Effects of exercise on blood flow to canine articular tissues

A Comparison Between the Effect of Combined Chain Exercises Plus Kinesio Taping With Combined Chain Exercises Alone in Knee Osteoarthritis: A Randomized Clinical Trial

OBJECTIVE

This study aimed to examine the effect of Kinesio taping as an adjunct to combined chain exercises compared with combined chain exercises alone in the management of individuals with knee osteoarthritis.

METHODS

A total of 60 (27 male, 33 female) individuals (age range = 50-71 yrs and mean age = 54.26 ± 8.83 yrs) diagnosed as having mild to moderate knee osteoarthritis (based on the Kellgren and Lawrence grade I-III classification) were randomly allocated into two groups with 30 participants each in the Kinesio taping + combined chain exercises and combined chain exercises groups. Participants in the Kinesio taping + combined chain exercises group received Kinesio taping plus combined chain exercises and those in the combined chain exercises group received only combined chain exercises. Each participant was assessed for pain, range of motion, functional mobility, and quality of life at baseline and after 8 wks of intervention. A mixed-design multivariate analysis of variance was used to analyze the treatment effect.

RESULTS

No significant differences were observed in the baseline characteristics of participants in both groups. The result indicated that there was a significant time effect for all outcomes, with a significant interaction between time and intervention (P < 0.001). The Bonferroni post hoc analyses of time and intervention effects indicated that the Kinesio taping + combined chain exercises group improved significantly better than the combined chain exercises group in all outcomes, pain (mean = 2.01 [0.64] vs. 3.94 [1.12], F[df] = 5.466[1,58], P = 0.011), flexion range of motion (mean = 121.15 [2.07] vs. 104.28 [3.24], F[df] = 26.722[1,58], P < 0.001), functional mobility (mean = 19.47 [1.95] vs. 31.01 [2.39], F[df] = 29.436[1,58], P < 0.001), and quality of life (mean = 68.76 [3.19] vs. 45.62 [2.87], F[df] = 71.984[1,58], P < 0.001), after 8 wks of intervention.

CONCLUSIONS

The findings of this study concluded that Kinesio taping + combined chain exercises and combined chain exercises were both effective but Kinesio taping plus combined chain exercises was more effective in the management of individuals with knee osteoarthritis.

TRIAL REGISTRATION

Pan African Clinical Trial Registry: PACTR201810603949411.

Clinical Validation of Pain Management Manipulative Therapy for Knee Osteoarthritis With the Squeeze-Hold Technique: A Case Series

OBJECTIVE

The purpose of this case series was to describe the short-term and long-term clinical effects of a manual technique for treating osteoarthritis (OA) knee pain.

METHODS

This study measured of the immediate effect and long-term effect by using a case series of different groups of subjects. Knee OA and activity restriction in patients were evaluated by using the Kellgren-Lawrence (K/L) Grading Scale and the Japanese Knee Osteoarthritis Measure (JKOM) index. In the intervention, lower limb muscles were squeezed by hand for 20 seconds. Each squeeze was performed for both lower limbs. Passive range-of-motion (ROM) exercise was performed on the knee joint. In one set of cases, immediate effects were measured after a one-time treatment with pretreatment and posttreatment outcome measures. Eleven people with knee OA participated in the study. On a visual analogue scale (VAS) for pain, muscle stiffness, and muscular hemodynamics for estimation of muscle blood flow were recorded before and after the squeeze-hold treatment. In another set of cases, the treatment was given to all patients once a week for 6 months, and long-term effects were measured. Data on 5 subjects with knee OA were collected for 6 months after initial treatment. The VAS for pain and JKOM were recorded every month for 6 months.

RESULTS

For immediate effects, the VAS was 69 ± 21 mm before treatment and 26 ± 22 mm after treatment. Muscle stiffness was 8.8 ± 3.6 (absolute number) before treatment and 3.5 ± 2.1 after treatment. Tissue (muscle) oxygen saturation was 60.1 ± 5.7% before treatment and 65.3 ± 4.8% after treatment. Total hemoglobin was 24.3 ± 3.3 (absolute number) before treatment and 25 ± 2.3 after treatment. A tendency for reduction in OA knee pain and muscle stiffness was observed, and a tendency for increase was observed in the blood flow in the muscle. For long-term effects in all 5 participants (any K/L grade, any JKOM score), OA knee pain and JKOM score improved gradually through 6 months.

CONCLUSIONS

The participants in this case series showed improvement in pain and function. These findings indicate the feasibility of a larger study on the squeeze-hold intervention for OA knee pain.

Increased nitric oxide-mediated vasodilation of bone resistance arteries is associated with increased trabecular bone volume after endurance training in rats

Old age-associated osteoporosis is related to diminished bone blood flow and impaired nitric oxide (NO)-mediated vasodilation of the bone vasculature. Endurance exercise training restores the age-associated reduction of vasodilation in numerous vascular beds, as well as improving bone properties. The purpose of this study was to determine whether functional improvements in the bone vasculature are associated with increased bone properties after an endurance training intervention. Young adult (4-6 months) and old (24-26 months) male Fischer-344 rats remained sedentary or were trained (15 m/min walking, 15 degrees incline, 5 days/week, 10-12 weeks). Endothelium-dependent vasodilation of the femoral principal nutrient artery (PNA) was assessed in vitro using acetylcholine (ACh) and inhibitors of NO synthase (NOS) and cyclooxygenase (COX). PNA endothelium-dependent vasodilation was greater after training by 16% in young and by 24% in old animals. The NOS-mediated contribution to endothelium-dependent vasodilation was enhanced by 77% after training in old rats. Distal femur trabecular bone volume (BV/TV, %) was lower with old age in sedentary animals (young: 27+/-2%, old: 23+/-1%; P<0.05). Exercise-induced elevations in bone and marrow blood flow and the NOS signaling pathway were associated with greater BV/TV (young trained: 34+/-2%, old trained: 26+/-1%; P<0.05) relative to sedentary groups. These data demonstrate that training-induced increases in bone properties are associated with enhanced endothelium-dependent vasodilation through a NOS signaling pathway in the bone vasculature.

The canine stifle

Cranial cruciate ligament (CCL) injury is a leading cause of lameness in dogs. Recent advances in diagnostic visualization and surgical treatments for CCL injury have stimulated an increased emphasis on early clinical recognition and an early return to function. Many surgical treatments have been described that aim to restore stifle joint stability and minimize the progression of osteoarthritis. Major advances have occurred not only in the treatment of CCL injury, but also in postoperative recovery, specifically, rehabilitation therapy. The benefits of rehabilitation therapy following CCL surgery are multifaceted including pain relief, decreased inflammation and swelling, increased tissue flexibility, strengthening, improved proprioception, improved limb and joint biomechanics, and improved weight-bearing. In this article, we introduce a variety of rehabilitation therapy options for postoperative CCL patients including modalities, manual therapy, therapeutic exercise, and the benchmarks for a full return to function.

Distribution of beta-endorphin and substance P in the shoulder joint of the dog before and after a low impact exercise programme

Beta-endorphin and substance P were immunolocalized in the articular cartilage, synovial membrane and fibrous joint capsule of dogs. Twelve adult greyhounds were randomly assigned to one of three groups: control, limited exercise, or regimented exercise. On day 0, biopsies of articular cartilage and joint capsule were obtained from the left shoulder joints of dogs receiving limited and regimented exercise. On day 72, biopsies of joint capsule from right and left shoulders and articular cartilage from the right shoulder joint were analysed for the presence of glycosaminoglycans (GAG) and for immunolocalization of substance P and beta-endorphin. Regimented exercise increased the presence of GAGs and immunolocalization of substance P and beta-endorphin in articular cartilage and synovial membrane compared to day 0 biopsies and untreated controls. Localization of beta-endorphin became prominent in and around the chondrocytes. Substance P was increased in chondrocytes and extracellular matrix. Concomitant changes in localization of beta-endorphin and substance P may have a role in the modulation of the microphysiological environment, metabolism, or function of joint tissues in response to low-impact exercise.

Swelling of synovial joints - An anatomical, physiological and energy metabolical approach

The direction and part of the rate of fluid filtration between synovial capillary (subscript capill) plasma and joint (subscript j) cavity fluid depends on the hydrostatic (P(capill)-P(j)) and colloid osmotic (COP(plasma)-COP(j)) pressure differences and on the osmotic efficiency (coefficient sigma) of 'colloids' across the barrier between plasma and synovial fluid. The rate of filtration also depends on capillary endothelial hydraulic conductance (L(p)) and surface area (A). Synovial fluid protein is removed by lymphatics, or split to be resorbed or used up by cells. Physiologists put together as equations the above, as well as other terms, all of these influenced by numerous factors. The equations offer a frame for a multifactorial approach to diseases associated with joint swelling and suggest, among others, that in the presence of weak generalized exsudation, synovial joints are loci minores resistentiae to swelling. The influence of joint cartilage energy demands on synovial blood flow may have been underrated. There are many accepted clinical, laboratory and morphological findings that fit this physiological frame that merits further clinical research.

Coloured microsphere assessment of blood flow to knee ligaments in adult rabbits: effects of injury

Coloured microspheres were used to determine standardized blood flow in an established model of medial collateral ligament injury in the adult rabbit knee. Resting blood flow in the ligament was ascertained to be on the order of 0.68 +/- 0.08 ml/min/100 g (mean +/- SEM) in normal rabbit knees, although errors in flow estimates of this magnitude may be quite high. In healing medial collateral ligament, however, flow had increased markedly 3 weeks after injury (21.45 +/- 5.48 ml/min/100 g). Flows in sham-operated control medial collateral ligaments were not significantly increased compared with those in control normal ligaments. Six weeks after injury, blood flow in the ligament remained elevated (16.90 +/- 3.20 ml/min/100 g) and was similarly elevated in other neighbouring joint tissues (i.e., ipsilateral synovial fat pad). The increase in flow to ipsilateral noninjured articular tissues did not persist beyond 6 weeks, but flow in the healing medial collateral ligament scar tended to remain elevated after 17 weeks (4.20 +/- 1.79 ml/min/100 g), although this did not achieve statistical significance. We conclude from these data that it is possible to measure the increase in blood flow in injured and healing articular tissues using the coloured microspheres technique and that ligament injury is a potent stimulus for increasing blood flow. Coloured microsphere measurements of blood flow to joint connective tissues may offer a valuable approach to future investigations of joint injury and arthritis.

Synovial perfusion in the human knee: a methodologic analysis

Synovial perfusion was quantified in milliliters per minute per knee by two quite different clearance methods based on (1) counting tritiated water in serial aspirates of intraarticular saline, and (2) external counting of joints injected with free radioiodide. In each case, the serial counting data determine a rate constant that is multiplied by a distribution volume to provide the clearance in flow terms of milliliters per minute. This report updates and summarizes these data and compares the two methods to each other and to alternative assessments of synovial blood flow. Available methods such as laser Doppler flowmetry (with data output measured in volts) and solute clearance constant determinations (in min-1) are useful for selected purposes but cannot be used to quantify the articular flux (in milligrams per minute) of any solute. Radiolabeled microspheres provide data (in milliliters per minute per g of tissue) but are unsuitable for human use. The two clearance methods provide comparable results, but the free iodide technique seems most suitable for physiologic investigations. The latter potentially includes critical evaluations of synovial blood flow in relation to issues such as palpable warmth, visible erythema, articular ischemia, the permeability of synovial vessels, the genesis of effusions, the delivery and removal of therapeutic agents, and the concentration of every synovial fluid solute from micronutrients through cytokines, plasma proteins, and molecular markers of cartilagenous injury.

Non-radioactive coloured microsphere measurement of regional tissue blood flow for axial pattern flaps in rabbits

We administered non-radioactive coloured microspheres (NRACM) to measure the regional tissue blood flow (RTBF) of eight axial pattern flaps and four kidneys in four rabbits using four repeated injections into each animal. As a control, we used radioactive microspheres (RAM) for six kidneys in three rabbits. There were no significant differences for RTBF values between NRACM and RAM, between the numbers of microspheres used (2 x 10(6) and 4 x 10(6)), or between the number of injections. These results showed that NRACM is a useful and safe laboratory method.