Wouber Hérickson de Brito Vieira

Transcutaneous electrical nerve stimulation (TENS) and exercise: strategy in fibromyalgia treatment.

We read with great interest the recent manuscript by Mutlu et al. [1] entitled ‘‘Efficacy of supervised exercise combined with transcutaneous electrical nerve stimulation in women with fibromyalgia: a prospective controlled study.’’ The authors investigate the results of a supervised exercise with transcutaneous electrical nerve stimulation (TENS) in an exercise-controlled study in women with fibromyalgia. The study showed that monitored exercise program was successful to decrease myalgic pain, improve functional capacity and quality of life of women with fibromyalgia, and that combined use of TENS and exercise can promote rapid relief of myalgic pain in the treatment for fibromyalgia. The importance of this type of study is unquestionable, since fibromyalgia covers a considerable part of the worldwide population [2, 3], and we are still in the ongoing study of the establishment of strategies to increase patients’ adherence to exercise. The exercise is a low-cost intervention that can promote health benefits in several ways and can relieve symptoms of fibromyalgia [4]. However, we believe that the use of gate control theory through TENS possibly had an effect on reducing pain due to completion of exercise, since this population is more susceptible to manifestations of muscle fatigue that may increase his pain and interfere with adherence to exercise, especially in the early stages of a physical training. Nevertheless, there are numerous evidences that pain in fibromyalgia has no peripheral sensory or muscular origin [5, 6]. Authors [6] describe that such responses suggest that these individuals have a fundamental problem with pain or sensory processing rather than an abnormality confined to the region of the body where pain is experienced. Many patients course with a set of symptoms that focus the presence of the central nervous system as a protagonist, and it is probable that the neurobiological changes found in the syndrome have its etiology in this system [3, 4]. Therefore, if the pain from fibromyalgia is possibly caused by central sensory disturbances, how the TENS could act on this system? Transcutaneous electrical nerve stimulation is, in fact, a form of noninvasive electrical stimulation able to control the pain; however, the mechanisms of action depend on the manipulable parameters, specifically the frequency and intensity of the pulses of current [7]. TENS in the parameters used in the study would act in a more peripheral level through the theory of ascending spinal locks initially proposed by Melzack and Wall [8] and thus has a more immediate effect (during application) and less permanent. This questioning is reinforced, mainly because of the fact that TENS has been used in different period (morning) of the execution of the exercise (afternoon). Mutlu et al. [1] present an immediate effect with the conventional TENS, which did not last throughout the exercise sessions. We believe that TENS in your BURST mode (pulse trains of high frequency modulated to low frequency) would be more appropriate since the mechanism of action involves the release of endogenous opioids [9, 10] and thus involves the central nervous system components whose effects would be more durable and suitable for chronic pain typical of fibromyalgia. This in turn could determine a lower frequency of use of equipment that unlike the one used in the study (daily use) could only happen on days the exercise takes place once the effects are more permanent. We focus that the TENS possibly decreases persistence of nociceptive inputs in peripheral tissue and the arrival of S. C. Andrade R. P. A. Freitas (&) W. H. de Brito Vieira Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil e-mail: rodrigopegado@gmail.com

Overview of ultrasound usage trends in orthopedic and sports physiotherapy.

BackgroundThe purpose of this study is to examine current beliefs about the use, the clinical importance, the theoretical fundamentals and the utilization criteria of therapeutic ultrasound (TUS) among physical therapists on the clinical practice in orthopedic and sports physiotherapy in Brazil.MethodsA brief survey was developed based on previous studies and was sent to 55 physical therapists with advanced competency in orthopedics and sports physiotherapy. The questions addressed general topics about the professional profile and ultrasound usage and dosage.ResultsOur data show the wide availability and frequent use of TUS in this sample of physical therapists. TUS is used in distinct musculoskeletal injuries and/or disorders in both acute and chronic conditions. Muscles, tendons and ligaments represented the major structures where TUS is used. Questions on the basic theory of TUS demonstrated a lack of knowledge of the ultrasound physiological effects as well as its interaction with biological tissues and TUS absolute contraindication.ConclusionA Brazilian profile about the US usage and dosage in orthopedic and sports physiotherapy is presented and highlights the need for a continuous upgrading process and further research into its effects.

Metalloproteinase Changes in Diabetes.

Matrix metalloproteinases (MMPs) constitute a group of over 20 structurally-related proteins which include a Zn(++) ion binding site that is essential for their proteolytic activities. These enzymes play important role in extracellular matrix turnover in order to maintain a proper balance in its synthesis and degradation. MMPs are associated to several physiological and pathophysiological processes, including diabetes mellitus (DM). The mechanisms of DM and its complications is subject of intense research and evidence suggests that MMPs are implicated with the development and progression of diabetic microvascular complications such as nephropathy, cardiomyopathy, retinopathy and peripheral neuropathy. Recent data has associated DM to changes in the tendon structure, including abnormalities in fiber structure and organization, increased tendon thickness, volume and disorganization obtained by image and a tendency of impairing biomechanical properties. Although not fully elucidated, it is believed that DM-induced MMP dysregulation may contribute to structural and biomechanical alterations and impaired process of tendon healing.

Peripheral and respiratory muscle strength in chronic obstructive pulmonary disease

Introducao: A historia natural da Doenca Pulmonar Obstrutiva Cronica esta associada a numerosas manifestacoes sistemicas e comorbidades que complicam sua evolucao. Dessas, a disfuncao dos musculos esqueleticos e respiratorios destacam-se por acarretar um comprometimento na capacidade funcional. Objetivo: Avaliar e comparar a forca muscular respiratoria e periferica em pacientes com DPOC e individuos saudaveis. Metodologia: Trata-se de um estudo transversal, analitico e observacional, no qual foram avaliados 18 individuos, sendo nove com DPOC e nove saudaveis. Foram avaliados quanto ao desempenho neuromuscular do quadriceps femoral (avaliado por meio da dinamometria isocinetica), forca de preensao manual (dinamometro manual) e pressoes respiratorias maximas (manovacuometria). Os dados foram expressos por meio de media e desvio padrao, analisados no pacote estatistico SPSS 20.0. Foi considerado um nivel de significância de 5% e intervalo de confianca de 95% para todas as medidas. Resultados: Os individuos com DPOC apresentam desempenho neuromuscular de quadriceps femoral e pressoes respiratorias maximas inferiores aos sujeitos saudaveis, no entanto houve diferenca estatisticamente significante apenas para potencia muscular e PImax (p<0,05). Ja a forca de preensao manual foi maior em individuos com DPOC (p<0,05). Conclusao: Os sujeitos com DPOC possuem alteracoes neuromusculares em musculos perifericos e respiratorios que possivelmente podem causar reducao do desempenho funcional.

Exercise training ameliorates matrix metalloproteinases 2 and 9 messenger RNA expression and mitigates adverse left ventricular remodeling in streptozotocin-induced diabetic rats☆

BACKGROUND The aim was to investigate whether exercise training (ExT) would ameliorate expression of key genes for myocardial morphostructure and mitigate adverse left ventricular (LV) remodeling in experimental type 1 diabetes (T1D). METHODS AND RESULTS Male Wistar rats were divided into four groups: sedentary control (SC, n=9), trained control (TC, n=13), sedentary diabetic (SD, n=20), and trained diabetic (TD, n=17). T1D was induced by 40 mg/kg streptozotocin (single dose, i.v.). Training program consisted of 4-week treadmill running (60 min/day, 5 days/wk). Structure of the LV was evaluated using histomorphometric techniques. Gene expression changes of LV collagens I and III, metalloproteinases (MMPs) 2 and 9, and transforming growth factor-β1 were detected by reverse transcriptase quantitative polymerase chain reaction. Compared with SC, SD rats presented LV eccentric remodeling, myocyte hypertrophy, and fibrosis, whereas TD animals showed normal LV geometry and collagen content but thinner myocytes. Expression of collagens and type I/III collagen messenger RNA (mRNA) ratio were diminished in diabetic hearts compared with SC. MMP-2 gene was down-regulated in SD, whereas TD group showed decreased MMP-9 mRNA levels and MMP-2 expression comparable to that of SC rats. CONCLUSIONS Attenuation of MMP-2 down-regulation and reduction in MMP-9 mRNA expression may constitute an underlying mechanism by which ExT counteracts progression of adverse LV remodeling in T1D.

Validity analysis of one-repetition maximum strength test for determining the hamstrings-to-quadriceps ratio

One of the approaches to evaluate injury prediction is the hamstrings-to-quadriceps peak torque conventional ratio (H:Q ratio). The gold standard for assessment of muscle strength in vivo is by isokinetic dynamometry; however, the one-repetition maximum strength test (1-RM) presents high correlation with isokinetic data. This study aimed to compare measures of H:Q ratio in young adults obtained by dynamometry and 1-RM testing. No significant differences were observed in the H:Q ratio when comparing 1-RM and dynamometry testing. However, there was a significant and strong correlation between the measurements obtained in the two tests. Despite this correlation, data from both tests are not equal as the H:Q ratio obtained from 1-RM test presents a systematic error. Nonetheless, the results can enhance the applicability of 1-RM test in clinical settings.

Efeito do ultrassom terapêutico sobre as propriedades mecânicas do gastrocnêmio em ratos

INTRODUCAO: Apesar de algumas controversias quanto a sua utilizacao, o ultrassom terapeutico (UST) e um recurso comumente aplicado na reabilitacao desportiva para aceleracao do reparo tecidual de lesoes musculares. Sabe-se que lesoes musculares influenciam negativamente as propriedades mecânicas da musculatura estriada esqueletica e algumas evidencias demonstram que o UST poderia ter efeitos beneficos sobre o reparo muscular e, consequentemente, sobre suas propriedades mecânicas.OBJETIVO: Analisar o efeito do UST no reparo tecidual por meio das propriedades mecânicas musculares de ratos apos trauma por criolesao.METODOS: Foram utilizados no estudo 30 ratos da linhagem Wistar, os quais foram divididos em tres grupos: grupo controle intacto (GC), grupo lesionado sem tratamento (GL), e grupo lesionado e estimulado com UST (frequencia de 1 MHz; intensidade de 0,5 W/cm2; ciclo de trabalho de 50%; por quatro minutos diarios), durante sete dias consecutivos (GLUST). As propriedades mecânicas obtidas atraves de ensaio mecânico de tracao foram avaliadas em uma maquina universal de ensaios.RESULTADOS: Foram analisados estatisticamente, com nivel de significância de 95% (P<0,05). Apos sete sessoes de tratamento, houve melhora estatisticamente significativa nas propriedades mecânicas de carga no limite de proporcionalidade, carga no limite maximo e resiliencia para o GLUST em relacao ao GL (p<0,05).CONCLUSAO: O UST foi eficaz no processo de reparo tecidual, conferindo ao tecido muscular maior resistencia a tracao e absorcao de energia.Introduction: Despite controversial, ultrasonic therapy (UST) is commonly applied in sports rehabilitation practice to accelerate tissue repair after muscle damage. Muscle injuries have a negative influence on the mechanical properties of skeletal striated muscles and some scientific evidence shows that UST could have a positive effects on tissue repair and, therefore, on its mechanical properties. Objective: To analyze the effect of UST on muscle repair by evaluation of the mechanical properties of rat muscles after cryolesion. Methods: We used 30 adult Wistar rats which were divided into three groups: CG (control group), IG (injured group) and IGUST (injured plus UST) (frequency of 1 MHz; intensity of 0.5 W/cm2; pulsed to 50%; four minutes daily) for seven consecutive days. The mechanical properties obtained through mechanical tests were evaluated in a universal testing machine. Results: Data were statistically analyzed with a significance level of 95% (p<0.05). After seven treatment sessions, we found significant improvement in the mechanical properties of load at the proportionality limit, load at maximum limit and resilience in IGUST compared to IG (p<0.05). Conclusion: The UST was effective in the tissue repair process, giving higher tensile strength and energy absorption to the muscle tissue.

Efecto del ultrasounido terapéutico sobre las propiedades mecánicas del gastrocnemio en ratones

INTRODUCAO: Apesar de algumas controversias quanto a sua utilizacao, o ultrassom terapeutico (UST) e um recurso comumente aplicado na reabilitacao desportiva para aceleracao do reparo tecidual de lesoes musculares. Sabe-se que lesoes musculares influenciam negativamente as propriedades mecânicas da musculatura estriada esqueletica e algumas evidencias demonstram que o UST poderia ter efeitos beneficos sobre o reparo muscular e, consequentemente, sobre suas propriedades mecânicas.OBJETIVO: Analisar o efeito do UST no reparo tecidual por meio das propriedades mecânicas musculares de ratos apos trauma por criolesao.METODOS: Foram utilizados no estudo 30 ratos da linhagem Wistar, os quais foram divididos em tres grupos: grupo controle intacto (GC), grupo lesionado sem tratamento (GL), e grupo lesionado e estimulado com UST (frequencia de 1 MHz; intensidade de 0,5 W/cm2; ciclo de trabalho de 50%; por quatro minutos diarios), durante sete dias consecutivos (GLUST). As propriedades mecânicas obtidas atraves de ensaio mecânico de tracao foram avaliadas em uma maquina universal de ensaios.RESULTADOS: Foram analisados estatisticamente, com nivel de significância de 95% (P<0,05). Apos sete sessoes de tratamento, houve melhora estatisticamente significativa nas propriedades mecânicas de carga no limite de proporcionalidade, carga no limite maximo e resiliencia para o GLUST em relacao ao GL (p<0,05).CONCLUSAO: O UST foi eficaz no processo de reparo tecidual, conferindo ao tecido muscular maior resistencia a tracao e absorcao de energia.Introduction: Despite controversial, ultrasonic therapy (UST) is commonly applied in sports rehabilitation practice to accelerate tissue repair after muscle damage. Muscle injuries have a negative influence on the mechanical properties of skeletal striated muscles and some scientific evidence shows that UST could have a positive effects on tissue repair and, therefore, on its mechanical properties. Objective: To analyze the effect of UST on muscle repair by evaluation of the mechanical properties of rat muscles after cryolesion. Methods: We used 30 adult Wistar rats which were divided into three groups: CG (control group), IG (injured group) and IGUST (injured plus UST) (frequency of 1 MHz; intensity of 0.5 W/cm2; pulsed to 50%; four minutes daily) for seven consecutive days. The mechanical properties obtained through mechanical tests were evaluated in a universal testing machine. Results: Data were statistically analyzed with a significance level of 95% (p<0.05). After seven treatment sessions, we found significant improvement in the mechanical properties of load at the proportionality limit, load at maximum limit and resilience in IGUST compared to IG (p<0.05). Conclusion: The UST was effective in the tissue repair process, giving higher tensile strength and energy absorption to the muscle tissue.

Effect of therapeutic ultrasound on mecnanical properties of gastrocnemius in rats

INTRODUCAO: Apesar de algumas controversias quanto a sua utilizacao, o ultrassom terapeutico (UST) e um recurso comumente aplicado na reabilitacao desportiva para aceleracao do reparo tecidual de lesoes musculares. Sabe-se que lesoes musculares influenciam negativamente as propriedades mecânicas da musculatura estriada esqueletica e algumas evidencias demonstram que o UST poderia ter efeitos beneficos sobre o reparo muscular e, consequentemente, sobre suas propriedades mecânicas.OBJETIVO: Analisar o efeito do UST no reparo tecidual por meio das propriedades mecânicas musculares de ratos apos trauma por criolesao.METODOS: Foram utilizados no estudo 30 ratos da linhagem Wistar, os quais foram divididos em tres grupos: grupo controle intacto (GC), grupo lesionado sem tratamento (GL), e grupo lesionado e estimulado com UST (frequencia de 1 MHz; intensidade de 0,5 W/cm2; ciclo de trabalho de 50%; por quatro minutos diarios), durante sete dias consecutivos (GLUST). As propriedades mecânicas obtidas atraves de ensaio mecânico de tracao foram avaliadas em uma maquina universal de ensaios.RESULTADOS: Foram analisados estatisticamente, com nivel de significância de 95% (P<0,05). Apos sete sessoes de tratamento, houve melhora estatisticamente significativa nas propriedades mecânicas de carga no limite de proporcionalidade, carga no limite maximo e resiliencia para o GLUST em relacao ao GL (p<0,05).CONCLUSAO: O UST foi eficaz no processo de reparo tecidual, conferindo ao tecido muscular maior resistencia a tracao e absorcao de energia.Introduction: Despite controversial, ultrasonic therapy (UST) is commonly applied in sports rehabilitation practice to accelerate tissue repair after muscle damage. Muscle injuries have a negative influence on the mechanical properties of skeletal striated muscles and some scientific evidence shows that UST could have a positive effects on tissue repair and, therefore, on its mechanical properties. Objective: To analyze the effect of UST on muscle repair by evaluation of the mechanical properties of rat muscles after cryolesion. Methods: We used 30 adult Wistar rats which were divided into three groups: CG (control group), IG (injured group) and IGUST (injured plus UST) (frequency of 1 MHz; intensity of 0.5 W/cm2; pulsed to 50%; four minutes daily) for seven consecutive days. The mechanical properties obtained through mechanical tests were evaluated in a universal testing machine. Results: Data were statistically analyzed with a significance level of 95% (p<0.05). After seven treatment sessions, we found significant improvement in the mechanical properties of load at the proportionality limit, load at maximum limit and resilience in IGUST compared to IG (p<0.05). Conclusion: The UST was effective in the tissue repair process, giving higher tensile strength and energy absorption to the muscle tissue.

Low-level laser therapy and micro current in burn wound healing in rats: associated or isolated therapy?

Este estudo teve o objetivo de investigar se ha diferencas entre as terapias associadas e isoladas do laser e microcorrentes no reparo de lesao por queimadura em ratos. Um total de 40 animais foi dividido aleatoriamente em quatro grupos: grupo controle (GC); grupo microcorrente (GM), grupo laser (GL) e grupo laser/microcorrente (GLM), tratados com laser associado a microcorrentes. Apos lesoes termicas induzidas no dorso do animal, foi realizado um total de dez dias de tratamento. Amostras do tecido foram coletadas para estudo histopatologico semiquantitativo com Hematoxilina Eosina e Tricromico de Masson. Foram utilizados os testes de Kruskal-Wallis e post-hoc de Dunn. Houve diferenca significativa entre os grupos para a producao de fibroblastos (p=0,0003), colageno (p=0,0153), neoangiogenese (p=0,0031) e anexos cutâneos (p=0,0004). Na analise histologica semiquantitativa, o GLM apresentou valores menores nos parâmetros histologicos de presenca de colageno, numero de fibroblastos e anexos cutâneos (p<0,05) em relacao as terapias isoladas, exceto para a neoangiogenese, cujos valores da terapia associada foram semelhantes aos grupos de terapia com modalidade unica. Apesar do laser e da microcorrente separadamente terem efeitos beneficos para a cicatrizacao tecidual, a associacao das modalidades parece ter diminuido a acao de reparo. No entanto, sugere-se que a associacao destes recursos parece diminuir os efeitos do tratamento quando se comparam os grupos de modalidade unica.Correspondence to: Rodrigo Pegado de Abreu Freitas – Faculdade de Ciências da Saúde do Trairí – Universidade Federal do Rio Grande do Norte – Rua Trairí, s/n – Centro – CEP: 59200-000 – Santa Cruz (RN), Brazil – E-mail: rodrigopegado@gmail.com Presentation: Jun. 2012 – Accepted for publication: Feb. 2013 – Financing source: none – Conflict of interest: nothing to declare – Approval at the Ethics Committee n. 062/2008. ABSTRACT | This study aimed to investigate if there are differences between the associated and isolated therapies from the laser and micro current on healing of burn wound healing in rats. A total of 40 male rats were randomly allocated into four groups: control group (CG), micro current group (MG), laser group (LG) and laser/micro current group (LMG), treated with associated laser and micro current. Thermal damage was done on the back of the animal and a total of ten days therapy was performed. After treatment samples were taken from the lesions to perform semi quantitative histopathological study using Hematoxylin Eosin and Masson Trichrome. The Kruskal-Wallis and Dunn’s Test were used for statistical analyses. We observed a significant difference between groups for production of fibroblasts (p=0.0003), collagen (p=0.0153), neoangiogenesis (p=0.0031) and skin annexes (p=0.0004). In semi-quantitative histological analysis, the LMG showed lower values in presence of collagen, fibroblasts and number of skin appendages, only for neoangiogenesis, the associated therapy showed similar values to single modality therapy groups. Laser and microcurrent have beneficial effects on tissue healing. However, it is suggested that the association of these two therapies reduces the effectiveness of the treatment when compared to single mode treatment.