• Ching-Hsia Hung, Po-Ching Huang, Jann-Inn Tzeng, Jhi-Joung Wang, and Yu-Wen Chen.
• C-H. Hung, PhD, Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan, and Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University.
• Phys Ther. 2016 Oct 1; 96 (10): 1545-1553.

BackgroundAlthough evidence suggests that therapeutic ultrasound (TU) in combination with treadmill training (TT) suppresses nerve injury-associated pain, the molecular mechanisms for this action are not clear.ObjectiveThe purpose of this research was to study the possible beneficial effects of TU and TT, alone and in combination, on 2 clinical indicators of neuropathic pain and correlate these findings with changes in inflammatory mediators within the spinal cord. Our experimental model used the well-known chronic constriction injury (CCI) of the rat sciatic nerve.DesignThis was an experimental study.MethodsEach group contained 10 rats. Group 1 underwent only the CCI procedure. Group 2 underwent a sham operation where the sciatic nerve was exposed but not ligated. Group 3 had the sham operation followed by both TT and TU. Groups 4, 5, and 6 underwent the CCI procedure followed by TT alone, TU alone, and both the TT and TU interventions, respectively. Heat and mechanical sensitivity, interleukin-6 (IL-6), interleukin-10 (IL-10), and ionized calcium binding adaptor molecule 1 (Iba1) were evaluated.ResultsCompared with group 1 animals, TT or TU, or both, produced smaller decreases in mechanical withdrawal threshold and heat withdrawal latencies. The combination of TT and TU was more effective than either treatment alone. In addition, rats that received these treatments did not express the upregulation of IL-6 and Iba1 in their spinal cords on postoperative days 14 and 28, as was found in the group 1 animals.LimitationsThese experimental findings may not be generalizable to humans.ConclusionsThe combination of TU and TT reduces neuropathic pain more than either modality alone. This beneficial effect appears related to downregulation of proinflammatory IL-6 and Iba1, while upregulating the anti-inflammatory IL-10.© 2016 American Physical Therapy Association.

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