RESUMEN
This study aimed to compare shoulder tendinopathy treatment with therapeutic ultrasound combined with LED photobiomodulation therapy using LED-infrared (850 nm) or LED-red (640 nm). The study assessed 75 patients, aged 45 to 70 years, distributed into five experimental groups (15 patients each): therapeutic ultrasound (US), infrared light irradiation (IR), visible red light irradiation (VR), infrared light and ultrasound combined (IR-US), and red light in conjunction with ultrasound (VR-US). The ultrasound parameters are 1 MHz, 0.5 W/cm2 (SATA), and 100 Hz repetition rate, applied for 4 min each session. LED irradiation protocols were as follows: 3 points, 7.5 J per point, IR-LED 750 mW, 10 s, VR-LED 250 mW, 30 s. LED irradiation is followed by ultrasound in the combined therapies. The efficiency of the five therapies was evaluated assessing 12 parameters: quality of life (Health Assessment Questionnaire, HAQ), pain intensity (Visual Analog Scale, VAS), articular amplitude of shoulder movement (flexion, extension, abduction, adduction, medial rotation, lateral rotation), muscle strength (abduction, lateral rotation), and electromyography (lateral rotation, abduction). Treatments comprised 12 sessions for 4 weeks. Intra-group analysis showed that the five therapies significantly improved the recovery of all parameters after treatment. Regarding the comparison of irradiated therapies and ultrasound, statistical analysis showed that IR-US was a better treatment than US for all 12 parameters. IR treatment exceeded US on 9 items, whereas that VR and VR-US therapies exceeded US in 7 and 10 parameters, respectively (p < 0.05). Because of that, IR-US shows to be the best treatment for rotator cuff tendinopathy. In conclusion, improvements in quality of life, pain intensity relief, shoulder amplitude motion, and muscle strength force obtained with ultrasound therapy are enhanced by adding infrared LED irradiation to ultrasound for patients suffering from rotator cuff tendinopathy. This study was registered with the Brazilian Registry of Clinical Trials (ReBEC) under Universal Trial Number (UTN) U1111-1219-3594 (2018/22/08).
Asunto(s)
Terapia por Luz de Baja Intensidad , Tendinopatía , Humanos , Terapia por Luz de Baja Intensidad/efectos adversos , Calidad de Vida , Rango del Movimiento Articular , Manguito de los Rotadores/diagnóstico por imagen , Dolor de Hombro/terapia , Tendinopatía/diagnóstico por imagen , Tendinopatía/radioterapia , Resultado del TratamientoRESUMEN
The aim of the present study was to investigate the effects of photobiomodulation (PBM) therapy on the expression of heat shock protein 70 (HSP70) and tissue repair in an experimental model of collagenase-induced Achilles tendinitis. Thirty Wistar rats (aged 12 weeks) were randomly distributed among control group (n = 8), tendinitis group (n = 11), and LED group (n = 11). Tendinitis was induced in the tendinitis and LED groups through a peritendinous injection of collagenase (100 µl). The LED group animals received the first irradiation 1 h after injury. A 630 ± 20 nm, 300-mW continuous wave light-emitting diode (LED), spot size 1 cm2, was placed in contact with the skin. One point over the tendon was irradiated for 30 s, delivering 9 J (9 J/cm2). LED irradiation was performed once daily for 7 days, with the total energy delivered being 63 J. The tendons were surgically removed and expression of the HSP70 protein was calculated using semi-quantitative analyses of immunohistochemistry (HSCORE). Number of fibroblasts and amount of collagen were measured using histological and histochemical analyses. An increase in the mean HSCORE for HSP70, in the number of fibroblasts, and in the amount of collagen were found in the LED group compared with those in the tendinitis and control group (P ≤ 0.05). PBM therapy increased the expression of the HSP70, number of fibroblasts, and amount of collagen in the acute Achilles tendinitis in rats.
Asunto(s)
Tendón Calcáneo/patología , Tendón Calcáneo/efectos de la radiación , Regulación de la Expresión Génica/efectos de la radiación , Proteínas HSP70 de Choque Térmico/metabolismo , Terapia por Luz de Baja Intensidad , Tendinopatía/metabolismo , Tendinopatía/radioterapia , Animales , Modelos Animales de Enfermedad , Fibroblastos/metabolismo , Fibroblastos/efectos de la radiación , Masculino , Ratas , Ratas Wistar , Tendinopatía/patologíaRESUMEN
PURPOSE: To evaluate the in vivo response of photobiomodulation therapy associated with norbixin-based poly(hydroxybutyrate) membrane (PHB) in tenotomized calcaneal tendon. METHODS: Thirty rats were randomly allocated to six groups (n=5 each): LED groups (L1, L2 and L3) and membrane + LED groups (ML1, ML2 and ML3). The right calcaneal tendons of all animals were sectioned transversely and were irradiated with LED daily, one hour after surgery every 24 hours, until the day of euthanasia. At the end of the experiments the tendons were removed for histological analysis. RESULTS: The histological analysis showed a significant reduction in inflammatory cells in the ML1, ML2 and ML3 groups (p=0.0056, p=0.0018 and p<0.0001, respectively) compared to those in the LED group. There was greater proliferation of fibroblasts in the ML1 (p<0.0001) and L3 (p<0.0001) groups. A higher concentration of type I collagen was also observed in the ML1 group (p=0.0043) replacing type III collagen. CONCLUSION: Photobiomodulation in association with norbixin-based PHB membrane led to control of the inflammatory process. However, it did not favor fibroblast proliferation and did not optimize type I collagen formation in the expected stage of the repair process.
Asunto(s)
Tendón Calcáneo/efectos de la radiación , Carotenoides/farmacología , Hidroxibutiratos/farmacología , Terapia por Luz de Baja Intensidad/métodos , Tendinopatía/radioterapia , Tenotomía/métodos , Tendón Calcáneo/efectos de los fármacos , Tendón Calcáneo/cirugía , Animales , Colágeno/farmacología , Colágeno Tipo I/análisis , Colágeno Tipo I/efectos de los fármacos , Colágeno Tipo III/análisis , Colágeno Tipo III/efectos de los fármacos , Evaluación Preclínica de Medicamentos , Fibroblastos/química , Fibroblastos/efectos de los fármacos , Masculino , Prohibitinas , Distribución Aleatoria , Ratas , Ratas Wistar , Cicatrización de Heridas/efectos de los fármacos , Cicatrización de Heridas/efectos de la radiaciónRESUMEN
OBJECTIVE: The purpose of this study was to determine the benefits and harms of low-level laser therapy for Achilles tendinopathy. DATA SOURCES: Search strategies were conducted (from inception to February 2020) in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Literatura Latino Americana em Ciências da Saúde e do Caribe (LILACS), Physiotherapy Evidence Database (PEDro), SPORTDiscus, ClinicalTrials.gov, World Health Organization (WHO)-ICTRP and OpenGrey databases, to retrieve all randomized controlled trials that compared laser therapy with inactive/active interventions. REVIEW METHODS: This study was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The risk of bias was assessed using the Cochrane Risk of bias table. Meta-analyses were performed on dependence of homogeneity, otherwise results were reported narratively. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: Four trials (119 participants) were analyzed. Laser therapy associated to eccentric exercises when compared to eccentric exercises and sham had very low to low certainty of evidence in pain and function assessment. Despite one trial favored laser therapy at two months (mean difference (MD) -2.55, 95% confidence interval (95% CI) -3.87 to -1.23), the CIs did not include important differences between groups at 3 and 13 months. The function assessment showed an improvement favoring the placebo group at one month (MD 9.19, 95% CI -16.16 to -2.23) and non-significant difference between groups at 3 and 13 months. Adverse events were poorly reported but restricted to minor events related to the exercises. CONCLUSION: The certainty of evidence was low to very low, and the results are insufficient to support the routine use laser therapy for Achilles tendinopathy.
Asunto(s)
Tendón Calcáneo , Terapia por Luz de Baja Intensidad , Tendinopatía/radioterapia , HumanosRESUMEN
Abstract Purpose: To evaluate the in vivo response of photobiomodulation therapy associated with norbixin-based poly(hydroxybutyrate) membrane (PHB) in tenotomized calcaneal tendon. Methods: Thirty rats were randomly allocated to six groups (n=5 each): LED groups (L1, L2 and L3) and membrane + LED groups (ML1, ML2 and ML3). The right calcaneal tendons of all animals were sectioned transversely and were irradiated with LED daily, one hour after surgery every 24 hours, until the day of euthanasia. At the end of the experiments the tendons were removed for histological analysis. Results: The histological analysis showed a significant reduction in inflammatory cells in the ML1, ML2 and ML3 groups (p=0.0056, p=0.0018 and p<0.0001, respectively) compared to those in the LED group. There was greater proliferation of fibroblasts in the ML1 (p<0.0001) and L3 (p<0.0001) groups. A higher concentration of type I collagen was also observed in the ML1 group (p=0.0043) replacing type III collagen. Conclusion: Photobiomodulation in association with norbixin-based PHB membrane led to control of the inflammatory process. However, it did not favor fibroblast proliferation and did not optimize type I collagen formation in the expected stage of the repair process.
Asunto(s)
Animales , Masculino , Ratas , Tendón Calcáneo/efectos de la radiación , Carotenoides/farmacología , Terapia por Luz de Baja Intensidad/métodos , Tendinopatía/radioterapia , Tenotomía/métodos , Hidroxibutiratos/farmacología , Tendón Calcáneo/cirugía , Tendón Calcáneo/efectos de los fármacos , Cicatrización de Heridas/efectos de los fármacos , Cicatrización de Heridas/efectos de la radiación , Distribución Aleatoria , Colágeno/farmacología , Ratas Wistar , Colágeno Tipo I/análisis , Colágeno Tipo I/efectos de los fármacos , Colágeno Tipo III/análisis , Colágeno Tipo III/efectos de los fármacos , Evaluación Preclínica de Medicamentos , Fibroblastos/efectos de los fármacos , Fibroblastos/química , ProhibitinasRESUMEN
Objective: The main objective was to verify the modulatory effects of MMP-1, MMP-3, and MMP-13 levels on the partially injured calcaneal tendons of rat exposure to photobiomodulation. Background: Photobiomodulation has been shown to have anti-inflammatory and regenerative effects on tendon injuries. However, there is still uncertainty regarding the beneficial effects in matrix metalloproteinase (MMP) levels, especially MMP-1, -3, and -13. Materials and methods: Sixty-five male Wistar rats were used. Sixty were submitted to a direct trauma on the calcaneal tendons and were randomly distributed into the following six groups: LASER 1, 3, and 7 (10 partially injured calcaneal tendons in each group treated with photobiomodulation for 1, 3, and 7 days, respectively) and Sham 1, 3, and 7 (same injury, with simulated photobiomodulation). The remaining five animals were allocated to the normal group (no injury or treatment procedure). The 780 nm low-level laser was applied with 70 mW of mean power and 17.5 J/cm2 of fluency for 10 sec, once a day. The tendons were surgically removed and analyzed for MMP-1, MMP-3, and MMP-13 through immunohistochemistry. Results: MMP-3 levels remained close to normal in all experimental groups (p > 0.05); however, reductions (p < 0.05) in MMP-1 and MMP-13 levels were detected in the groups submitted to one, three, and seven low level laser therapy applications. Conclusions: The photobiomodulation protocol was able to reduce MMP-1 and MMP-13 levels in injured calcaneal tendons.
Asunto(s)
Tendón Calcáneo/metabolismo , Terapia por Luz de Baja Intensidad/métodos , Metaloproteinasa 13 de la Matriz/metabolismo , Metaloproteinasa 1 de la Matriz/metabolismo , Metaloproteinasa 3 de la Matriz/metabolismo , Tendinopatía/metabolismo , Tendinopatía/radioterapia , Animales , Modelos Animales de Enfermedad , Masculino , Ratas , Ratas WistarRESUMEN
This study investigates the effect of photobiomodulation therapy (PBMT) on collagen type I and III, matrix metalloproteinase (MMP), and vascular endothelial growth factor (VEGF) in experimentally induced tendinopathy in female aged rats. Tendinopathy was induced by the Achilles tendoncollagenase peritendinous. Forty-two Wistar rats (Norvegicus albinus) were used; groups consisted of 36 aged animals (18 months old; mean body weight, 517.7 ± 27.54 g) and 6 adult animals (12 weeks old; mean body weight, 266± 19.30 g). The animals were divided into three groups: control, aged tendinopathy, and aged tendinopathy PBMT; the aged groups were subdivided based on time to euthanasia: 7, 14, and 21 days. PBMT involved a gallium-arsenide-aluminum laser (Theralaser, DMC®) with active medium operating at wavelength 830 ± 10 nm, 50 mW power, 0.028 cm2 laser beam, 107 J/cm2 energy density, 1.8 W/cm2 power density, and an energy of 3 J per point. The laser was applied by direct contact with the left Achilles tendon during 60 s per point at a frequency of three times per week, until the euthanasia date (7, 14, and 21 days). VEGF, MMP-3, and MMP-9 were analyzed by immunohistochemistry, and collagen type I and III by Sirius red. PBMT increased the deposition of collagen type I and III in a gradual manner, with significant differences relative to the group aged tendonitis (p < 0.001), and in relation to VEGF (p < 0.001); decreased expression of MMP-3 and 9 were observed in group aged tendinopathy (p < 0.001). PBMT, therefore, increased the production of collagen type I and III, downregulated the expression of MMP-3 and MMP-9, and upregulated that of VEGF, with age and age-induced hormonal deficiency.
Asunto(s)
Colágeno Tipo II/efectos de la radiación , Colágeno Tipo I/efectos de la radiación , Terapia por Luz de Baja Intensidad/métodos , Metaloproteinasa 9 de la Matriz/efectos de la radiación , Tendinopatía/radioterapia , Factor A de Crecimiento Endotelial Vascular/efectos de la radiación , Tendón Calcáneo , Animales , Modelos Animales de Enfermedad , Femenino , Láseres de Semiconductores/uso terapéutico , Metaloproteinasa 3 de la Matriz/efectos de la radiación , Ratas , Ratas WistarRESUMEN
Tendinopathy is a common disease with a variety of treatments and therapies. Laser therapy appears as an alternative treatment. Here, we investigate the effects of laser irradiation in an experimental model of tendinitis induced by collagenase injection on rats' Achilles tendon, verifying its action in important inflammatory markers. Male Wistar rats were used and divided into five groups: control saline (C), non-treated tendinitis (NT) and tendinitis treated with sodium diclofenac (D) or laser (1 J) and (3 J). The tendinitis was induced by collagenase (100 µg/tendon) on the Achilles tendon, which was removed for further analyses. The gene expression for COX-2; TNF-α; IL-6; and IL-10 (RT-PCR) was measured. The laser irradiation (660 nm, 100 mW, 3 J) used in the treatment of the tendinitis induced by collagenase in Achilles tendon in rats was effective in the reduction of important pro-inflammatory markers such as IL-6 and TNF-α, becoming a promising tool for the treatment of tendon diseases.
Asunto(s)
Tendón Calcáneo/efectos de la radiación , Expresión Génica/efectos de la radiación , Terapia por Luz de Baja Intensidad , Tendinopatía/radioterapia , Tendón Calcáneo/metabolismo , Tendón Calcáneo/patología , Animales , Antiinflamatorios no Esteroideos/uso terapéutico , Colagenasas , Ciclooxigenasa 2/genética , Ciclooxigenasa 2/metabolismo , Diclofenaco/uso terapéutico , Modelos Animales de Enfermedad , Interleucina-10/genética , Interleucina-10/metabolismo , Interleucina-6/genética , Interleucina-6/metabolismo , Masculino , Ratas , Ratas Wistar , Tendinopatía/inducido químicamente , Tendinopatía/metabolismo , Factor de Necrosis Tumoral alfa/genética , Factor de Necrosis Tumoral alfa/metabolismoAsunto(s)
Terapia por Luz de Baja Intensidad , Tendinopatía/radioterapia , Animales , Femenino , Humanos , MasculinoRESUMEN
The aim of this study was to investigate the effect of low-intensity laser (LILT) infrared (830 nm) therapy in tendon inflammation, tendinitis induced by mechanical trauma in rat Achilles tendon. For this, we used 65 young male Wistar rats, weighing ± 300 g divided into different groups: C = control (n = 5) and experimental (n = 10/group), with two different times of sacrifice such as treated with L = laser, D = treated with diclofenac, and T = untreated injured. The tendon inflammation was induced by controlled contusion in the medial region of the Achilles tendon of the animals. The treated groups received some kind of intervention every 24 h, all groups were sacrificed on the 7th or 14th day after the trauma. The tendons were dissected, extracted, and sent for analysis. Histological analysis of the L group showed a decrease in the number of inflammatory cells in relation to other groups in both periods studied. The comparative results between the number of inflammatory cells in the control and treated groups at 7 and 14 days showed statistically significant differences. Qualitative analysis findings obtained by the picrosirius red technique under polarized light showed that in 7 days, the T group presented collagen types I and III in the same proportion; group D presented a predominance of type III fibers, while in group L, type I collagen predominated. The 14-day group D showed collagen types I and III in the same proportion, while in group L, there was a predominance of type I fibers. Biomechanical analysis showed that 7-day groups L and C showed similar stiffness and increased breaking strength. The 14-day groups L and C showed greater rupturing strength as well as increased stiffness angle. Group D showed a decrease of maximum traction strength and degree of rigidity. It was concluded that treatment with LIL in the parameters used and the times studied reduces migration of inflammatory cells and improves the quality of repair while reducing the functional limitations.
Asunto(s)
Terapia por Luz de Baja Intensidad , Tendinopatía/radioterapia , Traumatismos de los Tendones/radioterapia , Tendón Calcáneo/lesiones , Tendón Calcáneo/fisiopatología , Tendón Calcáneo/efectos de la radiación , Animales , Antiinflamatorios no Esteroideos/farmacología , Antiinflamatorios no Esteroideos/uso terapéutico , Fenómenos Biomecánicos , Colágeno Tipo I/metabolismo , Diclofenaco/farmacología , Diclofenaco/uso terapéutico , Masculino , Ratas Wistar , Tendinopatía/inmunología , Traumatismos de los Tendones/inmunología , Cicatrización de Heridas/efectos de la radiaciónRESUMEN
A variety of treatments for tendinopathies is currently used or has been trialed. However, in fact, there is a remarkably little evidence that any conventional therapies are effective. In the last years, low-level laser therapy (LLLT) has been showing interesting results in inflammatory modulation in different musculoskeletal disorders, but the optimal parameters and mechanisms behind these effects are not fully understood. The aim of this study is to investigate if the LLLT modulates the acute and chronic phase of collagenase-induced tendinitis in rat by interfering in mRNA expression for matrix metalloproteinases (MMP13 and MMP1), vascular endothelial growth factor (VEGF), and anti-inflammatory mediator (interleukin (IL)-10). For such, tendinitis was induced by collagenase injection in male Wistar rats. Animals were treated with LLLT (780 nm, potency of 22 mW, 107 mW/cm(2), energy density of 7.5 J/cm(2), and energy delivered of 1.54 J) with different number of treatments in accordance with the inflammatory phase analyzed. LLLT was able to modulate mRNA gene expression of IL-10, VGEF, MMP1, and MMP13 both in acute than in chronic inflammatory phase (p<0.05). Our results suggest that LLLT with parameters employed in the present study was able to modulate IL-10, VEGF, MMP1, and MMP13 mRNA gene expression both in acute than in chronic tendon inflammation. However, further studies are needed to establish optimal parameters for LLLT.
Asunto(s)
Terapia por Luz de Baja Intensidad , Tendinopatía/radioterapia , Enfermedad Aguda , Animales , Enfermedad Crónica , Colagenasas/administración & dosificación , Modelos Animales de Enfermedad , Expresión Génica/efectos de la radiación , Inflamación/etiología , Inflamación/genética , Inflamación/radioterapia , Mediadores de Inflamación/metabolismo , Interleucina-10/genética , Masculino , Metaloproteinasa 1 de la Matriz/genética , Metaloproteinasa 13 de la Matriz/genética , ARN Mensajero/genética , ARN Mensajero/metabolismo , Ratas , Ratas Wistar , Tendinopatía/etiología , Tendinopatía/genética , Factor A de Crecimiento Endotelial Vascular/genéticaRESUMEN
NSAIDs are widely prescribed and used over the years to treat tendon injuries despite its well-known long-term side effects. In the last years several animal and human trials have shown that low-level laser therapy (LLLT) presents modulatory effects on inflammatory markers, however the mechanisms involved are not fully understood. The aim of this study was to evaluate the short-term effects of LLLT or sodium diclofenac treatments on biochemical markers and biomechanical properties of inflamed Achilles tendons. Wistar rats Achilles tendons (n = 6/group) were injected with saline (control) or collagenase at peritendinous area of Achilles tendons. After 1 h animals were treated with two different doses of LLLT (810 nm, 1 and 3 J) at the sites of the injections, or with intramuscular sodium diclofenac. Regarding biochemical analyses, LLLT significantly decreased (p < 0.05) COX-2, TNF-α, MMP-3, MMP-9, and MMP-13 gene expression, as well as prostaglandin E(2) (PGE(2) ) production when compared to collagenase group. Interestingly, diclofenac treatment only decreased PGE(2) levels. Biomechanical properties were preserved in the laser-treated groups when compared to collagenase and diclofenac groups. We conclude that LLLT was able to reduce tendon inflammation and to preserve tendon resistance and elasticity.
Asunto(s)
Tendón Calcáneo/patología , Colagenasas/metabolismo , Terapia por Luz de Baja Intensidad/métodos , Tendinopatía/radioterapia , Animales , Antiinflamatorios no Esteroideos/farmacología , Bioquímica/métodos , Fenómenos Biomecánicos , Colagenasas/química , Ciclooxigenasa 2/metabolismo , Diclofenaco/farmacología , Dinoprostona/metabolismo , Inflamación , Masculino , Metaloproteinasas de la Matriz/biosíntesis , Ratas , Ratas Wistar , Tendinopatía/etiología , Factor de Necrosis Tumoral alfa/biosíntesisRESUMEN
Low-level laser therapy (LLLT) has been found to produce anti-inflammatory effects in a variety of disorders. Tendinopathies are directly related to unbalance in expression of pro- and anti-inflammatory cytokines which are responsible by degeneration process of tendinocytes. In the current study, we decided to investigate if LLLT could reduce mRNA expression for TNF-α, IL-1ß, IL-6, TGF-ß cytokines, and COX-2 enzyme. Forty-two male Wistar rats were divided randomly in seven groups, and tendinitis was induced with a collagenase intratendinea injection. The mRNA expression was evaluated by real-time PCR in 7th and 14th days after tendinitis. LLLT irradiation with wavelength of 780 nm required for 75 s with a dose of 7.7 J/cm(2) was administered in distinct moments: 12 h and 7 days post tendinitis. At the 12 h after tendinitis, the animals were irradiated once in intercalate days until the 7th or 14th day in and them the animals were killed, respectively. In other series, 7 days after tendinitis, the animals were irradiated once in intercalated days until the 14th day and then the animals were killed. LLLT in both acute and chronic phases decreased IL-6, COX-2, and TGF-ß expression after tendinitis, respectively, when compared to tendinitis groups: IL-6, COX-2, and TGF-ß. The LLLT not altered IL-1ß expression in any time, but reduced the TNF-α expression; however, only at chronic phase. We conclude that LLLT administered with this protocol reduces one of features of tendinopathies that is mRNA expression for pro-inflammatory mediators.