Yakuwa T1, Inoue S1, Nomura M1,2, Wakimoto Y1, Li C1, Wakigawa T3, Kinoshita S3, Tsubaki T3, Hatakeyama J3, Sakai Y4, Akisue T5, Moriyama H5
1Kobe University Graduate School of Health Sciences, Department of Rehabilitation Science, Kobe, Japan, 2Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan, 3Kobe University School of Medicine Faculty of Health Sciences, Physical Therapy Major, Kobe, 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 immobilization is useful for the treatment of joint injuries and diseases, but it causes multiple alterations in muscles and joint components (e.g., muscle atrophy, fibrosis of these tissue, and shortening of posterior synovium). These alternations cause contractures that decrease activities of daily living and quality of life for the patients. In clinical settings, the contractures may be one of the most frequent problem faced by physical therapists. Recently, transcutaneous carbon dioxide (CO2) therapy has been developed, verifying this therapeutic application in various disorders: bone fracture, muscle injury, and tumor. In our experience, CO2 therapy can also be effective contractures secondary to joint immobilization. However, whether CO2 therapy can improve the alternations of muscles and joint components following joint immobilization remains unclear.
Purpose: We aimed to examine the effect of CO2 therapy on the alterations in muscles and joint components following joint immobilization.
Methods: Sixteen 10-week-old male Wistar rats were divided into the following 3 groups: control without intervention (control group), knee joint immobilization (IM group), and knee joint immobilization treated with CO2 therapy (CO2 group). The knee joints were immobilized at the full flexed position with external fixation. The hindlimbs of CO2 group were exposed to CO2 gas for 20 minutes once a day. As preventive intervention, CO2 therapy was started at the first day after joint immobilization and treated for either 2 or 4weeks. On the other hand, as therapeutic intervention, CO2 group was treated for 2weeks after 2-week or 4-week joint immobilization. After these interventions, semitendinosus was extracted and the muscle wet weight was measured to evaluate muscle atrophy. Moreover, the muscle sections were stained with picrosirius red for the quantification of fibrosis. The mRNA expressions of type I collagen, a marker of tissue stiffness, and TGF-b, a marker of fibrosis, from semitendinosus were assessed by real-time PCR. In addition, undecalcified frozen sections from the knee joints were stained with hematoxylin and eosin to measure the posterior synovial length. The fibrosis of joint capsules was evaluated with immunohistochemical staining of type I collagen and TGF-b.
Results: Joint immobilization decreased the muscle wet weight and the posterior synovial length, whereas CO2 therapy did not improve them. There were no differences in the histologic quantification of muscle fibrosis, and the type I collagen in muscles and joint capsules among the groups. Meanwhile, immobilization increased TGF-b in both muscles and joint capsules, and CO2 therapy improved this increase only in joint capsules, but not in muscles.
Conclusion(s): Our findings indicate that CO2 therapy may effective for attenuating the joint capsular fibrosis. CO2 gas is exposed and percutaneously absorbed, and therefore the improvements in deep-lying capsule but not superficial muscle is a surprising, and so far unexplained, finding.
Implications: CO2 therapy is easy and non-invasive treatment and has potential to be a novel therapeutic approach for the capsular fibrosis following joint immobilization.
Keywords: Carbon dioxide therapy, joint immobilization, fibrosis
Funding acknowledgements: This study was supported by the Japan Society for the Promotion of Science (17K19908).
Purpose: We aimed to examine the effect of CO2 therapy on the alterations in muscles and joint components following joint immobilization.
Methods: Sixteen 10-week-old male Wistar rats were divided into the following 3 groups: control without intervention (control group), knee joint immobilization (IM group), and knee joint immobilization treated with CO2 therapy (CO2 group). The knee joints were immobilized at the full flexed position with external fixation. The hindlimbs of CO2 group were exposed to CO2 gas for 20 minutes once a day. As preventive intervention, CO2 therapy was started at the first day after joint immobilization and treated for either 2 or 4weeks. On the other hand, as therapeutic intervention, CO2 group was treated for 2weeks after 2-week or 4-week joint immobilization. After these interventions, semitendinosus was extracted and the muscle wet weight was measured to evaluate muscle atrophy. Moreover, the muscle sections were stained with picrosirius red for the quantification of fibrosis. The mRNA expressions of type I collagen, a marker of tissue stiffness, and TGF-b, a marker of fibrosis, from semitendinosus were assessed by real-time PCR. In addition, undecalcified frozen sections from the knee joints were stained with hematoxylin and eosin to measure the posterior synovial length. The fibrosis of joint capsules was evaluated with immunohistochemical staining of type I collagen and TGF-b.
Results: Joint immobilization decreased the muscle wet weight and the posterior synovial length, whereas CO2 therapy did not improve them. There were no differences in the histologic quantification of muscle fibrosis, and the type I collagen in muscles and joint capsules among the groups. Meanwhile, immobilization increased TGF-b in both muscles and joint capsules, and CO2 therapy improved this increase only in joint capsules, but not in muscles.
Conclusion(s): Our findings indicate that CO2 therapy may effective for attenuating the joint capsular fibrosis. CO2 gas is exposed and percutaneously absorbed, and therefore the improvements in deep-lying capsule but not superficial muscle is a surprising, and so far unexplained, finding.
Implications: CO2 therapy is easy and non-invasive treatment and has potential to be a novel therapeutic approach for the capsular fibrosis following joint immobilization.
Keywords: Carbon dioxide therapy, joint immobilization, fibrosis
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.
