Wakigawa T1, Inoue S2, Yakuwa T2, Nomura M2,3, Wakimoto Y2, Li C2, Hatakeyama J1, Tsubaki T1, Kinoshita S1, Sakai Y4, Akisue T5, Moriyama H5
1Kobe University School of Medicine Faculty of Health Sciences, Physical Therapy Major, Kobe, Japan, 2Kobe University Graduate School of Health Sciences, Department of Rehabilitation Science, Kobe, Japan, 3Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan, 4Kobe University Graduate School of Medicine, Division of Rehabilitation Medicine, Kobe, Japan, 5Kobe University, Life and Medical Sciences Area, Health Sciences Discipline, Kobe, Japan
Background: Joint contractures are a major complication following joint immobilization, and are characterized by limitations in the passive range of motion (ROM) of the affected joints. ROM limitations diminish activities of daily living and quality of life for patients with immobilized joints. Positioning, stretching, and physical therapy are advocated to prevent and treat immobilization-induced contractures. However, the clinically worthwhile of these treatment are insufficient to heal completely, and therefore novel therapeutic approaches are required. Recently, transcutaneous carbon dioxide (CO₂) as a novel medical gas has gained much interest. Although CO₂ therapy were developed by verifying this therapeutic application in various disorders such as trauma, fracture, and sarcoma, its effect on contractures remains unclear.
Purpose: Our objective was to investigate the efficacy of CO₂ therapy as a prevention and treatment regimen for contractures following joint immobilization.
Methods: Sixteen 10-week-old male Wistar rats were randomized into 3 groups: control without interventions, knee joint immobilization (IM), and knee joint immobilization treated with CO₂ therapy (CO₂). In the IM and CO₂ groups, the animals' knee joints were immobilized in full flexed position with external fixation. As a preventive intervention, CO₂ group was started treatment at the first day and treated during immobilization for 2 or 4 weeks. On the other hand, as a therapeutic intervention, the fixation device was removed at either 2 or 4 weeks after immobilization, and subsequently CO₂ treatment performed for 2 weeks. The rats were applied the hydrogel which promote absorption of the CO₂ on the lower limbs. Then, the diluted 100% CO₂ gas was exposed and percurtaneously absorbed to the entire hind limb. This treatment was applied daily for 20 minutes. At the end of the intervention period, the degree of knee flexion contractures (total contracture) was assessed by measuring the ROM. Myotomy of the knee flexors was then performed, and the ROM was measured again. The degree of myogenic contracture and arthrogenic contracture were calculated from the ROM values before and after the myotomy.
Results: Knee flexion contractures developed in the rats following immobilization at all time points. The CO₂ treatment improved the limitation in extension ROM in the preventive intervention for 4 weeks and in the therapeutic intervention for 2 and 4 weeks, but not in the preventive intervention for 2 weeks. For the myogenic and arthrogenic contractures, no significant differences were found among groups in the preventive intervention. However, in the therapeutic intervention, arthrogenic contractures of the CO₂ group were significantly smaller than those in the IM group.
Conclusion(s): Our findings show that transcutaneous CO₂ application improves the limitation in ROM in the preventive and therapeutic intervention. Thus, CO₂ therapy may be effective for the treatment of immobilization-induced contractures.
Implications: CO₂ therapy allows easy and noninvasive topical application to the limb. Hence, this strategy may be novel therapeutic approaches of contractures following immobilization, which has potential to be available for clinical situations.
Keywords: Contractures, joint immobilization, carbon dioxide therapy
Funding acknowledgements: This study was supported by the Japan Society for the Promotion of Science (17K19908).
Purpose: Our objective was to investigate the efficacy of CO₂ therapy as a prevention and treatment regimen for contractures following joint immobilization.
Methods: Sixteen 10-week-old male Wistar rats were randomized into 3 groups: control without interventions, knee joint immobilization (IM), and knee joint immobilization treated with CO₂ therapy (CO₂). In the IM and CO₂ groups, the animals' knee joints were immobilized in full flexed position with external fixation. As a preventive intervention, CO₂ group was started treatment at the first day and treated during immobilization for 2 or 4 weeks. On the other hand, as a therapeutic intervention, the fixation device was removed at either 2 or 4 weeks after immobilization, and subsequently CO₂ treatment performed for 2 weeks. The rats were applied the hydrogel which promote absorption of the CO₂ on the lower limbs. Then, the diluted 100% CO₂ gas was exposed and percurtaneously absorbed to the entire hind limb. This treatment was applied daily for 20 minutes. At the end of the intervention period, the degree of knee flexion contractures (total contracture) was assessed by measuring the ROM. Myotomy of the knee flexors was then performed, and the ROM was measured again. The degree of myogenic contracture and arthrogenic contracture were calculated from the ROM values before and after the myotomy.
Results: Knee flexion contractures developed in the rats following immobilization at all time points. The CO₂ treatment improved the limitation in extension ROM in the preventive intervention for 4 weeks and in the therapeutic intervention for 2 and 4 weeks, but not in the preventive intervention for 2 weeks. For the myogenic and arthrogenic contractures, no significant differences were found among groups in the preventive intervention. However, in the therapeutic intervention, arthrogenic contractures of the CO₂ group were significantly smaller than those in the IM group.
Conclusion(s): Our findings show that transcutaneous CO₂ application improves the limitation in ROM in the preventive and therapeutic intervention. Thus, CO₂ therapy may be effective for the treatment of immobilization-induced contractures.
Implications: CO₂ therapy allows easy and noninvasive topical application to the limb. Hence, this strategy may be novel therapeutic approaches of contractures following immobilization, which has potential to be available for clinical situations.
Keywords: Contractures, joint immobilization, carbon dioxide therapy
Funding acknowledgements: This study was supported by the Japan Society for the Promotion of Science (17K19908).
Topic: Musculoskeletal: lower limb; Musculoskeletal: lower limb; Disability & rehabilitation
Ethics approval required: Yes
Institution: Kobe University
Ethics committee: Institutional Animal Care and Use Committee
Ethics number: P160506
All authors, affiliations and abstracts have been published as submitted.
