Tissue Eng Part B Rev. 2018 Apr;24(2):144-154. doi: 10.1089/ten.TEB.2017.0294. Epub 2017 Nov 17.

Pulsed Electromagnetic Fields and Tissue Engineering of the Joints.

Iwasa K¹, Reddi AH¹.

Author information

1 Department of Orthopaedic Surgery, Lawrence Ellison Center for Tissue Regeneration and Repair, School of Medicine, University of California , Davis, Davis, California.

Abstract

BACKGROUND:

Bone and joint formation, maintenance, and regeneration are regulated by both chemical and physical signals. Among the physical signals there is an increasing realization of the role of pulsed electromagnetic fields (PEMF) in the treatment of nonunions of bone fractures. The discovery of the piezoelectric properties of bone by Fukada and Yasuda in 1953 in Japan established the foundation of this field. Pioneering research by Bassett and Brighton and their teams resulted in the approval by the Food and Drug Administration (FDA) of the use of PEMF in the treatment of fracture healing. Although PEMF has potential applications in joint regeneration in osteoarthritis (OA), this evolving field is still in its infancy and offers novel opportunities.

METHODS:

We have systematically reviewed the literature on the influence of PEMF in joints, including articular cartilage, tendons, and ligaments, of publications from 2000 to 2016.

CONCLUSIONS:

PEMF stimulated chondrocyte proliferation, differentiation, and extracellular matrix synthesis by release of anabolic morphogens such as bone morphogenetic proteins and anti-inflammatory cytokines by adenosine receptors A2_A and A3 in both in vitro and in vivo investigations. It is noteworthy that in clinical translational investigations a beneficial effect was observed on improving function in OA knees. However, additional systematic studies on the mechanisms of action of PEMF on joints and tissues therein, articular cartilage, tendons, and ligaments are required.

KEYWORDS:

PEMF; articular cartilage; regeneration

Indian J Orthop. 2016 Jan-Feb; 50(1): 87–93. doi:  10.4103/0019-5413.173522 PMCID: PMC4759881

Low dose short duration pulsed electromagnetic field effects on cultured human chondrocytes: An experimental study

Selvam Anbarasan, Ulaganathan Baraneedharan,¹ Solomon FD Paul, Harpreet Kaur, Subramoniam Rangaswami,² andEmmanuel Bhaskar³ Department of Human Genetics, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India ¹Department of Biomedical Sciences, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India ²Department of Orthopaedics, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India ³Department of General Medicine, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India Address for correspondence: Mr. Selvam Anbarasan, Department of Human Genetics, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India. E-mail: moc.liamg@ivakbna Author information Copyright and License information Copyright : © Indian Journal of Orthopaedics This is an open access article distributed under the terms of the Creative Commons Attribution NonCommercial ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Abstract

Background:

Pulsed electromagnetic field (PEMF) is used to treat bone and joint disorders for over 30 years. Recent studies demonstrate a significant effect of PEMF on bone and cartilage proliferation, differentiation, synthesis of extracellular matrix (ECM) and production of growth factors. The aim of this study is to assess if PEMF of low frequency, ultralow field strength and short time exposure have beneficial effects on in-vitro cultured human chondrocytes.

Materials and Methods:

Primary human chondrocytes cultures were established using articular cartilage obtained from knee joint during joint replacement surgery. Post characterization, the cells were exposed to PEMF at frequencies ranging from 0.1 to 10 Hz and field intensities ranging from 0.65 to 1.95 ?T for 60 min/day for 3 consecutive days to analyze the viability, ECM component synthesis, proliferation and morphology related changes post exposure. Association between exposure doses and cellular effects were analyzed with paired’t’ test.

Results:

In-vitro PEMF exposure of 0.1 Hz frequency, 1.95 ?T and duration of 60 min/day for 3 consecutive days produced the most favorable response on chondrocytes viability (P < 0.001), ECM component production (P< 0.001) and multiplication. Exposure of identical chondrocyte cultures to PEMFs of 0.65 ?T field intensity at 1 Hz frequency resulted in less significant response. Exposure to 1.3 ?T PEMFs at 10 Hz frequency does not show any significant effects in different analytical parameters.

Conclusions:

Short duration PEMF exposure may represent a new therapy for patients with Osteoarthritis (OA).Keywords: Human chondrocytes, osteoarthritis, pulsed electromagnetic field MeSh terms: Osteoarthritis, cartilage, articular, chondrocytes, electromagnetic fields

Introduction

Pulsed electromagnetic field (PEMF) has been used to treat bone and joint disorders for over 30 years.¹Clinical use of PEMF preceded systematic research in its utility for bone and joint healing.² Later studies identified that PEMF is capable of producing significant cellular changes in bone and cartilage cells by proliferation, differentiation, synthesis of extracellular matrix (ECM) and production of growth factors.^{3,4,5,7,8,9,10} A systematic review based on 3 clinical studies which assessed effect of PEMF therapy for osteoarthritis (OA) of knee, incorporating factors like pain, physical function, patient assessment, joint imaging, health related quality of life and physician global assessment indicates that electrical stimulation therapy may be useful in OA of knee, but stresses the need for confirmation in future studies.¹¹ Proteoglycan (PG) loss occurs in joint cartilage in OA and PEMF therapy has been shown to induce PG synthesis in-vivoand in-vitro.¹² PEMF has also demonstrated to have positive effect on cellular proliferation and DNA synthesis through opening of voltage sensitive calcium channels.¹³ Animal models have shown that PEMF therapy retards progression of OA.^14,15

Most studies employing PEMF have used frequencies of 6- 75 Hz and field strengths of 0.4- 2.3 milli Tesla (mT). We desired to enquire if low frequency (0.1- 10 Hz), low field strength of 0.65- 1.95 µT and short duration exposure (60 min/day) of PEMF results in favorable effects on cultured human chondrocytes (synthesis of ECM; cell viability, proliferation and morphology). Further need for the study is to arrive at a minimal PEMF exposure protocol that is expected to decrease the concern related to unfavorable cellular changes and chromosomal aberrations that may result with high dose PEMF exposure.¹⁶

Materials and Methods

Isolation and characterization of chondrocytes

Articular cartilage samples were obtained from knee joint during joint replacement surgery after obtaining informed consent from patients. The study protocol was approved by Institutional Ethics Committee. Cartilage tissue over the nonweight bearing portion of the joint was removed and minced in Dulbecco’s modified eagle medium (DMEM) (Biogene technologies, India) supplemented with 10% FBS (Biogene technologies, India) and 1 ml Pen-strep (10000 units of penicillin and 10 mg of streptomycin, Invitrogen, India). Following this, the tissue was transferred into a conical flask and initially digested with pronase (1 mg/ml) (Biogene technologies, India) for 60 min, followed by type II collagenase (1 mg/1ml) (Invitrogen) for 16- 18 hours at 37°C. The following day, cellular debris and undigested tissue were removed and cells were separated using a 100 micron cell strainer. Isolated cells were seeded into 25 cm ² culture flasks (TPP, India) with DMEM complete medium and maintained at 37°C with 5% CO₂ levels. The cells were subcultured on attainment of 80% confluency. The attached cells were characterized by chondrocyte specific anti-Sox 9 transcription factor antibody staining (Abcam, India.). Chondrocytes that failed to form monolayer culture were not processed further. Post characterization, 4 × 10⁵ cells were seeded in each flask and used for PEMF exposure after first passage.

Pulsed electromagnetic field exposure

The PEMF coil system fashioned for exposure is a four member coil frames, two larger (inner) and two smaller (outer) coil frames. The coils are mounted coaxially and in a co-planar fashion to form an enclosure, where it delivers currents in milliamps at desired waveforms, varying frequencies and magnetic field strength (Madras Institute of Magnetobiology, Chennai, India). This system designed according to the parametrical equation of Fansleau and Brauenbeck and a modified version of the Helmhotz coil. A box is housed inside the coil in which a 100 W bulb with regulator was used to maintain the temperature at 37°C and water to maintain humidity. Instead of 5% CO₂, 20 mM HEPES was used as a buffering system. The chondrocytes were exposed to PEMF while monitoring field strength, frequency and temperature. The control (unexposed) cells were placed in the same environment and temperature but not exposed to PEMF.

Pulsed electromagnetic field treatment

The chondrocytes were seeded in 25 cm ² culture flasks at concentrations of 6.5 × 10⁵ cells/ml after 20 h being plated the cells were washed with phosphate buffer saline (PBS), and given fresh medium and exposed to PEMF for the first three daily trials; media was not changed from this point onwards. PEMF at a frequency of 0.1, 1 and 10 Hz were applied with flux densities of 0.65, 1.3 and 1.95 µT (peak-to-peak) for 60 min/day for 3 consecutive days. Whereas exposure to PEMFs at a repetition rate of 0.1 and 1 Hz with 1.95 and 0.65 µT caused a significant increase in chondrocyte viability that was dependent on PEMF amplitude, PEMFs applied at a repetition rate of 10 Hz and 1.3 µT did not produce any noticeable effects over cell viability and were not dealt with further in this manuscript. To test for effects of different exposure durations, cells were exposed to PEMFs of 1.95 and 0.65 µT magnitude and at frequency of 0.1 and 1 Hz for 60 min/day for 3 days. Cells were analyzed on third day for further experimental studies.

Cell viability assessment

Chondrocytes were cultured in 96 well plates at a density of 5 × 10³ cells per well and exposed to PEMF in accordance to the exposure protocol mentioned. Twenty microliter of 0.5% 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) (Invitrogen) in phosphate buffered saline was added to each well after removal of medium and cells were incubated for 3 h at 37°C. Post incubation, 150 µl dimethyl sulfoxide (Hi-media, India) was added to each well and absorbance values (optical density value) were noted at 570 nm and 695 nm in spectrophotometer.¹⁷

Quantitative measurement of extracellular matrix proteoglycan and glycosaminoglycan synthesis

Chondrocytes were cultured in 48 well plates at densities of 10⁴ cells per well and exposed to PEMF in accordance to the exposure protocol mentioned. Postexposure, glycosaminoglycan (GAG) synthesis was quantified by the dimethyl methylene blue (DMMB) assay. The DMMB reagent (Sigma, India) was prepared as detailed by Panin et al.¹⁸ and 200 µL was added to each well after removal of culture medium. Subsequently, absorbance values at 525 nm were noted.

Analysis of cell cycle by flow cytometry

Chondrocytes were cultured in 25 cm ² culture flasks and exposed to PEMFs as mentioned earlier. After exposure, the cells were trypsinized, converted to single cell suspension in PBS and subjected to flow cytometery (FACS calibur, Becton Dickinson, Germany) according to the manufacturer’s instruction (Invitrogen, India) as follows: The suspension was spun at 1000 rpm for 10 min and the cell pellet was fixed in 70% ice cold ethanol at 4°C overnight. The cells were washed with PBS, treated with 500 µl RNAse A (40 µg/ml) (Sigma, India.) for 30 min at 37°C and stained with 500 µl propidium iodide (40 µg/ml) for 15 min incubation at room temperature. Postincubation, cell distributions at distinct phases of the cell cycle were analyzed by flow cytometery.

Analysis of cell architecture and morphology

Cell architecture and morphology were analyzed by staining of actin filaments in chondrocytes. Chondrocytes were cultured on cover slips in 6 well culture plates and exposed to PEMFs as described earlier. Processing of cells was done according to the manufacturer’s instructions (Invitrogen, India.). Briefly, the cells were fixed in 3.7% formaldehyde solution for 10 min after washing the slide with PBS and permeabilized in 0.1% Triton X-100 for 5 min. After washing with PBS, the cells were stained with 0.05 mg/ml Phalloidin solution at room temperature for 20-30 min, followed by counterstaining with 300 µl Propidium Iodide (500 nM). The coverslips were then rinsed in PBS, placed on a glass slide and cellular architecture and stress fiber formation was qualitatively analyzed by fluorescent confocal microscopy (LSM 510 META, Carl Zeiss, Germany).

Statistical analysis

Discrete variables were expressed as number (%) and continuous variables expressed as mean ± Standard Deviation. Association between field strengths (0.65, 1.3, and 1.95 µT) in variable frequencies (0.1, 1, and 10 Hz) and cellular effects (cell viability and ECM production,) was analyzed with paired ‘t’ test. A P < 0.05 was considered as statistically significant. Analysis was done with Statistical Package for the social sciences (SPSS) software version 21.0. This software was released in 2012 and used to solve business and research problems by means of ad-hoc analysis, hypothesis testing and predictive analysis.

Results

Isolation of chondrocytes

Healthy chondrocytes were observed in cultures by 3 days and these monolayers were 80% confluent by a week. The chondrocytes were spherical prior to attachment and later appeared polygonal in shape [Figure 1].

Figure 1 Primary human chondrocytes displaying typical polygonal conformation after attachment

Cell viability assessment

Viability of chondrocytes after PEMF exposure was quantified by the MTT assay to ascertain the effects PEMFs on chondrocytes which were exposed to PEMFs of field intensities between 1.95 and 0.65 µT at frequencies of 0.1 and 1 Hz for 60 min/day for 3 days. Following the third day exposure, samples were treated with MTT to quantify the cell viability and compared to control (unexposed) cultures. A highly significant viability of chondrocyte was observed in following field intensities and frequencies (1.95 µT-0.1Hz [P < 0.001], 1.95 µT -1Hz [P < 0.001] and 0.65 µT-0.1 Hz [P < 0.001]). Moderate favourable response was observed in other field intensities and frequencies [Table 1]. After 3 days of 60 min daily exposure to 1.95 µT PEMFs at a frequency of 0.1 Hz, the total number of cells in the culture increased, indicating heightened viability in response to PEMFs.

Table 1 MTT assay for detection of viable cells after exposure to PEMFs for 3 consecutive days

Quantitative measurement of proteoglycan glycosaminoglycan synthesis

Our spectrophotometric quantification of the ECM components such as GAG and PGs were assayed with identical PEMF parameters (field strengths, frequencies, and days of exposure and duration of exposure) as those used for MTT assay of cell viability with identical results. As compared with previously observed results, favorable responses to the production of ECM components were seen in following field strengths and frequencies (1.95 µT-0.1 Hz [P < 0.001], 1.95 µT -1 Hz [P < 0.001], 0.65 µT-0.1 Hz [P < 0.001], 0.65 µT-1 Hz [P < 0.001], 1.95 µT-10 Hz [P = 0.001] and 0.65 µT-10 Hz [P = 0.001]. Moderate favorable response was observed in other field intensities and frequencies [Table 2]. Our spectrophotometric quantification thus corroborates and strengthen our MTT assay results, indicating that exposure with 1.95 µT field intensity at frequency of 0.1 Hz for 60 min/day was most effective in production of GAG and PG of chondrocytes.

Table 2 DMMB assay for detection of ECM components after exposure to PEMFs for 3 consecutive days

Cell cycle analysis

Cells were analyzed to assess their distribution at different phases of the cell cycle by flow cytometry after staining of DNA with propidium iodide and recording of 10⁶ events for each exposure parameter. The cells distribution in four distinct phases could be recognized in a proliferating cell population: G₁, S (DNA synthesis Phase), G₂ and M (Mitosis). As both G₂ and M phase have an identical DNA content, they could not be discriminated based on their differences in their DNA content. The percentage values were assigned to each population and also dot plot [Figure ?[Figure2a2a and ?andb]b] and histogram [Figure ?[Figure2c2c and ?andd]d] were used to denote the distribution of cells in distinct phases. PEMF at different field strengths and frequencies was found to promote cell cycle progression from the G1 phase to the S and G₂-M phases. Cells present in G2-M phase are in dividing state and show increased rate of proliferation. A shift to top of cell population (G₂-M) in dot plot shows great proliferation [Figure ?[Figure2a2a and ?andb].b]. Based on the percentage of cells distribution in G2-M phase, proliferation effect was determined at different exposure parameters. Histogram indicates, cells exposed at 0.1 Hz frequency with 1.95 µT of PEMFs show 20.24% of their significant presence in G2-M phase compared to other filed strengths such as 0.65 (18.9%) and 1.3 µT (17.54%) [Figure 2c]. The cells exposed to 1.95 µT of PEMFs at 0.1 Hz frequency shows 20.24% of their significant presence in G2-M phase compared to other frequencies such as 1 Hz (19.46%) and 10 Hz (17.83%) [Figure 2d].

Figure 2 Cell cycle analysis by flow cytometer to determine the proliferative effect of chondrocytes in distinct cell cycle phases. Percentage of chondrocytes distribution in G2-M phase indicates cell proliferation effects as it has all mitotic cells. Significant …

Analysis of cell architecture and morphology

Actin filaments of the cytoplasm stained by Phalloidin and nucleus was counterstained with propidium iodide observed by confocal fluorescent microscopy showed a significant difference in morphological structure and formation of stress fibers between exposed chondrocytes at varying frequencies (0.1, 1 and, 10 Hz) with specific field strength 1.95 µT and unexposed cells. Stress fiber formation was increased in chondrocytes exposed at frequency of 0.1 Hz with 1.95 µT compared to unexposed [Figure 3]. Stress fiber formation indicates that the cells stability, strength and their healthy attachment.

Figure 3 Human chondrocytes morphological structure was studied by staining with phalloidin and propidium iodide for visualizing stress fibers (green) and nuclear staining (red). (a) No stress fiber formation in chondrocytes unexposed to pulsed electromagnetic …

Discussion

Our study observed that short term in-vitro chondrocyte exposure to PEMFs at frequency of 0.1 Hz and field strength of 1.95 µT for 60 min/day for 3 consecutive days have shown highly significant effects in different experimental parameters such as cell viability, ECM production, cell cycle progression and stress fiber formation. By contrast, exposure of identical chondrocyte cultures to PEMFs of 0.65 µT field intensity at 1 Hz frequency resulted in less significant levels of different parameters. On the other hand, exposure to 1.3 µT PEMFs at 10 Hz frequency does not shown any significant effects in different analytical parameters. These findings, apart from observing benefits of certain range of field strengths, also bring to light the ability of PEMF to inhibit cellular effects when used at certain field strengths and frequencies, a fact which has been observed earlier.

In our study design, we limited our experiments to within 3 days of exposure to PEMF to stay within the realm of better clinical applicability. For our analysis, we have chosen 3 days as an appropriate end point as it avoided the over confluence of chondrocytes and also it would minimize the contact inhibition that can induce changes in biochemical status and cause dedifferentiation. As the number of days of exposure to PEMFs increases, it may enhance the proliferative effects to the chondrocytes. The design of longer day exposure to PEMFs will be taken into future study. PEMF parameters used in this study such as frequency, field strength and duration of exposure could translate into the clinical application and will be innocuous to the target tissue and their surrounding tissues which are exposed to PEMF during clinical therapy.

Our study observed correlation between critical cell characteristics (cell viability and promotion in cell multiplication) of exposed samples and induction of extracellular components which include GAG and PG. This raises the question on the validity of using changes in ECM components as a marker of chondrocyte healing in studies using in-vitro models.

The earliest in-vitro study with bovine articular chondrocytes exposed using Helmholtz coils found no significant effect of PEMF on ECM component synthesis.¹⁹ Sakai and colleagues studied the effect of 0.4 mT field strength at 6.4 Hz delivered over a period of 5 days on rabbit growth cartilage and human articular cartilage and observed that PEMF stimulated cell proliferation and GAG synthesis in growth cartilage cells but resulted in only cell proliferation with no increase in GAG content in articular cartilage cells.²⁰ The latter finding of our observation on extracellular components (GAG and PG) synthesis is comparable with earlier studies observation.

De Mattei et al. exposed chondrocytes from healthy patients to PEMF to varying duration of exposure (1- 18 h and 1- 6 days) using a field strength of 2.3 mT at 75 Hz. The study observed that short duration of exposure (1 and 6 h) did not result in increased DNA synthesis, while longer duration of exposure (9 and 18 h) increased DNA synthesis.²¹ Chang et al., exposed porcine chondrocytes to a field of 1.8- 3 mT at a frequency of 75 Hz for 2 h/day for 3 weeks and observed that long term 3 weeks PEMF exposure was beneficial over the short term 1 week exposure.²² However, our observations contradict these findings and reports the better efficacy of even short term PEMF exposures. Though our study observed the efficacy of a daily PEMF exposure of 60 min for only 3 days, benefits of exposure should be expected to enhance with daily exposures exceeding 3 days. We could not observe the benefits beyond day 3, since confluent chondrocyte cultures de-differentiated due to contact inhibition beyond this period in two-dimensional cultures.

Our observation on promotion of cell cycle from G1 phase to G2-M phase with certain field strengths is comparable with the findings of Nicolin et al. which observed similar results with field strength of 2 mT at 75 Hz with an exposure time of 4 h or 12 h/day.²³ The striking observation of similar findings in our study with much lower field strength for exposure duration of 60 min has better clinical applicability.

A recent in-vivo animal study exposed rabbits with experimental osteochondral defect to PEMF for a period of 60 min/day for 6 weeks and observed a better total histological score in the study group to conclude that PEMF is beneficial for hyaline cartilage formation.²⁴ The only in-vitro study on human chondrocytes harvested from OA knee reports no effect on PG production using field strength of 2mT at 50 Hz for 14 days.²⁵ However both studies did not evaluate fine cellular effects (cell viability and cell cycle promotion).

Based on our data, the study informs that the future in-vitro studies on the topic should probably use exposure duration not more than 60 min/day but we can increase more number of days to PEMFs at 0.1 and 1 Hz frequencies and 1.95 and 0.65 µT field intensities. However, future studies should aim to utilize collagen matrix in three-dimensional (3D) cultures and focus more on exposure for more number of days to overcome the limitation of dedifferentiation and contact inhibition due to over confluent in 3D model and also focus on the effect of PEMF on chondrocyte cytoskeleton (observed as stress fibers in Phalloidin staining). It would of interest to investigate the strength of the chondrocyte cytoskeleton between exposed and control cells. Though it may be argued that occurrence of stress fiber formation observed with PEMF exposure is a result of heating effect due to Helmholtz system, the low dose of PEMF is less likely to have produced a heating effect which may happen with higher doses.

To conclude, our study observed that short duration (60 min/day) low frequency (0.1 Hz) low field strength (1.95 µT) PEMFs have beneficial effects on chondrocyte viability, ECM production, multiplication and probably cytoskeleton even for a short period of 3 days. Short duration PEMF exposure for patients with OA has the potential to produce favorable clinical effects. However, the results of the study have to be confirmed with a methodology incorporating assessment of both mass and strength of PEMF exposed chondrocytes.

Financial support and sponsorship

Defence Institute of Physiology and Allied Sciences (DIPAS), Defence Research and Development Organisation (DRDO), Ministry of Defence, Government of India.

Conflicts of interest

There are no conflicts of interest.

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Millimeter wave treatment promotes chondrocyte proliferation via G1/S cell cycle transition.

Li X, Ye H, Yu F, Cai L, Li H, Chen J, Wu M, Chen W, Lin R, Li Z, Zheng C, Xu H, Wu G, Liu X.

Source

Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350108, P.R. China.

Abstract

Millimeter waves, high-frequency electromagnetic waves, can effectively alleviate the clinical symptoms in osteoarthritis patients, as a non-pharmaceutical and non-invasive physical therapy regimen. However, the molecular mechanisms of the therapeutic effects of millimeter wave treatment are not well understood. In the present study, the effect of millimeter waves on the G1/S cell cycle progression in chondrocytes and the underlying mechanism was investigated. Chondrocytes isolated from the knee of SD rats were cultured and identified using toluidine blue staining. The second generation chondrocytes were collected and stimulated with or without millimeter waves for 48 h. Chondrocyte viability was analyzed using the MTT assay. The cell cycle distribution of chondrocytes was analyzed by flow cytometry. mRNA and protein expression levels of cyclin D1, cyclin-dependent kinases 4 and 6 (CDK4 and CDK6) and p21 were detected using real-time PCR and western blotting, respectively. Millimeter wave stimulation was found to significantly enhance chondrocyte viability. Moreover, the percentage of chondrocytes in the G0/G1 phase was significantly decreased, whereas that in the S phase was significantly increased. In addition, following millimeter wave treatment, cyclin D1, CDK4 and CDK6 expression was significantly upregulated, whereas p21 expression was significantly downregulated. The results indicate that millimeter wave treatment promotes chondrocyte proliferation via cell cycle progression.

Vopr Kurortol Fizioter Lech Fiz Kult.  2010 Jul-Aug;(4):20-2.

The use of magnetic-laser therapy in the combined treatment of osteoarthrosis in workers exposed to inorganic fluoride compounds.

[Article in Russian]

Fedorov AA, Riabko EV, Gromov AS.

Abstract

The present study included 67 patients who had been exposed to the impact of inorganic fluoride compounds. It demonstrated beneficial effect of magnetolaser therapy in combination with whole body iodine-bromide-sodium chlorine baths, physical exercises, and massage on clinical manifestations of the primary disease and concomitant pathologies. Simultaneously, metabolic processes in the articular cartilage and bone tissue were normalized, lipid peroxidation was improved and optimization of antioxidative protection achieved. These changes are indicative of high therapeutic efficiency of the combined treatment employed in this study and its favourable influence on the quality of life of the patients.

Indian J Exp Biol. 2009 Dec;47(12):939-48.

Low frequency pulsed electromagnetic field–a viable alternative therapy for arthritis.

Ganesan K, Gengadharan AC, Balachandran C, Manohar BM, Puvanakrishnan R.

Department of Biotechnology, Central Leather Research Institute, Adyar, Chennai 600 020, India.

Abstract

Arthritis refers to more than 100 disorders of the musculoskeletal system. The existing pharmacological interventions for arthritis offer only symptomatic relief and they are not definitive and curative. Magnetic healing has been known from antiquity and it is evolved to the present times with the advent of electromagnetism. The original basis for the trial of this form of therapy is the interaction between the biological systems with the natural magnetic fields. Optimization of the physical window comprising the electromagnetic field generator and signal properties (frequency, intensity, duration, waveform) with the biological window, inclusive of the experimental model, age and stimulus has helped in achieving consistent beneficial results. Low frequency pulsed electromagnetic field (PEMF) can provide noninvasive, safe and easy to apply method to treat pain, inflammation and dysfunctions associated with rheumatoid arthritis (RA) and osteoarthritis (OA) and PEMF has a long term record of safety. This review focusses on the therapeutic application of PEMF in the treatment of these forms of arthritis. The analysis of various studies (animal models of arthritis, cell culture systems and clinical trials) reporting the use of PEMF for arthritis cure has conclusively shown that PEMF not only alleviates the pain in the arthritis condition but it also affords chondroprotection, exerts antiinflammatory action and helps in bone remodeling and this could be developed as a viable alternative for arthritis therapy.

J Rehabil Med. 2009 Nov;41(13):1090-5.

Effect of biomagnetic therapy versus physiotherapy for treatment of knee osteoarthritis: a randomized controlled trial.

Gremion G, Gaillard D, Leyvraz PF, Jolles BM.

Department of Orthopaedic Surgery (DAL), Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.

Abstract

OBJECTIVE: To assess the effectiveness of pulsed signal therapy in the treatment of knee osteoarthritis (Kellgren II or III).

METHODS: A randomized, double-blind controlled clinical trial. The first 95 patients sent to the clinic with knee osteo-arthritis were selected and randomized into treatment with pulsed signal therapy or conventional physiotherapy. Assessment included recording of usual demographic data, pertinent history, baseline medication and radiographs. Clinical evaluation was made at baseline, 6 weeks and 6 months after the end of treatment by the same blinded doctor. At each follow-up time, the patient was asked to complete a visual analogue pain scale and a Lequesne score. The doctor recorded the degree of pain on motion and the ability to move the affected knee.

RESULTS: Both treatments resulted in significant improvements in pain and physical function. A statistical difference was observed only for activities of daily living, where the physiotherapy was more efficient (p<0.03). The cost of treatment with pulsed signal therapy was significantly higher, double the treatment cost of conventional physiotherapy.

CONCLUSION: Like physiotherapy, pulsed signal therapy has improved the clinical state of treated patients but with no significant statistical difference. Pulsed signal therapy is, however, more expensive.

J Rehabil Med. 2009 May;41(6):406-11.

Effectiveness of pulsed electromagnetic field therapy in the management of osteoarthritis of the knee: a meta-analysis of randomized controlled trials.

Vavken P, Arrich F, Schuhfried O, Dorotka R.

Department of Orthopedic Surgery, Children’s Hospital Boston, 300 Longwood Avenue, Enders 1016, Boston, MA 02115, USA. Patrick.vavken@childrens.harvard.edu

Abstract

OBJECTIVE: To assess the effectiveness of pulsed electromagnetic fields compared with placebo in the management of osteoarthritis of the knee.

DATA SOURCES: A systematic review of PubMed, EMBASE, and the Cochrane Controlled Trials Register.

METHODS: Randomized, controlled trials reporting on the blinded comparison of pulsed electromagnetic fields with placebo were included. Validity was tested according to the Jadad Scale. Studies were pooled using fixed-effects and random-effects models after exclusion of publication bias and assessment of heterogeneity. Sensitivity analyses and meta-regression were performed to test the stability of our findings.

RESULTS: Nine studies, including 483 patients, were pooled. No significant difference could be shown for pain (weighted mean difference 0.2 patients; 95% confidence interval (CI): -0.4 to 0.8) or stiffness (weighted mean difference 0.3; 95% CI: -0.3 to 0.9). There was a significant effect on activities of daily living (weighted mean difference 0.8; 95% CI 0.2-1.4, p = 0.014) and scores (standardized mean difference 0.4; 95% CI: 0.05-0.8, p = 0.029). We saw only statistically insignificant differences between studies with different treatment protocols.

CONCLUSION: Pulsed electromagnetic fields improve clinical scores and function in patients with osteoarthritis of the knee and should be considered as adjuvant therapies in their management. There is still equipoise of evidence for an effect on pain in the current literature.

Rheumatol Int. 2009 Apr;29(6):663-6. Epub 2008 Nov 18.

The effects of pulsed electromagnetic fields in the treatment of knee osteoarthritis: a randomized, placebo-controlled trial.

Ay S, Evcik D.

Department of Physical Medicine and Rehabilitation, Ufuk University School of Medicine Doctor Ridvan Ege Hospital, Balgat, 06520, Ankara, Turkey.saimeay@yahoo.com

Abstract

In this study, we planned to investigate the effects of pulse electromagnetic field (PEMF) on pain relief and functional capacity of patients with knee osteoarthritis (OA). Fifty-five patients with knee OA were included in a randomized, placebo-controlled study. At the end of the therapy, there was statistically significant improvement in pain scores in both groups (P < 0.05). However, no significant difference was observed within the groups (P > 0.05). We observed statistically significant improvement in some of the subgroups of Lequesne index. These are morning stiffness and activities of daily living activities compared to placebo group. However, we could not observe statistically significant differences in total of the scale between two groups (P > 0.05). Applying between-group analysis, we were unable to demonstrate a beneficial symptomatic effect of PEMF in the treatment of knee OA in all patients. Further studies using different types of magnetic devices, treatment protocols and patient populations are warranted to confirm the general efficacy of PEMF therapy in OA and other conditions.

Knee Surg Sports Traumatol Arthrosc. 2007 Jul;15(7):830-4. Epub 2007 Feb 28.

Effects of pulsed electromagnetic fields on patients’ recovery after arthroscopic surgery: prospective, randomized and double-blind study.

Zorzi C, Dall’Oca C, Cadossi R, Setti S.

“Sacro Cuore Don Calabria” Hospital, Via don A. Sempreboni 5, 37024 Negrar (Vr), Italy.

Abstract

Severe joint inflammation following trauma, arthroscopic surgery or infection can damage articular cartilage, thus every effort should be made to protect cartilage from the catabolic effects of pro-inflammatory cytokines and stimulate cartilage anabolic activities. Previous pre-clinical studies have shown that pulsed electromagnetic fields (PEMFs) can protect articular cartilage from the catabolic effects of pro-inflammatory cytokines, and prevent its degeneration, finally resulting in chondroprotection. These findings provide the rational to support the study of the effect of PEMFs in humans after arthroscopic surgery. The purpose of this pilot, randomized, prospective and double-blind study was to evaluate the effects of PEMFs in patients undergoing arthroscopic treatment of knee cartilage. Patients with knee pain were recruited and treated by arthroscopy with chondroabrasion and/or perforations and/or radiofrequencies. They were randomized into two groups: a control group (magnetic field at 0.05 mT) and an active group (magnetic field of 1.5 mT). All patients were instructed to use PEMFs for 90 days, 6 h per day. The patients were evaluated by the Knee injury and Osteoarthritis Outcome Score (KOOS) test before arthroscopy, and after 45 and 90 days. The use of non-steroidal anti-inflammatory drugs (NSAIDs) to control pain was also recorded. Patients were interviewed for the long-term outcome 3 years after arthroscopic surgery. Thirty-one patients completed the treatment. KOOS values at 45 and 90 days were higher in the active group and the difference was significant at 90 days (P < 0.05). The percentage of patients who used NSAIDs was 26% in the active group and 75% in the control group (P = 0.015). At 3 years follow-up, the number of patients who completely recovered was higher in the active group compared to the control group (P < 0.05). Treatment with I-ONE aided patient recovery after arthroscopic surgery, reduced the use of NSAIDs, and also had a positive long-term effect.

Life Sci. 2007 Jun 6;80(26):2403-10. Epub 2007 May 1.

Low frequency and low intensity pulsed electromagnetic field exerts its antiinflammatory effect through restoration of plasma membrane calcium ATPase activity.

Selvam R, Ganesan K, Narayana Raju KV, Gangadharan AC, Manohar BM, Puvanakrishnan R.

Department of Pharmacology and Toxicology, Madras Veterinary College, Vepery, Chennai, India.

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory disorder affecting 1% of the population worldwide. Pulsed electromagnetic field (PEMF) has a number of well-documented physiological effects on cells and tissues including antiinflammatory effect. This study aims to explore the antiinflammatory effect of PEMF and its possible mechanism of action in amelioration of adjuvant induced arthritis (AIA). Arthritis was induced by a single intradermal injection of heat killed Mycobacterium tuberculosis at a concentration of 500 microg in 0.1 ml of paraffin oil into the right hind paw of rats. The arthritic animals showed a biphasic response regarding changes in the paw edema volume. During the chronic phase of the disease, arthritic animals showed an elevated level of lipid peroxides and depletion of antioxidant enzymes with significant radiological and histological changes. Besides, plasma membrane Ca(2+) ATPase (PMCA) activity was inhibited while intracellular Ca(2+) level as well as prostaglandin E(2) levels was noticed to be elevated in blood lymphocytes of arthritic rats. Exposure of arthritic rats to PEMF at 5 Hzx4 microT x 90 min, produced significant antiexudative effect resulting in the restoration of the altered parameters. The antiinflammatory effect could be partially mediated through the stabilizing action of PEMF on membranes as reflected by the restoration of PMCA and intracellular Ca(2+) levels in blood lymphocytes subsequently inhibiting PGE(2) biosynthesis. The results of this study indicated that PEMF could be developed as a potential therapy for RA in human beings.

BMC Musculoskelet Disord. 2007 Jun 22;8:51.

Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials.

Bjordal JM, Johnson MI, Lopes-Martins RA, Bogen B, Chow R, Ljunggren AE.

Faculty of Health and Social Sciences, Institute of Physiotherapy, Bergen University College, Moellendalsvn, Bergen Norway. jmb@hib.no

Abstract

BACKGROUND: Treatment efficacy of physical agents in osteoarthritis of the knee (OAK) pain has been largely unknown, and this systematic review was aimed at assessing their short-term efficacies for pain relief.

METHODS: Systematic review with meta-analysis of efficacy within 1-4 weeks and at follow up at 1-12 weeks after the end of treatment.

RESULTS: 36 randomised placebo-controlled trials (RCTs) were identified with 2434 patients where 1391 patients received active treatment. 33 trials satisfied three or more out of five methodological criteria (Jadad scale). The patient sample had a mean age of 65.1 years and mean baseline pain of 62.9 mm on a 100 mm visual analogue scale (VAS). Within 4 weeks of the commencement of treatment manual acupuncture, static magnets and ultrasound therapies did not offer statistically significant short-term pain relief over placebo. Pulsed electromagnetic fields offered a small reduction in pain of 6.9 mm [95% CI: 2.2 to 11.6] (n = 487). Transcutaneous electrical nerve stimulation (TENS, including interferential currents), electro-acupuncture (EA) and low level laser therapy (LLLT) offered clinically relevant pain relieving effects of 18.8 mm [95% CI: 9.6 to 28.1] (n = 414), 21.9 mm [95% CI: 17.3 to 26.5] (n = 73) and 17.7 mm [95% CI: 8.1 to 27.3] (n = 343) on VAS respectively versus placebo control. In a subgroup analysis of trials with assumed optimal doses, short-term efficacy increased to 22.2 mm [95% CI: 18.1 to 26.3] for TENS, and 24.2 mm [95% CI: 17.3 to 31.3] for LLLT on VAS. Follow-up data up to 12 weeks were sparse, but positive effects seemed to persist for at least 4 weeks after the course of LLLT, EA and TENS treatment was stopped.

Pain Res Manag. 2006 Summer;11(2):85-90.

Exposure to a specific pulsed low-frequency magnetic field: a double-blind placebo-controlled study of effects on pain ratings in rheumatoid arthritis and fibromyalgia patients.

Shupak NM, McKay JC, Nielson WR, Rollman GB, Prato FS, Thomas AW.

Lawson Health Research Institute, St. Joseph’s Health Care, London, Ontario N6A 4V2.

Abstract

BACKGROUND: Specific pulsed electromagnetic fields (PEMFs) have been shown to induce analgesia (antinociception) in snails, rodents and healthy human volunteers.

OBJECTIVE: The effect of specific PEMF exposure on pain and anxiety ratings was investigated in two patient populations.

DESIGN: A double-blind, randomized, placebo-controlled parallel design was used.

METHOD: The present study investigated the effects of an acute 30 min magnetic field exposure (less than or equal to 400 microTpk; less than 3 kHz) on pain (McGill Pain Questionnaire [MPQ], visual analogue scale [VAS]) and anxiety (VAS) ratings in female rheumatoid arthritis (RA) (n=13; mean age 52 years) and fibromyalgia (FM) patients (n=18; mean age 51 years) who received either the PEMF or sham exposure treatment.

RESULTS: A repeated measures analysis revealed a significant pre-post-testing by condition interaction for the MPQ Pain Rating Index total for the RA patients, F(1,11)=5.09, P<0.05, estimate of effect size = 0.32, power = 0.54. A significant pre-post-effect for the same variable was present for the FM patients, F(1,15)=16.2, P<0.01, estimate of effect size = 0.52, power =0.96. Similar findings were found for MPQ subcomponents and the VAS (pain). There was no significant reduction in VAS anxiety ratings pre- to post-exposure for either the RA or FM patients.

CONCLUSION: These findings provide some initial support for the use of PEMF exposure in reducing pain in chronic pain populations and warrants continued investigation into the use of PEMF exposure for short-term pain relief.

Z Orthop Ihre Grenzgeb. 2005 Sep-Oct;143(5):544-50.

Adjuvant treatment of knee osteoarthritis with weak pulsing magnetic fields. Results of a placebo-controlled trial prospective clinical trial.

[Article in German]

Fischer G, Pelka RB, Barovic J.

Institut für Hygiene an der Universität Graz, Osterreich.

Abstract

PURPOSE: The aim of this study was the objective control of the therapeutic effect of weak pulsing magnetic fields (series of periodically repeating square pulses increasing according to an e-function, frequencies of 10, 20, 30, and 200-300 Hz) by means of a double-blind study on osteoarthritis of the knee. Measured parameters were the Knee Society score, pain sensation, blood count and cardiocirculatory values.

METHODS: 36 placebo and 35 verum test persons (all with a knee gap smaller than 3 mm) were exposed daily for 16 minutes over 6 weeks to a low frequency magnetic field (flux densities increasing gradually from 3.4 up to 13.6 microT) encompassing the whole body. The last data collection was made 4 weeks after the end of treatment.

RESULTS: Principally, the statistically ensured results exclusively favour the used magnetic field therapy; by far the greatest number of at least significant differences was found at the end of the whole treatment, lasting 6 weeks. In particular, it is striking that all 4 questioned pain scales showed at least significant improvements in favour of the verum collective; also the walking distance was increased. As another confirmed fact, even after 4 weeks without therapy the persistence of several functional and analgesic effects could be documented.

CONCLUSIONS: Predominantly, on the one hand, pain relief in osteoarthritis patients was confirmed by a double-blind trial, on the other hand, increases in mobility could be proven. Furthermore, we describe mainly the modes of action of low frequency magnetic energy and 3 physical concepts that are seen as the connecting link between electromagnetic fields coupled into connective tissue and biochemical repair and growth processes in bones and cartilage. Proceeding from the results of this and preceding studies, one has to consider seriously whether this kind of magnetic field application should not be employed as cost-effective and side effect-free alternative or adjuvant form of therapy in the field of orthopaedic disorders.

Bioelectromagnetics. 2005 Sep;26(6):431-9.

Optimization of pulsed electromagnetic field therapy for management of arthritis in rats.

Kumar VS, Kumar DA, Kalaivani K, Gangadharan AC, Raju KV, Thejomoorthy P, Manohar BM, Puvanakrishnan R.

Department of Pharmacology and Toxicology, Madras Veterinary College, Vepery, Chennai, India.

Studies were undertaken to find out the effects of low frequency pulsed electromagnetic field (PEMF) in adjuvant induced arthritis (AIA) in rats, a widely used model for screening potential therapies for rheumatoid arthritis (RA). AIA was induced by an intradermal injection of a suspension of heat killed Mycobacterium tuberculosis (500 mug/0.1 ml) into the right hind paw of male Wistar rats. This resulted in swelling, loss of body weight, increase in paw volume as well as the activity of lysosomal enzymes viz., acid phosphatase, cathepsin D, and beta-glucuronidase and significant radiological and histological changes. PEMF therapy for arthritis involved optimization of three significant factors, viz., frequency, intensity, and duration; and the waveform used is sinusoidal. The use of factorial design in lieu of conventional method resulted in the development of an ideal combination of these factors. PEMF was applied using a Fransleau-Braunbeck coil system. A magnetic field of 5 Hz x 4 muT x 90 min was found to be optimal in lowering the paw edema volume and decreasing the activity of lysosomal enzymes. Soft tissue swelling was shown to be reduced as evidenced by radiology. Histological studies confirmed reduction in inflammatory cells infiltration, hyperplasia, and hypertrophy of cells lining synovial membrane. PEMF was also shown to have a membrane stabilizing action by significantly inhibiting the rate of release of beta-glucuronidase from lysosomal rich and sub-cellular fractions. The results indicated that PEMF could be developed as a potential therapy in the treatment of arthritis in humans.

Biomed Pharmacother. 2005 Aug 2; [Epub ahead of print]

Effects of pulsed electromagnetic fields on articular hyaline cartilage: review of experimental and clinical studies.

Fini M, Giavaresi G, Carpi A, Nicolini A, Setti S, Giardino R.

Experimental Surgery Department, Research Institute Codivilla-Putti-Rizzoli, Orthopedic Institute, via di Barbiano 1/10, 40136 Bologna, Italy.

Osteoarthritis (OA) is the most common disorder of the musculoskeletal system and is a consequence of mechanical and biological events that destabilize tissue homeostasis in articular joints. Controlling chondrocyte death and apoptosis, function, response to anabolic and catabolic stimuli, matrix synthesis or degradation and inflammation is the most important target of potential chondroprotective treatment, aimed to retard or stabilize the progression of OA. Although many drugs or substances have been recently introduced for the treatment of OA, the majority of them relieve pain and increase function, but do not modify the complex pathological processes that occur in these tissues. Pulsed electromagnetic fields (PEMFs) have a number of well-documented physiological effects on cells and tissues including the upregulation of gene expression of members of the transforming growth factor beta super family, the increase in glycosaminoglycan levels, and an anti-inflammatory action. Therefore, there is a strong rationale supporting the in vivo use of biophysical stimulation with PEMFs for the treatment of OA. In the present paper some recent experimental in vitro and in vivo data on the effect of PEMFs on articular cartilage were reviewed. These data strongly support the clinical use of PEMFs in OA patients.

Osteoarthritis Cartilage. 2005 Jul;13(7):575-81. Treatment of knee osteoarthritis with pulsed electromagnetic fields: a randomized, double-blind, placebo-controlled study. Thamsborg G, Florescu A, Oturai P, Fallentin E, Tritsaris K, Dissing S. Department of Geriatri and Rheumatology, Glostrup Hospital, 2600 Glostrup, Denmark. OBJECTIVE: The investigation aimed at determining the effectiveness of pulsed electromagnetic fields (PEMF) in the treatment of osteoarthritis (OA) of the knee by conducting a randomized, double-blind, placebo-controlled clinical trial. DESIGN: The trial consisted of 2h daily treatment 5 days per week for 6 weeks in 83 patients with knee OA. Patient evaluations were done at baseline and after 2 and 6 weeks of treatment. A follow-up evaluation was done 6 weeks after treatment. Activities of daily living (ADL), pain and stiffness were evaluated using the Western Ontario and McMaster Universities (WOMAC) questionnaire. RESULTS: Within group analysis revealed a significant improvement in ADL, stiffness and pain in the PEMF-treated group at all evaluations. In the control group there was no effect on ADL after 2 weeks and a weak significance was seen after 6 and 12 weeks. Significant effects were seen on pain at all evaluations and on stiffness after 6 and 12 weeks. Between group analysis did not reveal significant improvements over time. Analysis of ADL score for the PEMF-treated group revealed a significant correlation between less improvement and increasing age. Analysis of patients <65 years using between group analysis revealed a significant improvement for stiffness on treated knee after 2 weeks, but this effect was not observed for ADL and pain. CONCLUSIONS: Applying between group analysis we were unable to demonstrate a beneficial symptomatic effect of PEMF in the treatment of knee OA in all patients. However, in patients <65 years of age there is significant and beneficial effect of treatment related to stiffness Orthop Res. 2005 Jul;23(4):899-908. Epub 2005 Mar 17. Pulsed electromagnetic fields reduce knee osteoarthritis lesion progression in the aged Dunkin Hartley guinea pig. Fini M, Giavaresi G, Torricelli P, Cavani F, Setti S, Cane V, Giardino R. Department of Experimental Surgery, Codivilla-Putti Research Institute, Rizzoli Institute of Orthopaedics, Via di Barbiano, 1/10, 40136 Bologna, Italy. milena.fini@ior.it An experimental in vivo study was performed to test if the effect of Pulsed Electromagnetic Fields (PEMFs) on chondrocyte metabolism and adenosine A2a agonist activity could have a chondroprotective effect on the knee of Dunkin Hartley guinea-pigs of 12 months with spontaneously developed osteoarthritis (OA). After a pilot study, 10 animals were randomly divided into two groups: PEMF-treated group (6 h/day for 3 months) and Sham-treated group. Microradiography and histomorphometry were performed on the entire articular surface of knee joints used in evaluating chondropathy severity, cartilage thickness (CT), cartilage surface Fibrillation Index (FI), subchondral bone plate thickness (SBT) and histomorphometric characteristics of trabecular epiphyseal bone. The PEMF-treated animals showed a significant reduction of chondropathy progression in all knee examined areas (p<0.05). CT was significantly higher (p<0.001) in the medial tibia plateaus of the PEMF-treated group when compared to the Sham-treated group. The highest value of FI was observed in the medial tibia plateau of the Sham-treated group (p<0.05). Significant lower values were observed in SBT of PEMF-treated group in comparison to Sham-treated group in all knee examined areas (p<0.05). The present study results show that PEMFs preserve the morphology of articular cartilage and slower the progression of OA lesions in the knee of aged osteoarthritic guinea pigs. The chondroprotective effect of PEMFs was demonstrated not only in the medial tibial plateau but also on the entire articular surface of the knee. B Rheumatol Int. 2005 Jun 29; [Epub ahead of print] The effect of pulsed electromagnetic fields in the treatment of cervical osteoarthritis: a randomized, double-blind, sham-controlled trial. Sutbeyaz ST, Sezer N, Koseoglu BF. Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Turk ocagi S No: 3 Sihhiye, Ankara, Turkey. The purpose of this study was to evaluate the effect of electromagnetic field therapy (PEMF) on pain, range of motion (ROM) and functional status in patients with cervical osteoarthritis (COA). Thirty-four patients with COA were included in a randomized, double-blind study. PEMF was administrated to the whole body using a mat 1.8×0.6 m in size. During the treatment, the patients lay on the mat for 30 min per session, twice a day for 3 weeks. Pain levels in the PEMF group decreased significantly after therapy (p<0.001), but no change was observed in the placebo group. The active ROM, paravertebral muscle spasm and neck pain and disability scale (NPDS) scores improved significantly after PEMF therapy (p<0.001) but no change was observed in the sham group. The results of this study are promising, in that PEMF treatment may offer a potential therapeutic adjunct to current COA therapies in the future.

Osteoarthritis Cartilage. 2003 Jun;11(6):455-62.

Modification of osteoarthritis by pulsed electromagnetic field–a morphological study.

Ciombor DM, Aaron RK, Wang S, Simon B.

Department of Orthopaedics, Brown Medical School, Providence, RI 02906, USA.

Abstract

OBJECTIVE: Hartley guinea pigs spontaneously develop arthritis that bears morphological, biochemical, and immunohistochemical similarities to human osteoarthritis. It is characterized by the appearance of superficial fibrillation by 12 months of age and severe cartilage lesions and eburnation by 18 months of age. This study examines the effect of treatment with a pulsed electromagnetic field (PEMF) upon the morphological progression of osteoarthritis in this animal model.

DESIGN: Hartley guinea pigs were exposed to a specific PEMF for 1h/day for 6 months, beginning at 12 months of age. Control animals were treated identically, but without PEMF exposure. Tibial articular cartilage was examined with histological/histochemical grading of the severity of arthritis, by immunohistochemistry for cartilage neoepitopes, 3B3(-) and BC-13, reflecting enzymatic cleavage of aggrecan, and by immunoreactivity to collagenase (MMP-13) and stromelysin (MMP-3). Immunoreactivity to TGFbeta, interleukin (IL)-1beta, and IL receptor antagonist protein (IRAP) antibodies was examined to suggest possible mechanisms of PEMF activity.

RESULTS: PEMF treatment preserves the morphology of articular cartilage and retards the development of osteoarthritic lesions. This observation is supported by a reduction in the cartilage neoepitopes, 3B3(-) and BC-13, and suppression of the matrix-degrading enzymes, collagenase and stromelysin. Cells immunopositive to IL-1 are decreased in number, while IRAP-positive cells are increased in response to treatment. PEMF treatment markedly increases the number of cells immunopositive to TGFbeta.

CONCLUSIONS: Treatment with PEMF appears to be disease-modifying in this model of osteoarthritis. Since TGFbeta is believed to upregulate gene expression for aggrecan, downregulate matrix metalloprotease and IL-1 activity, and upregulate inhibitors of matrix metalloprotease, the stimulation of TGFbeta may be a mechanism through which PEMF favorably affects cartilage homeostasis.

The Effect of Pulsed Electromagnetic Fields in the Treatment of Osteoarthritis of the Knee and Cervical Spine.  Report of Randomized, Double-Blind, Placebo Controlled Trials

Trock D. et.al. Department of Medicine, Danbury Hospital, CT. J. of Rheumatology

OBJECTIVE. We conducted a randomized, double blind clinical trial to determine the effectiveness of pulsed electromagnetic fields (PEMF) in the treatment of osteoarthritis (OA) of the knee and cervical spine.

METHODS. A controlled trial of 18 half-hour active or placebo treatments was conducted in 86 patients with OA of the knee and 81 patients with OA of the cervical spine, in which pain was evaluated using a 10 cm visual analog scale, activities of daily living using a series of questions (answered by the patient as never, sometimes, most of the time, or always), pain on passive motion (recorded as none, slight, moderate, or severe), and joint tenderness (recorded using a modified Ritchie scale). Global evaluations of improvement were made by the patient and examining physician. Evaluations were made at baseline, midway, end of treatment, and one month after completion of treatment.

RESULTS. Matched pair t tests showed extremely significant changes from baseline for the treated patients in both knee and cervical spine studies at the end of treatment and the one month follow-up observations, whereas the changes in the placebo patients showed lesser degrees of significance at the end of treatment, and had lost significance for most variables at the one month follow-up. Means of the treated group of patients with OA of the knee showed greater improvement from baseline values than the placebo group by the end of treatment and at the one month follow-up observation. Using the 2-tailed t test, at the end of treatment the differences in the means of the 2 groups reached statistical significance for pain, pain on motion, and both the patient overall assessment and the physician global assessment. The means of the treated patients with OA of the cervical spine showed greater improvement from baseline than the placebo group for most variables at the end of treatment and one month follow-up observations; these differences reached statistical significance at one or more observation points for pain, pain on motion, and tenderness.

CONCLUSION. PEMF has therapeutic benefit in painful OA of the knee or cervical spine.

J Med Eng Technol. 2002 Nov-Dec;26(6):253-8.

Comparison between the analgesic and therapeutic effects of musically modulated electromagnetic field (TAMMEF) and those if a 100 Hz electromagnetic field: blind experiemnt on patients suffering from cervical spondylosis or shoulder periarthritis.

Rigato M, Battisti E, Fortunato M, Giordano N.

Department of Physics, Section of Medical Physics University of Sienna, Italy. rigato@unisi.it

The analgesic-therapeutic efficacy and tolerability of a low-frequency electromagnetic field (ELF), modulated at a frequency of 100 Hz with a sinusoidal waveform and mean induction of a few gauss, has been demonstrated by the authors in numerous previous studies of various hyperalgic pathologies, particularly of the locomotor apparatus. In the present study, the authors tested a new type of all-inclusive field, denoted TAMMEF, whose parameters (frequency, intensity, waveform) are modified in time, randomly varying within the respective ranges, so that all the possible codes can occur during a single application. For the comparison, 150 subjects (118 women and 32 men, between 37 and 66 years of age) were enrolled. They were affected by cervical spondylosis (101 cases) or shoulder periarthritis (49 cases). Unbeknownst to them, they were randomly divided into three groups of 50 subjects. One group was exposed to the new TAMMEF, another group to the usual ELF, and the third group to simulated treatment. The results show that the effects of the new TAMMEF therapy are equivalent to those obtained with the ELF.

: Curr Opin Rheumatol. 2002 Sep;14(5):603-7.

Nonpharmacologic management of osteoarthritis.

Sharma L.

Department of Medicine, Northwestern University Medical School, Chicago, Illinois 60611, USA. L-Sharma@northwestern.edu

Several nonpharmacologic interventions for osteoarthritis are in different stages of development, investigation, and application. Such interventions capitalize on current knowledge of the causes of symptoms, disease progression, and disability in patients with osteoarthritis. Many nonpharmacologic interventions are low in cost and incorporate self-management approaches or home-based activities and, as such, may ultimately have substantial public health impact. Recent studies and reviews of exercise, weight loss, education, inserts, footwear, bracing, therapeutic ultrasound, acupuncture, and pulsed electromagnetic field therapy will be highlighted in this review. For many of these interventions, further investigation will be necessary to define their place in the management of osteoarthritis.

Wien Klin Wochenschr. 2002 Aug 30;114(15-16):678-84.

Pulsed magnetic field therapy for osteoarthritis of the knee–a double-blind sham-controlled trial.

Nicolakis P, Kollmitzer J, Crevenna R, Bittner C, Erdogmus CB, Nicolakis J.

Department of Physical Medicine and Rehabilitation, AKH Wien, University of Vienna, Vienna, Austria. Peter.nicolakis@akh-wien.ac.at

BACKGROUND AND METHODS: Pulsed magnetic field therapy is frequently used to treat the symptoms of osteoarthritis, although its efficacy has not been proven. We conducted a randomized, double-blind comparison of pulsed magnetic field and sham therapy in patients with symptomatic osteoarthritis of the knee. Patients were assigned to receive 84 sessions, each with a duration of 30 minutes, of either pulsed magnetic field or sham treatment. Patients administered the treatment on their own at home, twice a day for six weeks.

RESULTS: According to a sample size estimation, 36 consecutive patients were enrolled. 34 patients completed the study, two of whom had to be excluded from the statistical analysis, as they had not applied the PMF sufficiently. Thus, 15 verum and 17 sham-treated patients were enrolled in the statistical analysis. After six weeks of treatment the WOMAC Osteoarthritis Index was reduced in the pulsed magnetic field-group from 84.1 (+/- 45.1) to 49.7 (+/- 31.6), and from 73.7 (+/- 43.3) to 66.9 (+/- 52.9) in the sham-treated group (p = 0.03). The following secondary parameters improved in the pulsed magnetic field group more than they did in the sham group: gait speed at fast walking [+6.0 meters per minute (1.6 to 10.4) vs. -3.2 (-8.5 to 2.2)], stride length at fast walking [+6.9 cm (0.2 to 13.7) vs. -2.9 (-8.8 to 2.9)], and acceleration time in the isokinetic dynamometry strength tests [-7.0% (-15.2 to 1.3) vs. 10.1% (-0.3 to 20.6)].

CONCLUSION: In patients with symptomatic osteoarthritis of the knee, PMF treatment can reduce impairment in activities of daily life and improve knee function.

Cochrane Database Syst Rev. 2002;(1):CD003523.

Electromagnetic fields for the treatment of osteoarthritis.

Hulme J, Robinson V, DeBie R, Wells G, Judd M, Tugwell P.

Cochrane Collaborating Center, Center for Global Health, Institute of Population Health – University of Ottawa, 1 Stewart Street, Ottawa, Ontario, Canada, K1N 6N5. jhulme@uottawa.ca

BACKGROUND: As the focus for osteoarthritis (OA) treatment shifts away from drug therapy, we consider the effectiveness of pulsed electric stimulation which is proven to stimulate cartilage growth on the cellular level.

OBJECTIVES: 1)To assess the effectiveness of pulsed electric stimulation for the treatment of osteoarthritis (OA). 2) To assess the most effective and efficient method of applying an electromagnetic field, through pulsed electromagnetic fields (PEMF) or electric stimulation, as well as the consideration of length of treatment, dosage, and the frequency of the applications.

SEARCH STRATEGY: We searched PREMEDLINE, MEDLINE, HealthSTAR, CINAHL, PEDro, and the Cochrane Controlled Trials Register (CCTR) up to and including 2001. This included searches through the coordinating offices of the trials registries of the Cochrane Field of Physical and Related Therapies and the Cochrane Musculoskeletal Group for further published and unpublished articles. The electronic search was complemented by hand searches and experts in the area.

SELECTION CRITERIA: Randomized controlled trials and controlled clinical trials that compared PEMF or direct electric stimulation against placebo in patients with OA.

DATA COLLECTION AND ANALYSIS: Two reviewers determined the studies to be included in the review based on inclusion and exclusion criteria (JH,VR) and extracted the data using pre-developed extraction forms for the Cochrane Musculoskeletal Group. The methodological quality of the trials was assessed by the same reviewers using a validated scale (Jadad 1996). Osteoarthritis outcome measures were extracted from the publications according to OMERACT guidelines (Bellamy 1997) and additional secondary outcomes considered.

MAIN RESULTS: Only three studies with a total of 259 OA patients were included in the review. Electrical stimulation therapy had a small to moderate effect on outcomes for knee OA, all statistically significant with clinical benefit ranging from 13-23% greater with active treatment than with placebo. Only 2 outcomes for cervical OA were significantly different with PEMF treatment and no clinical benefit can be reported with changes of 12% or less.

REVIEWER’S CONCLUSIONS: Current evidence suggests that electrical stimulation therapy may provide significant improvements for knee OA, but further studies are required to confirm whether the statistically significant results shown in these trials confer to important benefits.

Arch Phys Med Rehabil. 2001 Oct;82(10):1453-60.

Two configurations of static magnetic fields for treating rheumatoid arthritis of the knee: a double-blind clinical trial.

Segal NA, Toda Y, Huston J, Saeki Y, Shimizu M, Fuchs H, Shimaoka Y, Holcomb R, McLean MJ.

Vanderbilt University Medical School, Nashville, TN 37232, USA.

Abstract

OBJECTIVE: To assess the efficacy of a nonpharmacologic, noninvasive static magnetic device as adjunctive therapy for knee pain in patients with rheumatoid arthritis (RA).

DESIGN: Randomized, double-blind, controlled, multisite clinical trial.

SETTING: An American and a Japanese academic medical center as well as 4 community rheumatology and orthopedics practices.

PATIENTS: Cohort of 64 patients over age 18 years with rheumatoid arthritis and persistent knee pain, rated greater than 40/100mm, despite appropriate use of medications.

INTERVENTION: Four blinded MagnaBloc (with 4 steep field gradients) or control devices (with 1 steep field gradient) were taped to a knee of each subject for 1 week.

MAIN OUTCOME MEASURES: The American College of Rheumatology recommended core set of disease activity measures for RA clinical trials and subjects’ assessment of treatment outcome.

RESULTS: Subjects randomly assigned to the MagnaBloc (n = 38) and control treatment groups (n = 26) reported baseline pain levels of 63/100mm and 61/100mm, respectively. A greater reduction in reported pain in the MagnaBloc group was sustained through the 1-week follow-up (40.4% vs 25.9%) and corroborated by twice daily pain diary results (p < .0001 for each vs baseline). However, comparison between the 2 groups demonstrated a statistically insignificant difference (p < .23). Subjects in the MagnaBloc group reported an average decrease in their global assessment of disease activity of 33% over 1 week, as compared with a 2% decline in the control group (p < .01). After 1 week, 68% of the MagnaBloc treatment group reported feeling better or much better, compared with 27% of the control group, and 29% and 65%, respectively, reported feeling the same as before treatment (p < .01).

CONCLUSIONS: Both devices demonstrated statistically significant pain reduction in comparison to baseline, with concordance across multiple indices. However, a significant difference was not observed between the 2 treatment groups (p < .23). In future studies, the MagnaBloc treatment should be compared with a nonmagnetic placebo treatment to characterize further its therapeutic potential for treating RA. This study did elucidate methods for conducting clinical trials with magnetic devices.

Curr Med Res Opin. 2001;17(3):190-6.

Magnetic pulse treatment for knee osteoarthritis: a randomised, double-blind, placebo-controlled study.

Pipitone N, Scott DL.

Rheumatology Department, King’s College Hospital (Dulwich), London, UK.

Abstract

We assessed the efficacy and tolerability of low-frequency pulsed electromagnetic fields (PEMF) therapy in patients with clinically symptomatic knee osteoarthritis (OA) in a randomised, placebo-controlled, double-blind study of six weeks’ duration. Patients with radiographic evidence and symptoms of OA (incompletely relieved by conventional treatments), according to the criteria of the American College of Rheumatology, were recruited from a single tertiary referral centre. 75 patients fulfilling the above criteria were randomised to receive active PEMF treatment by unipolar magnetic devices (Medicur) manufactured by Snowden Healthcare (Nottingham, UK) or placebo. Six patients failed to attend after the screening and were excluded from analysis. The primary outcome measure was reduction in overall pain assessed on a four-point Likert scale ranging from nil to severe. Secondary outcome measures included the WOMAC Osteoarthritis Index (Likert scale) and the EuroQol (Euro-Quality of Life, EQ-5D). Baseline assessments showed that the treatment groups were equally matched. Although there were no significant differences between active and sham treatment groups in respect of any outcome measure after treatment, paired analysis of the follow-up observations on each patient showed significant improvements in the actively treated group in the WOMAC global score (p = 0.018), WOMAC pain score (p = 0.065), WOMAC disability score (p = 0.019) and EuroQol score (p = 0.001) at study end compared to baseline. In contrast, there were no improvements in any variable in the placebo-treated group. There were no clinically relevant adverse effects attributable to active treatment. These results suggest that the Medicur unipolar magnetic devices are beneficial in reducing pain and disability in patients with knee OA resistant to conventional treatment in the absence of significant side-effects. Further studies using different types of magnetic devices, treatment protocols and patient populations are warranted to confirm the general efficacy of PEMF therapy in OA and other conditions.

Altern Ther Health Med. 2001 Sep-Oct;7(5):54-64, 66-9.

Low-amplitude, extremely low frequency magnetic field for the treatment of osteoarthritic knees: a double-blind clinical study.

Jacobson JI, Gorman R, Yamanashi WS, Saxena BB, Clayton L.

Institute of Theoretical Physics and Advanced Studies for Biophysical Research, Perspectivism Foundation, 2006 Mainsail Cir, Jupiter, FL 33477-1418, USA. drjjacobson@aol.com

CONTEXT: Noninvasive magnetotherapeutic approaches to bone healing have been successful in past clinical studies. OBJECTIVE: To determine the effectiveness of low-amplitude, extremely low frequency magnetic fields on patients with knee pain due to osteoarthritis. DESIGN: Placebo-controlled, randomized, double-blind clinical study.

SETTING: 4 outpatient clinics.

PARTICIPANTS: 176 patients were randomly assigned to 1 of 2 groups, the placebo group (magnet off) or the active group (magnet on).

INTERVENTION: 6-minute exposure to each magnetic field signal using 8 exposure sessions for each treatment session, the number of treatment sessions totaling 8 during a 2-week period, yielded patients being exposed to uniform magnetic fields for 48 minutes per treatment session 8 times in 2 weeks. The magnetic fields used in this study were generated by a Jacobson Resonator, which consists of two 18-inch diameter (46-cm diameter) coils connected in series, in turn connected to a function generator via an attenuator to obtain the specific amplitude and frequency. The range of magnetic field amplitudes used was from 2.74 x 10(-7) to 3.4 x 10(-8) G, with corresponding frequencies of 7.7 to 0.976 Hz.

OUTCOME MEASURES: Each subject rated his or her pain level from 1 (minimal) to 10 (maximal) before and after each treatment and 2 weeks after treatment. Subjects also recorded their pain intensity in a diary while outside the treatment environment for 2 weeks after the last treatment session (session 8) twice daily: upon awakening (within 15 minutes) and upon retiring (just before going to bed at night).

RESULTS: Reduction in pain after a treatment session was significantly (P < .001) greater in the magnet-on group (46%) compared to the magnet-off group (8%).

CONCLUSION: Low-amplitude, extremely low frequency magnetic fields are safe and effective for treating patients with chronic knee pain due to osteoarthritis.

Acta Med Austriaca. 2000;27(3):61-8.

Clinical effectiveness of magnetic field therapy–a review of the literature

[Article in German].

Quittan M, Schuhfried O, Wiesinger GF, Fialka-Moser V.

Universitätsklinik für Physikalische Medizin und Rehabilitation, Wien. michael.quittan@akh-wien.ac.at

Abstract

To verify the efficacy of electromagnetic fields on various diseases we conducted a computer-assisted search of the pertinent literature. The search was performed with the aid of the Medline and Embase database (1966-1998) and reference lists. Clinical trials with at least one control group were selected. The selection criteria were met by 31 clinical studies. 20 trials were designed double-blind, randomised and placebo-controlled. The studies were categorised by indications. Electromagnetic fields were applied to promote bone-healing, to treat osteoarthritis and inflammatory diseases of the musculoskeletal system, to alleviate pain, to enhance healing of ulcers and to reduce spasticity. The action on bone healing and pain alleviation of electromagnetic fields was confirmed in most of the trials. In the treatment of other disorders the results are contradictory. Application times varied between 15 minutes and 24 hours per day for three weeks up to eighteen months. There seems to be a relationship between longer daily application time and positive effects particular in bone-healing. Patients were treated with electromagnetic fields of 2 to 100 G (0.2 mT to 10 mT) with a frequency between 12 and 100 Hz. Optimal dosimetry for therapy with electromagnetic fields is yet not established.

Rheum Dis Clin North Am. 2000 Feb;26(1):51-62, viii.

Electromagnetic fields and magnets. Investigational treatment for musculoskeletal disorders.

Trock DH.

Yale University School of Medicine, New Haven, Connecticut, USA.

Abstract

Certain pulsed electromagnetic fields (PEMF) affect the growth of bone and cartilage in vitro, with potential application as an arthritis treatment. PEMF stimulation is already a proven remedy for delayed fractures, with potential clinical application for osteoarthritis, osteonecrosis of bone, osteoporosis, and wound healing. Static magnets may provide temporary pain relief under certain circumstances. In both cases, the available data is limited. The mechanisms underlying the use of PEMF and magnets are discussed.

Vopr Kurortol Fizioter Lech Fiz Kult. 1997 Sep-Oct;(5):25-6. Experience in using saprogel mud in combination with a magnetic field in treating cervical osteochondrosis. [Article in Russian] Samutin NM. Patients with cervical osteochondrosis were successfully treated with Deshembinskoe Lake [correction of Deshembinskaya] sapropel mud in combination with exposure to magnetic field. The details of this treatment regimen are described. Combination of pelotherapy with effects of the magnetic field proved beneficial for patients with cervical osteochondrosis. J Rheumatol. 1993 Mar;20(3):456-60. A double-blind trial of the clinical effects of pulsed electromagnetic fields in osteoarthritis. Trock DH, Bollet AJ, Dyer RH Jr, Fielding LP, Miner WK, Markoll R. Department of Medicine (Rheumatology), Danbury Hospital, CT 06810. Abstract OBJECTIVE: Further evaluation of pulsed electromagnetic fields (PEMF), which have been observed to produce numerous biological effects, and have been used to treat delayed union fractures for over a decade. METHODS: In a pilot, double-blind randomized trial, 27 patients with osteoarthritis (OA), primarily of the knee, were treated with PEMF. Treatment consisted of 18 half-hour periods of exposure over about 1 month in a specially designed noncontact, air-coil device. Observations were made on 6 clinical variables at baseline, midpoint of therapy, end of treatment and one month later; 25 patients completed treatment. RESULTS: An average improvement of 23-61% occurred in the clinical variables observed with active treatment, while 2 to 18% improvement was observed in these variables in placebo treated control patients. No toxicity was observed. CONCLUSION: The decreased pain and improved functional performance of treated patients suggests that this configuration of PEMF has potential as an effective method of improving symptoms in patients with OA. This method warrants further clinical investigation. Scand J Rehabil Med. 1992;24(1):51-9. Low energy high frequency pulsed electromagnetic therapy for acute whiplash injuries.  A double blind randomized controlled study. Foley-Nolan D. et.al. Mater Hospital, Dublin, Ireland. The standard treatment of acute whiplash injuries (soft collar and analgesia) is frequently unsuccessful. Pulsed electromagnetic therapy PEMT has been shown to have pro-healing and anti-inflammatory effects. This study examines the effect of PEMT on the acute whiplash syndrome. PEMT as described is safe for domiciliary use and this study suggests that PEMT has a beneficial effect in the management of the acute whiplash injury. Minerva Anestesiol. 1989 Jul-Aug;55(7-8):295-9. Pulsed magnetic fields.  Observations in 353 patients suffering from chronic pain. [Article in Italian] Di Massa A, Misuriello I, Olivieri MC, Rigato M. Three hundred-fifty-three patients with chronic pain have been treated with pulsed electromagnetic fields. In this work the Authors show the result obtained in the unsteady follow-up (2-60 months). The eventual progressive reduction of benefits is valued by Spearman’s test. We noted the better results in the group of patients with post-herpetic pain (deafferentation) and in patients simultaneously suffering from neck and low back pain.

Lik Sprava. 1997 Sep-Oct;(5):170-2.

A comparative evaluation of the efficacy of magneto- and laser therapy in patients with osteoarthrosis deformans.

[Article in Russian]

Selivonenko VG, Syvolap VD, Porada LV, Medvedeva VN, Boev SS, Morozov AI, Slin’ko VG, Berest SM, Garbuz LN, Sholokh SG.

A comparative evaluation of efficacy of magneto- and laser therapy was carried out in 82 patients with osteoarthrosis deformans. The magnetic field and laser irradiation dispelled the pain syndrome and synovitis manifestations. It is recommendable that the multiple-modality therapy of patients with osteoarthrosis deformans should involve magneto- and laser therapy (15 to 20 procedures per one course) that improve results of the treatment being received and allow the time of hospitalization to be reduced at an average by 5 bed-days. Laser appeared to be a very effective mode of treatment. No unfavourable side effects were recordable.

Panminerva Med. 1992 Oct-Dec;34(4):187-96.

Therapeutic effects of pulsed magnetic fields on joint diseases.

Riva Sanseverino E, Vannini A, Castellacci P.

Universita di Bologna, Italy.

The present paper describes the effects of pulsed magnetic fields (MF) on diseases of different joints, in chronic as well as acute conditions where the presence of a phlogistic process is the rule. Optimal parameters for MF applications were sought at the beginning of the study and then applied for 11 years; a technical modification in the MF generator was introduced 5 years ago to satisfy the requirement of a hypothesis advanced to understand the mechanism of MF treatment. 3,014 patients were treated by means of MF at extremely low frequencies and intensities. Patient follow-up was pursued as constantly as possible. Pain removal, recovery of joint mobility and maintenance of the improved conditions represented the parameters for judging the results as good or poor. The chi-square test was applied in order to evaluate the probability that the results are not casual. A general average value of 78.8% of good results and 21.2% of poor results was obtained. Higher (82%) percentages of good results were observed when single joint diseases were considered with respect to multiple joint diseases (polyarthrosis); in the latter, the percentage of good results was definitely lower (66%). The high percentage of good results obtained and the absolute absence of both negative results and undesired side-effects, together with the therapeutic advantage due to a technical modification in the MF generator, led to the conclusion that magnetic field treatment is an excellent physical therapy in cases of joint diseases. A hypothesis is advanced that external magnetic fields influence transmembrane ionic activity.

Arch Phys Med Rehabil. 1991 Apr;72(5):284-7.

Electromagnetic treatment of shoulder periarthritis: a randomized controlled trial of the efficiency and tolerance of magnetotherapy.

Leclaire R, Bourgouin J.

Rehabilitation Medicine Service, Notre Dame Hospital, Montreal, Quebec, Canada.

The potential benefit of magnetotherapy was investigated in 47 consecutive outpatients with periarthritis of the shoulder. Using a controlled triple-blind study design, one group of patients received hot pack applications and passive manual stretching and pulley exercises; the other group received the same therapy plus magnetotherapy. Treatment was administered three times a week. For a maximum of three months, a standardized treatment protocol was used. There was no significant improvement in pain reduction or in range of motion with electromagnetic field therapy. After 12 weeks of therapy, the patients who received magnetotherapy showed mean pain scores of 1.5 (+/- .61 SD) at rest, 2.2 (+/- .76 SD) on movement, and 1.9 (+/- .94 SD), on lying, compared to scores for the control group of 1.4 (+/- .65 SD), 2.2 (+/- .7 SD), and 1.9 (+/- .95 SD), respectively. Linear pain scale scores improved from 71 to 21 for both groups. At 12 weeks the gain in range of motion was mean 109 degrees +/- 46.8 in patients receiving electromagnetic field therapy, compared to 122 degrees +/- 33.4 for the controls (not significant). At entry, the functional handicap score was 53.5 for both groups. At 12 weeks, it was 24 for the magnetotherapy group and 17 for the control group (difference not significant). In conclusion, this study showed no benefit from magnetotherapy in the pain score, range of motion, or improvement of functional status in patients with periarthritis of the shoulder.

Bratisl Lek Listy. 1999 Dec;100(12):678-81.

Personal experience in the use of magnetotherapy in diseases of the musculoskeletal system.

[Article in Slovak]

Sadlonova J, Korpas J.

Ist Dpt of Internal Medicine, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia. bll@fmed.uniba.sk

Therapeutic application of pulsatile electromagnetic field in disorders of motility is recently becoming more frequent. Despite this fact information about the effectiveness of this therapy in the literature are rare. The aim of this study was therefore the treatment of 576 patients who suffered from vertebral syndrome, gonarthritis and coxarthritis. For application of pulsatile electromagnetic field MTU 500H Therapy System was used. Pulsatile electromagnetic field had a frequency valve of 4.5 mT in all studied groups and magnetic induction valve 12.5-18.75 mT in the 1st group. In the 2nd group the intensity was 5.8-7.3 mT and in the 3rd group it was 7.6-11.4 mT. The time of inclination/declination in the 1st group was 20/60 ms, in the 2nd group 40/80 ms and in the 3rd group 40/90 ms. The electromagnetic field was applied during 10 days. In the 1st-3rd day during 20 minutes and in the 4th-10th day during 30 minutes. The therapy was repeated in every patient after 3 months with values of intensity higher by 50%. In the time of pulsatile electro-magnetotherapy the patients were without pharmacotherapy or other physiotherapy. The application of pulsatile electromagnetic field is a very effective therapy of vertebral syndrome, gonarthritis and coxarthritis. The results have shown that the therapy was more effective in patients suffering from gonarthrosis, than in patients with vertebral syndrome and least effective in patients with coxarthosis. Owing to regression of oedema and pain relieve the motility of patients improved. (Tab. 3, Ref. 19.)