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      Promising Effect of Visually-Assisted Motor Imagery Against Arthrogenic Muscle Inhibition – A Human Experimental Pain Study

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          Clinically, arthrogenic muscle inhibition (AMI) has a negative impact on functional recovery in musculoskeletal disorders. One possible technique to relieve AMI is motor imagery, which is widely used in neurological rehabilitation to enhance motor neuron excitability. The purpose of this study was to verify the efficacy of visually-assisted motor imagery against AMI using a human experimental pain model.


          Ten healthy volunteers were included. Experimental ankle pain was induced by hypertonic saline infusion into unilateral Kager’s fat pad. Isotonic saline was used as control. Subjects were instructed to imagine while watching a movie in which repetitive motion of their own ankle or fingers was shown. H-reflex normalized by the motor response (H/M ratio) on soleus muscle, maximal voluntary contraction (MVC) force of ankle flexion, and contractile activities of the calf muscles during MVC were recorded at baseline, pre-intervention, post-intervention, and 10 minutes after the pain had subsided.


          Hypertonic saline produced continuous and constant peri-ankle pain (VAS peak [median]= 6.7 [2.1–8.4] cm) compared to isotonic saline (0 [0–0.8] cm). In response to pain, there were significant decreases in the H/M ratio, MVC and contractile activities (P<0.01), all of which were successfully reversed after the ankle motion imagery. In contrast, no significant changes were observed with the finger motion imagery.


          Visually-assisted motor imagery improved the pain-induced AMI. Motor imagery of the painful joint itself would efficiently work for relieving AMI. This investigation possibly shows the potential of a novel and versatile approach against AMI for patients with musculoskeletal pain.

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          Most cited references 55

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          The neural network of motor imagery: an ALE meta-analysis.

          Motor imagery (MI) or the mental simulation of action is now increasingly being studied using neuroimaging techniques such as positron emission tomography and functional magnetic resonance imaging. The booming interest in capturing the neural underpinning of MI has provided a large amount of data which until now have never been quantitatively summarized. The aim of this activation likelihood estimation (ALE) meta-analysis was to provide a map of the brain structures involved in MI. Combining the data from 75 papers revealed that MI consistently recruits a large fronto-parietal network in addition to subcortical and cerebellar regions. Although the primary motor cortex was not shown to be consistently activated, the MI network includes several regions which are known to play a role during actual motor execution. The body part involved in the movements, the modality of MI and the nature of the MI tasks used all seem to influence the consistency of activation within the general MI network. In addition to providing the first quantitative cortical map of MI, we highlight methodological issues that should be addressed in future research. Copyright © 2013 Elsevier Ltd. All rights reserved.
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            Quadriceps weakness in knee osteoarthritis: the effect on pain and disability.

            (1) To determine the importance of quadriceps strength, structural change, and psychological status in terms of knee pain in the community. (2) To determine the relative importance of quadriceps function, structural change, and psychological status with respect to disability in subjects with knee pain. 300 men and women with pain and 300 controls without pain (aged 40-79) were seen. Isometric quadriceps strength (MVC) was measured and muscle activation was assessed by twitch superimposition. Disability (Western Ontario McMaster Osteoarthritis Index (WOMAC)) and anxiety and depression were assessed (Hospital Anxiety and Depression Index (HAD)). Radiographs were obtained of the tibiofemoral and patellofemoral joints and total score for osteophyte, narrowing, and sclerosis calculated for each knee. Subjects with knee pain had lower voluntary quadriceps strength than those without pain (p or = 8); and radiographic change (odds ratio 4.1, CI 1.9, 8.6 for radiographic score > or = 4) were independently associated with pain. In those with knee pain, disability was independently associated with quadriceps strength (odds ratio 8.2, CI 1.5, 44.4 for MVC or = 8); but not with radiographic score. Quadriceps strength is strongly associated with knee pain and disability in the community, even when activation and psychological factors are taken into account. This has important therapeutic implications.
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              Quadriceps arthrogenic muscle inhibition: neural mechanisms and treatment perspectives.

              Arthritis, surgery, and traumatic injury of the knee joint are associated with long-lasting inability to fully activate the quadriceps muscle, a process known as arthrogenic muscle inhibition (AMI). The goal of this review is to provide a contemporary view of the neural mechanisms responsible for AMI as well as to highlight therapeutic interventions that may help clinicians overcome AMI. An extensive literature search of electronic databases was conducted including AMED, CINAHL, MEDLINE, OVID, SPORTDiscus, and Scopus. While AMI is ubiquitous across knee joint pathologies, its severity may vary according to the degree of joint damage, time since injury, and knee joint angle. AMI is caused by a change in the discharge of articular sensory receptors due to factors such as swelling, inflammation, joint laxity, and damage to joint afferents. Spinal reflex pathways that likely contribute to AMI include the group I nonreciprocal (Ib) inhibitory pathway, the flexion reflex, and the gamma-loop. Preliminary evidence suggests that supraspinal pathways may also play an important role. Some of the most promising interventions to counter the effects of AMI include cryotherapy, transcutaneous electrical nerve stimulation, and neuromuscular electrical stimulation. Nonsteroidal anti-inflammatory drugs and intra-articular corticosteroids may also be effective when a strong inflammatory component is present with articular pathology. AMI remains a significant barrier to effective rehabilitation in patients with arthritis and following knee injury and surgery. Gaining a better understanding of AMI's underlying mechanisms will allow the development of improved therapeutic strategies, enhancing the rehabilitation of patients with knee joint pathology. Copyright © 2010 Elsevier Inc. All rights reserved.

                Author and article information

                J Pain Res
                J Pain Res
                Journal of Pain Research
                03 February 2021
                : 14
                : 285-295
                [1 ]Department of Rehabilitation Center, Kochi Medical School Hospital , Nankoku, Kochi, Japan
                [2 ]Department of Orthopedic Surgery, Kochi University , Nankoku, Kochi, Japan
                [3 ]Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University , Aalborg, Denmark
                Author notes
                Correspondence: Masashi Izumi Department of Orthopedic Surgery, Kochi University , Oko-Cho Kohasu, Nankoku, Kochi, Japan, 783-8505Tel +81-88-880-2386Fax +81-88-880-2388 Email izumim@kochi-u.ac.jp
                © 2021 Oda et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 7, Tables: 5, References: 56, Pages: 11
                Funded by: Center for Neuroplasticity and Pain (CNAP);
                This study was supported by JSPS KAKENHI Grant Number 19K19868. Center for Neuroplasticity and Pain (CNAP) is supported by the Danish National Research Foundation (DNRF121).
                Original Research


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