventive Medicine,
Harvard Medical School, Brigham and Women’s
Hospital, Boston, MA, USA
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13
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Muñoz-Vergara D, Grabowska W, Yeh GY, Khalsa SB, Schreiber KL, Huang CA, Zavacki AM, Wayne PM. A systematic review of in vivo stretching regimens on inflammation and its relevance to translational yoga research. PLoS One 2022; 17:e0269300. [PMID: 35648793 PMCID: PMC9159623 DOI: 10.1371/journal.pone.0269300] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 05/18/2022] [Indexed: 12/09/2022] Open
Abstract
OBJECTIVE To conduct a systematic review evaluating the impact of stretching on inflammation and its resolution using in vivo rodent models. Findings are evaluated for their potential to inform the design of clinical yoga studies to assess the impact of yogic stretching on inflammation and health. METHODS Studies were identified using four databases. Eligible publications included English original peer-reviewed articles between 1900-May 2020. Studies included those investigating the effect of different stretching techniques administered to a whole rodent model and evaluating at least one inflammatory outcome. Studies stretching the musculoskeletal and integumentary systems were considered. Two reviewers removed duplicates, screened abstracts, conducted full-text reviews, and assessed methodological quality. RESULTS Of 766 studies identified, 25 were included for synthesis. Seven (28%) studies had a high risk of bias in 3 out of 10 criteria. Experimental stretching protocols resulted in a continuum of inflammatory responses with therapeutic and injurious effects, which varied with a combination of three stretching parameters--duration, frequency, and intensity. Relative to injurious stretching, therapeutic stretching featured longer-term stretching protocols. Evidence of pro- and mixed-inflammatory effects of stretching was found in 16 muscle studies. Evidence of pro-, anti-, and mixed-inflammatory effects was found in nine longer-term stretching studies of the integumentary system. CONCLUSION Despite the overall high quality of these summarized studies, evaluation of stretching protocols paralleling yogic stretching is limited. Both injurious and therapeutic stretching induce aspects of inflammatory responses that varied among the different stretching protocols. Inflammatory markers, such as cytokines, are potential outcomes to consider in clinical yoga studies. Future translational research evaluating therapeutic benefits should consider in vitro studies, active vs. passive stretching, shorter-term vs. longer-term interventions, systemic vs. local effects of stretching, animal models resembling human anatomy, control and estimation of non-specific stresses, development of in vivo self-stretching paradigms targeting myofascial tissues, and in vivo models accounting for gross musculoskeletal posture.
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Affiliation(s)
- Dennis Muñoz-Vergara
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
- Osher Center for Integrative Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
- * E-mail:
| | - Weronika Grabowska
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Gloria Y. Yeh
- Osher Center for Integrative Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Sat Bir Khalsa
- Osher Center for Integrative Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Kristin L. Schreiber
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Christene A. Huang
- The Department of Surgery, School of Medicine, University of Colorado, Denver, CO, United States of America
| | - Ann Marie Zavacki
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Peter M. Wayne
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
- Osher Center for Integrative Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
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14
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Alqahtani S, Xia L, Jannasch A, Ferreira C, Franco J, Shannahan JH. Disruption of pulmonary resolution mediators contribute to exacerbated silver nanoparticle-induced acute inflammation in a metabolic syndrome mouse model. Toxicol Appl Pharmacol 2021; 431:115730. [PMID: 34601004 PMCID: PMC8545917 DOI: 10.1016/j.taap.2021.115730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/08/2021] [Accepted: 09/22/2021] [Indexed: 12/18/2022]
Abstract
Pre-existing conditions modulate sensitivity to numerous xenobiotic exposures such as air pollution. Specifically, individuals suffering from metabolic syndrome (MetS) demonstrate enhanced acute inflammatory responses following particulate matter inhalation. The mechanisms associated with these exacerbated inflammatory responses are unknown, impairing interventional strategies and our understanding of susceptible populations. We hypothesize MetS-associated lipid dysregulation influences mediators of inflammatory resolution signaling contributing to increased acute pulmonary toxicity. To evaluate this hypothesis, healthy and MetS mouse models were treated with either 18-hydroxy eicosapentaenoic acid (18-HEPE), 14-hydroxy docosahexaenoic acid (14-HDHA), 17-hydroxy docosahexaenoic acid (17-HDHA), or saline (control) via intraperitoneal injection prior to oropharyngeal aspiration of silver nanoparticles (AgNP). In mice receiving saline treatment, AgNP exposure resulted in an acute pulmonary inflammatory response that was exacerbated in MetS mice. A targeted lipid assessment demonstrated 18-HEPE, 14-HDHA, and 17-HDHA treatments altered lung levels of specialized pro-resolving lipid mediators (SPMs). 14-HDHA and 17-HDHA treatments more efficiently reduced the exacerbated acute inflammatory response in AgNP exposed MetS mice as compared to 18-HEPE. This included decreased neutrophilic influx, diminished induction of inflammatory cytokines/chemokines, and reduced alterations in SPMs. Examination of SPM receptors determined baseline reductions in MetS mice compared to healthy as well as decreases due to AgNP exposure. Overall, these results demonstrate AgNP exposure disrupts inflammatory resolution, specifically 14-HDHA and 17-HDHA derived SPMs, in MetS contributing to exacerbated acute inflammatory responses. Our findings identify a potential mechanism responsible for enhanced susceptibility in MetS that can be targeted for interventional therapeutic approaches.
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Affiliation(s)
- Saeed Alqahtani
- School of Health Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, IN, United States; National Center for Pharmaceuticals, Life Science and Environment Research Institute, King Abdulaziz City for Science and Technology (KACST), Riyadh, Saudi Arabia
| | - Li Xia
- School of Health Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, IN, United States
| | - Amber Jannasch
- Purdue Metabolite Profiling Facility, Purdue University, West Lafayette, IN, United States
| | - Christina Ferreira
- Purdue Metabolite Profiling Facility, Purdue University, West Lafayette, IN, United States
| | - Jackeline Franco
- Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
| | - Jonathan H Shannahan
- School of Health Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, IN, United States.
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15
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Yao D, Qiao F, Song C, Lv Y. Matrix stiffness regulates bone repair by modulating 12-lipoxygenase-mediated early inflammation. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 128:112359. [PMID: 34474906 DOI: 10.1016/j.msec.2021.112359] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/04/2021] [Accepted: 08/04/2021] [Indexed: 12/21/2022]
Abstract
Lipid metabolism in macrophages has been increasingly emphasized in exerting an anti-inflammatory effect and accelerating fracture healing. 12-lipoxygenase (12-LOX) is expressed in several cell types, including macrophages, and oxidizes polyunsaturated fatty acids (PUFAs) to generate both pro- and anti-inflammatory lipid mediators, of which the n-3 PUFAs play an important part in tissue homeostasis/fibrosis. Although mechanical factor regulates the lipid metabolic axis of inflammatory cells, specifically matrix stiffness influences macrophages metabolic responses, little is known about how matrix stiffness affects the 12-LOX-mediated early inflammation in bone repair. In the present study, demineralized bone matrix (DBM) scaffolds with different matrix stiffness were constructed by controlling the duration of decalcification (0 h (control), 1 h (high), 12 h (medium), and 5 d (low)) to repair the defected rat skull. The expression of inflammatory cytokines and macrophages polarization were analyzed. The lipid metabolites and lipid mediators' biosynthesis by matrix stiffness-regulated were further detected. The results showed that the low matrix stiffness could polarize macrophages into an anti-inflammatory phenotype, promote the expression of anti-inflammatory cytokines and specialized pro-resolving lipid mediators (SPMs) biosynthesis beneficial for the osteogenesis of mesenchymal stem cells (MSCs). After treated with ML355, the expression of anti-inflammatory cytokines/proteins and SPMs biosynthesis in macrophages cultured on low-matrix stiffness scaffolds were repressed, and there were almost no statistical differences among all groups. Findings from this study support that matrix stiffness regulates bone repair by modulating 12-LOX-mediated early inflammation, which suggest a direct mechanical impact of matrix stiffness on macrophages lipid metabolism and provide a new insight into the clinical application of SPMs for bone regeneration.
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Affiliation(s)
- Dongdong Yao
- Mechanobiology and Regenerative Medicine Laboratory, Bioengineering College, Chongqing University, Chongqing 400044, PR China
| | - Fangyu Qiao
- Mechanobiology and Regenerative Medicine Laboratory, Bioengineering College, Chongqing University, Chongqing 400044, PR China
| | - Chenchen Song
- Mechanobiology and Regenerative Medicine Laboratory, Bioengineering College, Chongqing University, Chongqing 400044, PR China
| | - Yonggang Lv
- Mechanobiology and Regenerative Medicine Laboratory, Bioengineering College, Chongqing University, Chongqing 400044, PR China.
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16
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Lutke Schipholt IJ, Coppieters MW, Meijer OG, Tompra N, de Vries RBM, Scholten-Peeters GGM. Effects of joint and nerve mobilisation on neuroimmune responses in animals and humans with neuromusculoskeletal conditions: a systematic review and meta-analysis. Pain Rep 2021; 6:e927. [PMID: 34104836 PMCID: PMC8177878 DOI: 10.1097/pr9.0000000000000927] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/18/2021] [Accepted: 03/12/2021] [Indexed: 12/14/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. There is evidence that joint and nerve mobilisations compared with sham or no intervention positively influence various neuroimmune responses in animal and human neuromusculoskeletal conditions. Several animal and human studies revealed that joint and nerve mobilisations positively influence neuroimmune responses in neuromusculoskeletal conditions. However, no systematic review and meta-analysis has been performed. Therefore, this study aimed to synthesize the effects of joint and nerve mobilisation compared with sham or no intervention on neuroimmune responses in animals and humans with neuromusculoskeletal conditions. Four electronic databases were searched for controlled trials. Two reviewers independently selected studies, extracted data, assessed the risk of bias, and graded the certainty of the evidence. Where possible, meta-analyses using random effects models were used to pool the results. Preliminary evidence from 13 animal studies report neuroimmune responses after joint and nerve mobilisations. In neuropathic pain models, meta-analysis revealed decreased spinal cord levels of glial fibrillary acidic protein, dorsal root ganglion levels of interleukin-1β, number of dorsal root ganglion nonneuronal cells, and increased spinal cord interleukin-10 levels. The 5 included human studies showed mixed effects of spinal manipulation on salivary/serum cortisol levels in people with spinal pain, and no significant effects on serum β-endorphin or interleukin-1β levels in people with spinal pain. There is evidence that joint and nerve mobilisations positively influence various neuroimmune responses. However, as most findings are based on single studies, the certainty of the evidence is low to very low. Further studies are needed.
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Affiliation(s)
- Ivo J Lutke Schipholt
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Department of Clinical Chemistry, Laboratory Medical Immunology, Amsterdam UMC, Location VU Medical Centre, Amsterdam, the Netherlands
| | - Michel W Coppieters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia
| | - Onno G Meijer
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Orthopaedic Biomechanics Laboratory, Fujian Medical University, Quanzhou, Fujian, PR China
| | - Nefeli Tompra
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Rob B M de Vries
- SYRCLE, Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Gwendolyne G M Scholten-Peeters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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17
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Barbe MF, Harris MY, Cruz GE, Amin M, Billett NM, Dorotan JT, Day EP, Kim SY, Bove GM. Key indicators of repetitive overuse-induced neuromuscular inflammation and fibrosis are prevented by manual therapy in a rat model. BMC Musculoskelet Disord 2021; 22:417. [PMID: 33952219 PMCID: PMC8101118 DOI: 10.1186/s12891-021-04270-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/07/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND We examined the effectiveness of a manual therapy consisting of forearm skin rolling, muscle mobilization, and upper extremity traction as a preventive treatment for rats performing an intensive lever-pulling task. We hypothesized that this treatment would reduce task-induced neuromuscular and tendon inflammation, fibrosis, and sensorimotor declines. METHODS Sprague-Dawley rats performed a reaching and lever pulling task for a food reward, 2 h/day, 3 days/week, for 12 weeks, while simultaneously receiving the manual therapy treatment 3 times per week for 12 weeks to either the task-involved upper extremities (TASK-Tx), or the lower extremities as an active control group (TASK-Ac). Results were compared to similarly treated control rats (C-Tx and C-Ac). RESULTS Median nerves and forearm flexor muscles and tendons of TASK-Ac rats showed higher numbers of inflammatory CD68+ and fibrogenic CD206+ macrophages, particularly in epineurium, endomysium and epitendons than TASK-Tx rats. CD68+ and CD206+ macrophages numbers in TASK-Tx rats were comparable to the non-task control groups. TASK-Ac rats had more extraneural fibrosis in median nerves, pro-collagen type I levels and immunoexpression in flexor digitorum muscles, and fibrogenic changes in flexor digitorum epitendons, than TASK-Tx rats (which showed comparable responses as control groups). TASK-Ac rats showed cold temperature, lower reflexive grip strength, and task avoidance, responses not seen in TASK-Tx rats (which showed comparable responses as the control groups). CONCLUSIONS Manual therapy of forelimbs involved in performing the reaching and grasping task prevented the development of inflammatory and fibrogenic changes in forearm nerves, muscle, and tendons, and sensorimotor declines.
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Affiliation(s)
- Mary F Barbe
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA, 19140, USA.
| | - Michele Y Harris
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA, 19140, USA
| | - Geneva E Cruz
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA, 19140, USA
| | - Mamta Amin
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA, 19140, USA
| | - Nathan M Billett
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA, 19140, USA
| | - Jocelynne T Dorotan
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA, 19140, USA
| | - Emily P Day
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA, 19140, USA
| | - Seung Y Kim
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA, 19140, USA
| | - Geoffrey M Bove
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA, 19140, USA.,Bove Consulting, Kennebunkport, ME, 04046, USA
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18
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Riehl BD, Kim E, Bouzid T, Lim JY. The Role of Microenvironmental Cues and Mechanical Loading Milieus in Breast Cancer Cell Progression and Metastasis. Front Bioeng Biotechnol 2021; 8:608526. [PMID: 33585411 PMCID: PMC7874074 DOI: 10.3389/fbioe.2020.608526] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/22/2020] [Indexed: 01/08/2023] Open
Abstract
Cancer can disrupt the microenvironments and mechanical homeostatic actions in multiple scales from large tissue modification to altered cellular signaling pathway in mechanotransduction. In this review, we highlight recent progresses in breast cancer cell mechanobiology focusing on cell-microenvironment interaction and mechanical loading regulation of cells. First, the effects of microenvironmental cues on breast cancer cell progression and metastasis will be reviewed with respect to substrate stiffness, chemical/topographic substrate patterning, and 2D vs. 3D cultures. Then, the role of mechanical loading situations such as tensile stretch, compression, and flow-induced shear will be discussed in relation to breast cancer cell mechanobiology and metastasis prevention. Ultimately, the substrate microenvironment and mechanical signal will work together to control cancer cell progression and metastasis. The discussions on breast cancer cell responsiveness to mechanical signals, from static substrate and dynamic loading, and the mechanotransduction pathways involved will facilitate interdisciplinary knowledge transfer, enabling further insights into prognostic markers, mechanically mediated metastasis pathways for therapeutic targets, and model systems required to advance cancer mechanobiology.
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Affiliation(s)
- Brandon D Riehl
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Eunju Kim
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Tasneem Bouzid
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Jung Yul Lim
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, United States.,Mary and Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, NE, United States
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19
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Fishbein A, Hammock BD, Serhan CN, Panigrahy D. Carcinogenesis: Failure of resolution of inflammation? Pharmacol Ther 2021; 218:107670. [PMID: 32891711 PMCID: PMC7470770 DOI: 10.1016/j.pharmthera.2020.107670] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2020] [Indexed: 02/06/2023]
Abstract
Inflammation in the tumor microenvironment is a hallmark of cancer and is recognized as a key characteristic of carcinogens. However, the failure of resolution of inflammation in cancer is only recently being understood. Products of arachidonic acid and related fatty acid metabolism called eicosanoids, including prostaglandins, leukotrienes, lipoxins, and epoxyeicosanoids, critically regulate inflammation, as well as its resolution. The resolution of inflammation is now appreciated to be an active biochemical process regulated by endogenous specialized pro-resolving lipid autacoid mediators which combat infections and stimulate tissue repair/regeneration. Environmental and chemical human carcinogens, including aflatoxins, asbestos, nitrosamines, alcohol, and tobacco, induce tumor-promoting inflammation and can disrupt the resolution of inflammation contributing to a devastating global cancer burden. While mechanisms of carcinogenesis have focused on genotoxic activity to induce mutations, nongenotoxic mechanisms such as inflammation and oxidative stress promote genotoxicity, proliferation, and mutations. Moreover, carcinogens initiate oxidative stress to synergize with inflammation and DNA damage to fuel a vicious feedback loop of cell death, tissue damage, and carcinogenesis. In contrast, stimulation of resolution of inflammation may prevent carcinogenesis by clearance of cellular debris via macrophage phagocytosis and inhibition of an eicosanoid/cytokine storm of pro-inflammatory mediators. Controlling the host inflammatory response and its resolution in carcinogen-induced cancers will be critical to reducing carcinogen-induced morbidity and mortality. Here we review the recent evidence that stimulation of resolution of inflammation, including pro-resolution lipid mediators and soluble epoxide hydrolase inhibitors, may be a new chemopreventive approach to prevent carcinogen-induced cancer that should be evaluated in humans.
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Affiliation(s)
- Anna Fishbein
- Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
| | - Bruce D. Hammock
- Department of Entomology and Nematology, and UCD Comprehensive Cancer Center, University of California, Davis, CA 95616, USA
| | - Charles N. Serhan
- Center for Experimental Therapeutics and Reperfusion Injury, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Dipak Panigrahy
- Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA,Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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20
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Vieira C, Salm DC, Horewicz VV, Ludtke DD, Emer AA, Koerich JF, Mazzardo G, Elias S, Moré AOO, Mazzardo-Martins L, Cidral-Filho FJ, Reed WR, Piovezan AP, Martins DF. Electroacupuncture decreases inflammatory pain through a pro-resolving mechanism involving the peripheral annexin A1-formyl peptide receptor 2/ALX-opioid receptor pathway. Pflugers Arch 2021; 473:683-695. [PMID: 33474635 DOI: 10.1007/s00424-020-02502-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/28/2020] [Accepted: 12/03/2020] [Indexed: 12/31/2022]
Abstract
The pro-resolving mechanism is a recently described endogenous process that controls inflammation. The present study evaluated components of this mechanism, including annexin 1 (ANXA1) and the formyl peptide receptor 2/ALX (FPR2/ALX) receptor, in the antihyperalgesic effect induced by electroacupuncture (EA) in an animal model of persistent peripheral inflammation. Male Swiss mice underwent intraplantar (i.pl.) injection with complete Freund's adjuvant (CFA). Mechanical hyperalgesia was assessed with von Frey monofilaments. Animals were treated with EA (2-10 Hz, ST36-SP6) or subcutaneous BML-111 injection (FPR2/ALX agonist) for 5 consecutive days. In a separate set of experiments, on the first and fifth days after CFA injection, animals received i.pl. WRW4 (FPR2/ALX antagonist) or naloxone (non-selective opioid receptor antagonist) before EA or BML-111 injection. Paw protein levels of FPR2/ALX and ANXA1 were evaluated on the second day after CFA injection by western blotting technique. EA and BML-111 reduced mechanical hyperalgesia. I.pl. naloxone or WRW4 prevented the antihyperalgesic effect induced by either EA or BML-111. EA increased ANXA1 but did not alter FPR2/ALX receptor levels in the paw. Furthermore, i.pl. pretreatment with WRW4 prevented the increase of ANXA1 levels induced by EA. This work demonstrates that the EA antihyperalgesic effect on inflammatory pain involves the ANXA1/FPR2/ALX pro-resolution pathway. This effect appears to be triggered by the activation of FPR2/ALX receptors and crosstalk communication with the opioid system.
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Affiliation(s)
- Cintia Vieira
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil.,Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Daiana C Salm
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil.,Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Verônica V Horewicz
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil.,Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Daniela D Ludtke
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil.,Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Aline A Emer
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil.,Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Júlia F Koerich
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil.,Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Gustavo Mazzardo
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Sayron Elias
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Ari O O Moré
- Integrative Medicine and Acupuncture Division, University Hospital, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Leidiane Mazzardo-Martins
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil.,Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Francisco J Cidral-Filho
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil.,Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - William R Reed
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA.,Rehabilitation Science Program, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anna Paula Piovezan
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil.,Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Daniel F Martins
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil. .,Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil.
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21
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França MED, Sinhorim L, Martins DF, Schleip R, Machado-Pereira NAMM, de Souza GM, Horewicz VV, Santos GM. Manipulation of the Fascial System Applied During Acute Inflammation of the Connective Tissue of the Thoracolumbar Region Affects Transforming Growth Factor-β1 and Interleukin-4 Levels: Experimental Study in Mice. Front Physiol 2020; 11:587373. [PMID: 33424619 PMCID: PMC7793886 DOI: 10.3389/fphys.2020.587373] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 10/29/2020] [Indexed: 12/27/2022] Open
Abstract
Fascia can become rigid and assume a fibrotic pattern due to inflammatory processes. Manipulation of the fascial system (MFS), manual technique targeting connective tissues, is commonly used in clinical practice in pain management. We aimed to verify MFS effects on the connective tissue inflammatory changes in mice. Swiss Mus musculus male mice (n = 44) were distributed into groups: carrageenan without treatment (Car, n = 11), carrageenan with MFS (Car + MFS, n = 12), saline without treatment (n = 10), and saline with MFS (saline + MFS, n = 11). Interleukin 4 (IL-4), IL-6, tumor necrosis factor (TNF), transforming growth factor β1 (TGF-β1), and monocyte chemoattractant protein 1 (MCP-1) levels were verified by enzyme-linked immunosorbent assay. Neutrophil (Ly-6G), macrophage (F4/80), and nitric oxide synthase 2 (NOS-2) were identified using Western blot. The MFS protocol was applied from the first to the third day after inflammation of the connective tissue of the thoracolumbar region. There was a significant MFS effect on IL-4 (p = 0.02) and TGF-β1 (p = 0.04), without increasing MCP-1, TNF, and IL-6 levels (p > 0.05) on thoracolumbar region from Car + MFS, in comparison with saline. Ly-6G in Car + MFS presented lower levels when compared with saline (p = 0.003) or saline + MFS (0.003). NOS-2 levels were lower in Car + MFS than in saline + MFS (p = 0.0195) or saline (p = 0.003). MFS may have an anti-inflammatory effect, based on TGF-β1 and IL-4. IL-4 may have inhibited neutrophil migration. Lower levels of NOS-2 may be linked to the lack of macrophages, which are responsible for NOS-2 expression.
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Affiliation(s)
- Maria Elisa Duarte França
- Posture and Balance Laboratory (LAPEQ), College of Health Sciences and Sports, Santa Catarina State University (UDESC), Florianópolis, Brazil
| | - Larissa Sinhorim
- Posture and Balance Laboratory (LAPEQ), College of Health Sciences and Sports, Santa Catarina State University (UDESC), Florianópolis, Brazil.,Neurosciences Experimental Laboratory (LANEX), Postgraduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina, Palhoça, Brazil
| | - Daniel Fernandes Martins
- Neurosciences Experimental Laboratory (LANEX), Postgraduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina, Palhoça, Brazil
| | - Robert Schleip
- Department of Sport and Health Sciences, Associate Professorship of Conservative and Rehabilitative Orthopedics, Technical University of Munich, Munich, Germany.,Department for Medical Professions, DIPLOMA Hochschule Bad Sooden-Allendorf, Bad Sooden-Allendorf, Germany
| | - Nicolas A M M Machado-Pereira
- Posture and Balance Laboratory (LAPEQ), College of Health Sciences and Sports, Santa Catarina State University (UDESC), Florianópolis, Brazil
| | - Gabriel Melo de Souza
- Posture and Balance Laboratory (LAPEQ), College of Health Sciences and Sports, Santa Catarina State University (UDESC), Florianópolis, Brazil
| | - Verônica Vargas Horewicz
- Neurosciences Experimental Laboratory (LANEX), Postgraduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina, Palhoça, Brazil
| | - Gilmar Moraes Santos
- Posture and Balance Laboratory (LAPEQ), College of Health Sciences and Sports, Santa Catarina State University (UDESC), Florianópolis, Brazil
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22
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França MED, Sinhorim L, Martins DF, Schleip R, Machado-Pereira NAMM, de Souza GM, Horewicz VV, Santos GM. Manipulation of the Fascial System Applied During Acute Inflammation of the Connective Tissue of the Thoracolumbar Region Affects Transforming Growth Factor-β1 and Interleukin-4 Levels: Experimental Study in Mice. Front Physiol 2020. [DOI: 10.58737310.3389/fphys.2020.587373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Fascia can become rigid and assume a fibrotic pattern due to inflammatory processes. Manipulation of the fascial system (MFS), manual technique targeting connective tissues, is commonly used in clinical practice in pain management. We aimed to verify MFS effects on the connective tissue inflammatory changes in mice. Swiss Mus musculus male mice (n = 44) were distributed into groups: carrageenan without treatment (Car, n = 11), carrageenan with MFS (Car + MFS, n = 12), saline without treatment (n = 10), and saline with MFS (saline + MFS, n = 11). Interleukin 4 (IL-4), IL-6, tumor necrosis factor (TNF), transforming growth factor β1 (TGF-β1), and monocyte chemoattractant protein 1 (MCP-1) levels were verified by enzyme-linked immunosorbent assay. Neutrophil (Ly-6G), macrophage (F4/80), and nitric oxide synthase 2 (NOS-2) were identified using Western blot. The MFS protocol was applied from the first to the third day after inflammation of the connective tissue of the thoracolumbar region. There was a significant MFS effect on IL-4 (p = 0.02) and TGF-β1 (p = 0.04), without increasing MCP-1, TNF, and IL-6 levels (p > 0.05) on thoracolumbar region from Car + MFS, in comparison with saline. Ly-6G in Car + MFS presented lower levels when compared with saline (p = 0.003) or saline + MFS (0.003). NOS-2 levels were lower in Car + MFS than in saline + MFS (p = 0.0195) or saline (p = 0.003). MFS may have an anti-inflammatory effect, based on TGF-β1 and IL-4. IL-4 may have inhibited neutrophil migration. Lower levels of NOS-2 may be linked to the lack of macrophages, which are responsible for NOS-2 expression.
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23
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Mota GR, Marocolo M. Comment on: "The Case for Retiring Flexibility as a Major Component of Physical Fitness". Sports Med 2020; 51:187-188. [PMID: 33057934 DOI: 10.1007/s40279-020-01357-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Gustavo R Mota
- Exercise Science, Health and Human Performance Research Group, Department of Sport Sciences, Institute of Health Sciences, Federal University of Triangulo Mineiro, Uberaba, MG, Brazil.
| | - Moacir Marocolo
- Physiology and Human Performance Research Group, Department of Physiology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
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Establishment of a Novel Porcine Model to Study the Impact of Active Stretching on a Local Carrageenan-Induced Inflammation. Am J Phys Med Rehabil 2020; 99:1012-1019. [PMID: 32427602 DOI: 10.1097/phm.0000000000001465] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Active stretching of the body is integral to complementary mind-body therapies such as yoga, as well as physical therapy, yet the biologic mechanisms underlying its therapeutic effects remain largely unknown. A previous study showed the impact of active stretching on inflammatory processes in rats. The present study tested the feasibility of using a porcine model, with a closer resemblance to human anatomy, to study the effects of active stretching in the resolution of localized inflammation. DESIGN A total of 12 pigs were trained to stretch before subcutaneous bilateral Carrageenan injection in the back at the L3 vertebrae, 2 cm from the midline. Animals were randomized to no-stretch or stretch, twice a day for 5 mins over 48 hrs. Animals were euthanized for tissue collection 48 hrs postinjection. RESULTS The procedure was well tolerated by the pigs. On average, lesion area was significantly smaller by 36% in the stretch group compared with the no-stretch group (P = 0.03). CONCLUSION This porcine model shows promise for studying the impact of active stretching on inflammation-resolution mechanisms. These results are relevant to understanding the stretching-related therapeutic mechanisms of mind-body therapies. Future studies with larger samples are warranted.
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Seeber GH, Wilhelm MP, Sizer PS, Guthikonda A, Matthijs A, Matthijs OC, Lazovic D, Brismée JM, Gilbert KK. THE TENSILE BEHAVIORS OF THE ILIOTIBIAL BAND - A CADAVERIC INVESTIGATION. Int J Sports Phys Ther 2020; 15:451-459. [PMID: 32566381 PMCID: PMC7296993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
BACKGROUND Clinical stretching is frequently recommended for iliotibial band syndrome management. Current literature lacks conclusive findings regarding isolated human iliotibial band tissue elongation and stiffness behaviors. Applying clinical-grade stretching force results to iliotibial band tissue behavior is thus challenging. PURPOSE This study's objectives were to determine isolated iliotibial band tissue tensile behaviors during tension-to-failure testing and to relate the results to previously reported iliotibial band stretch findings. STUDY DESIGN Descriptive in vitro laboratory study. METHODS Ten isolated un-embalmed iliotibial band specimens were exposed to tension-to-failure testing using a 10kN material testing system. Peak load, load at yield point, and ultimate failure load were measured in Newtons. Corresponding absolute (mm) and relative (%) tissue deformation was recorded. Load-deformation curves were established to calculate iliotibial band stiffness (N/mm). RESULTS A mean peak load of 872.8 ± 285.9N and resulting 9.0 ± 3.9% tissue deformation from initial length was recorded. An 805.5 ± 249.7N mean load at yield point and resulting 7.0 ± 1.9% tissue deformation was observed. A 727.6 ± 258.4N mean load was recorded directly prior to ultimate tissue failure. Mean tissue deformation at ultimate failure was 11.3 ± 4.2%. Mean iliotibial band system stiffness was 27.2 ± 4.5N/mm. CONCLUSION The iliotibial band can withstand substantial tensile forces. Clinical stretching forces likely fall within the load-deformation curve elastic region and may not result in permanent iliotibial band tissue deformation. Sustained elongation resulting from stretching the ITB may require substantial patient compliance. Future studies should investigate potential underlying factors related to positive symptom relief from iliotibial band stretching that include immunological responses, fluid accumulation, altered proprioception, and pain perception. LEVEL OF EVIDENCE 3.
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Affiliation(s)
| | | | - Phillip S Sizer
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Amini Guthikonda
- Department of Kinesiology and Sports Management, Texas Tech University, Lubbock, TX, USA
| | | | | | - Djordje Lazovic
- University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Jean-Michel Brismée
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Kerry K Gilbert
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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26
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Seeber GH, Lierly M, Bassett C, Douthit C, Wilhelm M, Matthijs A, Matthijs O, Lazovic D, Brismée JM, Gilbert K, Sizer P. THE CONSTRAINING EFFECT OF THE LATERAL FEMORAL INTERMUSCULAR SEPTUM ON PASSIVE HIP ADDUCTION IN UN-EMBALMED CADAVERS. Int J Sports Phys Ther 2020; 15:42-52. [PMID: 32089957 PMCID: PMC7015031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Due to the lack of verifiable iliotibial band elongation in response to stretching, the anatomical, biomechanical, and physiological responses to treatment of iliotibial band syndrome remain unclear. The lateral intermuscular septum, consisting of multiple myofibroblasts, firmly anchors the iliotibial band to the femur. PURPOSE AND HYPOTHESIS The purpose of this in-situ study was to examine the constraining effect of the lateral intermuscular septum on available passive hip adduction range of motion in un-embalmed cadavers. It was hypothesized that an iliotibial band-septum-complex release would significantly increase passive hip adduction. DESIGN Within-specimen repeated measures in-situ design. SETTING Anatomy laboratory. METHODS Metal markers were inserted into selected anatomical landmarks in eleven (11) un-embalmed human cadavers. With the specimen supine, the test-side lower limb was passively adducted until maximum passive hip adduction was reached. This movement was repeated three times each within two conditions: (1) band-septum-complex intact and (2) band-septum-complex dissected. Digital video of marker displacement was captured throughout each trial. Still images from a start and an end position were extracted from each video sequence. A custom Matlab program was used to calculate frontal plane hip adduction angle changes from obtained images. RESULTS Mean change in passive hip adduction after band-septum-complex release was -0.3 ° (SD 1.6 °;95% CI: -1.33,0.76). A paired samples t-test revealed a non-significant difference (t=-.611; p=.555) in passive hip adduction for the band-septum-dissected condition (18.8 ± 3.9 °) versus the band-septum-intact condition (18.5 °±4.7 °). CONCLUSION The lateral intermuscular septum does not appear to have a constraining effect on passive hip adduction in un-embalmed cadavers. Future research should evaluate the constraining effect of other selected tissues and conditions on hip adduction. Furthermore, inflammatory, metabolic, viscoelastic, and sensorimotor control properties within the iliotibial band in response to stretching should be investigated. LEVEL OF EVIDENCE 3.
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Affiliation(s)
| | - Micah Lierly
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Cameron Bassett
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Christian Douthit
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Mark Wilhelm
- Tufts University School of Medicine, Medford, MA, USA
| | | | | | - Djordje Lazovic
- University Hospital of Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Jean-Michel Brismée
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Kerry Gilbert
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Phil Sizer
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
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27
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Nunes CADB, Melo PG, Malaquias SG, Amaral KVÁ, Alves GR, Meira AA, Cardoso AL, Pereira LV, Bachion MM. Effectiveness of two bundles in venous leg ulcer healing: A randomized controlled trial. JOURNAL OF VASCULAR NURSING 2019; 37:232-245. [DOI: 10.1016/j.jvn.2019.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 09/13/2019] [Accepted: 09/14/2019] [Indexed: 01/08/2023]
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28
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Gevaert AB, Adams V, Bahls M, Bowen TS, Cornelissen V, Dörr M, Hansen D, Kemps HM, Leeson P, Van Craenenbroeck EM, Kränkel N. Towards a personalised approach in exercise-based cardiovascular rehabilitation: How can translational research help? A 'call to action' from the Section on Secondary Prevention and Cardiac Rehabilitation of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2019; 27:1369-1385. [PMID: 31581819 DOI: 10.1177/2047487319877716] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The benefit of regular physical activity and exercise training for the prevention of cardiovascular and metabolic diseases is undisputed. Many molecular mechanisms mediating exercise effects have been deciphered. Personalised exercise prescription can help patients in achieving their individual greatest benefit from an exercise-based cardiovascular rehabilitation programme. Yet, we still struggle to provide truly personalised exercise prescriptions to our patients. In this position paper, we address novel basic and translational research concepts that can help us understand the principles underlying the inter-individual differences in the response to exercise, and identify early on who would most likely benefit from which exercise intervention. This includes hereditary, non-hereditary and sex-specific concepts. Recent insights have helped us to take on a more holistic view, integrating exercise-mediated molecular mechanisms with those influenced by metabolism and immunity. Unfortunately, while the outline is recognisable, many details are still lacking to turn the understanding of a concept into a roadmap ready to be used in clinical routine. This position paper therefore also investigates perspectives on how the advent of 'big data' and the use of animal models could help unravel inter-individual responses to exercise parameters and thus influence hypothesis-building for translational research in exercise-based cardiovascular rehabilitation.
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Affiliation(s)
- Andreas B Gevaert
- GENCOR Department, University of Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital (UZA), Belgium.,Heart Centre Hasselt, Jessa Hospital, Belgium
| | - Volker Adams
- Department of Molecular and Experimental Cardiology, TU Dresden, Germany
| | - Martin Bahls
- Department of Internal Medicine B, University of Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Germany
| | - T Scott Bowen
- School of Biomedical Sciences, University of Leeds, UK
| | | | - Marcus Dörr
- Department of Internal Medicine B, University of Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Germany
| | - Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Belgium.,Faculty of Rehabilitation Sciences, Hasselt University, Belgium
| | - Hareld Mc Kemps
- Fitheid, Leefstijl, Ontwikkeling en Wetenschap (FLOW), Máxima Medical Centre, The Netherlands
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, University of Oxford, UK
| | - Emeline M Van Craenenbroeck
- GENCOR Department, University of Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital (UZA), Belgium
| | - Nicolle Kränkel
- Department of Cardiology, Charité Universitätsmedizin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Germany
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29
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Manual therapy prevents onset of nociceptor activity, sensorimotor dysfunction, and neural fibrosis induced by a volitional repetitive task. Pain 2019; 160:632-644. [PMID: 30461558 DOI: 10.1097/j.pain.0000000000001443] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Painful and disabling musculoskeletal disorders remain prevalent. In rats trained to perform repetitive tasks leading to signs and dysfunction similar to those in humans, we tested whether manual therapy would prevent the development of the pathologies and symptoms. We collected behavioral, electrophysiological, and histological data from control rats, rats that trained for 5 weeks before performing a high-repetition high-force (HRHF) task for 3 weeks untreated, and trained rats that performed the task for 3 weeks while being treated 3x/week using modeled manual therapy (MMT) to the forearm (HRHF + MMT). The MMT included bilateral mobilization, skin rolling, and long axis stretching of the entire upper limb. High-repetition high-force rats showed decreased performance of the operant HRHF task and increased discomfort-related behaviors, starting after training. HRHF + MMT rats showed improved task performance and decreased discomfort-related behaviors compared with untreated HRHF rats. Subsets of rats were assayed for presence or absence of ongoing activity in C neurons and slow Aδ neurons in their median nerves. Neurons from HRHF rats had a heightened proportion of ongoing activity and altered conduction velocities compared with control and MMT-treated rats. Median nerve branches in HRHF rats contained increased numbers of CD68 macrophages and degraded myelin basic protein, and showed increased extraneural collagen deposition, compared with the other groups. We conclude that the performance of the task for 3 weeks leads to increased ongoing activity in nociceptors, in parallel with behavioral and histological signs of neuritis and nerve injury, and that these pathophysiologies are largely prevented by MMT.
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30
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Krisciunas GP, Vakharia A, Lazarus C, Taborda SG, Martino R, Hutcheson K, McCulloch T, Langmore SE. Application of Manual Therapy for Dysphagia in Head and Neck Cancer Patients: A Preliminary National Survey of Treatment Trends and Adverse Events. Glob Adv Health Med 2019; 8:2164956119844151. [PMID: 31041144 PMCID: PMC6482656 DOI: 10.1177/2164956119844151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/24/2019] [Accepted: 03/11/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Radiation-associated dysphagia is a common and debilitating consequence of treatment for head and neck cancer (HNC). Since commonly employed dysphagia therapy programs for HNC patients still lack authoritative efficacy, some speech-language pathologists (SLPs) have started employing manual therapy (MT) techniques in an attempt to prevent or rehabilitate dysphagia in this patient population. However, exceptionally little is known about the use of MT in this patient population. OBJECTIVES The purpose of this study was to describe practice patterns as well as the rate, type, and severity of adverse events associated with SLP provision of MT to HNC patients. METHODS An Internet-based questionnaire geared toward SLPs who practice MT was developed and sent to SLPs practicing in the United States, 3 times, through 3 national listservs (American Speech Language Hearing Association [ASHA] Special Interest Division 13, ASHA Special Interest Division 3, and University of Iowa Voiceserv), over the course of 4 weeks. RESULTS Of the 255 respondents, 116 (45.5%) performed MT on HNC patients. Of these 116 SLPs, 27.6% provided proactive MT during radiation, 62.1% provided 1 to 2 sessions per week, and 94.8% prescribed a MT home program. The rate, type, and severity of reported adverse events were similar between HNC and non-HNC patients. CONCLUSION This preliminary survey demonstrated that SLPs provide MT to HNC patients during and after cancer treatment, and that reported adverse events paralleled those experienced by noncancer patients. However, these results should be taken with caution, and a well-designed prospective study is needed to formally establish the safety and the preliminary efficacy of this novel clinical intervention.
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Affiliation(s)
- Gintas P Krisciunas
- Department of Otolaryngology, Boston University Medical Center, Boston, Massachusetts
| | - Aneri Vakharia
- Department of Otolaryngology, Boston University Medical Center, Boston, Massachusetts
- Aneri Vakharia, Boston University Medical Center, BCD Building, 800 Harrison Avenue, Boston, MA 02218, USA.
| | - Cathy Lazarus
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Rosemary Martino
- Department of Otolaryngology, University of Toronto, Toronto, Ontario, Canada
| | - Katherine Hutcheson
- Department of Head & Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Timothy McCulloch
- Department of Otolaryngology, University of Wisconsin, Madison, Wisconsin
| | - Susan E Langmore
- Department of Otolaryngology, Boston University Medical Center, Boston, Massachusetts
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31
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Liu J, Tao J, Liu W, Huang J, Xue X, Li M, Yang M, Zhu J, Lang C, Park J, Tu Y, Wilson G, Chen L, Kong J. Different modulation effects of Tai Chi Chuan and Baduanjin on resting-state functional connectivity of the default mode network in older adults. Soc Cogn Affect Neurosci 2019; 14:217-224. [PMID: 30690554 PMCID: PMC6374601 DOI: 10.1093/scan/nsz001] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 11/14/2018] [Accepted: 01/12/2019] [Indexed: 02/06/2023] Open
Abstract
The default mode network (DMN) plays an important role in age-related cognitive decline. This study aims to explore the modulation effect of two mind-body interventions (Tai Chi Chuan and Baduanjin) on DMN in elderly individuals. Participants between 50 and 70 years old were recruited and randomized into a Tai Chi Chuan, Baduanjin or control group. The Wechsler Memory Scale-Chinese Revision and resting-state fMRI scans were administered at baseline and following 12 weeks of exercise. Seed-based resting-state functional connectivity (rsFC) was calculated. We found that (i) compared to the Baduanjin group, Tai Chi Chuan was significantly associated with increased rsFC between the medial prefrontal cortex (mPFC) and right putamen/caudate and (ii) compared to the control group, Tai Chi Chuan increased posterior cingulate cortex rsFC with the right putamen/caudate, while Baduanjin decreased rsFC between the mPFC and orbital prefrontal gyrus/putamen. Baseline mPFC rsFC with orbital prefrontal gyrus was negatively correlated with visual reproduction subscore. These results suggest that both Tai Chi Chuan and Baduanjin can modulate the DMN, but through different pathways. Elucidating the mechanisms underlying different mind-body interventions may shed light on the development of new methods to prevent age-related diseases as well as other disorders associated with disrupted DMN.
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Affiliation(s)
- Jiao Liu
- Fujian Rehabilitation Tech Co-innovation Center, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
- Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Jing Tao
- Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Weilin Liu
- Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Jia Huang
- Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Xiehua Xue
- Affiliated Rehabilitation Hospital, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Ming Li
- Affiliated Rehabilitation Hospital, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Mingge Yang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Jingfang Zhu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Courtney Lang
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Joel Park
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Yiheng Tu
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Georgia Wilson
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Lidian Chen
- Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
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How can mindfulness-led breathing of qigong/Tai Chi work on qi and the meridian network? ADVANCES IN INTEGRATIVE MEDICINE 2018. [DOI: 10.1016/j.aimed.2018.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Zügel M, Maganaris CN, Wilke J, Jurkat-Rott K, Klingler W, Wearing SC, Findley T, Barbe MF, Steinacker JM, Vleeming A, Bloch W, Schleip R, Hodges PW. Fascial tissue research in sports medicine: from molecules to tissue adaptation, injury and diagnostics: consensus statement. Br J Sports Med 2018; 52:1497. [PMID: 30072398 PMCID: PMC6241620 DOI: 10.1136/bjsports-2018-099308] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2018] [Indexed: 01/10/2023]
Abstract
The fascial system builds a three-dimensional continuum of soft, collagen-containing, loose and dense fibrous connective tissue that permeates the body and enables all body systems to operate in an integrated manner. Injuries to the fascial system cause a significant loss of performance in recreational exercise as well as high-performance sports, and could have a potential role in the development and perpetuation of musculoskeletal disorders, including lower back pain. Fascial tissues deserve more detailed attention in the field of sports medicine. A better understanding of their adaptation dynamics to mechanical loading as well as to biochemical conditions promises valuable improvements in terms of injury prevention, athletic performance and sports-related rehabilitation. This consensus statement reflects the state of knowledge regarding the role of fascial tissues in the discipline of sports medicine. It aims to (1) provide an overview of the contemporary state of knowledge regarding the fascial system from the microlevel (molecular and cellular responses) to the macrolevel (mechanical properties), (2) summarise the responses of the fascial system to altered loading (physical exercise), to injury and other physiological challenges including ageing, (3) outline the methods available to study the fascial system, and (4) highlight the contemporary view of interventions that target fascial tissue in sport and exercise medicine. Advancing this field will require a coordinated effort of researchers and clinicians combining mechanobiology, exercise physiology and improved assessment technologies.
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Affiliation(s)
- Martina Zügel
- Division of Sports Medicine, Ulm University, Ulm, Germany
| | - Constantinos N Maganaris
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Jan Wilke
- Department of Sports Medicine, Goethe University, Frankfurt, Germany
| | | | - Werner Klingler
- Department of Anesthesiology, BKH Günzburg, Günzburg, Germany
| | - Scott C Wearing
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Thomas Findley
- Department of Physical Medicine, New Jersey Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Mary F Barbe
- Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Andry Vleeming
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Medical University Ghent, Ghent, Belgium
| | - Wilhelm Bloch
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Cologne, Germany
| | - Robert Schleip
- Fascia Research Group, Experimental Anesthesiology, Ulm University, Ulm, Germany
| | - Paul William Hodges
- Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Stretching Reduces Tumor Growth in a Mouse Breast Cancer Model. Sci Rep 2018; 8:7864. [PMID: 29777149 PMCID: PMC5959865 DOI: 10.1038/s41598-018-26198-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/02/2018] [Indexed: 12/31/2022] Open
Abstract
There is growing interest in developing non-pharmacological treatments that could boost natural defenses against cancer and contribute to primary and secondary cancer prevention. Recent studies have shown that gentle daily stretching for 10 minutes can reduce local connective tissue inflammation and fibrosis. Because mechanical factors within the stroma can influence the tumor microenvironment, we hypothesized that stretching would reduce the growth of tumors implanted within locally stretched tissues and tested this hypothesis in a mouse orthotopic breast cancer model. Female FVB mice (N = 66) underwent bilateral injection of p53/PTEN double-null primary mouse mammary tumor cells into the third mammary fat pad. Mice were randomized to stretch vs. no stretch, and treated for 10 minutes once a day, for four weeks. Tumor volume at end-point was 52% smaller in the stretch group, compared to the no-stretch group (p < 0.001) in the absence of any other treatment. Cytotoxic immune responses were activated and levels of Specialized Pro-Resolving Mediators were elevated in the stretch group. These results suggest a link between immune exhaustion, inflammation resolution and tumor growth. Stretching is a gentle, non-pharmacological intervention that could become an important component of cancer treatment and prevention.
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Tsuchiya M, Sekiai S, Hatakeyama H, Koide M, Chaweewannakorn C, Yaoita F, Tan-No K, Sasaki K, Watanabe M, Sugawara S, Endo Y, Itoi E, Hagiwara Y, Kanzaki M. Neutrophils Provide a Favorable IL-1-Mediated Immunometabolic Niche that Primes GLUT4 Translocation and Performance in Skeletal Muscles. Cell Rep 2018; 23:2354-2364. [DOI: 10.1016/j.celrep.2018.04.067] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/09/2018] [Accepted: 04/14/2018] [Indexed: 11/27/2022] Open
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Chimenti RL, Frey-Law LA, Sluka KA. A Mechanism-Based Approach to Physical Therapist Management of Pain. Phys Ther 2018; 98:302-314. [PMID: 29669091 PMCID: PMC6256939 DOI: 10.1093/ptj/pzy030] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 02/12/2018] [Indexed: 12/11/2022]
Abstract
Pain reduction is a primary goal of physical therapy for patients who present with acute or persistent pain conditions. The purpose of this review is to describe a mechanism-based approach to physical therapy pain management. It is increasingly clear that patients need to be evaluated for changes in peripheral tissues and nociceptors, neuropathic pain signs and symptoms, reduced central inhibition and enhanced central excitability, psychosocial factors, and alterations of the movement system. In this Perspective, 5 categories of pain mechanisms (nociceptive, central, neuropathic, psychosocial, and movement system) are defined, and principles on how to evaluate signs and symptoms for each mechanism are provided. In addition, the underlying mechanisms targeted by common physical therapist treatments and how they affect each of the 5 categories are described. Several different mechanisms can simultaneously contribute to a patient's pain; alternatively, 1 or 2 primary mechanisms may cause a patient's pain. Further, within a single pain mechanism, there are likely many possible subgroups. For example, reduced central inhibition does not necessarily correlate with enhanced central excitability. To individualize care, common physical therapist interventions, such as education, exercise, manual therapy, and transcutaneous electrical nerve stimulation, can be used to target specific pain mechanisms. Although the evidence elucidating these pain mechanisms will continue to evolve, the approach outlined here provides a conceptual framework for applying new knowledge as advances are made.
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Affiliation(s)
- Ruth L Chimenti
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa
| | - Laura A Frey-Law
- Department of Physical Therapy and Rehabilitation Science, University of Iowa
| | - Kathleen A Sluka
- Department of Physical Therapy and Rehabilitation Science, 1-242 MEB, University of Iowa, Iowa City, IA 52242 (USA)
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Anandkumar S, Manivasagam M. Effect of dry needling on cubital tunnel syndrome: Three case reports. Physiother Theory Pract 2018. [PMID: 29528796 DOI: 10.1080/09593985.2018.1449275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This case series describes three patients who presented with right medial elbow pain managed unsuccessfully with conservative treatment that included medication, massage, exercise therapy, ultrasound therapy, neurodynamic mobilization, and taping. Diagnosis of cubital tunnel syndrome was based on palpatory findings, a positive elbow flexion test, and a positive Tinel's sign. Conventionally, the intervention for this entrapment has been surgical decompression, with successful outcomes. This is potentially a first-time description of the successful management of cubital tunnel syndrome with dry needling (DN) using a recently published DN grading system. The patients were seen twice a week for 2 weeks with immediate improvements noted in all the outcome measures after the first treatment session. At discharge, they were pain-free and fully functional, which was maintained up to a 6-month follow-up.
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Affiliation(s)
- Sudarshan Anandkumar
- a Registered Physiotherapist, CBI Health Centre , Chilliwack , British Columbia , Canada
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Langevin HM, Bishop J, Maple R, Badger GJ, Fox JR. Effect of Stretching on Thoracolumbar Fascia Injury and Movement Restriction in a Porcine Model. Am J Phys Med Rehabil 2018; 97:187-191. [PMID: 28901961 PMCID: PMC7411307 DOI: 10.1097/phm.0000000000000824] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Stretching of fascia is an important component of manual and movement therapies. We previously showed that in pigs, a unilateral thoracolumbar fascia injury combined with movement restriction (hobble) produced contralateral loss of fascia mobility (shear strain during passive trunk flexion measured with ultrasound) similar to findings in human subjects with chronic low back pain. We now tested whether such abnormalities could be reversed by removing the hobble with or without daily stretching for 1 mo. DESIGN Thirty pigs were randomized to control, injury, or injury + hobble for 8 wks. The hobble restricted hip extension ipsilateral to the injury. At week 8, the injury + hobble group was subdivided into continued hobble, removed hobble, and removed hobble + stretching (passively extending the hip for 10 min daily). RESULTS Removing hobbles restored normal gait speed but did not restore fascia mobility. Daily passive stretching was not superior to removing hobbles, as there was no significant improvement in fascia mobility with either treatment group (removed hobble or stretching). CONCLUSIONS Reduced fascia mobility in response to injury and movement restriction worsens over time and persists even when movement is restored. Reversing fascia abnormalities may require either longer than 1 mo or a different treatment "dose" or modality.
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Affiliation(s)
- Helene M Langevin
- From the Department of Neurological Sciences, University of Vermont, Burlington, Vermont (HML, JB, RM, JRF); Department of Medical Biostatistics, University of Vermont, Burlington, Vermont (GJB); and Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (HML)
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Abstract
This case report describes a 45-year-old male who presented with chronic right lateral elbow pain managed unsuccessfully with conservative treatment that included anti-inflammatory medication, injection, massage, exercise, bracing, taping, electro-physical agents, and manual therapy. Diagnosis of radial tunnel syndrome (RTS) was based on palpatory findings, range of motion testing, resisted isometrics, and a positive upper limb neural tension test 2b (radial nerve bias). Conventionally, the intervention for this entrapment has been surgical decompression, with successful outcomes. This is potentially a first-time report, describing the successful management of RTS with dry needling (DN) using a recently published DN grading system. Immediate improvements were noted in all the outcome measures after the first treatment, with complete pain-resolution maintained at a 6-month follow-up. A model is proposed describing the mechanism by which DN could be used to intervene for nerve entrapment interfaces.
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Affiliation(s)
- Sudarshan Anandkumar
- a Registered Physiotherapist , CBI Health Centre , Chilliwack , British Columbia , Canada
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Abstract
Background: Complementary and alternative medicine is a rapidly growing area of biomedical inquiry. Yoga has emerged in the forefront of holistic medical care due to its long history of linking physical, mental, and spiritual well-being. Research in yoga therapy (YT) has associated improved cardiovascular and quality of life (QoL) outcomes for the special needs of heart failure (HF) patients. Aim: The aim of this study is to review yoga intervention studies on HF patients, discuss proposed mechanisms, and examine yoga's effect on physiological systems that have potential benefits for HF patients. Second, to recommend future research directions to find the most effective delivery methods of yoga to medically stable HF patients. Methods: The authors conducted a systematic review of the medical literature for RCTs involving HF patients as participants in yoga interventions and for studies utilizing mechanistic theories of stretch and new technologies. We examined physical intensity, mechanistic theories, and the use of the latest technologies. Conclusions: Based on the review, there is a need to further explore yoga mechanisms and research options for the delivery of YT. Software apps as exergames developed for use at home and community activity centers may minimize health disparities and increase QoL for HF patients.
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Affiliation(s)
- Paula R Pullen
- Department of Kinesiology, University of North Georgia, Oakwood, GA, USA
| | | | - Walter R Thompson
- College of Education and Human Development at Georgia State University, Atlanta, GA, USA
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The Efficacy of Dynamic Contract-Relax Stretching on Delayed-Onset Muscle Soreness Among Healthy Individuals: A Randomized Clinical Trial. Clin J Sport Med 2018; 28:28-36. [PMID: 28742609 DOI: 10.1097/jsm.0000000000000442] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the efficacy of dynamic contract-relax stretching on delayed-onset muscle soreness (DOMS) in the calf muscle of healthy individuals. DESIGN Randomized clinical trial. SETTING Research laboratory. PARTICIPANTS Three groups of 16 healthy participants (n = 48) were recruited by convenience sampling. INTERVENTIONS Three sets of resisted bilateral heel-raising exercises until exhaustion were conducted to initiate DOMS. Participants were randomly allocated into control group without any interventions, dynamic contract-relax stretching (DS), or static stretching (SS) groups. Dynamic contract-relax stretching and SS groups performed DS and SS, respectively, on the dominant leg twice a day for 5 consecutive days (before time points of outcome measurements at 24, 48, 72, 96, and 120 hours postexercise, respectively). MAIN OUTCOME MEASURES Muscle soreness, lower leg girth, pressure pain threshold (PPT), range of motion (ROM), and muscle strength were measured before exercise, immediately after, and at 24, 48, 72, 96, and 120 hours postexercise. RESULTS There was a significant effect of time in all outcome measures including muscle soreness, lower leg girth, PPT, ROM, and muscle strength; however, there were no significant group differences or group by time interactions. CONCLUSIONS The effect of DS on relieving DOMS in the calf muscle is insignificant in this study. Further evidence is needed to prove the efficacy of DS on DOMS. CLINICAL RELEVANCE Stretching is commonly recommended before and after exercise; however, this study showed no significant impact of DS or SS in treating DOMS.
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Fryer G. Integrating osteopathic approaches based on biopsychosocial therapeutic mechanisms. Part 1: The mechanisms. INT J OSTEOPATH MED 2017. [DOI: 10.1016/j.ijosm.2017.05.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Heinz J, Marinello M, Fredman G. Pro-resolution therapeutics for cardiovascular diseases. Prostaglandins Other Lipid Mediat 2017; 132:12-16. [DOI: 10.1016/j.prostaglandins.2017.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 02/27/2017] [Accepted: 03/23/2017] [Indexed: 12/22/2022]
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Fredman G, Tabas I. Boosting Inflammation Resolution in Atherosclerosis: The Next Frontier for Therapy. THE AMERICAN JOURNAL OF PATHOLOGY 2017; 187:1211-1221. [PMID: 28527709 DOI: 10.1016/j.ajpath.2017.01.018] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 01/30/2017] [Indexed: 02/08/2023]
Abstract
Defective inflammation resolution is the underlying cause of prevalent chronic inflammatory diseases, such as arthritis, asthma, cancer, and neurodegenerative and cardiovascular diseases. Inflammation resolution is governed by several endogenous factors, including fatty acid-derived specialized proresolving mediators and proteins, such as annexin A1. Specifically, specialized proresolving mediators comprise a family of mediators that include arachidonic acid-derived lipoxins, omega-3 fatty acid eicosapentaenoic acid-derived resolvins, docosahexaenoic acid-derived resolvins, protectins, and maresins. Emerging evidence indicates that imbalances between specialized proresolving mediators and proinflammatory mediators are associated with several prevalent human diseases, including atherosclerosis. Mechanisms that drive this imbalance remain largely unknown and will be discussed in this review. Furthermore, the concept of dysregulated inflammation resolution in atherosclerosis has been known for several decades. Recently, there has been an explosion of new work with regard to the therapeutic application of proresolving ligands in experimental atherosclerosis. Therefore, this review will highlight recent advances in our understanding of how inflammation resolution may become defective in atherosclerosis and the potential for proresolving therapeutics in atherosclerosis. Last, we offer insight for future implications of the field.
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Affiliation(s)
- Gabrielle Fredman
- Department of Molecular and Cellular Physiology, Center for Cardiovascular Sciences, Albany Medical College, Albany, New York.
| | - Ira Tabas
- Departments of Medicine, Pathology and Cell Biology, and Physiology, Columbia University Medical Center, New York, New York
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Albano L. Innovative application of Cox Flexion Distraction Decompression to the knee: a retrospective case series. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2017; 61:153-161. [PMID: 28928498 PMCID: PMC5596966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The purpose of this study is to introduce the application of Cox flexion distraction decompression as an innovative approach to treating knee pain and osteoarthritis. METHODS Six months of clinical files from one chiropractic practice were retrospectively screened for patients who had been treated for knee pain. Twenty-five patients met the criteria for inclusion. The treatment provided was Cox flexion distraction decompression. Pre-treatment and post-treatment visual analog pain scales (VAS) were used to measure the results. In total, eight patients presented with acute knee pain (less than three months' duration) and 18 patients presented with chronic knee pain (greater than three months) including two patients with continued knee pain after prosthetic replacement surgery. RESULTS For all 25 patients, a change was observed in the mean VAS scores from 7.7 to 1.8. The mean number of treatments was 5.3 over an average of 3.0 weeks. Acute patient mean VAS scores dropped from 8.1 to 1.1 within 4.8 treatments over 2.4 weeks. Chronic patient mean VAS scores dropped from 7.5 to 2.2 within 5.4 treatments over 3.3 weeks. No adverse events were reported. CONCLUSION This study showed clinical improvement in patients with knee pain who were managed with Cox flexion distraction decompression applied to the knee.
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Xiong Y, Berrueta L, Urso K, Olenich S, Muskaj I, Badger GJ, Aliprantis A, Lafyatis R, Langevin HM. Stretching Reduces Skin Thickness and Improves Subcutaneous Tissue Mobility in a Murine Model of Systemic Sclerosis. Front Immunol 2017; 8:124. [PMID: 28261202 PMCID: PMC5311037 DOI: 10.3389/fimmu.2017.00124] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 01/25/2017] [Indexed: 12/18/2022] Open
Abstract
Objective Although physical therapy can help preserve mobility in patients with systemic sclerosis (SSc), stretching has not been used systematically as a treatment to prevent or reverse the disease process. We previously showed in rodent models that stretching promotes the resolution of connective tissue inflammation and reduces new collagen formation after injury. Here, we tested the hypothesis that stretching would impact scleroderma development using a mouse sclerodermatous graft-versus-host disease (sclGvHD) model. Methods The model consists in the adoptive transfer (allogeneic) of splenocytes from B10.D2 mice (graft) into Rag2−/− BALB/c hosts (sclGvHD), resulting in skin inflammation followed by fibrosis over 4 weeks. SclGvHD mice and controls were randomized to stretching in vivo for 10 min daily versus no stretching. Results Weekly ultrasound measurements of skin thickness and subcutaneous tissue mobility in the back (relative tissue displacement during passive trunk motion) successfully captured the different phases of the sclGvHD model. Stretching reduced skin thickness and increased subcutaneous tissue mobility compared to no stretching at week 3. Stretching also reduced the expression of CCL2 and ADAM8 in the skin at week 4, which are two genes known to be upregulated in both murine sclGvHD and the inflammatory subset of human SSc. However, there was no evidence that stretching attenuated inflammation at week 2. Conclusion Daily stretching for 10 min can improve skin thickness and mobility in the absence of any other treatment in the sclGvHD murine model. These pre-clinical results suggest that a systematic investigation of stretching as a therapeutic modality is warranted in patients with SSc.
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Affiliation(s)
- Ying Xiong
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Lisbeth Berrueta
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Katia Urso
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Sara Olenich
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Igla Muskaj
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Gary J Badger
- Department of Medical Biostatistics, University of Vermont , Burlington, VT , USA
| | - Antonios Aliprantis
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Robert Lafyatis
- University of Pittsburgh, School of Medicine , Pittsburgh, PA , USA
| | - Helene M Langevin
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurological Sciences, University of Vermont, Burlington, VT, USA
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Langevin HM, Keely P, Mao J, Hodge LM, Schleip R, Deng G, Hinz B, Swartz MA, de Valois BA, Zick S, Findley T. Connecting (T)issues: How Research in Fascia Biology Can Impact Integrative Oncology. Cancer Res 2016; 76:6159-6162. [DOI: 10.1158/0008-5472.can-16-0753] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/20/2016] [Indexed: 11/16/2022]
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Fede C, Albertin G, Petrelli L, Sfriso MM, Biz C, De Caro R, Stecco C. Expression of the endocannabinoid receptors in human fascial tissue. Eur J Histochem 2016; 60:2643. [PMID: 27349320 PMCID: PMC4933831 DOI: 10.4081/ejh.2016.2643] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 11/30/2022] Open
Abstract
Cannabinoid receptors have been localized in the central and peripheral nervous system as well as on cells of the immune system, but recent studies on animal tissue gave evidence for the presence of cannabinoid receptors in different types of tissues. Their presence was supposed also in myofascial tissue, suggesting that the endocannabinoid system may help resolve myofascial trigger points and relieve symptoms of fibromyalgia. However, until now the expression of CB1 (cannabinoid receptor 1) and CB2 (cannabinoid receptor 2) in fasciae has not yet been established. Small samples of fascia were collected from volunteers patients during orthopedic surgery. For each sample were done a cell isolation, immunohistochemical investigation (CB1 and CB2 antibodies) and real time RT-PCR to detect the expression of CB1 and CB2. Both cannabinoid receptors are expressed in human fascia and in human fascial fibroblasts culture cells, although to a lesser extent than the control gene. We can assume that the expression of mRNA and protein of CB1 and CB2 receptors in fascial tissue are concentrated into the fibroblasts. This is the first demonstration that the fibroblasts of the muscular fasciae express CB1 and CB2. The presence of these receptors could help to provide a description of cannabinoid receptors distribution and to better explain the role of fasciae as pain generator and the efficacy of some fascial treatments. Indeed the endocannabinoid receptors of fascial fibroblasts can contribute to modulate the fascial fibrosis and inflammation.
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