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Lambi AG, DeSante RJ, Patel PR, Hilliard BA, Popoff SN, Barbe MF. Blocking CCN2 Reduces Established Palmar Neuromuscular Fibrosis and Improves Function Following Repetitive Overuse Injury. Int J Mol Sci 2023; 24:13866. [PMID: 37762168 PMCID: PMC10531056 DOI: 10.3390/ijms241813866] [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: 06/30/2023] [Revised: 08/22/2023] [Accepted: 09/03/2023] [Indexed: 09/29/2023] Open
Abstract
The matricellular protein cell communication factor 2/connective tissue growth factor (CCN2/CTGF) is critical to development of neuromuscular fibrosis. Here, we tested whether anti-CCN2 antibody treatment will reduce established forepaw fibro-degenerative changes and improve function in a rat model of overuse injury. Adult female rats performed a high repetition high force (HRHF) task for 18 weeks. Tissues were collected from one subset after 18 wks (HRHF-Untreated). Two subsets were provided 6 wks of rest with concurrent treatment with anti-CCN2 (HRHF-Rest/anti-CCN2) or IgG (HRHF-Rest/IgG). Results were compared to IgG-treated Controls. Forepaw muscle fibrosis, neural fibrosis and entheseal damage were increased in HRHF-Untreated rats, compared to Controls, and changes were ameliorated in HRHF-Rest/anti-CCN2 rats. Anti-CCN2 treatment also reduced phosphorylated-β-catenin (pro-fibrotic protein) in muscles and distal bone/entheses complex, and increased CCN3 (anti-fibrotic) in the same tissues, compared to HRHF-Untreated rats. Grip strength declines and mechanical sensitivity observed in HRHF-Untreated improved with rest; grip strength improved further in HRHF-Rest/anti-CCN2. Grip strength declines correlated with muscle fibrosis, entheseal damage, extraneural fibrosis, and decreased nerve conduction velocity, while enhanced mechanical sensitivity (a pain-related behavior) correlated with extraneural fibrosis. These studies demonstrate that blocking CCN2 signaling reduces established forepaw neuromuscular fibrosis and entheseal damage, which improves forepaw function, following overuse injury.
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Affiliation(s)
- Alex G. Lambi
- Department of Surgery, Plastic Surgery Section, New Mexico Veterans Administration Health Care System, Albuquerque, NM 87108, USA;
- Division of Plastic Surgery, University of New Mexico School of Medicine, Albuquerque, NM 87106, USA
| | - Robert J. DeSante
- Aging + Cardiovascular Discovery Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA; (R.J.D.); (P.R.P.); (B.A.H.)
| | - Parth R. Patel
- Aging + Cardiovascular Discovery Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA; (R.J.D.); (P.R.P.); (B.A.H.)
| | - Brendan A. Hilliard
- Aging + Cardiovascular Discovery Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA; (R.J.D.); (P.R.P.); (B.A.H.)
| | - Steven N. Popoff
- Department of Biomedical Education and Data Science, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA;
| | - Mary F. Barbe
- Aging + Cardiovascular Discovery Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA; (R.J.D.); (P.R.P.); (B.A.H.)
- Department of Biomedical Education and Data Science, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA;
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Lutke Schipholt IJ, Scholten-Peeters G, Bontkes H, Coppieters MW. Neuroimmune responses following joint mobilisation and manipulation in people with persistent neck pain: a protocol for a randomised placebo-controlled trial. BMJ Open 2022; 12:e055748. [PMID: 35260459 PMCID: PMC8905979 DOI: 10.1136/bmjopen-2021-055748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Joint mobilisation and manipulation often results in immediate pain relief in people with neck pain. However, the biological mechanisms behind pain relief are largely unknown. There is preliminary evidence that joint mobilisation and manipulation lessens the upregulated neuroimmune responses in people with persistent neck pain. METHODS AND ANALYSIS This study protocol describes a randomised placebo-controlled trial to investigate whether joint mobilisation and manipulation influence neuroimmune responses in people with persistent neck pain. People with persistent neck pain (N=100) will be allocated, in a randomised and concealed manner, to the experimental or control group (ratio 3:1). Short-term (ie, baseline, immediately after and 2 hours after the intervention) neuroimmune responses will be assessed, such as inflammatory marker concentration following in vitro stimulation of whole blood cells, systemic inflammatory marker concentrations directly from blood samples, phenotypic analysis of peripheral blood mononuclear cells and serum cortisol. Participants assigned to the experimental group (N=75) will receive cervical mobilisations targeting the painful and/or restricted cervical segments and a distraction manipulation of the cervicothoracic junction. Participants assigned to the control group (N=25) will receive a placebo mobilisation and placebo manipulation. Using linear mixed models, the short-term neuroimmune responses will be compared (1) between people in the experimental and control group and (2) within the experimental group, between people who experience a good outcome and those with a poor outcome. Furthermore, the association between the short-term neuroimmune responses and pain relief following joint mobilisation and manipulation will be tested in the experimental group. ETHICS AND DISSEMINATION This trial is approved by the Medical Ethics Committee of Amsterdam University Medical Centre, location VUmc (Approval number: 2018.181). TRIAL REGISTRATION NUMBER NL6575 (trialregister.nl.
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Affiliation(s)
- Ivo J Lutke Schipholt
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Clinical Chemistry, Laboratory Medical Immunology, Amsterdam UMC, Location VU Medical Centre, Amsterdam, Netherlands
| | - Gwendolyne Scholten-Peeters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Hetty Bontkes
- Department of Clinical Chemistry, Laboratory Medical Immunology, Amsterdam UMC, Location VU Medical Centre, Amsterdam, Netherlands
| | - Michel W Coppieters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Queensland, Australia
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3
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Koop MA, Lutke Schipholt IJ, Scholten-Peeters GGM, Coppieters MW. Identifying the most important confounders when assessing the association between low-grade systemic inflammation and musculoskeletal pain: A modified Delphi study. PAIN MEDICINE 2021; 22:2661-2669. [PMID: 34343332 PMCID: PMC8633774 DOI: 10.1093/pm/pnab243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective The association between low-grade systemic inflammation and musculoskeletal pain may be influenced by multiple factors. However, little is known about the relative importance of these factors, and few studies account for them. This Delphi study aimed to reach consensus on the most important confounders which influence the association between low-grade systemic inflammation and musculoskeletal pain. Methods The panel consisted of 48 experts. In Round 1, the experts proposed what they believed were important confounders. In Round 2, the experts indicated for each confounder whether they believed it was important (yes/no). At least 50% of experts had to indicate the confounder was important to be considered in the final round. In Round 3, the experts rated the importance of each confounder on a 7-point Likert scale. Consensus was reached if ≥75% of the experts considered the factor either extremely or moderately important. Results In Round 1, 120 confounders were proposed, which were synthesized into 38 distinct factors. In Round 2, 33 confounders met the criterion to be considered important. In Round 3, consensus was reached for 14 confounders: acute illness/trauma, immune disease, medication use, endocrine, nutritional, or metabolic disease, other musculoskeletal conditions, age, handling of blood samples, sex, cancer, body composition, pregnancy, cardiovascular disease, physical activity, and pain characteristics. Conclusions These findings provide insight in the complexity of the association between low-grade systemic inflammation and musculoskeletal pain. Some factors currently listed as confounders may be re-classified as moderators or mediators as insights progress.
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Affiliation(s)
- Meghan A Koop
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 7 1081 BT Amsterdam, The Netherlands
| | - Ivo J Lutke Schipholt
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 7 1081 BT Amsterdam, The Netherlands.,Department of Clinical Chemistry, Laboratory Medical Immunology, Amsterdam UMC, Location VU Medical Centre, De Boelelaan 1117 1081 HV Amsterdam, The Netherlands
| | - Gwendolyne G M Scholten-Peeters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 7 1081 BT Amsterdam, The Netherlands
| | - Michel W Coppieters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 7 1081 BT Amsterdam, The Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast Campus (G40; LVL 8.82), Parklands Drive, Southport, QLD 4215, Australia
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Hilliard BA, Amin M, Popoff SN, Barbe MF. Force dependent effects of chronic overuse on fibrosis-related genes and proteins in skeletal muscles. Connect Tissue Res 2021; 62:133-149. [PMID: 33030055 PMCID: PMC7718395 DOI: 10.1080/03008207.2020.1828379] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM To examine the chronic effect of force on mRNA and protein expression levels of fibrosis-related genes in flexor digitorum muscles in a rat model of repetitive overuse injury that induces muscle fibrosis at high force levels. MATERIALS AND METHODS Two groups of rats were trained to perform a voluntary repetitive lever-pulling task at either a high (HFHR) or a low force (LFHR) for 18 weeks, while a control group (FRC) performed no task. RNA and protein were prepared from forelimb flexor digitorum muscles. Fibrosis-related gene RNA transcripts were evaluated using quantitative PCR (qPCR) and analyzed using the geometric mean of three housekeeping genes or the mean of each individually as reference. Protein levels were quantified using ELISA, western blot, or immunohistofluorescence. RESULTS Of eight fibrosis-related mRNAs examined, only FGF2 demonstrated a consistent significant increase in the HFHR group, compared to the FRC group. However, protein amounts of collagen type 1, collagen type 3, and TGFβ1 were significantly higher in the HFHR, compared to the FRC and LFHR groups, while CCN2 and FGF2 were higher in both HFHR and LFHR, compared to the FRC group. CONCLUSIONS Our results suggest that there is steady-state transcription of fibrogenic genes in muscles with established fibrosis, implying that post-transcriptional processes are responsible for the increased protein levels of fibrotic factors during muscle overuse conditions. We hypothesize that targeting such pathways represents a valid approach to treat overuse injury. Alternatively, FGF2 gene expression may represent a valid target for therapy.
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Affiliation(s)
| | - Mamta Amin
- Temple University, Lewis Katz School of Medicine, Philadelphia, PA
| | - Steven N. Popoff
- Temple University, Lewis Katz School of Medicine, Philadelphia, PA
| | - Mary F. Barbe
- Temple University, Lewis Katz School of Medicine, Philadelphia, PA
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5
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Barbe MF, Hilliard B, Fisher PW, White AR, Delany SP, Iannarone VJ, Harris MY, Amin M, Cruz GE, Popoff SN. Blocking substance P signaling reduces musculotendinous and dermal fibrosis and sensorimotor declines in a rat model of overuse injury. Connect Tissue Res 2020; 61:604-619. [PMID: 31443618 PMCID: PMC7036028 DOI: 10.1080/03008207.2019.1653289] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose/Aim: Substance P-NK-1R signaling has been implicated in fibrotic tendinopathies and myositis. Blocking this signaling with a neurokinin 1 receptor antagonist (NK1RA) has been proposed as a therapeutic target for their treatment.Materials and Methods: Using a rodent model of overuse injury, we pharmacologically blocked Substance P using a specific NK1RA with the hopes of reducing forelimb tendon, muscle and dermal fibrogenic changes and associated pain-related behaviors. Young adult rats learned to pull at high force levels across a 5-week period, before performing a high repetition high force (HRHF) task for 3 weeks (2 h/day, 3 days/week). HRHF rats were untreated or treated in task weeks 2 and 3 with the NK1RA, i.p. Control rats received vehicle or NK1RA treatments.Results: Grip strength declined in untreated HRHF rats, and mechanical sensitivity and temperature aversion increased compared to controls; these changes were improved by NK1RA treatment (L-732,138). NK1RA treatment also reduced HRHF-induced thickening in flexor digitorum epitendons, and HRHF-induced increases of TGFbeta1, CCN2/CTGF, and collagen type 1 in flexor digitorum muscles. In the forepaw upper dermis, task-induced increases in collagen deposition were reduced by NK1RA treatment.Conclusions: Our findings indicate that Substance P plays a role in the development of fibrogenic responses and subsequent discomfort in forelimb tissues involved in performing a high demand repetitive forceful task.
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Affiliation(s)
- MF Barbe
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, United States
| | - B Hilliard
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, United States
| | - PW Fisher
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, United States
| | - AR White
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, United States
| | - SP Delany
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, United States
| | - VJ Iannarone
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, United States
| | - MY Harris
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, United States
| | - M Amin
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, United States
| | - GE Cruz
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, United States
| | - SN Popoff
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, United States
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Barbe MF, Popoff SN. Occupational Activities: Factors That Tip the Balance From Bone Accrual to Bone Loss. Exerc Sport Sci Rev 2020; 48:59-66. [PMID: 32004169 PMCID: PMC7077966 DOI: 10.1249/jes.0000000000000217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Bone adaptation to persistent overloading can be counteracted by superimposed inflammatory and loading-induced damage that can tip the balance from bone accrual to loss. Supplemental digital content is available in the text. It is commonly assumed that beneficial adaptations in bone occur with vigorous exercise, yet any adaptive re/modeling in bone undergoing persistent overloading can be counteracted by superimposed inflammatory, compressive, and tensile loading–induced damage responses above thresholds of tissue fatigue failure and repair. This leads to a tenuous balance between achieving bone accrual and loss.
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Affiliation(s)
- Mary F Barbe
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
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Smith TTG, Barr-Gillespie AE, Klyne DM, Harris MY, Amin M, Paul RW, Cruz GE, Zhao H, Gallagher S, Barbe MF. Forced treadmill running reduces systemic inflammation yet worsens upper limb discomfort in a rat model of work-related musculoskeletal disorders. BMC Musculoskelet Disord 2020; 21:57. [PMID: 32000751 PMCID: PMC6993343 DOI: 10.1186/s12891-020-3085-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 01/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Musculoskeletal disorders can result from prolonged repetitive and/or forceful movements. Performance of an upper extremity high repetition high force task increases serum pro-inflammatory cytokines and upper extremity sensorimotor declines in a rat model of work-related musculoskeletal disorders. Since one of the most efficacious treatments for musculoskeletal pain is exercise, this study investigated the effectiveness of treadmill running in preventing these responses. METHODS Twenty-nine young adult female Sprague-Dawley rats were used. Nineteen were trained for 5 weeks to pull a lever bar at high force (15 min/day). Thirteen went on to perform a high repetition high force reaching and lever-pulling task for 10 weeks (10-wk HRHF; 2 h/day, 3 days/wk). From this group, five were randomly selected to undergo forced treadmill running exercise (TM) during the last 6 weeks of task performance (10-wk HRHF+TM, 1 h/day, 5 days/wk). Results were compared to 10 control rats and 6 rats that underwent 6 weeks of treadmill running following training only (TR-then-TM). Voluntary task and reflexive sensorimotor behavioral outcomes were assessed. Serum was assayed for inflammatory cytokines and corticosterone, reach limb median nerves for CD68+ macrophages and extraneural thickening, and reach limb flexor digitorum muscles and tendons for pathological changes. RESULTS 10-wk HRHF rats had higher serum levels of IL-1α, IL-1β and TNFα, than control rats. In the 10-wk HRHF+TM group, IL-1β and TNFα were lower, whereas IL-10 and corticosterone were higher, compared to 10-wk HRHF only rats. Unexpectedly, several voluntary task performance outcomes (grasp force, reach success, and participation) worsened in rats that underwent treadmill running, compared to untreated 10-wk HRHF rats. Examination of forelimb tissues revealed lower cellularity within the flexor digitorum epitendon but higher numbers of CD68+ macrophages within and extraneural fibrosis around median nerves in 10-wk HRHF+TM than 10-wk HRHF rats. CONCLUSIONS Treadmill running was associated with lower systemic inflammation and moderate tendinosis, yet higher median nerve inflammation/fibrosis and worse task performance and sensorimotor behaviors. Continued loading of the injured tissues in addition to stress-related factors associated with forced running/exercise likely contributed to our findings.
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Affiliation(s)
- Tianqi Tenchi Gao Smith
- Department of Industrial and Systems Engineering, Auburn University, 3323 Shelby Engineering Center, Auburn, AL 36849 USA
- Department of Systems Science and Industrial Engineering, SUNY – Binghamton, Vestal, NY USA
| | - Ann E. Barr-Gillespie
- College of Health Professions, Pacific University, 190 S.E. 8th Avenue, Suite 230, Hillsboro, OR 97123 USA
| | - David M. Klyne
- Department of Anatomy and Cell Biology, Temple University Medical School, 3500 North Broad Street, Philadelphia, PA 19140 USA
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD 4072 Australia
| | - Michelle Y. Harris
- Department of Anatomy and Cell Biology, Temple University Medical School, 3500 North Broad Street, Philadelphia, PA 19140 USA
| | - Mamta Amin
- Department of Anatomy and Cell Biology, Temple University Medical School, 3500 North Broad Street, Philadelphia, PA 19140 USA
| | | | - Geneva E. Cruz
- Department of Anatomy and Cell Biology, Temple University Medical School, 3500 North Broad Street, Philadelphia, PA 19140 USA
| | - Huaqing Zhao
- Department of Clinical Sciences, Temple University Medical School, 3440 North Broad Street, Philadelphia, PA 19140 USA
| | - Sean Gallagher
- Department of Industrial and Systems Engineering, Auburn University, 3323 Shelby Engineering Center, Auburn, AL 36849 USA
| | - Mary F. Barbe
- Department of Anatomy and Cell Biology, Temple University Medical School, 3500 North Broad Street, Philadelphia, PA 19140 USA
- Anatomy and Cell Biology, Lewis Katz School of Medicine at Temple University, 3500 North Broad Street, Philadelphia, PA 19140 USA
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8
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Burne G, Mansfield M, Gaida JE, Lewis JS. Is there an association between metabolic syndrome and rotator cuff-related shoulder pain? A systematic review. BMJ Open Sport Exerc Med 2019; 5:e000544. [PMID: 31921436 PMCID: PMC6937110 DOI: 10.1136/bmjsem-2019-000544] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2019] [Indexed: 12/13/2022] Open
Abstract
Objectives Rotator cuff-related shoulder pain (RCRSP) is a common upper limb complaint. It has been suggested that this condition is more common among people with cardiometabolic risk factors. This systematic review has synthesised evidence from case–control, cross-sectional and cohort studies on the association between metabolic syndrome (MetS) and RCRSP. Design and data sources Five medical databases (MEDLINE, EMBASE, SCOPUS, CINAHL and AMED) and reference checking methods were used to identify all relevant English articles that considered MetS and RCRSP. Studies were appraised using the Newcastle-Ottawa Scale (NOS). Two reviewers performed critical appraisal and data extraction. Narrative synthesis was performed via content analysis of statistically significant associations. Results Three cross-sectional, two case–control and one cohort study met the inclusion criteria, providing a total of 1187 individuals with RCRSP. Heterogeneity in methodology and RCRSP or MetS definition precluded a meaningful meta-analysis. Four of the included studies identified associations between the prevalence of MetS and RCRSP. Studies consistently identified independent cardiometabolic risk factors associated with RCRSP. All studies were level III evidence. Summary and conclusion The low-moderate quality evidence included in this review suggests an association between MetS and RCRSP. Most studies demonstrated moderate quality on appraisal. The direction of association and cardiometabolic factors influencing should be investigated by longitudinal and treatment studies. These preliminary conclusions and clinical utility should be treated with caution due to limitations of the evidence base.
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Affiliation(s)
- Graham Burne
- Physiotherapy Department, Guy's and Saint Thomas' NHS Foundation Trust, London, UK.,Physiotherapy, University of Hertfordshire School of Health and Social Work, Hatfield, UK
| | - Michael Mansfield
- Allied Health Sciences, School of Health and Social Care, London Southbank University, London, UK
| | - Jamie E Gaida
- Research Institute for Sport and Exercise (UCRISE), University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Jeremy S Lewis
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK.,Therapy Department, Central London Community Healthcare National Health Service Trust, London, UK.,Department of Physical Therapy and Rehabilitation Science, College of Health Sciences, Qatar University, Doha, Qatar
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9
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Calcium Fluxes in Work-Related Muscle Disorder: Implications from a Rat Model. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5040818. [PMID: 31662979 PMCID: PMC6791278 DOI: 10.1155/2019/5040818] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/13/2019] [Accepted: 08/20/2019] [Indexed: 01/16/2023]
Abstract
Introduction Ca2+ regulatory excitation-contraction coupling properties are key topics of interest in the development of work-related muscle myalgia and may constitute an underlying cause of muscle pain and loss of force generating capacity. Method A well-established rat model of high repetition high force (HRHF) work was used to investigate if such exposure leads to an increase in cytosolic Ca2+ concentration ([Ca2+]i) and changes in sarcoplasmic reticulum (SR) vesicle Ca2+ uptake and release rates. Result Six weeks exposure of rats to HRHF increased indicators of fatigue, pain behaviors, and [Ca2+]i, the latter implied by around 50-100% increases in pCam, as well as in the Ca2+ handling proteins RyR1 and Casq1 accompanied by an ∼10% increased SR Ca2+ uptake rate in extensor and flexor muscles compared to those of control rats. This demonstrated a work-related altered myocellular Ca2+ regulation, SR Ca2+ handling, and SR protein expression. Discussion These disturbances may mirror intracellular changes in early stages of human work-related myalgic muscle. Increased uptake of Ca2+ into the SR may reflect an early adaptation to avoid a sustained detrimental increase in [Ca2+]i similar to the previous findings of deteriorated Ca2+ regulation and impaired function in fatigued human muscle.
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Barbe MF, Hilliard BA, Delany SP, Iannarone VJ, Harris MY, Amin M, Cruz GE, Barreto‐Cruz Y, Tran N, Day EP, Hobson LJ, Assari S, Popoff SN. Blocking CCN2 Reduces Progression of Sensorimotor Declines and Fibrosis in a Rat Model of Chronic Repetitive Overuse. J Orthop Res 2019; 37:2004-2018. [PMID: 31041999 PMCID: PMC6688947 DOI: 10.1002/jor.24337] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 04/12/2019] [Indexed: 02/06/2023]
Abstract
Fibrosis may be a key factor in sensorimotor dysfunction in patients with chronic overuse-induced musculoskeletal disorders. Using a clinically relevant rodent model, in which performance of a high demand handle-pulling task induces tissue fibrosis and sensorimotor declines, we pharmacologically blocked cellular communication network factor 2 (CCN2; connective tissue growth factor) with the goal of reducing the progression of these changes. Young adult, female Sprague-Dawley rats were shaped to learn to pull at high force levels (10 min/day, 5 weeks), before performing a high repetition high force (HRHF) task for 3 weeks (2 h/day, 3 days/week). HRHF rats were untreated, or treated in task weeks 2 and 3 with a monoclonal antibody that blocks CCN2 (FG-3019), or a control immunoglobulin G (IgG). Control rats were untreated or received FG-3019, IgG, or vehicle (saline) injections. Mean task reach rate and grasp force were higher in 3-week HRHF + FG-3019 rats, compared with untreated HRHF rats. Grip strength declined while forepaw mechanical sensitivity increased in untreated HRHF rats, compared with controls; changes improved by FG-3019 treatment. The HRHF task increased collagen in multiple tissues (flexor digitorum muscles, nerves, and forepaw dermis), which was reduced with FG-3019 treatment. FG-3019 treatment also reduced HRHF-induced increases in CCN2 and transforming growth factor β in muscles. In tendons, FG-3019 reduced HRHF-induced increases in CCN2, epitendon thickening, and cell proliferation. Our findings indicate that CCN2 is critical to the progression of chronic overuse-induced multi-tissue fibrosis and functional declines. FG-3019 treatment may be a novel therapeutic strategy for overuse-induced musculoskeletal disorders. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 37:2004-2018, 2019.
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Affiliation(s)
- Mary F. Barbe
- Department of Anatomy and Cell Biology, Lewis Katz School of MedicineTemple UniversityPhiladelphiaPennsylvania 19140
| | - Brendan A. Hilliard
- Department of Anatomy and Cell Biology, Lewis Katz School of MedicineTemple UniversityPhiladelphiaPennsylvania 19140
| | - Sean P. Delany
- Department of Anatomy and Cell Biology, Lewis Katz School of MedicineTemple UniversityPhiladelphiaPennsylvania 19140
| | - Victoria J. Iannarone
- Department of Anatomy and Cell Biology, Lewis Katz School of MedicineTemple UniversityPhiladelphiaPennsylvania 19140
| | - Michele Y. Harris
- Department of Anatomy and Cell Biology, Lewis Katz School of MedicineTemple UniversityPhiladelphiaPennsylvania 19140
| | - Mamta Amin
- Department of Anatomy and Cell Biology, Lewis Katz School of MedicineTemple UniversityPhiladelphiaPennsylvania 19140
| | - Geneva E. Cruz
- Department of Anatomy and Cell Biology, Lewis Katz School of MedicineTemple UniversityPhiladelphiaPennsylvania 19140
| | - Yeidaliz Barreto‐Cruz
- Department of Anatomy and Cell Biology, Lewis Katz School of MedicineTemple UniversityPhiladelphiaPennsylvania 19140
| | - Ngih Tran
- Department of Anatomy and Cell Biology, Lewis Katz School of MedicineTemple UniversityPhiladelphiaPennsylvania 19140
| | - Emily P. Day
- Department of Anatomy and Cell Biology, Lewis Katz School of MedicineTemple UniversityPhiladelphiaPennsylvania 19140
| | - Lucas J. Hobson
- Department of Anatomy and Cell Biology, Lewis Katz School of MedicineTemple UniversityPhiladelphiaPennsylvania 19140
| | - Soroush Assari
- Department of Mechanical Engineering, College of EngineeringTemple UniversityPhiladelphiaPennsylvania 19122
| | - Steven N. Popoff
- Department of Anatomy and Cell Biology, Lewis Katz School of MedicineTemple UniversityPhiladelphiaPennsylvania 19140
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11
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Best Evidence Rehabilitation for Chronic Pain Part 4: Neck Pain. J Clin Med 2019; 8:jcm8081219. [PMID: 31443149 PMCID: PMC6723111 DOI: 10.3390/jcm8081219] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/05/2019] [Accepted: 08/08/2019] [Indexed: 12/28/2022] Open
Abstract
Neck pain, whether from a traumatic event such as a motor vehicle crash or of a non-traumatic nature, is a leading cause of worldwide disability. This narrative review evaluated the evidence from systematic reviews, recent randomised controlled trials, clinical practice guidelines, and other relevant studies for the effects of rehabilitation approaches for chronic neck pain. Rehabilitation was defined as the aim to restore a person to health or normal life through training and therapy and as such, passive interventions applied in isolation were not considered. The results of this review found that the strongest treatment effects to date are those associated with exercise. Strengthening exercises of the neck and upper quadrant have a moderate effect on neck pain in the short-term. The evidence was of moderate quality at best, indicating that future research will likely change these conclusions. Lower quality evidence and smaller effects were found for other exercise approaches. Other treatments, including education/advice and psychological treatment, showed only very small to small effects, based on low to moderate quality evidence. The review also provided suggestions for promising future directions for clinical practice and research.
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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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Kaufman-Cohen Y, Portnoy S, Sopher R, Mashiach L, Baruch-Halaf L, Ratzon NZ. The correlation between upper extremity musculoskeletal symptoms and joint kinematics, playing habits and hand span during playing among piano students. PLoS One 2018; 13:e0208788. [PMID: 30566535 PMCID: PMC6300245 DOI: 10.1371/journal.pone.0208788] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 11/23/2018] [Indexed: 12/20/2022] Open
Abstract
Objective We aimed to investigate the correlations between Upper Extremity Musculoskeletal Symptoms (MSD) and joint kinematics while playing the piano, as well as correlations between MSD and psychosocial, professional and personal habits, and bio-demographic risk factors of piano students. Method This cross-sectional study included 15 piano students. The research tools included 3D motion capture, anthropometric measurements, and questionnaires for obtaining data about MSD, psychological, and personal factors. Results The piano students recruited for this study experienced a variety of MSD during the past 12 months, with a particularly high prevalence of neck pain (80%). Extreme wrist extension and/or elbow flexion while playing the piano also correlated with MSD. Additionally, this study identified correlations between MSD and hand span (r = -.69, p≤.004) and number of playing hours per week (r = .58, p≤.024). Conclusions Anthropometric factors and playing patterns should be considered together with well-known MSD risk factors, like extreme and repetitive movements. However, considering each joint singularly might not be sufficient to prevent the development of MSD when instructing the piano player; accordingly, joint synchronization should also be considered.
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Affiliation(s)
- Yael Kaufman-Cohen
- Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- * E-mail:
| | - Sigal Portnoy
- Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Sopher
- Department of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Lital Mashiach
- Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lilach Baruch-Halaf
- Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Navah Z. Ratzon
- Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Gold JE, Hallman DM, Hellström F, Björklund M, Crenshaw AG, Mathiassen SE, Barbe MF, Ali S. Systematic review of quantitative imaging biomarkers for neck and shoulder musculoskeletal disorders. BMC Musculoskelet Disord 2017; 18:395. [PMID: 28899384 PMCID: PMC5596923 DOI: 10.1186/s12891-017-1694-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 07/24/2017] [Indexed: 01/04/2023] Open
Abstract
Background This study systematically summarizes quantitative imaging biomarker research in non-traumatic neck and shoulder musculoskeletal disorders (MSDs). There were two research questions: 1) Are there quantitative imaging biomarkers associated with the presence of neck and shoulder MSDs?, 2) Are there quantitative imaging biomarkers associated with the severity of neck and shoulder MSDs? Methods PubMed and SCOPUS were used for the literature search. One hundred and twenty-five studies met primary inclusion criteria. Data were extracted from 49 sufficient quality studies. Results Most of the 125 studies were cross-sectional and utilized convenience samples of patients as both cases and controls. Only half controlled for potential confounders via exclusion or in the analysis. Approximately one-third reported response rates. In sufficient quality articles, 82% demonstrated at least one statistically significant association between the MSD(s) and biomarker(s) studied. The literature synthesis suggested that neck muscle size may be decreased in neck pain, and trapezius myalgia and neck/shoulder pain may be associated with reduced vascularity in the trapezius and reduced trapezius oxygen saturation at rest and in response to upper extremity tasks. Reduced vascularity in the supraspinatus tendon may also be a feature in rotator cuff tears. Five of eight studies showed an association between a quantitative imaging marker and MSD severity. Conclusions Although research on quantitative imaging biomarkers is still in a nascent stage, some MSD biomarkers were identified. There are limitations in the articles examined, including possible selection bias and inattention to potentially confounding factors. Recommendations for future studies are provided. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1694-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Judith E Gold
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden. .,Gold Standard Research Consulting, 830 Montgomery Ave, Bryn Mawr, PA, USA.
| | - David M Hallman
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden
| | - Fredrik Hellström
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden
| | - Martin Björklund
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden.,Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Albert G Crenshaw
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden
| | - Svend Erik Mathiassen
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden
| | - Mary F Barbe
- Department of Anatomy and Cell Biology, Temple University Medical School, Philadelphia, PA, USA
| | - Sayed Ali
- Department of Radiology, Temple University Medical School, Philadelphia, PA, USA
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Rashid M, Kristofferzon ML, Nilsson A, Heiden M. Factors associated with return to work among people on work absence due to long-term neck or back pain: a narrative systematic review. BMJ Open 2017; 7:e014939. [PMID: 28674139 PMCID: PMC5734441 DOI: 10.1136/bmjopen-2016-014939] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE The purpose of this narrative systematic review was to summarise prognostic factors for return to work (RTW) among people with long-term neck/shoulder or back pain. METHODS A systematic literature search was performed through three databases (Medline, CINAHL and PsycINFO) for studies published until February 2016. Only observational studies of people on work absence (≥2 weeks) due to neck/shoulder or back pain were included. The methodological quality of the included studies was assessed using guidelines for assessing quality in prognostic studies on the basis of Framework of Potential Biases. Factors found in the included studies were grouped into categories based on similarities and then labelled according to the aspects covered by the factors in the category. RESULTS Nine longitudinal prospective cohort studies and one retrospective study fulfilled the inclusion criteria. From these, five categories of factors were extracted. Our findings indicate that recovery beliefs, health-related factors and work capacity are important for RTW among people with long-term neck or back pain. We did not find support for workplace factors and behaviour being predictive of RTW. CONCLUSIONS Our findings suggest that recovery beliefs, perceived health and work capacity may be important targets of intervention for people with long-term neck or back pain. However, more high-quality prospective studies are needed to confirm the results and improve our understanding of what is needed to facilitate RTW in this population.
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Affiliation(s)
- Mamunur Rashid
- Department of Occupational and Public Health Sciences, Centre for Musculoskeletal Research, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
| | - Marja-Leena Kristofferzon
- Department of Health and Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
- Department of Public Health and Caring Sciences, Faculty of Medicine, Uppsala University, Uppsala, Sweden
| | - Annika Nilsson
- Department of Health and Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
- Department of Public Health and Caring Sciences, Faculty of Medicine, Uppsala University, Uppsala, Sweden
| | - Marina Heiden
- Department of Occupational and Public Health Sciences, Centre for Musculoskeletal Research, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
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Søgaard K, Sjøgaard G. Physical Activity as Cause and Cure of Muscular Pain: Evidence of Underlying Mechanisms. Exerc Sport Sci Rev 2017; 45:136-145. [PMID: 28418998 PMCID: PMC5473374 DOI: 10.1249/jes.0000000000000112] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2017] [Indexed: 01/18/2023]
Abstract
Work-related physical activity (PA), in terms of peak loads and sustained and/or repetitive contractions, presents risk factors for the development of muscular pain and disorders. However, PA as a training tailored to the employee's work exposure, health, and physical capacity offers prevention and rehabilitation. We suggest the concept of "Intelligent Physical Exercise Training" relying on evidence-based sports science training principles.
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Affiliation(s)
- Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
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Effectiveness of conservative interventions for sickness and pain behaviors induced by a high repetition high force upper extremity task. BMC Neurosci 2017; 18:36. [PMID: 28356066 PMCID: PMC5371184 DOI: 10.1186/s12868-017-0354-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 03/16/2017] [Indexed: 11/29/2022] Open
Abstract
Background Systemic inflammation is known to induce sickness behaviors, including decreased social interaction and pain. We have reported increased serum inflammatory cytokines in a rat model of repetitive strain injury (rats perform an upper extremity reaching task for prolonged periods). Here, we sought to determine if sickness behaviors are induced in this model and the effectiveness of conservative treatments. Methods Experimental rats underwent initial training to learn a high force reaching task (10 min/day, 5 days/week for 6 weeks), with or without ibuprofen treatment (TRHF vs. TRHF + IBU rats). Subsets of trained animals went on to perform a high repetition high force (HRHF) task for 6 or 12 weeks (2 h/day, 3 days/week) without treatment, or received two secondary interventions: ibuprofen (HRHF + IBU) or a move to a lower demand low repetition low force task (HRHF-to-LRLF), beginning in task week 5. Mixed-effects models with repeated measures assays were used to assay duration of social interaction, aggression, forepaw withdrawal thresholds and reach performance abilities. One-way and two-way ANOVAs were used to assay tissue responses. Corrections for multiple comparisons were made. Results TRHF + IBU rats did not develop behavioral declines or systemic increases in IL-1beta and IL-6, observed in untreated TRHF rats. Untreated HRHF rats showed social interaction declines, difficulties performing the operant task and forepaw mechanical allodynia. Untreated HRHF rats also had increased serum levels of several inflammatory cytokines and chemokines, neuroinflammatory responses (e.g., increased TNFalpha) in the brain, median nerve and spinal cord, and Substance P and neurokinin 1 immunoexpression in the spinal cord. HRHF + IBU and HRHF-to-LRLF rats showed improved social interaction and reduced inflammatory serum, nerve and brain changes. However, neither secondary treatment rescued HRHF-task induced forepaw allodynia, or completely attenuated task performance declines or spinal cord responses. Conclusions These results suggest that inflammatory mechanisms induced by prolonged performance of high physical demand tasks mediate the development of social interaction declines and aggression. However, persistent spinal cord sensitization was associated with persistent behavioral indices of discomfort, despite use of conservative secondary interventions indicating the need for prevention or more effective interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12868-017-0354-3) contains supplementary material, which is available to authorized users.
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Gaida JE, Alfredson H, Forsgren S, Cook JL. A pilot study on biomarkers for tendinopathy: lower levels of serum TNF-α and other cytokines in females but not males with Achilles tendinopathy. BMC Sports Sci Med Rehabil 2016; 8:5. [PMID: 26925234 PMCID: PMC4768326 DOI: 10.1186/s13102-016-0026-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 01/21/2016] [Indexed: 12/16/2022]
Abstract
Background Achilles tendinopathy is a painful musculoskeletal condition that is common among athletes, and which limits training capacity and competitive performance. The lack of biomarkers for tendinopathy limits research into risk factors and also the evaluation of new treatments. Cytokines and growth factors involved in regulating the response of tendon cells to mechanical load have potential as biomarkers for tendinopathy. Methods This case–control study compared serum concentration of cytokines and growth factors (TNF-α, IL-1β, bFGF, PDFG-BB, IFN-γ, VEGF) between individuals with chronic Achilles tendinopathy and controls. These were measured in fasting serum from 22 individuals with chronic Achilles tendinopathy and 10 healthy controls. Results were analysed in relation to gender and physical activity pattern. Results TNF-α concentration was lower in the entire tendinopathy group compared with the entire control group; none of the other cytokines were significantly different. TNF-α levels were nevertheless highly correlated with the other cytokines measured, in most of the subgroups. Analysed by gender, TNF-α and PDGF-BB concentrations were lower in the female tendinopathy group but not the male tendinopathy group. A trend was seen for lower IL-1β in the female tendinopathy group. Physical activity was correlated with TNF-α, PDGF-BB and IL-1β to varying extents for control subgroups, but not for the female tendinopathy group. No correlations were seen with BMI or duration of symptoms. Conclusions This pilot study indicates a lower level of TNF-α and PDGF-BB, and to some extent IL-1β among females, but not males, in the chronic phase of Achilles tendinopathy. It is suggested that future studies on tendinopathy biomarkers analyse male and female data separately. The lack of correlation between cytokine level and physical activity in the female tendinopathy group warrants further study.
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Affiliation(s)
- James E Gaida
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Canberra, Australia ; Discipline of Physiotherapy, University of Canberra, ACT 2601 Canberra, Australia ; Department of Surgical and Perioperative Sciences, Sports Medicine, Umeå University, Umeå, Sweden ; Department of Integrative Medical Biology, Anatomy Section, Umeå University, Umeå, Sweden
| | - Håkan Alfredson
- Department of Community Medicine and Rehabilitation, Umeå University, S-901 87 Umeå, Sweden ; Institute of Sport Exercise and Health, University College Hospital London, London, UK
| | - Sture Forsgren
- Department of Integrative Medical Biology, Anatomy Section, Umeå University, Umeå, Sweden
| | - Jill L Cook
- La Trobe University Sport and Exercise Medicine Research Centre, Melbourne, Australia
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