Photobiomodulation therapy combined with static magnetic field is better than placebo in patients with fibromyalgia: a randomized placebo-controlled trial.

BACKGROUND: Fibromyalgia is a syndrome characterized by generalized chronic pain and tenderness in specific areas. Photobiomodulation therapy (PBMT) using low-level laser therapy and/or light emitting diode therapy is an electrophysical agent that can be used alone or together with a static magnetic field (PBMT-sMF) to promote analgesia in several health conditions. Little evidence exists regarding the effects of using PBMT and PBMT-sMF in patients with fibromyalgia; this evidence is conflicting. AIM: We aimed to investigate the effects of using PBMT-sMF versus a placebo on reduction of the degree-of-pain rating, impact of fibromyalgia, pain intensity, and satisfaction with treatment in patients with fibromyalgia. DESIGN: A prospectively registered, monocentric, randomized placebo-controlled trial, with blinding of patients, therapists, and assessors, was performed. SETTING: The study was conducted at the Laboratory of Phototherapy and Innovative Technologies in Health (LaPIT) in Brazil, between March and October 2020. POPULATION: Ninety female patients with fibromyalgia were randomized to undergo either PBMT-sMF (N.=45) or placebo (N.=45) treatment. METHODS: Patients from both groups received nine treatment sessions, three times a week, for 3 weeks. Clinical outcomes were collected at baseline, the end of treatment, and at the follow-up appointment 4 weeks post-treatment. The primary outcome was the degree-of-pain rating, measured by the reduction of the tender point count. RESULTS: A decrease in the degree-of-pain rating was observed in patients allocated to the PBMT-sMF group, decreasing the number of tender points when compared to placebo group at the end of treatment (P<0.0001) and at the follow-up assessment (P<0.0001). Patients did not report any adverse events. CONCLUSIONS: PBMT-sMF is superior to placebo, supporting its use in patients with fibromyalgia. CLINICAL REHABILITATION IMPACT: PBMT-sMF might be considered an important adjuvant to the treatment regimens of patients with fibromyalgia.

Low-intensity LASER and LED (photobiomodulation therapy) for pain control of the most common musculoskeletal conditions.

Pain is the most common reason for physician consultations and the number one reason for missed work or school days is musculoskeletal pain. Pain management is utilized for easing the suffering and improving the Quality of Life of those living with chronic pain. Over the past several decades, physicians have become increasingly willing to prescribe opioids to manage pain. However, the opioid use can cause side effects as poor coordination, sedation, mood swings, depression, and anxiety combined with a dependence on the drugs. In the rehabilitation setting, patients benefit most when their health providers utilize a multimodal approach combining different types of therapies and when patients take on a significant role in optimal management of their own pain. The use of light as a therapeutic alternative form of medicine to manage pain and inflammation has been proposed to fill this void. Photobiomodulation therapy applied in the form of low-intensity Light Amplification by Stimulated Emission of Radiation (LASER) and light-emitting diode (LED) has been shown to reduce inflammation and swelling, promote healing, and reduce pain for an array of musculoskeletal conditions. There is evidence that photobiomodulation therapy reduces pain intensity in non-specific knee pain, osteoarthritis, pain post-total hip arthroplasty, fibromyalgia, temporomandibular diseases, neck pain, and low back pain. Therefore, the purpose of this paper was to present the up-to-dated evidence about the effects of low-intensity LASER and LED (photobiomodulation therapy) on pain control of the most common musculoskeletal conditions. We observed that the photobiomodulation therapy offers a non-invasive, safe, drug-free, and side-effect-free method for pain relief of both acute and chronic musculoskeletal conditions as well as fibromyalgia.

Comparison of blood flow changes with soft tissue mobilization and massage therapy.

OBJECTIVES: Instrument-assisted soft tissue mobilization and massage therapy are manual techniques that claim to increase blood flow to treated areas, yet no data on these techniques are available. This study sought to compare the effects of the Graston Technique(®) (GT) and massage therapy on calf blood flow, using skin temperature measures on the lower leg. DESIGN: Single-blinded prospective, longitudinal, controlled, repeated-measures design. SETTING: Research laboratory. PARTICIPANTS: Twenty-eight participants (mean age, 23±3 years; 14 men and 14 women; mean calf girth, 39.5±4.31 cm; calf skinfold thickness, 27.9±5.6 cm). INTERVENTIONS: Each participant received 10-minute treatments (massage or GT) on two separate sessions, with the untreated leg as a control. OUTCOME MEASURES: Baseline skin temperature of the calf was measured before treatment and again every 5 minutes after treatment for a total of 60 minutes. Differences between the 4 treatment conditions (GT, GT control, massage, and massage control) performed 13 times were evaluated with a repeated-measures analysis of variance. Significance was set a priori at p<0.05. RESULTS: Significant differences with Greenhouse-Geisser corrections were seen between conditions (F(2.4,61.2)=39.252; p<0.001; effect size [ES]=0.602) and time (F(2.1,54.4)=192.8; p<0.001; ES=0.881), but the main effect was not significant (F(2.1,53.5)=2.944; p=0.060; 1-ß=0.558). The massage condition (32.05±0.16°C) yielded significantly higher skin temperatures than did massage control (30.53±0.14°C; p<0.001), GT (31.11±0.20°C; p<0.001), and GT control (30.32±0.14°C; p<0.001) conditions. Significant differences in time occurred: The temperatures at 5 minutes (30.21±0.12°C), 10 minutes (31.00±0.30°C), and 15 minutes (31.65±0.12°C) showed significant increases (p<0.001). Peak temperature was achieved at 25 minutes after treatment (31.76±0.12°C). CONCLUSION: Massage and GT increased skin temperature. A rise in temperature theoretically indicates an increase in blood flow to the area.

Adjunctive use of combination of super-pulsed laser and light-emitting diodes phototherapy on nonspecific knee pain: double-blinded randomized placebo-controlled trial.

Phototherapy with low-level laser therapy (LLLT) and light-emitting diode therapy (LEDT) has arisen as an interesting alternative to drugs in treatments of musculoskeletal disorders. However, there is a lack of studies investigating the effects of combined use of different wavelengths from different light sources like lasers and light-emitting diodes (LEDs) in skeletal muscle disorders. With this perspective in mind, this study aimed to investigate the effects of phototherapy with combination of different light sources on nonspecific knee pain. It was performed a randomized, placebo-controlled, double-blinded clinical trial. Eighty-six patients rated 30 or greater on the pain visual analogue scale (VAS) were recruited and included in study. Patients of LLLT group received 12 treatments with active phototherapy (with 905 nm super-pulsed laser and 875 and 640 nm LEDs, Manufactured by Multi Radiance Medical, Solon, OH, USA) and conventional treatment (physical therapy or chiropractic care), and patients of placebo group were treated at same way but with placebo phototherapy device. Pain assessments (VAS) were performed at baseline, 4th, 7th, and 10th treatments, after the completion of treatments and at 1-month follow-up visit. Quality of life assessments (SF-36®) were performed at baseline, after the completion of treatments and at 1-month follow-up visit. Our results demonstrate that phototherapy significantly decreased pain (p < 0.05) from 10th treatment to follow-up assessments and significantly improved (p < 0.05) SF-36® physical component summary at posttreatments and follow-up assessments compared to placebo. We conclude that combination of super-pulsed laser, red and infrared LEDs is effective to decrease pain and improve quality of life in patients with knee pain.

Effect of core strength on the measure of power in the extremities.

The purpose of this study was to (a) develop a functional field test to assess the role of the core musculature and its impact on sport performance in an athletic population and (b) develop a functional field test to determine how well the core can transfer forces from the lower to the upper extremities. Twenty-five DI collegiate football players performed medicine ball throws (forward, reverse, right, and left) in static and dynamic positions. The results of the medicine ball throws were compared with several athletic performance measurements: 1 repetition maximum (1RM) squat, squat kg/bw, 1RM bench press, bench kg/bw, countermovement vertical jump (CMJ), 40-yd dash (40 yd), and proagility (PrA). Push press power (PWR) was used to measure the transfer of forces through the body. Several correlations were found in both the static and dynamic medicine ball throws when compared with the performance measures. Static reverse correlated with CMJ (r = 0.44), 40 yd (r = 0.5), and PrA (r = 0.46). Static left correlated with bench kg/bw (0.42), CMJ (0.44), 40 yd (0.62), and PrA (0.59). Static right also correlated with bench kg/bw (0.41), 40 yd (0.44), and PrA (0.65). Dynamic forward (DyFw) correlated with the 1RM squat (r = 0.45) and 1RM bench (0.41). Dynamic left and Dynamic right correlated with CMJ, r = 0.48 and r = 0.40, respectively. Push press power correlated with bench kg/bw (0.50), CMJ (0.48), and PrA (0.48). A stepwise regression for PWR prediction identified 1RM squat as the best predictor. The results indicate that core strength does have a significant effect on an athlete's ability to create and transfer forces to the extremities. Currently, plank exercises are considered an adequate method of training the core for athletes to improve core strength and stability. This is a problem because it puts the athletes in a nonfunctional static position that is very rarely replicated in the demands of sport-related activities. The core is the center of most kinetic chains in the body and should be trained accordingly.

Cryotherapy and ankle bracing effects on peroneus longus response during sudden inversion.

Cryotherapy and ankle bracing are often used in conjunction as a treatment for ankle injury. No studies have evaluated the combined effect of these treatments on reflex responses during inversion perturbation. This study examined the combined influence of ankle bracing and joint cooling on peroneus longus (PL) muscle response during ankle inversion. A 2x2 RM factorial design guided this study; the independent variables were: ankle brace condition (lace-up brace, control), and treatment (ice, control), and the dependent variables studied were PL stretch reflex latency (ms), and PL stretch reflex amplitude (% of max). Twenty-four healthy participants completed 5 trials of a sudden inversion perturbation to the ankle/foot complex under each ankle brace and cryotherapy treatment condition. No two-way interaction was observed between ankle brace and treatment conditions on PL latency (P=0.283) and amplitude (P=0.884). The ankle brace condition did not differ from control on PL latency and amplitude. Cooling the ankle joint did not alter PL latency or amplitude compared to the no-ice treatment. Ankle bracing combined with joint cooling does not have a deleterious effect on dynamic ankle joint stabilization during an inversion perturbation in normal subjects.

Effectiveness of clinical ultrasound parameters on changing intramuscular temperature.

CONTEXT: Researchers have recommended certain ultrasound treatment parameters for deep heating; however, we observed different parameters in the clinical setting. OBJECTIVE: To compare the treatment effect of using observed clinical parameters (OCP) from 8 clinicians to the treatment effect of using the recommended parameters (RP) sited in research. DESIGN: 2 x 2 repeated measures design. SETTING: Sports injury research laboratory. PARTICIPANTS: Ten healthy volunteers. INTERVENTIONS: Two 1 MHz treatment, 1 RP treatment (1.5 W/cm2, 10-min, area-2 to 3 x ERA), and 1 OCP treatment (1.3 W/cm2, 8-min, area 3.9 X ERA). MAIN OUTCOME MEASURE: Tricep surae temperature 3 cm below superficial tissue. RESULTS: The RP treatment increase temperature from 36.4 +/- 1.0 to 40.3+/- 2.0 degrees C, which was a greater change than the OCP (36.5 +/- 1.2 to 38.2 +/- 1.6 degrees C). CONCLUSIONS: The OCP treatment resulted in a lower heating affect than the RP. Small change in treatment area, intensity, and duration can have a large effect on temperature change.

Ultrasound heating is curvilinear in nature and varies between transducers from the same manufacturer.

CONTEXT: Ultrasound heating rates are known to differ between various manufacturers; it is unknown whether this difference exists within a manufacturer. OBJECTIVE: Determine if intramuscular heating differences exist between transducers from the same manufacturer. STUDY DESIGN: 3 x 10 repeated measures. Independent variables were Transducer (A, B, and C) and Time (10-min time points during the treatment). SETTING: Controlled laboratory. PARTICIPANTS: Twelve volunteers (M = 4, F = 8; age: 23 +/- 4 years; calf-girth: 37.94 +/- 4.16 cm; calf-skinfold: 27 +/- 17 mm). INTERVENTION: Three 10-min 1MHz continuous ultrasound treatments performed at an intensity of 1.2 W/cm2, over an area 2x transducer. MAIN OUTCOME MEASURES: Calf temperature increase. RESULTS: Heating curve generated for each transducer were significantly different (P = .034) but the overall temperature increases following 10 minutes of treatment were within 0.1 degree C (F = 1.023 P = .573). CONCLUSION: Heating curves differ between transducers from the same manufacturer but peak heating at 10 minutes was similar.

The role of quantitative Schlieren assessment of physiotherapy ultrasound fields in describing variations between tissue heating rates of different transducers.

Differences in tissue heating rates between ultrasound transducers have been well documented; however, comparative analysis between ultrasound fields to determine why tissue heating rates may differ is lacking. We selected three transducers from the same manufacturer with similar effective radiating area, output power, effective intensity and beam nonuniformity ratio [as defined by the FDA, 21 CFR Chap. 1, part 1,050 (10)], but markedly different Schlieren images. Each transducer was utilized to heat tissue with a standardized ultrasound application to determine whether Schlieren analysis may be useful in understanding variability in tissue heating rates. Thermocouples were inserted into the left triceps surae of 12 volunteers at a depth of 1.5 cm below one half the measured skin fold thickness (estimated average depth of the thermocouple was 1.99 +/- 0.27 cm). Each subject received one treatment from each transducer in a single session (n = 3); 3 MHz at 1.2 W/cm(2) for 8 min with a 100% duty cycle. Each transducer increased the IM temperature over time (p < 0.0001). IM temperatures were not significantly different between transducers from time zero to the fourth minute of treatment. After the fourth min, transducers B and C generated significantly higher tissue temperatures (p < 0.01). Transducer A, B and C increased IM temperature from 34.9 +/- 0.5 to 41.2 +/- 1.3 degrees C, 34.9 +/- 0.6 to 42.5 +/- 1.4 degrees C and 34.9 +/- 0.5 to 42.7 +/- 1.7 degrees C, respectively. Interestingly, transducer C emitted 22% lower output power but heated 24% higher than transducer A and our Schlieren images demonstrate that transducers B and C produced a more concentrated field compared with transducer A. The data we present here supports the general contention that a more concentrated field will heat to a higher temperature than a more disperse field, however, technical challenges in estimating output power, ERA and Schlieren analysis remain an issue.

Effect of transducer velocity on intramuscular temperature during a 1-MHz ultrasound treatment.

STUDY DESIGN: A 3 x 2 repeated-measures design was used. The independent variables were transducer velocity (2-3 cm/s, 4-5 cm/s, and 7-8 cm/s) and time (pretreatment and posttreatment). OBJECTIVE: To determine if transducer velocity of a 1-MHz ultrasound treatment affects intramuscular tissue temperature. BACKGROUND: Most authors advocate ultrasound transducer velocities of 2 to 4 cm/s within an area of 2 to 3 times the effective radiating area or 2 times the size of the transducer head. However, a much faster rate of application (approximately 7-8 cm/s) is often observed in clinical settings. METHODS AND MEASURES: Eleven healthy screened volunteers (9 males, 2 females; mean +/- SD age, 22.6 +/- 1.7 years; mean +/- SD height, 175.7 +/- 13.7 cm; mean +/- SD body mass, 82.5 +/- 19.5 kg) were randomly assigned to a treatment order with all conditions administered during a single testing session. Each transducer velocity condition was administered for 10 minutes, using 1-MHz ultrasound with a 100% continuous duty cycle at an intensity of 1.5 W/cm2 over an area twice the size of the transducer head. After the first treatment, the 2 remaining subsequent velocity conditions were administered after the intramuscular temperature returned to within +/- 0.3 degrees C of the initial pretreatment temperature for 5 minutes. The dependent variable was left triceps surae muscle temperature measured at 3 cm below one half the measured skinfold thickness. RESULTS: Temperature increase across the 3 velocities was within 0.4 degrees C (F2.20 = 0.07, P = .93). Posttreatment values (mean +/- SD) ranged from 42.7 degrees C +/- 2.3 degrees C for the slowest velocity to 43.1 degrees C +/- 1.4 degrees C for the fastest velocity. Temperature increase was significant for time (F1.01 = 155.68, P<.00001), increasing from 37.8 degrees C +/- 0.8 degrees C pretreatment to 42.9 degrees C +/- 1.9 degrees C after treatment. CONCLUSION: Very similar intramuscular temperature increases can be observed among ultrasound treatments (10-minute duration, 1-MHz frequency, 100% continuous duty cycle, 1.5 W/cm2 intensity, within an area twice the size of the transducer head), with transducer velocities of 2 to 3, 4 to 5, and 7 to 8 cm/s.

Certified athletic trainers' knowledge and perception of professional preparation involving eating disorders among athletes.

The perceived adequacy of professional preparation about eating disorders and disordered eating has not been evaluated in certified athletic trainers (ATCs). This study was intended to establish how ATCs perceive their professional preparation and educational background in identifying and managing eating disorders. A 42-item Web-based survey was specifically created for this study and disseminated to certified 14,477 members of the National Athletic Trainers' Association (NATA), of whom 13.6% (n = 1,966) responded (mean age of respondents, 31.87 +/- 7.82 yrs). The survey consisted of an 11-question demographic section, 13 Likert-scale statements, five "check all that apply" questions, 10 yes/no questions, two "fill in the best answer" questions, and one "check one that applies" question. Statistical analysis focused on qualitative and descriptive analysis of survey items. Our results suggest that ATCs believe that they do not receive enough professional preparation or education in dealing with eating disordered athletes. Despite this finding, they also believe it is their responsibility to identify and deal with eating disordered athletes. The overall findings indicate a need and desire for continuing education about eating disorders.

Effects of functional electric stimulation cycle ergometry training on lower limb musculature in acute sci individuals.

The purpose of this study was to compare three different intervals for a between sets rest period during a common isokinetic knee extension strength-testing protocol of twenty older Brazilian men (66.30 ± 3.92 yrs). The volunteers underwent unilateral knee extension (Biodex System 3) testing to determine their individual isokinetic peak torque at 60, 90, and 120° ·s-1. The contraction speeds and the rest periods between sets (30, 60 and 90 s) were randomly performed in three different days with a minimum rest period of 48 hours. Significant differences between and within sets were analyzed using a One Way Analysis of Variance (ANOVA) with repeated measures. Although, at angular velocity of 60°·s-1 produced a higher peak torque, there were no significant differences in peak torque among any of the rest periods. Likewise, there were no significant differences between mean peak torque among all resting periods (30, 60 and 90s) at angular velocities of 90 and 120°·s-1. The results showed that during a common isokinetic strength testing protocol a between set rest period of at least 30 s is sufficient for recovery before the next test set in older men. Key PointsMuscle fiber cross sectional area (CSAf ) decreased 38% following spinal cord injury (SCI).Early intervention with functional electric stimulation cycle ergometry (FES-CE) prevented further loss of CSAf in SCI patients and increased power output.Muscle myosin heavy chain (MHC) and myonuclear density were unaffected by SCI or FES-CE.

Exercise and quadriceps muscle cooling time.

CONTEXT: Cryotherapy is commonly used for a variety of purposes; however, the body's response to cryotherapy immediately postexercise is unknown. OBJECTIVE: To investigate the effect of prior exercise on crushed-ice-bag treatment of a large muscle group. DESIGN: 2 x 3 repeated-measures design on depth (1 cm and 2 cm below adipose tissue) and treatment (exercise followed by ice, exercise followed by no ice, and no exercise followed by ice). SETTING: Sports Injury Research Laboratory. PATIENTS OR OTHER PARTICIPANTS: Six physically active, uninjured male volunteers. INTERVENTION(S): For the 2 exercise conditions, subjects rode a stationary cycle ergometer at 70% to 80% of their age-predicted maximum heart rate, as calculated by the Karvonen method. For the no-exercise condition, subjects lay supine on a treatment table. The cryotherapy treatment consisted of a 1-kg ice bag applied to the anterior mid thigh. For the no-ice condition, subjects lay supine on a treatment table. MAIN OUTCOME MEASURE(S): Time required for the intramuscular temperatures at the 1-cm and 2-cm depths below adipose tissue to return to pre-exercise baseline and time required to cool the 1-cm and 2-cm depths to 10 degrees C below the pre-exercise temperature. RESULTS: The time to cool the rectus femoris to the pre-exercise temperature using a crushed-ice-bag treatment was reduced by approximately 40 minutes (P < .001). The ice bag cooled the 1-cm and 2-cm depths to the pre-exercise temperature within 7 minutes (P = .38), but the 2-cm tissue depth took nearly 13.5 minutes longer to cool than the 1-cm depth when no ice was applied (P = .001). The 1-cm depth cooled to 10 degrees C below the pre-exercise temperature about 8 minutes sooner than the 2-cm depth, regardless of whether the tissue was exercised or not (P < .001). Exercise shortened the cooling time to 10 degrees C below the pre-exercise temperature by approximately 13 minutes (P = .05). CONCLUSIONS: Exercise before cooling with a crushed-ice bag enhanced the removal of intramuscular heat.

Local ice-bag application and triceps surae muscle temperature during treadmill walking.

CONTEXT: Ice bags "to go" are a common practice in athletic training. OBJECTIVE: To determine the effect of submaximal exercise on tissue temperatures during a common ice-bag application. DESIGN: 2 X 5 fully repeated-measures design with treatment (cooling while resting, cooling while walking) and time (pretreatment, immediately after ice application, and at 10, 20, and 30 minutes during treatment) as the independent variables. SETTING: Laboratory setting. PATIENTS OR OTHER PARTICIPANTS: Sixteen healthy, physically active volunteers (age = 21.63 +/- 2.63 yrs, height = 68.97 +/- 4.00 cm, mass = 80.97 +/- 18.18 kg, calf skinfold = 21.1 +/- 9.3 mm). MAIN OUTCOME MEASURE(S): Left triceps surae intramuscular and skin temperatures, as measured by thermocouples to the nearest 0.1 degrees C, served as dependent measures. INTERVENTION(S): After collecting baseline temperatures, we secured a 1.0-kg ice bag to the calf using plastic wrap before the subject either rested prone or walked on a treadmill at 4.5 km/h for 30 minutes. RESULTS: Treatment did not (P < 0.10) affect the approximately 15 degrees C (P < 0.0001) surface temperature decrease, which remained depressed immediately upon ice-bag application (P < 0.05). Conversely, intramuscular temperature continually cooled (34 to 28 degrees C), while subjects rested (P < 0.0001), whereas no change took place during walking (P = 0.49). Moreover, at the 20- and 30-minute treatment intervals, the resting intramuscular temperatures were, respectively, 3.9 degrees C and 5.4 degrees C cooler than the walking intramuscular temperatures (P < 0.01). CONCLUSIONS: The current trend of wrapping "to go" ice bags to the leg is not likely to achieve deep tissue cooling despite surface temperature decreases.