1
|
He K, Zhou X, Zheng F, Ju X, Fu SN, Wong AYL. Histological, Physiological and Biomechanical Effects of Low-Level Laser Therapy on Tendon Healing in Animals and Humans: A Systematic Review. Ann Biomed Eng 2023; 51:2659-2707. [PMID: 37899380 DOI: 10.1007/s10439-023-03364-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/05/2023] [Indexed: 10/31/2023]
Abstract
Low-level Laser Therapy (LLLT) was widely used in clinical practice for tendon disorders. However, the underlying mechanisms and effectiveness of LLLT in treating tendon injury remain unclear. Therefore, the present study was conducted aiming to summarize the evidence regarding the histological, physiological, and biomechanical effects of LLLT on tendon healing in animal and human models. Four databases were searched for relevant literature. Four independent reviewers screened abstracts and full-text articles, extracted relevant data, evaluated the risk of bias, and quantified the quality of evidence. Database searches yielded 1400 non-duplicated citations. Fifty-five studies were included (50 animal and five human studies). Animal studies revealed that LT had stimulating effects on collagen organization, collagen I and collagen II formation, matrix metalloproteinase (MMP)-8, transforming growth factor β1, vascular endothelial growth factor, hydroxyproline, maximum load, maximum elongation before breaking, and tendon stiffness. However, LLLT had inhibitory effects on the number of inflammatory cells, histological scores, relative amount of collagen III, cyclooxygenase-2, prostaglandin E2 (PGE2), interleukin-6, tumor necrosis factor-α, MMP-1, and MMP-3. Although one human study found that LLLT reduced the concentration of PGE2 in peritendinous tissue of the Achilles tendon, other human studies revealed that the effects of LLLT on the physiology and biomechanics of human tendons remained uncertain. LLLT facilitates tendon healing through various histological, physiological, and biomechanical effects in animal models. Only post-LLLT anti-inflammatory effects were found in human studies.
Collapse
Affiliation(s)
- Kexu He
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuelian Zhou
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Feisheng Zheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Xiaojie Ju
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Siu-Ngor Fu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Arnold Y L Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China.
| |
Collapse
|
2
|
The Influence of Different Modes of Exercise on Healthy and Injured Tendons. Stem Cells Int 2022; 2022:3945210. [PMID: 36117720 PMCID: PMC9481386 DOI: 10.1155/2022/3945210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/03/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
Tendons are essential components of the musculoskeletal system that links the skeletal muscle to the skeleton. This dense connective tissue exhibits great plasticity. Therefore, research on the influence of types of exercise, including acute and long-term training, on the structural and mechanical properties of tendons in athletic and sedentary populations is of critical importance in the design of scientific-based exercise plans and effective tendinopathy treatment. Here, we review recent studies on the relationship between exercise and tendon health and tendinopathy repair to provide a general understanding of how exercise may reshape tendons.
Collapse
|
3
|
Alzyoud JA, Omoush SA, Al-Qtaitat A. Photobiomodulation for Tendinopathy: A Review of Preclinical Studies. Photobiomodul Photomed Laser Surg 2022; 40:370-377. [DOI: 10.1089/photob.2021.0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Affiliation(s)
- Jihad A.M. Alzyoud
- Department of Basic Medical Sciences, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Samya A. Omoush
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, Jordan
| | - Aiman Al-Qtaitat
- Department of Anatomy and Histology, Faculty of Medicine, Mutah University, Karak, Jordan
| |
Collapse
|
4
|
De Agustín Del Burgo JM, Blaya Haro F, D’Amato R, Blaya A, Juanes Méndez JA. Development of a Smart Leg Splint by Using New Sensor Technologies and New Therapy Possibilities. SENSORS 2021; 21:s21155252. [PMID: 34372488 PMCID: PMC8348511 DOI: 10.3390/s21155252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 11/22/2022]
Abstract
Nowadays, after suffering a fracture in an upper or lower limb, a plaster cast is placed on the affected limb. It is a very old and efficient technique for recovery from an injury that has not had significant changes since its origin. This project aims to develop a new low-cost smart 3D printed splint concept by using new sensing techniques. Two rapidly evolving Advanced Manufacturing (AM) technologies will be used: 3D scanning and 3D printing, thus combining engineering, medicine and materials evolution. The splint will include new small and lightweight sensors to detect any problem during the treatment process. Previous studies have already incorporated this kind of sensor for medical purposes. However, in this study it is implemented with a new concept: the possibility of applying treatments during the immobilization process and obtaining information from the sensors to modify the treatment. Due to this, rehabilitation treatments like infrared, ultrasounds or electroshock may be applied during the treatment, and the sensors (as it is showed in the study) will be able to detect changes during the rehabilitation process. Data of the pressure, temperature, humidity and colour of the skin will be collected in real time and sent to a mobile device so that they can be consulted remotely by a specialist. Moreover, it would be possible to include these data into the Internet of Things movement. This way, all the collected data might be compared and studied in order to find the best treatment for each kind of injury. It will be necessary to use a biocompatible material, submersible and suitable for contact with skin. These materials make it necessary to control the conditions in which the splint is produced, to assure that the properties are maintained. This development, makes it possible to design a new methodology that will help to provide faster and easier treatment.
Collapse
Affiliation(s)
| | - Fernando Blaya Haro
- ETSIDI-Departamento de Ingeniería Mecánica, Química y Diseño Industrial, Universidad Politécnica de Madrid (UPM), Ronda de Valencia 3, 28012 Madrid, Spain;
| | - Roberto D’Amato
- ETSIDI-Departamento de Ingeniería Mecánica, Química y Diseño Industrial, Universidad Politécnica de Madrid (UPM), Ronda de Valencia 3, 28012 Madrid, Spain;
- Correspondence: ; Tel.: +34-91-067-7654
| | - Alonso Blaya
- Departamento de Fisioterapía de la, Universidad Europea de Madrid, 28670 Madrid, Spain;
| | | |
Collapse
|
5
|
Gavish L, Spitzer E, Friedman I, Lowe J, Folk N, Zarbiv Y, Gelman E, Vishnevski L, Fatale E, Herman M, Gofshtein R, Gam A, Gertz SD, Eisenkraft A, Barzilay Y. Photobiomodulation as an Adjunctive Treatment to Physiotherapy for Reduction of Anterior Knee Pain in Combat Soldiers: A Prospective, Double-Blind, Randomized, Pragmatic, Sham-Controlled Trial. Lasers Surg Med 2021; 53:1376-1385. [PMID: 34101208 DOI: 10.1002/lsm.23442] [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: 02/18/2021] [Revised: 04/22/2021] [Accepted: 05/23/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Anterior knee pain (AKP) is the most common knee pathology in athletes and occurs in 15% of army recruits of elite units during basic training. Of these, 50% are symptomatic 6 years later. Photobiomodulation (PBM) is a nonthermal red-to-near-infrared irradiation used for pain reduction of a variety of etiologies. This study was designed to determine whether addition of PBM to physiotherapy (PT) for AKP in combat soldiers is superior to PT alone. STUDY DESIGN/MATERIALS AND METHODS In this prospective, double-blind, sham-controlled, randomized clinical trial (NCT02845869), 26 combat soldiers/policemen (male:female, 15:11; body mass index [BMI] = 24.2 ± 3.9, n = 46 knees), with AKP due to overuse/load, received 4 weeks of PT + sham (PT + Sham) or active PBM (wavelength = 660 and 850 nm, pulsing = 2.5 Hz, LED power = 50 mW/cm2 [local tissue/regional lymph nodes]; 810 nm continuous beam, laser cluster 6 W/cm2 [analgesia] and laser pointer 4.75 W/cm2 [trigger points]) (PT + PBM). The main outcome measures were subjective pain by visual analog scale (VAS) (0 [none]-100 [intolerable]) and functional disability by Kujala score (0 [worst]-100 [best]). Evaluations were carried out at baseline, end of treatments, and 3-month follow-up. RESULTS All participants completed the treatment protocol without any reported adverse device effects. Post-treatment pain was significantly reduced in the PT+PBM group, compared with baseline and sham (Δpain, VAS, mean ± SD: PT + PBM = -19 ± 23, P = 0.002; PT + Sham = -6 ± 21, P = 0.16; between groups, P = 0.032). At 3-month follow-up, pain reduction was similar between groups; however, the Kujala score was significantly improved only in the PBM-treated group (ΔKujala: PT + PBM = 11 ± 10, P = 0.003; PT + Sham = 5 ± 7, P = 0.059). CONCLUSIONS Addition of PBM to PT for AKP resulted in earlier reduction in pain and improved functionality, compared with PT alone. This noninvasive, nonpharmacologic, adjunctive therapeutic modality can be easily incorporated into team healthcare frameworks or end units and may lead to earlier return to competition or combat-level service. Lasers Surg. Med. © 2021 Wiley Periodicals LLC.
Collapse
Affiliation(s)
- Lilach Gavish
- Institute for Research in Military Medicine (IRMM), Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Forces Medical Corps, Jerusalem, 9112001, Israel.,The Saul and Joyce Brandman Hub for Cardiovascular Research and the Department of Medical Neurobiology, Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, 9112001, Israel
| | - Elad Spitzer
- MeDES Medical Center, Jerusalem, 9314103, Israel
| | - Ilan Friedman
- Shaare Zedek Medical Center, Jerusalem, 9103102, Israel
| | - Joseph Lowe
- Hadassah Medical Organization, Mount Scopus, Jerusalem, 9765422, Israel
| | - Nathalie Folk
- Institute for Research in Military Medicine (IRMM), Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Forces Medical Corps, Jerusalem, 9112001, Israel
| | - Yonaton Zarbiv
- Israel Defense Forces Medical Corps, Ramat Gan, 5260416, Israel
| | - Evgeny Gelman
- Israel Defense Forces Medical Corps, Ramat Gan, 5260416, Israel
| | - Lev Vishnevski
- Israel Defense Forces Medical Corps, Ramat Gan, 5260416, Israel
| | | | | | - Roni Gofshtein
- Israel Defense Forces Medical Corps, Ramat Gan, 5260416, Israel
| | - Arnon Gam
- Israel Defense Forces Medical Corps, Ramat Gan, 5260416, Israel
| | - S David Gertz
- Institute for Research in Military Medicine (IRMM), Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Forces Medical Corps, Jerusalem, 9112001, Israel.,The Saul and Joyce Brandman Hub for Cardiovascular Research and the Department of Medical Neurobiology, Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, 9112001, Israel
| | - Arik Eisenkraft
- Institute for Research in Military Medicine (IRMM), Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Forces Medical Corps, Jerusalem, 9112001, Israel
| | - Yair Barzilay
- Shaare Zedek Medical Center, Jerusalem, 9103102, Israel
| |
Collapse
|
6
|
de Oliveira AR, da Silva FS, Bortolin RH, Marques DEDS, Ramos GV, Marqueti RC, da Silva NB, Medeiros KCDP, Corrêa MA, Lima JPMS, de Rezende AA, Ackermann PW, Abreu BJ, de Brito Vieira WH. Effect of photobiomodulation and exercise on early remodeling of the Achilles tendon in streptozotocin-induced diabetic rats. PLoS One 2019; 14:e0211643. [PMID: 30716140 PMCID: PMC6361457 DOI: 10.1371/journal.pone.0211643] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/17/2019] [Indexed: 02/06/2023] Open
Abstract
The aim of this study was to compare the treatment effects of laser photobiomodulation (LPBM) therapy and aerobic exercise on the biomechanical properties, tissue morphology and the expression of tendon matrix molecules during early remodeling of Achilles tendon (AT) injury in diabetic rats. Animals were randomly assigned to five groups: injured non diabetic (I, n = 15), injured diabetic (ID, n = 15), injured diabetic plus LPBM (IDL, n = 16), injured diabetic plus aerobic exercise (IDE, n = 16) and injured diabetic plus aerobic exercise and LPBM (IDEAL, n = 17). Type 1 diabetes was induced via a single intravenous injection of Streptozotocin at a dose of 40 mg/kg. A partial tenotomy was performed in the right AT. LPBM was performed with an indium-gallium-aluminum-phosphide 660 nm 10 mW laser device (spot size 0.04 cm2, power density 250 mW/cm2, irradiation duration 16 s, energy 0.16 J, energy density 4 J/cm2) on alternate days for a total of 9 sessions over 3 weeks (total energy 1.44 J), using a stationary contact technique to a single point over the dorsal aspect of the AT. Moderate aerobic exercise was performed on a motorized treadmill (velocity 9 m/min for 60 minutes). At 3 weeks post-injury, biomechanical analyzes as well as assessment of fibroblast number and orientation were performed. Collagen 1 (Col1) and 3 (Col3) and matrix metalloproteinases (MMPs) -3 and 13 protein distributions were studied by immunohistochemistry; while Col1 and Col3 and MMP-2 and 9 gene expression were assessed by quantitative RT-PCR (qRT-PCR). IDEAL exhibited significant increases in several biomechanical parameters in comparison to the other groups. Moreover, IDEAL presented stronger Col1 immunoreactivity when compared to ID, and weaker Col3 immunoreactivity than IDE. Both IDL and IDEAL demonstrated weaker expression of MMP-3 in comparison to I, while IDL presented no expression of MMP-13 when compared to ID. ID, IDL and IDE showed an increased number of fibroblasts in comparison to I, while IDEAL decreased the number of these cells in comparison to ID and IDE. IDL and IDEAL groups exhibited decreased angular dispersion among the fibroblasts when compared to I. The gene expression results showed that IDE demonstrated a downregulation in Col1 mRNA expression in comparison to I and ID. IDEAL demonstrated upregulation of Col1 mRNA expression when compared to IDL or IDE alone and increased MMP-2 expression when compared to IDL and IDE. MMP-9 expression was upregulated in IDEAL when compared to I, IDL and IDE. Our results suggest a beneficial interaction of combining both treatment strategies i.e., aerobic exercise and LPBM, on the biomechanical properties, tissue morphology and the expression of matrix molecules in diabetic tendons.
Collapse
MESH Headings
- Achilles Tendon/metabolism
- Achilles Tendon/physiopathology
- Animals
- Collagen Type I/metabolism
- Collagen Type III/metabolism
- Diabetes Mellitus, Experimental/chemically induced
- Diabetes Mellitus, Experimental/etiology
- Diabetes Mellitus, Experimental/metabolism
- Diabetes Mellitus, Experimental/physiopathology
- Diabetes Mellitus, Type 1/chemically induced
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/metabolism
- Diabetes Mellitus, Type 1/physiopathology
- Fibroblasts/metabolism
- Low-Level Light Therapy/methods
- Male
- Metalloendopeptidases/metabolism
- RNA, Messenger/metabolism
- Rats
- Rats, Wistar
- Streptozocin/pharmacology
- Tendon Injuries/etiology
- Tendon Injuries/metabolism
- Tendon Injuries/physiopathology
- Tendon Injuries/therapy
- Up-Regulation/physiology
- Wound Healing/physiology
Collapse
Affiliation(s)
| | - Flávio Santos da Silva
- Department of Health Sciences, Federal University of the Semiarid Region, Mossoró, Brazil
| | - Raul Hernandes Bortolin
- Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | | | | | | | | | | | | | - Adriana Augusto de Rezende
- Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Paul W. Ackermann
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Bento J. Abreu
- Department of Morphology, Federal University of Rio Grande do Norte, Natal, Brazil
- * E-mail:
| | | |
Collapse
|
7
|
Iacopetti I, Perazzi A, Maniero V, Martinello T, Patruno M, Glazar M, Busetto R. Effect of MLS(®) laser therapy with different dose regimes for the treatment of experimentally induced tendinopathy in sheep: pilot study. Photomed Laser Surg 2017; 33:154-63. [PMID: 25751667 DOI: 10.1089/pho.2014.3775] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The aim of this preliminary study was to investigate the effect of Multiwave Locked System (MLS(®)), a particular model of low-level laser, in the acute phase of collagenase-induced tendon lesions in six adult sheep randomly assigned to two groups. BACKGROUND DATA Tendon injuries are common among human athletes and in sport horses, require a long recovery time, and have a high risk of relapse. Many traditional treatments are not able to repair the injured tendon tissue correctly. In recent years, the use of low-level laser therapy (LLLT) produced interesting results in inflammatory modulation in different musculoskeletal disorders. METHODS Group 1 received 10 treatments of MLS laser therapy at a fluence of 5 J/cm(2) on the left hindlimb. Group 2 received 10 treatments of MLS laser therapy at a fluence of 2.5 J/cm(2) on the left hindlimb. In every subject in both groups, the right hindlimb was considered as the control leg. RESULTS Clinical follow-up and ultrasonography examinations were performed during the postoperative period, and histological examinations were performed at day 30 after the first application of laser therapy. In particular, results from histological examinations indicate that both treatments induced a statistically significant cell number decrease, although only in the second group did the values return to normal. Moreover, the MLS laser therapy dose of 2.5 J/cm(2) (group 2) caused a significant decrease of vessel area. CONCLUSIONS In this study, clinical and histological evaluation demonstrated that a therapeutic dose <5 J/cm(2) furnished an anti-inflammatory effect, and induced a decrease of fibroblasts and vessel area. Overall, our results suggest that MLS laser therapy was effective in improving collagen fiber organization in the deep digital flexor tendon.
Collapse
Affiliation(s)
- Ilaria Iacopetti
- 1 Department of Animal Medicine, Production and Health, University of Padua , Padua, Italy
| | | | | | | | | | | | | |
Collapse
|
8
|
Chan KOW, Tong HHY, Ng GYF. Topical Fish Oil Application Coupling with Therapeutic Ultrasound Improves Tendon Healing. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2983-2989. [PMID: 27692307 DOI: 10.1016/j.ultrasmedbio.2016.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 08/10/2016] [Accepted: 08/12/2016] [Indexed: 06/06/2023]
Abstract
Fish oil has been shown to promote collagen synthesis, and hence, connective tissue healing. Therapeutic ultrasound is commonly used to treat soft tissue injuries. This study aimed to investigate the therapeutic effect of topical fish oil on the management of Achilles tendon rupture, comparing normal therapeutic ultrasound with a combination of ultrasound and fish oil. Eighty-five Sprague-Dawley rats underwent surgical hemitenotomy of the right medial Achilles tendon. The rats received daily treatment of either topical placebo ointment (control group [CON]), topical fish oil (FO), therapeutic ultrasound (US) or ultrasound with fish oil as the coupling medium (FU). The treatment started on post-surgical day 2 over a 2-wk or 4-wk period. On days 15 and 29, the rats were sacrificed and their Achilles tendons were tested for structural stiffness, ultimate tensile strength (UTS) and energy absorption capacity. At 2 wk, only US showed higher normalized UTS compared with CON (p < 0.05). At 4 wk, both US and FU demonstrated better UTS (p < 0.05), while both FO and FU had improved in structural stiffness (p < 0.05). Four wk of treatment with ultrasound using fish oil as coupling medium showed improvement in both structural stiffness and UTS (p < 0.05).
Collapse
Affiliation(s)
- Karly O W Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China.
| | - Henry H Y Tong
- School of Health Sciences, Macao Polytechnic Institute, Macau SAR, China
| | - Gabriel Y F Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| |
Collapse
|
9
|
Tumilty S, McDonough S, Hurley DA, Baxter GD. Clinical effectiveness of low-level laser therapy as an adjunct to eccentric exercise for the treatment of Achilles' tendinopathy: a randomized controlled trial. Arch Phys Med Rehabil 2012; 93:733-9. [PMID: 22541305 DOI: 10.1016/j.apmr.2011.08.049] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 08/23/2011] [Accepted: 08/23/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the effectiveness of low-level laser therapy (LLLT) as an adjunct to a program of eccentric exercises for the treatment of Achilles' tendinopathy. DESIGN Randomized controlled trial with evaluations at baseline and 4, 12, and 52 weeks. SETTING Primary care clinic. PARTICIPANTS Participants with midportion Achilles' tendinopathy were randomly assigned to 2 groups (LLLT n=20: mean age ± SD, 45.6±9.1y; placebo n=20: mean age ± SD, 46.5±6.4y). The 12-week evaluation was completed by 36 participants (90%), and 33 participants (82.5%) completed the 52-week evaluation. INTERVENTION Both groups of participants performed eccentric exercises over a 3-month period. In addition, they received either an active or placebo application of LLLT 3 times per week for the first 4 weeks; the dose was 3J per point. MAIN OUTCOME MEASURES The primary outcome was the Victorian Institute of Sport Assessment-Achilles' questionnaire (VISA-A) score at 12 weeks; secondary outcome was a visual analog scale for pain. Outcomes were measured at baseline and 4, 12, and 52 weeks. RESULTS Baseline characteristics exhibited no differences between groups. At the primary outcome point, there was no statistically significant difference in VISA-A scores between groups (P>.05). The difference in VISA-A scores at the 4-week point significantly favored the placebo group (F(1)=6.411, sum of squares 783.839; P=.016); all other outcome scores showed no significant difference between the groups at any time point. Observers were blinded to groupings. CONCLUSIONS The clinical effectiveness of adding LLLT to eccentric exercises for the treatment of Achilles' tendinopathy has not been demonstrated using the parameters in this study.
Collapse
Affiliation(s)
- Steve Tumilty
- Centre for Physiotherapy Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand.
| | | | | | | |
Collapse
|
10
|
de Oliveira RR, Bezerra MA, de Lira KDS, Novaes KA, Teixeira MFHBI, Chaves CDC, Moraes SRAD. Aerobic physical training restores biomechanical properties of Achilles tendon in rats chemically induced to diabetes mellitus. J Diabetes Complications 2012; 26:163-8. [PMID: 22520401 DOI: 10.1016/j.jdiacomp.2012.03.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Revised: 03/15/2012] [Accepted: 03/15/2012] [Indexed: 01/21/2023]
Abstract
UNLABELLED The aim of this study is to evaluate if the application of a moderate aerobic exercise protocol reverses the damage caused by diabetes on the mechanical properties of the Achilles tendon. METHODS Forty-four rats were divided randomly into four groups as follows: Sedentary Control Group-SCG, Sedentary Diabetic Group-SDG, Trained Control Group-TCG and Trained Diabetic Group-TDG, the trained groups were submitted to a protocol of moderate physical training on a continuous treadmill. For mechanical testing the tendons were fixed in a conventional mechanical testing machine and pulled to the point of failure of the specimen, the cell load of 500N. The parameters were: Elastic Modulus (MPa), Stress Maximum Strength (MPa), Strain Specific Maximum Force (mm), Energy / Tendon Area (N.mm/mm(2)) and Cross-sectional Area (mm(2)). RESULTS The evaluation of the biomechanical properties of the Achilles tendon of the SDG indicated that the elastic modulus (MPa) is decreased when compared to the TDG and the other groups (p<0.01). However, the specific deformation (%), the deformation at maximum force (mm), and energy / tendon area (N.mm/mm(2)) of the SDG were significantly higher than in the other groups (p<0.01). Moreover, moderate aerobic training on a treadmill caused the biomechanical property values to move closer to the values shown by the control groups (p>0.01). CONCLUSION In summary, our study indicates that moderate-intensity aerobic training restored the normal mechanical properties of tendons in diabetic animals, since the elastic modulus (MPa), the specific deformation (%), the deformation of the maximum force (mm) and energy / tendon area (N.mm/mm(2)) approached the values shown by the control groups.
Collapse
|
11
|
Ng GYF, Chung PYM. Effects of a therapeutic laser and passive stretching program for treating tendon overuse. Photomed Laser Surg 2012; 30:155-9. [PMID: 22235970 DOI: 10.1089/pho.2011.3095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE This study investigated the effects of a therapeutic laser, passive stretching, and their combined treatment on the strength of Achilles tendons with overuse pathologies. BACKGROUND DATA Tendinopathy involving overuse is usually treated with exercise and stretching, but there has been no report on the treatment effect of a therapeutic laser combined with passive stretching on managing this condition. Despite the beneficial effect of a therapeutic laser on healing tendons that have had traumatic injury, its effect on degenerative tendons is not known. METHODS Twenty-five mature Sprague-Dawley (SD) rats were used, with 20 subjected to daily bipedal downhill running for 8 weeks, to induce Achilles overuse, and 5 as normal controls. The exercised rats were divided into four groups: 1, laser treatment; 2, passive stretching; 3, combined laser and stretching; and 4, no treatment, running controls. GaAlAs laser with 660 nm wavelength was applied to both Achilles tendons for 50 sec for Groups 1 and 3. Passive stretching of 20 times/10 sec of maximum ankle plantar flexion was applied to Groups 2 and 3. Treatments were applied after each running session for a a total of 56 treatment sessions. On week 9, the tendons were tested for load-relaxation, stiffness, and ultimate strength. RESULTS Stiffness was different (p=0.01), difference in ultimate strength was marginally insignificant (p=0.07), and load-relaxation difference was not significant among groups. Post-hoc analyses revealed that the mean stiffness of all the four exercise groups was lower than the normal control, whereas the ultimate strength from the laser and combined laser and stretching was not different from that of the normal control group, but was higher than that of the passive stretching and no treatment groups. CONCLUSIONS We conclude that a therapeutic laser and combined laser with passive stretching might slow down the decrease in Achilles tendon strength but would not be able to stop the pathological changes of overuse from developing.
Collapse
Affiliation(s)
- Gabriel Y F Ng
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong (SAR), China.
| | | |
Collapse
|
12
|
Neves MAI, Pinfildi CE, Wood VT, Gobbato RC, da Silva FM, Parizotto NA, Hochman B, Ferreira LM. Different power settings of LLLT on the repair of the calcaneal tendon. Photomed Laser Surg 2011; 29:663-8. [PMID: 21668375 DOI: 10.1089/pho.2010.2919] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the effect of an 830-nm GaAlAs diode laser operating at output powers of 40, 60, 80, and 100 mW and energy density of 30 J/cm(2) on the repair of partial calcaneal tendon ruptures in rats. METHODS A partial tendon rupture was induced in all animals, which were treated with laser irradiation for 5 consecutive days. Six days after injury, the injured tendons were removed and examined by polarized light microscopy. Collagen fiber organization was evaluated by birefringence measurements, and collagen content was determined by Picrosirius Red staining. RESULTS It was observed that the higher the output power (60-100 mW) the greater the amount of type III collagen (p<0.01). The amount of type I collagen was significantly greater (p=0.05) in the 80 mW group than in the control group (sham stimulation). A non-statistically significant improvement in the realignment of collagen fibers was observed in the irradiated groups. CONCLUSIONS Low-level laser therapy resulted in significantly greater amounts of type III collagen (output powers of 60 mW or more) and type I collagen (output power of 80 mW), however, no significant differences between groups were found in the realignment of collagen fibers.
Collapse
Affiliation(s)
- Marco Aurelio Invaldi Neves
- Department of Plastic Surgery, Universidade Federal de São Paulo, Rua Napoleão de Barros 715, São Paulo, Brazil.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Joensen J, Gjerdet NR, Hummelsund S, Iversen V, Lopes-Martins RAB, Bjordal JM. An experimental study of low-level laser therapy in rat Achilles tendon injury. Lasers Med Sci 2011; 27:103-11. [PMID: 21547473 PMCID: PMC3254871 DOI: 10.1007/s10103-011-0925-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 04/06/2011] [Indexed: 12/27/2022]
Abstract
The aim of this controlled animal study was to investigate the effect of low-level laser therapy (LLLT) administered 30 min after injury to the Achilles tendon. The study animals comprised 16 Sprague Dawley male rats divided in two groups. The right Achilles tendons were injured by blunt trauma using a mini guillotine, and were treated with LLLT or placebo LLLT 30 min later. The injury and LLLT procedures were then repeated 15 hours later on the same tendon. One group received active LLLT (λ = 904 nm, 60 mW mean output power, 0.158 W/cm2 for 50 s, energy 3 J) and the other group received placebo LLLT 23 hours after LLLT. Ultrasonographic images were taken to measure the thickness of the right and left Achilles tendons. Animals were then killed, and all Achilles tendons were tested for ultimate tensile strength (UTS). All analyses were performed by blinded observers. There was a significant increase in tendon thickness in the active LLLT group when compared with the placebo group (p < 0.05) and there were no significant differences between the placebo and uninjured left tendons. There were no significant differences in UTS between laser-treated, placebo-treated and uninjured tendons. Laser irradiation of the Achilles tendon at 0.158 W/cm2 for 50 s (3 J) administered within the first 30 min after blunt trauma, and repeated after 15 h, appears to lead to edema of the tendon measured 23 hours after LLLT. The guillotine blunt trauma model seems suitable for inflicting tendon injury and measuring the effects of treatment on edema by ultrasonography and UTS. More studies are needed to further refine this model.
Collapse
Affiliation(s)
- Jon Joensen
- Department of Physiotherapy, Faculty of Health and Social Science, Bergen University College, Bergen, Norway.
| | | | | | | | | | | |
Collapse
|
14
|
Oliveira FS, Pinfildi CE, Parizoto NA, Liebano RE, Bossini PS, Garcia ÉB, Ferreira LM. Effect of low level laser therapy (830 nm) with different therapy regimes on the process of tissue repair in partial lesion calcaneous tendon. Lasers Surg Med 2009; 41:271-6. [DOI: 10.1002/lsm.20760] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|