Effects of Low-Level Laser Therapy Applied Before Treadmill Training on Recovery of Injured Skeletal Muscle in Wistar Rats

Preventive and therapeutic vascular photobiomodulation decreases the inflammatory markers and enhances the muscle repair process in an animal model

Photobiomodulation therapy (PBM) has shown positive effects when applied locally to modulate the inflammatory process and facilitate muscle repair. However, the available literature on the mechanisms of action of vascular photobiomodulation (VPBM), a non-invasive method of vascular irradiation, specifically in the context of local muscle repair, is limited. Thus, this study aimed to assess the impact of vascular photobiomodulation (VPBM) using a low-level laser (LLL) on the inflammatory response and the process of skeletal muscle repair whether administered prior to or following cryoinjury-induced acute muscle damage in the tibialis anterior (TA) muscles. Wistar rats (n = 85) were organized into the following experimental groups: (1) Control (n = 5); (2) Non-Injury + VPBM (n = 20); (3) Injured (n = 20); (4) Pre-VPBM + Injury (n = 20); (5) Injury + Post-VPBM (n = 20). VPBM was administered over the vein/artery at the base of the animals' tails (wavelength: 780 nm; power: 40 mW; application area: 0.04 cm2; energy density: 80 J/cm2). Euthanasia of the animals was carried out at 1, 2, 5, and 7 days after inducing the injuries. Tibialis anterior (TA) muscles were collected for both qualitative and quantitative histological analysis using H&E staining and for assessing protein expression of TNF-α, MCP-1, IL-1β, and IL-6 via ELISA. Blood samples were collected and analyzed using an automatic hematological analyzer and a leukocyte differential counter. Data were subjected to statistical analysis (ANOVA/Tukey). The results revealed that applying VPBM prior to injury led to an increase in circulating neutrophils (granulocytes) after 1 day and a subsequent increase in monocytes after 2 and 5 days, compared to the Non-Injury + VPBM and Injured groups. Notably, an increase in erythrocytes and hemoglobin concentration was observed in the Non-Injury + VPBM group on days 1 and 2 in comparison to the Injured group. In terms of histological aspects, only the Prior VPBM + Injured group exhibited a reduction in the number of inflammatory cells after 1, 5, and 7 days, along with an increase in blood vessels at 5 days. Both the Prior VPBM + Injured and Injured + VPBM after groups displayed a decrease in myonecrosis at 1, 2, and 7 days, an increase in newly-formed and immature fibers after 5 and 7 days, and neovascularization after 1, 2, and 7 days. Regarding protein expression, there was an increase in MCP-1 after 1 and 5 days, TNF-α, IL-6, and IL-1β after 1, 2, and 5 days in the Injured + VPBM after group when compared to the other experimental groups. The Prior VPBM + Injured group exhibited increased MCP-1 production after 2 days, in comparison to the Non-Injury + VPBM and Control groups. Notably, on day 7, the Injured group continued to show elevated MCP-1 protein expression when compared to the VPBM groups. In conclusion, VPBM effectively modulated hematological parameters, circulating leukocytes, the protein expression of the chemokine MCP-1, and the proinflammatory cytokines TNF-α and IL-1β, ultimately influencing the inflammatory process. This modulation resulted in a reduction of myonecrosis, restoration of tissue architecture, increased formation of newly and immature muscle fibers, and enhanced neovascularization, with more pronounced effects when VPBM was applied prior to the muscle injury.

miRNAs contributing to the repair of tendon injury

Tendon injury is one of the most common disorders of the musculoskeletal system, with a higher likelihood of occurrence in elderly individuals and athletes. In posthealing tendons, two undesirable consequences, tissue fibrosis and a reduction in mechanical properties, usually occur, resulting in an increased probability of rerupture or reinjury; thus, it is necessary to propose an appropriate treatment. Currently, most methods do not sufficiently modulate the tendon healing process and restore the function and structure of the injured tendon to those of a normal tendon, since there is still inadequate information about the effects of multiple cellular and other relevant signaling pathways on tendon healing and how the expression of their components is regulated. microRNAs are vital targets for promoting tendon repair and can modulate the expression of biological components in signaling pathways involved in various physiological and pathological responses. miRNAs are a type of noncoding ribonucleic acid essential for regulating processes such as cell proliferation, differentiation, migration and apoptosis; inflammatory responses; vascularization; fibrosis; and tissue repair. This article focuses on the biogenesis response of miRNAs while presenting their mechanisms in tendon healing with perspectives and suggestions.

Histological and biochemical effects of preventive and therapeutic vascular photobiomodulation on rat muscle injury

The intravascular or transcutaneous application of photobiomodulation (PBM) over blood vessels (vascular photobiomodulation, VPBM) has been used for the treatment of inflammatory and chronic conditions with promising systemic results. This study evaluated the VPBM effects on a model of muscle regeneration after acute injury and compared the outcomes of preventive and therapeutic VPBM. Transcutaneous VPBM was administered over the rat's main tail vein. Serum levels of creatine kinase (CK), aspartate aminotransferase (AST), and lactate were evaluated and muscles were processed for macroscopic and microscopic analysis. Preventive and therapeutic VPBM led to decreased inflammatory infiltrate, edema, and myonecrosis but with an increase in immature muscle fibers. CK, AST, and lactate levels were lower in the groups treated with VPBM (lowest concentrations in preventive VPBM application). Preventive and therapeutic VPBM were capable of exerting a positive effect on acute muscle injury repair, with more accentuated results when preventive VPBM was administered.

The Functions and Mechanisms of Low-Level Laser Therapy in Tendon Repair (Review)

Tendon injury is a common disease of the musculoskeletal system, accounting for roughly 30%–40% of sports system disorder injuries. In recent years, its incidence is increasing. Many studies have shown that low-level laser therapy (LLLT) has a significant effect on tendon repair by firstly activating cytochrome C oxidase and thus carrying out the photon absorption process, secondly acting in all the three phases of tendon repair, and finally improving tendon recovery. The repair mechanisms of LLLT are different in the three phases of tendon repair. In the inflammatory phase, LLLT mainly activates a large number of VEGF and promotes angiogenesis under hypoxia. During the proliferation phase, LLLT increases the amount of collagen type III by promoting the proliferation of fibroblasts. Throughout the remodeling phase, LLLT mainly activates M2 macrophages and downregulates inflammatory factors, thus reducing inflammatory responses. However, it should also be noted that in the final phase of tendon repair, the use of LLLT causes excessive upregulation of some growth factors, which will lead to tendon fibrosis. In summary, we need to further investigate the functions and mechanisms of LLLT in the treatment of tendon injury and to clarify the nature of LLLT for the treatment of diverse tendon injury diseases.

Indirect Structural Muscle Injuries of Lower Limb: Rehabilitation and Therapeutic Exercise

Muscle injuries are the most common trauma in team and individual sports. The muscles most frequently affected are those of the lower limb, and in particular hamstrings, adductors, rectus femoris and calf muscles. Although several scientific studies have tried to propose different rehabilitation protocols, still too often the real rehabilitation process is not based on scientific knowledge, especially in non-elite athletes. Moreover, the growing use of physical and instrumental therapies has made it increasingly difficult to understand what can be truly effective. Therefore, the aim of the present paper is to review proposed therapeutic algorithms for muscle injuries, proposing a concise and practical summary. Following a three-phase rehabilitation protocol, this review aims to describe the conservative treatment of indirect structural muscle injuries, which are the more routinely found and more challenging type. For each phase, until return to training and return to sport are completed, the functional goal, the most appropriate practitioner, and the best possible treatment according to current evidence are expressed. Finally, the last section is focused on the specific exercise rehabilitation for the four main muscle groups with a structured explanatory timetable.

Muscle Precursor Cells Enhance Functional Muscle Recovery and Show Synergistic Effects With Postinjury Treadmill Exercise in a Muscle Injury Model in Rats

BACKGROUND

Skeletal muscle injuries represent a major concern in sports medicine. Cell therapy has emerged as a promising therapeutic strategy for muscle injuries, although the preclinical data are still inconclusive and the potential clinical use of cell therapy has not yet been established.

PURPOSE

To evaluate the effects of muscle precursor cells (MPCs) on muscle healing in a small animal model.

STUDY DESIGN

Controlled laboratory study.

METHODS

A total of 27 rats were used in the study. MPCs were isolated from rat (n = 3) medial gastrocnemius muscles and expanded in primary culture. Skeletal muscle injury was induced in 24 rats, and the animals were assigned to 3 groups. At 36 hours after injury, animals received treatment based on a single ultrasound-guided MPC (10⁵ cells) injection (Cells group) or MPC injection in combination with 2 weeks of daily exercise training (Cells+Exercise group). Animals receiving intramuscular vehicle injection were used as controls (Vehicle group). Muscle force was determined 2 weeks after muscle injury, and muscles were collected for histological and immunofluorescence evaluation.

RESULTS

Red fluorescence-labeled MPCs were successfully transplanted in the site of the injury by ultrasound-guided injection and were localized in the injured area after 2 weeks. Transplanted MPCs participated in the formation of regenerating muscle fibers as corroborated by the co-localization of red fluorescence with developmental myosin heavy chain (dMHC)-positive myofibers by immunofluorescence analysis. A strong beneficial effect on muscle force recovery was detected in the Cells and Cells+Exercise groups (102.6% ± 4.0% and 101.5% ± 8.5% of maximum tetanus force of the injured vs healthy contralateral muscle, respectively) compared with the Vehicle group (78.2% ± 5.1%). Both Cells and Cells+Exercise treatments stimulated the growth of newly formed regenerating muscles fibers, as determined by the increase in myofiber cross-sectional area (612.3 ± 21.4 µm² and 686.0 ± 11.6 µm², respectively) compared with the Vehicle group (247.5 ± 10.7 µm²), which was accompanied by a significant reduction of intramuscular fibrosis in Cells and Cells+Exercise treated animals (24.2% ± 1.3% and 26.0% ± 1.9% of collagen type I deposition, respectively) with respect to control animals (40.9% ± 4.1% in the Vehicle group). MPC treatment induced a robust acceleration of the muscle healing process as demonstrated by the decreased number of dMHC-positive regenerating myofibers (enhanced replacement of developmental myosin isoform by mature myosin isoforms) (4.3% ± 2.6% and 4.1% ± 1.5% in the Cells and Cells+Exercise groups, respectively) compared with the Vehicle group (14.8% ± 13.9%).

CONCLUSION

Single intramuscular administration of MPCs improved histological outcome and force recovery of the injured skeletal muscle in a rat injury model that imitates sports-related muscle injuries. Cell therapy showed a synergistic effect when combined with an early active rehabilitation protocol in rats, which suggests that a combination of treatments can generate novel therapeutic strategies for the treatment of human skeletal muscle injuries.

CLINICAL RELEVANCE

Our study demonstrates the strong beneficial effect of MPC transplant and the synergistic effect when the cell therapy is combined with an early active rehabilitation protocol for muscle recovery in rats; this finding opens new avenues for the development of effective therapeutic strategies for muscle healing and clinical trials in athletes undergoing MPC transplant and rehabilitation protocols.

Photobiomodulation reduces nociception and edema in a CFA-induced muscle pain model: effects of LLLT and LEDT

Photobiomodulation therapy (PBMT) is an effective therapeutic strategy and a noninvasive method to improve the regulation of inflammation and pain. Our aim was to examine the effects of different doses of PBMT on improvement of edematogenic and nociceptive responses in a myositis model in rats. We administered complete Freund's adjuvant (CFA) into the gastrocnemius muscle (GS) of rats to induce myositis and observe the effect of PBMT using different doses of energy and two types of light sources, a low-level laser (LLL) and light emitting diodes (LED). For this, we evaluated the effects of these different energies to improve nociceptive and edematogenic responses using behavioural tests. In addition, we analysed histological images in animals with myositis induced by CFA. The administration of CFA to the GS induced increased cellular infiltrates, edema and a nociceptive response when compared to animals without myositis. When we treated the CFA-induced myositis animals with PBMT (LLLT or LEDT), we observed a decrease in nociception and edema formation. Our results demonstrated that only the major energy for both the LED and LLL was able to remain in a homogeneous form throughout the period analyzed. Based on our results, we suggest that both LLLT and LEDT using the highest dose (3 J) could be an alternative treatment for myositis in rats.

Effects of the infrared laser on classical ballerinas' feet: Analysis of plantar foot and static balance

BACKGROUND AND PURPOSE

Overuse injuries and painful symptoms in athletes and dancers (especially classical ballerinas) may lead to reduced functional performance. However, laser application may reduce pain and increase physical conditioning. The aim of the current study was to evaluate the immediate and long-term effects of infrared laser on classical ballerinas' feet.

METHODS

Eight female adults who perform classical ballet training and feel pain in their foot, but report no injuries in the last 6 months participated in the study. Infrared laser (808 nm) was applied on ballerina's feet twice a week during three months. The laser parameters utilized were 100 mW average optical power and spot size of 0.04 cm² applied during 1 min, leading to 6 J and 125 J/cm² per point. Thermography, algometry and unipodal static standing balance test were performed.

RESULTS

There was a significant increase in plantar arch temperature (1.6 °C for center and 2.3 °C for border, p < 0.05) immediately after laser treatment for all ballerinas. The pressure pain thresholds (PPT) were significantly increased for 5 of 7 analyzed sites (p < 0.05). Regarding to the static standing balance, the time on one-foot showed a significant increases (from 23 ± 12 s to 34 ± 13 s, p < 0.05) only when the test was performed on the left foot (support foot).

CONCLUSION

Then, there were pain relief and improvement of functional performance in ballerinas. The possible mechanism of laser action in reducing pain and thus enhancing performance, like higher blood flow of foot due to an increase of cutaneous temperature, will be discussed.

Remodeling of the skeletal muscle and postsynaptic component after short-term joint immobilization and aquatic training

Joint immobilization is commonly used as a conservative treatment for osteoarticular and musculotendinous traumas. However, joint immobilization might elicit degenerative effects on the neuromuscular system and muscle atrophy. For this reason, the choice of strategies that mitigate these effects is essential in the post-immobilization period. Therefore, this study aimed to investigate the impact of aquatic training on the morphology of muscle fibers and motor endplates of the gastrocnemius muscle in the post-immobilization period. Male Wistar rats (90 days old) were divided into groups: Sedentary: no procedure; Immobilization: joint immobilization protocol (10 days); Immobilization/non-training: joint immobilization protocol (10 days) followed by four weeks without exercise intervention; Immobilization/training: joint immobilization protocol (10 days) and post-immobilization aquatic training (4 weeks). After the procedures, we quantified the cross-sectional area (CSA), volume and numerical density of different myofibers types, and total and stained area and perimeter of the motor endplate. We demonstrate the following main results: (a) short-term joint immobilization resulted in myofibers atrophy; however, we verified a small change in the postsynaptic component; (b) the period of inactivity after immobilization caused severe changes in the motor endplate (lower stained area, stained perimeter, total area, and total perimeter) and maintenance of muscle atrophy due to immobilization; (c) the prescription of post-immobilization exercise proved to be effective in restoring muscle morphology and inducing plasticity in the motor endplate. We conclude that short-term joint immobilization (10 days) results in atrophy type I and II myofibers, in addition to a decline in the total perimeter of the motor endplate. Besides, the post-immobilization period appears to be decisive in muscle and postsynaptic remodeling. Thus, aquatic training is effective in stimulating adjustments associated with muscle hypertrophy and plasticity of the motor endplate during the post-immobilization period.

Synergistic effects of vacuum therapy and laser therapy on physical rehabilitation

[Purpose] This study aims to evaluate the synergistic effects of laser therapy and vacuum therapy in the rehabilitation of some disorders of the osteomuscular articular system (shoulder bursitis, low back pain, hip dysfunction after long-term impact of femoral endoprosthesis). [Participants and Methods] Three case reports were described. A vacuum laser system was used, which is a device that contains 1 handpiece with 3 red lasers (660 nm) and 3 infrared lasers (808 nm). This device contains 6 laser beams that are arranged around the vacuum chamber bore which generate negative pressure. Two weekly sessions were held, totalling 10 treatment sessions. Active goniometry was performed to assess range of motion (ROM) of the shoulder, lumbar spine and hip, and visual analogue scale (VAS) was used to evaluate pain in the pre and posttreatment period. [Results] There was a pain reduction and an increase in ROM in the different clinical cases. [Conclusion] Potentiating laser therapy through suctioning during the rehabilitation process leads to pain relief and increased functionality.

Short-term and long-term effects of osteoporosis on incisor teeth and femoral bones evaluated by Raman spectroscopy and energy dispersive X-ray analysis in ovariectomized rats

There are few published data on the relationship between loss of bone mass due to osteoporosis and poor tooth quality. This study analyzed the effects of osteoporosis on incisor teeth and femoral bones using optical techniques in rats. Twenty female Wistar rats aged 6 months (n = 20) were randomized into two groups: control group, non-ovariectomized rats (n = 10); ovariectomy group, ovariectomized rats to induce osteoporosis (n = 10). Each group was subdivided randomly into two groups containing five rats each as follows. Control group 1: non-ovariectomized rats euthanized at the age of 9 or 3 months post-ovariectomy (n = 5); Control group 2: non-ovariectomized rats euthanized at the age of 1 year or 6 months post-ovariectomy (n = 5); ovariectomy group 1: ovariectomized rats euthanized at the age of 9 months or 3 months post-ovariectomy (n = 5); ovariectomy group 2: ovariectomized rats euthanized at the age of 1 year or 6 months post-ovariectomy (n = 5). The incisor teeth and femoral bones of Wistar rats were removed to perform Raman spectroscopy using an excitation laser at 785 nm. In addition, an energy-dispersive X-ray spectrometer system was used to evaluate calcium (Ca) and phosphorus (P). The main findings included significant changes (p < 0.05) for phosphate and carbonate band areas for both incisor teeth and femur bones. In addition, there was significant negative correlation between the P concentration and phosphate/carbonate ratio (lower P content-larger ratio, p < 0.05) for incisor teeth and femoral bones. The proline and CH₂ wag band areas were significantly reduced only for the incisor teeth (p < 0.05). Therefore, Raman spectroscopy assessed the compositional, physicochemical and structural changes in hard tissue. The current study also pointed out the possible action mechanisms of these changes, bone fracture risk and dental fragility. It is important to emphasize that poor dental quality may also occur due to osteoporosis.

Fractal dimension in the evaluation of different treatments of muscular injury in rats

OBJECTIVES

To evaluate alterations from different therapies in muscular injury using the Fractal Dimension (FD) method.

METHODS

35 animals were allocated in Control Group (C), Injury Control Group (IC), Injury Low Level Laser Therapy Group (ILT), Injury Platelet Rich Plasma Group (IP), and Injury LLLT and PRP Group (ILP). The animals suffered a stretch injury in gastrocnemius muscle and after that IP and ILP groups received PRP application. The ILT and ILP groups received daily LLLT applications for seven days. After seven days the animals were euthanized and the gastrocnemius muscle removed and frozen. The muscles were stained with Hematoxylin and Eosin (HE) and Picrosirius Red, for observation of the morphology of the injury and semi-quantitative and quantitative analysis through the Fractal Dimension (FD) method.

RESULTS

In the qualitative and semi-quantitative analysis, in relation to IC group, the ILT presented a reduction in rounded fibers and the IP in angular fibers. The ILP group demonstrated a reduction in both polymorphic fibers and inflammatory infiltrate. The FD of the muscles stained with HE was higher in the groups that suffered the injury when compared to the C group (p < 0.05); the FD of the collagen demonstrated no statistical difference between the groups.

CONCLUSION

Both treatments were able to accelerate injury repair, and the association of both presented better results than the isolated applications. However, the FD method showed no sensitivity to differentiate the treatments, either in the histological aspects or the injury in collagen.

Infrared Laser Improves Collagen Organization in Muscle and Tendon Tissue During the Process of Compensatory Overload

BACKGROUND

The photobiomodulation using the low-level laser therapy (LLLT) exerts a positive modulating effect on the synthesis of collagen in skeletal muscles and tendons. However, few studies have addressed this effect during the compensatory overload.

OBJECTIVE

Evaluate the effect of infrared laser on the deposition and organization of collagen fibers in muscle and tendon tissue during compensatory overload of the plantar muscle in rats.

MATERIALS AND METHODS

Wistar rats were submitted to bilateral ablation of the synergist muscles of the hind paws and divided in groups: Control, Hypertrophy, and Hypertrophy (H)+LLLT (780 nm, 40 mW, 9.6 J/cm² and 10 s/point, 8 points, total energy 3.2 J, daily), evaluated at 7 and 14 days. Muscle cuts were stained with Picrosirius-Red and hematoxylin-eosin and tendon cuts were submitted to birefringence for determination of collagen distribution and organization.

RESULTS

After 7 days an increase was observed in the area between beam muscles in H+LLLT (25.45% ± 2.56) in comparison to H (20.3% ± 3.31), in mature fibers and fibrilis in H+LLLT (29346.88 μm² ± 2182.56; 47602.8 μm² ± 2201.86 respectively) in comparison to H (26656.5 μm² ± 1880.46; 45630.34 μm² ± 2805.82 respectively) and in the collagen area in H+LLLT (2.25% ± 0.19) in comparison to H (2.0% ± 0.15). However, after 14 days a reduction was observed in the area between beam muscles in H+LLLT (13.88% ± 2.54) in comparison to H (19.1% ± 2.61), in fibrils and mature fibers in H+LLLT (17174.1 μm² ± 2563.82; 32634.04 μm² ± 1689.38 respectively) in comparison to H (55249.86 μm² ± 1992.65; 44318.36 μm² ± 1759.57) and in the collagen area in H+LLLT (1.76% ± 0.16) in comparison to H (2.09 ± 0.27). A greater organization of collagen fibers in the tendon was observed after 7 and 14 days in H+LLLT groups.

CONCLUSIONS

Infrared laser irradiation induces an improvement in collagen organization in tendons and a reduction in the total area of collagen in muscles during compensatory atrophy following the ablation of synergist muscles.