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Equine veterinary journal2024; doi: 10.1111/evj.14083

Blood flow restriction training does not negatively alter the mechanical strength or histomorphology of uninjured equine superficial digital flexor tendons.

Abstract: Low load exercise training with blood flow restriction (BFR) has become increasingly used by human physical therapists to prescribe controlled exercise following orthopaedic injury; its effects on the equine superficial digital flexor tendon (SDFT), however, are unknown. Objective: To investigate outcomes of pressure specific BFR walking exercise on uninjured equine SDFT biomechanics and histomorphology. Methods: Controlled in vivo experiment. Methods: Four forelimbs of four horses were exposed to 40 BFR-walk sessions (10-min interval walking) on a treadmill over a 56-day study period with their contralateral forelimbs serving as untreated controls. Similarly, four forelimbs of four control horses were exposed to 40 sham cuff walk sessions. On study Day 56, all horses (n = 8) were humanely euthanised and forelimb SDFTs underwent non-destructive biomechanical testing and corresponding histomorphological analysis. Significance in biomechanical parameters between treatment groups was analysed using a mixed-effects ANOVA with Tukey's post-hoc tests. Results: Statistically significant differences in SDFT stiffness for both first (p = 0.02) and last cycles (p = 0.03) were appreciated within the BFR treated group only, with BFR exposed forelimbs being significantly stiffer than the contralateral unexposed forelimbs. When normalised to cross-sectional area, no significant differences were appreciated among treatment groups in elastic modulus for the first (p = 0.5) or last cycles (p = 0.4). No histological differences were appreciated among treatment groups according to Bonar, Movin, or musculotendinous junction evaluation criteria. Conclusions: Short-term comparisons were performed in a small sample population without correlation to performance outcome measures. Optimal occlusion percentages and walk protocols remain unknown. Conclusions: This study demonstrated no negative impact of BFR on mechanical strength of the equine SDFT; however, evidence suggests that BFR results in increased tendon stiffness based on biomechanical testing and subsequent calculations. No consistent detrimental histomorphological changes were seen. Unassigned: Exercício de baixa carga com restrição do fluxo sanguíneo (RFS) tem sido cada vez mais utilizado por fisioterapeutas humanos para tratar lesões ortopédicas. Porém, seus efeitos no tendão flexor digital superficial (TFDS) de equinos não é conhecida. Objective: O objetivo deste estudo foi investigar o efeito de específicas pressões com RFS durante o passo em cavalos sem lesão no TFDS, por meio de histologia e análise biomecânica. Unassigned: Estudo controlado. MÉTODOS: Quatro membros torácicos de quatro cavalos foram expostos a 40 sessões de RFS durante o passo (10 minutos de caminhada intervalada), ao longo de 56 dias. O membro contralateral foi utilizado como controle. Da mesma forma, quatro membros de quatro cavalos controle foram expostos a 40 sessões simuladas de caminhada com torniquete. No dia 56, todos os cavalos (n = 8) foram eutanasiados, e os TFDS foram submetidos a testes biomecânicos não destrutivos e análise histológica. A significância dos parâmetros biomecânicos entre tratamentos foi analisada utilizando ANOVA de efeitos mistos, seguida pelo teste de Tukey. Results: A rigidez do TFDS foi estatisticamente diferente nos primeiros (p = 0.02) e últimos (p = 0.03) ciclos no grupo submetido à RFS, sendo os membros tratados significativamente mais rígidos do que os membros contralaterais não expostos ao tratamento. Quando normalizado para a área transversal, não foi observada diferença significativa entre os grupos de tratamento no módulo de elasticidade para os primeiros (p = 0.5) e últimos (p = 0.4) ciclos. Não foram identificadas diferenças histológicas nos diferentes tipos de tratamento, de acordo com os critérios de avaliação Bonar, Movin e de junção musculo‐tendínea. PRINCIPAIS LIMITAÇÕES: Comparações de curto prazo foram realizadas em uma amostra pequena da população, sem correlação com medidas de resultados de desempenho. As porcentagens ideais de oclusão e os protocolos de caminhada permanecem desconhecidos. CONCLUSÕES: Este estudo não demonstrou impacto negativo do RFS na resistência mecânica do TFDS equino; no entanto, as evidências sugerem que a RFS resulta em aumento da rigidez do tendão com base em testes biomecânicos e cálculos subsequentes. Nenhuma alteração histológica prejudicial consistente foi observada.
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Publication Date: 2024-04-24 PubMed ID: 38659234DOI: 10.1111/evj.14083Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

The research examines the effect of low load exercise with blood flow restriction (BFR) on the biomechanical strength and histomorphology of uninjured equine superficial digital flexor tendons (SDFT). The study showed no negative impact of BFR on the mechanical strength of SDFT, but there was evidence of increased tendon stiffness.

Study Method

  • The study was a controlled in vivo experiment that involved eight horses. Four of them were exposed to 40 BFR walk sessions on a treadmill over a period of 56 days. The contralateral forelimbs of these horses were not treated and hence served as controls.
  • The other four horses were exposed to 40 sham cuff walk sessions which served as another control measure.
  • At the end of the 56 days, all eight horses were humanely euthanized. The SDFTs were subjected to non-destructive biomechanical testing and detailed histological analysis.
  • The results were analyzed using a mixed-effects ANOVA with Tukey’s post-hoc tests to determine significance.

Study Results

  • Biomechanical testing revealed significant differences in tendon stiffness within the BFR treated group. The BFR exposed limbs were significantly stiffer than their unexposed counterparts.
  • No significant differences were observed when the results were normalized to cross-sectional area, with regards to the elastic modulus for the first or the last cycles.
  • On a histological scale, no consistent detrimental changes were observed based on evaluation criteria such as Bonar, Movin, or musculotendinous junction evaluation.

Study Limitations and Conclusions

  • The research was limited by its short-term timeline and small sample size. It also did not present any correlation to performance outcome measures.
  • Optimal occlusion percentages and walk protocols for BFR also remain unclear.
  • Despite these limitations, the study affirms that BFR does not have a negative impact on the mechanical strength of the equine SDFT. However, it does increase tendon stiffness.
  • As such, more detailed and larger studies are needed to further understand the effects of BFR on equine tendons and to determine the optimal parameters for BFR application.

Cite This Article

APA
Johnson SA, Sikes KJ, Johnson JW, Van Zeeland E, Wist S, Santangelo KS, King MR, Frisbie DD. (2024). Blood flow restriction training does not negatively alter the mechanical strength or histomorphology of uninjured equine superficial digital flexor tendons. Equine Vet J. https://doi.org/10.1111/evj.14083

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English

Researcher Affiliations

Johnson, Sherry A
  • Department of Clinical Sciences, Orthopaedic Research Center at the Translational Medicine Institute, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.
Sikes, Katie J
  • Department of Clinical Sciences, Orthopaedic Research Center at the Translational Medicine Institute, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.
Johnson, James W
  • Department of Mechanical Engineering, Colorado State University, Fort Collins, Colorado, USA.
Van Zeeland, Emily
  • Department of Clinical Sciences, Orthopaedic Research Center at the Translational Medicine Institute, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.
Wist, Sara
  • Department of Clinical Sciences, Orthopaedic Research Center at the Translational Medicine Institute, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.
Santangelo, Kelly S
  • Department of Microbiology, Immunology & Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.
King, Melissa R
  • Department of Clinical Sciences, Orthopaedic Research Center at the Translational Medicine Institute, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.
Frisbie, David D
  • Department of Clinical Sciences, Orthopaedic Research Center at the Translational Medicine Institute, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.

Grant Funding

  • Translational Acceleration Program (TAP) of the Translational Medicine Institute, College of Veterinary Medicine and Biomedical Sciences, Colorado State University

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