Furqan Haq

Effectiveness of sports massage for recovery of skeletal muscle from strenuous exercise

Objective:Sport massage, a manual therapy for muscle and soft tissue pain and weakness, is a popular and widely used modality for recovery after intense exercise. Our objective is to determine the effectiveness of sport massage for improving recovery after strenuous exercise. Data Sources:We searched MEDLINE, EMBASE, and CINAHL using all current and historical names for sport massage. Reference sections of included articles were scanned to identify additional relevant articles. Study Selection:Study inclusion criteria required that subjects (1) were humans, (2) performed strenuous exercise, (3) received massage, and (4) were assessed for muscle recovery and performance. Ultimately, 27 studies met inclusion criteria. Data Extraction:Eligible studies were reviewed, and data were extracted by the senior author (TMB). The main outcomes extracted were type and timing of massage and outcome measures studied. Data Synthesis:Data from 17 case series revealed inconsistent results. Most studies evaluating post-exercise function suggest that massage is not effective, whereas studies that also evaluated the symptoms of DOMS did show some benefit. Data from 10 randomized controlled trials (RCTs) do, however, provide moderate evidence for the efficacy of massage therapy. The search identified no trend between type and timing of massage and any specific outcome measures investigated. Conclusions:Case series provide little support for the use of massage to aid muscle recovery or performance after intense exercise. In contrast, RCTs provide moderate data supporting its use to facilitate recovery from repetitive muscular contractions. Further investigation using standardized protocols measuring similar outcome variables is necessary to more conclusively determine the efficacy of sport massage and the optimal strategy for its implementation to enhance recovery following intense exercise.

Cyclic Compressive Loading Facilitates Recovery after Eccentric Exercise

PURPOSE To assess the biologic basis of massage therapies, we developed an experimental approach to mimic Swedish massage and evaluate this approach on recovery from eccentric exercise-induced muscle damage using a well-controlled animal model. METHODS Tibialis anterior muscles of six New Zealand White rabbits were subjected to one bout of damaging, eccentric contractions. One muscle was immediately subjected to cyclic compressive loads, and the contralateral served as the exercised control. RESULTS We found that commencing 30 min of cyclic compressive loading to the muscle, immediately after a bout of eccentric exercise, facilitated recovery of function and attenuated leukocyte infiltration. In addition, fiber necrosis and wet weight of the tissue were also reduced by compressive loading. CONCLUSION We conclude that subjecting muscle to compressive loads immediately after exercise leads to an enhanced recovery of muscle function and attenuation of the damaging effects of inflammation in the rabbit model. Although these observations suggest that skeletal muscle responds to cyclic compressive forces similar to those generated by clinical approaches, such as therapeutic massage, further research is needed to assess the translational efficacy of these findings.

Semi-automated segmentation to assess the lateral meniscus in normal and osteoarthritic knees

OBJECTIVE The goal of this study was to develop an algorithm to semi-automatically segment the meniscus in a series of magnetic resonance (MR) images to use for normal knees and those with moderate osteoarthritis (OA). METHOD The segmentation method was developed then evaluated on 10 baseline MR images obtained from subjects with no evidence, symptoms, or risk factors of knee (OA), and 14 from subjects with established knee OA enrolled in the Osteoarthritis Initiative (OAI). After manually choosing a seed point within the meniscus, a threshold level was calculated through a Gaussian fit model. Under anatomical, intensity, and range constraints, a threshold operation was completed followed by conditional dilation and post-processing. The post-processing operation reevaluates the pixels included and excluded in the area surrounding the meniscus to improve accuracy. The developed method was evaluated for both normal and degenerative menisci by comparing the segmentation algorithm results with manual segmentations from five human readers. RESULTS The semi-automated segmentation method produces results similar to those of trained observers, with an average similarity index over 0.80 for normal participants and 0.75, 0.67, and 0.64 for participants with established knee OA with Osteoarthritis Research Society International (OARSI) joint space narrowing (JSN) scores of 0, one, and two respectively. CONCLUSION The semi-automatic segmentation method produced accurate and consistent segmentations of the meniscus when compared to manual segmentations in the assessment of normal menisci in mild to moderate OA. Future studies will examine the change in volume, thickness, and intensity characteristics at different stages of OA.

Anatomically Anchored Template-Based Level Set Segmentation: Application to Quadriceps Muscles in MR Images from the Osteoarthritis Initiative

In this paper, we present a semi-automated segmentation method for magnetic resonance images of the quadriceps muscles. Our method uses an anatomically anchored, template-based initialization of the level set-based segmentation approach. The method only requires the input of a single point from the user inside the rectus femoris. The templates are quantitatively selected from a set of images based on modes in the patient population, namely, sex and body type. For a given image to be segmented, a template is selected based on the smallest Kullback–Leibler divergence between the histograms of that image and the set of templates. The chosen template is then employed as an initialization for a level set segmentation, which captures individual anatomical variations in the image to be segmented. Images from 103 subjects were analyzed using the developed method. The algorithm was trained on a randomly selected subset of 50 subjects (25 men and 25 women) and tested on the remaining 53 subjects. The performance of the algorithm on the test set was compared against the ground truth using the Zijdenbos similarity index (ZSI). The average ZSI means and standard deviations against two different manual readers were as follows: rectus femoris, 0.78 ± 0.12; vastus intermedius, 0.79 ± 0.10; vastus lateralis, 0.82 ± 0.08; and vastus medialis, 0.69 ± 0.16.

An automated method to segment the femur for osteoarthritis research

In this paper we develop a fully automated method for the segmentation of the femur in axial MR images and its use in the analysis of imaging biomarkers for osteoarthritis (OA). The proposed method is based on anatomical constraints implemented using morphological operations to extract the femur medulla and a level set evolution to extract the femur cortex. The average agreement of the automated segmentation algorithm with ground truth manual segmentations was 0.94 plusmn 0.03 calculated using the Zijdenbos similarity index (ZSI). A pooled variance t-test analysis found significant associations between the KL grade, a clinical measure of OA severity, and both the cross-sectional area (CSA) of the femur medulla (p = 3D 0.02) and the ratio of the femur medulla CSA to the femur cortex CSA (p = 3D 0.04) for women. No significant association between femur measurements and KL grade was found for men.

An automated method to detect interstitial adipose tissue in thigh muscles for patients with osteoarthritis

In this paper we explore a method of segmentation of muscle interstitial adipose tissue (IAT) in MR images of the thigh. The objective is to apply the method towards research into biomarkers of osteoarthritis (OA). T1-weighted images of the thigh are intensity standardized through bias field correction and intensity normalization. IAT within the thigh muscles is then segmented using a threshold combined with morphological constraints applied on connected regions in the thresholded image. The morphological constraints can be adjusted to allow for highly sensitive or highly specific IAT segmentation. The use of the morphological constraints improved the specificity of IAT segmentation over a threshold segmentation method from 0.54 to 0.67, while retaining a nearly equivalent sensitivity of 0.82 compared to 0.84. We then present a preliminary statistical analysis to demonstrate the application of the automated IAT segmentation. Finally, we specify a protocol for further exploration of IAT by leveraging the massive imaging dataset of the Osteoarthritis Initiative (OAI).

An Engineering Approach for Quantitative Analysis of the Lengthwise Strokes in Massage Therapies

Massage therapies are widely used for improving and restoring the function of human tissues. It is generally accepted that such therapies promote human health and well-being by several possible mechanisms, including increase in blood flow and parasympathetic activity, release of relaxation hormones, and inhibition of muscle tension, neuromuscular excitability, and stress hormones. Nonetheless, most of the purported beneficial/adverse effects of massage are based on anecdotal experiences, providing little insight on its effectiveness or the mechanisms underlying its usefulness. Furthermore, most studies to date have not quantitatively demonstrated the efficacy of massage on human health. This might be due to the lack of appropriate tools necessary for the application of quantitatively controlled loading and for the evaluation of the subsequent responses. To address this issue, we developed a device that applies compression in lengthwise strokes to the soft tissues of the New Zealand white rabbit, thereby mimicking the rubbing and effleurage techniques of massage. This device permits control of the magnitude and frequency of mechanical load applied to the rabbit’s hind limb for various durations. The measurement of tissue compliance and the viscoelastic properties as a function of loading parameters was also demonstrated. Findings of this study suggest that this device offers a quantitative analysis of the applied loads on the tissue to determine an optimal range of loading conditions required for the safe and effective use of massage therapies.

Template-based level set segmentation using anatomical information

We present a preliminary evaluation of an automated segmentation method of the quadriceps muscles from MR images of the thigh. The method is being developed to assist research into morphological properties of the quadriceps muscles as biomarkers of osteoarthritis (OA) incidence and progression. Our method uses an anatomically anchored, template-based initialization of the level set-based segmentation approach. A template image is selected using the Kullback-Leibler divergence measure based on the muscle and fat content of the thigh images. Contours of the quadriceps muscles of the chosen template are then semi-automatically registered to the image to be segmented using an affine transformation. These registered contours are used as initializations for the multi-phase level-set segmentation of the image, which is pre-processed to reduce arterial flow artifacts, the bias field, and intramuscular fat/connective tissue. Thirteen studies from eleven different subjects were analyzed. The performance was compared against manual segmentations using the Zijdenbos similarity index (ZSI). The ZSI means and standard deviations were: rectus femoris, 0.73 plusmn 0.13; vastus intermedius, 0.78 plusmn 0.09; vastus lateralis, 0.81 plusmn 0.14; vastus medialis, 0.85 plusmn 0.10.

An analysis of methods for the selection of atlases for use in medical image segmentation

The use of atlases has been shown to be a robust method for segmentation of medical images. In this paper we explore different methods of selection of atlases for the segmentation of the quadriceps muscles in magnetic resonance (MR) images, although the results are pertinent for a wide range of applications. The experiments were performed using 103 images from the Osteoarthritis Initiative (OAI). The images were randomly split into a training set consisting of 50 images and a testing set of 53 images. Three different atlas selection methods were systematically compared. First, a set of readers was assigned the task of selecting atlases from a training population of images, which were selected to be representative subgroups of the total population. Second, the same readers were instructed to select atlases from a subset of the training data which was stratified based on population modes. Finally, every image in the training set was employed as an atlas, with no input from the readers, and the atlas which had the best initial registration, judged by an appropriate registration metric, was used in the final segmentation procedure. The segmentation results were quantified using the Zijdenbos similarity index (ZSI). The results show that over all readers the agreement of the segmentation algorithm decreased from 0.76 to 0.74 when using population modes to assist in atlas selection. The use of every image in the training set as an atlas outperformed both manual atlas selection methods, achieving a ZSI of 0.82.

027 KNEE STRENGTH PREDICTS LOSS OF FUNCTION AND DECLINE IN PHYSICAL ACTIVITY IN PARTICIPANTS WITH OSTEOARTHRITIS: A 2-YR FOLLOW-UP OF THE OAI STUDY

Correlations: Non-significant correlations (rs= -0.03 to 0.23) were observed between concentric and eccentric muscle strength and the KOOS subscales Sport/Rec and Pain. Conclusions: No differences were found in concentric and eccentric muscle strength between the operated and non-operated leg in patients. Furthermore, no differences in strength parameters were observed between patients compared to controls at 2 years post surgery. Self-reported outcomes were however significantly worse in patients. These results indicate that maximal concentric and eccentric muscle strength is not related to pain and function in meniscectomized patients.