by John Baur, PT, OCS, FAAOMPT
Ulcerative colitis (UC) is a chronic inflammatory bowel disease that affects the colon and rectum. It is characterized by symptoms such as abdominal pain, diarrhea, and rectal bleeding. While the exact cause of UC is unknown, it is believed to be related to an imbalance in the gut microbiota and inflammation. Probiotics are live microorganisms that can provide health benefits when consumed in adequate amounts. Bacillus spp. spores are a type of probiotic that have been shown to modulate the gut microbiota and improve overall health. In this report, we will discuss a study that investigated the effects of a probiotic containing Bacillus spp. spores, amino acids, and immunoglobulins on a rat model of UC.
The study used a rat model of UC induced by dextran sulfate sodium (DSS). The rats were divided into four groups: a control group, a DSS group, a DSS group treated with the probiotic, and a DSS group treated with mesalazine, a standard treatment for UC. The probiotic contained Bacillus spp. spores, amino acids, and immunoglobulins.
The rats were treated with the probiotic or mesalazine for a period of 14 days. The severity of UC was assessed by measuring body weight, stool consistency, and rectal bleeding. The inflammatory response was assessed by measuring levels of inflammatory cytokines in the colon tissue.
The study found that treatment with the probiotic containing Bacillus spp. spores, amino acids, and immunoglobulins exerted protective effects on the rat model of UC. The probiotic significantly reduced the severity of UC, as evidenced by improvements in body weight, stool consistency, and rectal bleeding. The probiotic also reduced the inflammatory response, as evidenced by reductions in levels of inflammatory cytokines in the colon tissue.
The study suggests that treatment with a probiotic containing Bacillus spp. spores, amino acids, and immunoglobulins can exert protective effects on a rat model of UC. The probiotic reduced the severity of UC and the inflammatory response, suggesting that it could be a promising treatment option for UC. Further research is needed to confirm these findings in human clinical trials, but the study provides a promising avenue for future research in the field of probiotics and UC treatment.
Physical Therapy First recognizes the importance staying well-informed with the latest health and wellness topics that affect our patients. Megasporebiotic made by Microbiome Labs (microbiomelabs.com) is the first spore-base probiotic with research which supports it use for Ulcerative colitis (UC) and many other health conditions.
Probiotic Bacillus Spores Together with Amino Acids and Immunoglobulins Exert Protective Effects on a Rat Model of Ulcerative Colitis. Catinean A, Neag MA, Krishnan K, Muntean DM, Bocsan CI, Pop RM, Mitre AO, Melincovici CS, Buzoianu AD. Nutrients. 2020 Nov 24;12(12):3607. doi: 10.3390/nu12123607.
By John Baur, PT, DPT, OCS, FAAOMPT
The gut microbiota plays a crucial role in maintaining overall health and well-being. An imbalance in the gut microbiota has been linked to a variety of health problems, including gastrointestinal disorders, metabolic disorders, and immune dysfunction. Probiotics are live microorganisms that can provide health benefits when consumed in adequate amounts. Bacillus spp. spores are a type of probiotic that have been shown to modulate the gut microbiota and improve overall health. In this report, we will discuss a study that investigated the effects of a spore-based probiotic containing five strains of Bacillus on the gut microbiota in a SHIME® model of the human gastrointestinal system.
The study used a SHIME® (Simulator of the Human Intestinal Microbial Ecosystem) model to simulate the human gastrointestinal system. The SHIME® model consists of five compartments that simulate different parts of the gastrointestinal tract, including the stomach, small intestine, and colon. The model was inoculated with fecal samples from healthy human donors to establish a complex and diverse gut microbiota.
The spore-based probiotic containing five strains of Bacillus (Bacillus subtilis, Bacillus clausii, Bacillus coagulans, Bacillus licheniformis, and Bacillus pumilus) was added to the SHIME® model for a period of 21 days. The metabolic activity and community composition of the gut microbiota were analyzed before and after treatment with the probiotic.
The study found that treatment with the spore-based probiotic containing five strains of Bacillus induced changes in the metabolic activity and community composition of the gut microbiota in the SHIME® model. Specifically, the probiotic increased the production of short-chain fatty acids (SCFAs), which are important for maintaining gut health and reducing inflammation. The probiotic also increased the abundance of beneficial bacteria such as Bifidobacterium and Lactobacillus, while reducing the abundance of harmful bacteria such as Clostridium difficile.
In conclusion, the study provides evidence that treatment with a spore-based probiotic containing five strains of Bacillus can induce changes in the metabolic activity and community composition of the gut microbiota in a SHIME® model of the human gastrointestinal system. The probiotic increased the production of short-chain fatty acids and the abundance of beneficial bacteria, while reducing the abundance of harmful bacteria. These findings suggest that Bacillus spp. spores could be a promising treatment option for a variety of health problems related to gut microbiota imbalance, including gastrointestinal disorders, metabolic disorders, and immune dysfunction. Further research is needed to confirm these findings in human clinical trials, but the study provides a promising avenue for future research in the field of probiotics and gut health.
Physical Therapy First recognizes the importance staying well-informed with the latest health and wellness topics that affect our patients. Megasporebiotic made by Microbiome Labs (microbiomelabs.com) is the first spore-base probiotic with research which supports it use for maintaining gut health and reducing systemic inflammation.
Food Res Int. 2021 Nov; 149:110676. doi: 10.1016/j.foodres.2021.110676. Epub 2021 Aug 30.
Treatment with a spore-based probiotic containing five strains of Bacillus induced changes in the metabolic activity and community composition of the gut microbiota in a SHIME® model of the human gastrointestinal system. Massimo Marzorati, Pieter Van den Abbeele, Sarah Bubeck, Thomas Bayne, Kiran Krishnan, Aicacia Young
By John Baur, PT, DPT, OCS, FAAOMPT
Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that affects millions of people worldwide. It is characterized by symptoms such as abdominal pain, bloating, and changes in bowel habits. While the exact cause of IBS is unknown, it is believed to be related to an imbalance in the gut microbiota and inflammation. In recent years, there has been growing interest in the use of probiotics and other microbiota-targeted therapies for the treatment of IBS. In this report, we will discuss the potential of Bacillus spp. spores as a promising treatment option for patients with IBS.
Bacillus spp. Spores and Gut Microbiota
Bacillus spp. are a group of spore-forming bacteria that are commonly found in soil and water. They are known for their ability to survive in harsh environments and have been used for centuries in traditional medicine for the treatment of various ailments. In recent years, there has been growing interest in the use of Bacillus spp. spores as a probiotic for the treatment of gastrointestinal disorders.
Studies have shown that Bacillus spp. spores have the ability to modulate the gut microbiota and reduce inflammation. They have been shown to increase the abundance of beneficial bacteria such as Bifidobacterium and Lactobacillus, while reducing the abundance of harmful bacteria such as Clostridium difficile. Bacillus spp. spores also produce short-chain fatty acids (SCFAs), which are important for maintaining gut health and reducing inflammation.
Bacillus spp. Spores and Irritable Bowel Syndrome
Several studies have investigated the potential of Bacillus spp. spores as a treatment option for patients with IBS. A randomized, double-blind, placebo-controlled trial found that a combination of Bacillus coagulans and fructooligosaccharides (FOS) significantly improved symptoms of IBS, including abdominal pain, bloating, and stool consistency. Another study found that Bacillus clausii spores significantly reduced symptoms of IBS, including abdominal pain and bloating.
The mechanism by which Bacillus spp. spores improve symptoms of IBS is not fully understood. However, it is believed that their ability to modulate the gut microbiota and reduce inflammation plays a key role. Bacillus spp. spores may also improve gut barrier function, which is important for preventing the entry of harmful bacteria and toxins into the bloodstream.
In conclusion, Bacillus spp. spores have shown promising results as a treatment option for patients with irritable bowel syndrome (IBS). Studies have shown that Bacillus spp. spores have the ability to modulate the gut microbiota and reduce inflammation, which are key factors in the development of IBS. Bacillus spp. spores have been shown to improve symptoms of IBS, including abdominal pain, bloating, and stool consistency. While more research is needed to fully understand the mechanism by which Bacillus spp. spores improve symptoms of IBS, they offer a promising treatment option for patients who do not respond to traditional therapies. Bacillus spp. spores are generally safe and well-tolerated, making them a viable option for long-term use.
Physical Therapy First recognizes the importance staying well-informed with the latest health and wellness topics that affect our patients. Megasporebiotic made by Microbiome Labs (microbiomelabs.com) is the first spore-base probiotic with research which supports it use for IBS and many other health conditions.
Bacillus spp. Spores-A Promising Treatment Option for Patients with Irritable Bowel Syndrome.
Catinean A, Neag AM, Nita A, Buzea M, Buzoianu AD.Nutrients. 2019 Aug 21;11(9):1968. doi: 10.3390/nu11091968.
by Tyler Tice, PT, DPT, MS, ATC
As life expectancy increases globally as modern medicine becomes more advanced, chronic diseases will affect a larger portion of our population as a result. One of the leading causes of chronic pain and disability worldwide is knee osteoarthritis (OA). Knee OA affects the entire joint and its symptoms are frequently related to physical inactivity. Currently, there are many lines of treatment that a patient with knee OA can undergo. There is substantial research supporting the use of exercise in positively impacting knee OA symptoms, however pharmacological intervention continues to be the primary form of treatment. This purpose of this article was to provide updated information regarding current treatment interventions for knee OA.
Key Treatments – Non-pharmacological
Patient education: Patient education is an essential role in decision-making, disease self-management, and medication adherence of individuals with knee OA. As healthcare providers, it’s essential to develop a clear understanding of the disease to effectively direct patients towards high-quality health information. Some key messages that should be included in your education should be: 1) regular physical activity and individualized exercise programs can reduce pain, prevent worsening, and improve daily function in OA; 2) losing weight for overweight individuals is a benefit, as well as maintaining a healthy weight through appropriate diet and exercise; and 3) OA symptoms can often be significantly reduced without the need for undergoing surgery.
Exercise: The role of physical activity and exercise therapy to reduce symptoms and improve physical function in individuals with knee OA is well-established in the world of research. Current research shows that 150 minutes per week of moderate intensity aerobic exercise or 2 days per week of moderate to vigorous physical activity muscle-strengthening exercises are beneficial for individuals with knee OA. Additionally, more pain reduction was observed when quadriceps-specific exercises were incorporated to exercise routines compared to general lower-limb strengthening exercises and were performed at least 3 times per week. When creating a patient’s exercise program it should focus on patient-centered rehabilitation, consider patient preferences and access to exercise equipment. A key piece that patients should be educated on prior to beginning an exercise program is that pain/discomfort during physical activity does not mean increased structural damage to the joint.
Weight loss: Because of its systemic effects on the body due to inflammatory and metabolic changes, obesity and overweight are considered primary risk factors related to chronic disease, including knee OA. A reduction in weight of approximately 5.1 kilograms (11.22 pounds) decreases the risk of developing knee OA by more than 50% in women with a baseline BMI higher than 25 kg/m2. For individuals with knee OA, a combination of diet and exercise has a moderate effect on relieving pain. After successfully losing weight, maintenance of weight loss remains a substantial challenge. Successful strategies for weight maintenance included creating consecutive weight loss goals, having a regular meal pattern that includes breakfast and healthier eating, having a physically activity lifestyle, and controlling over-eating through self-monitoring behaviors.
Thermal modalities: There is a lack of evidence that supports the use of thermal modalities such as ice packs or moist hot packs in individuals with knee OA.
Laser, therapeutic ultrasound, and electrical stimulation: The Osteoarthritis Research Society International (OARSI) strongly recommends against the use of laser therapy for knee OA. There is currently low-quality evidence that supports the use of therapeutic ultrasound for individuals with knee OA. There is currently very low-quality evidence that supports the use of transcutaneous electrical stimulation in patients with knee OA.
Manual therapy techniques, taping, and acupuncture: There is currently low-level evidence showing that manual therapy techniques provide additional benefit when compared to exercise intervention alone in patients with knee OA. There is very low-level of evidence to support the use of taping for the management of knee OA. When utilizing traditional acupuncture, there is low-level evidence that supports the use of this intervention in patients with knee OA.
Non-steroidal anti-inflammatory drugs (NSAIDs): Topical NSAIDs are strongly recommended as first-line treatment in both the OARSI and American College of Rheumatology (ACR). OARSI recommends topical NSAIDs for individuals with GI or cardiovascular comorbidities as well as frailty. In addition to topical NSAIDs, the ACR strongly recommends the use of oral NSAIDs and intra-articular glucocorticoid injections.
Opioids: There is high-quality evidence that demonstrates opioids only have small effects on pain and physical function in individuals with knee OA. Additionally, when compared to placebo, patients that used opioids have 3-4 times higher risk of serious adverse effects and/or dropouts due to adverse events.
Nutraceuticals: Nutraceuticals are foods or food supplements that are thought to have health benefits. Glucosamine and chondroitin sulfate are commonly used by patients with knee OA; however, they lack scientific evidence to support their use.
Surgery: Surgery is typically the last resort for knee OA management. There are a wide variety of surgical intervention options available with arthroscopic joint lavage being the most common procedure performed. There are several studies that demonstrate low efficacy of this surgical intervention and the clinical practice guideline published by the Journal of the American Academy of Orthopedic Surgeons strongly recommends against the use of arthroscopy in nearly all patients with degenerative knee disease. Joint replacement surgery is another popular surgery for individuals with end-stage knee OA. Before undergoing this surgery, individuals should trial conservative management for 6 months. If conservative management is unsuccessful in improving symptoms and function, then joint replacement should be considered. However, it is important to note that one in five patients that undergo total knee replacement (TKR) is not satisfied with the outcome. When assessing patients following TKR, it is important for clinicians to measure both self-reported measures and objective measures to comprehensively assess individuals with knee OA.
Take Home Messages:
Knee OA is a degenerative disease that effects a high number of individuals, many of which utilize physical therapy to manage their symptoms and improve their function. It is important for clinicians to stay up to date on evidence-based treatment interventions to provide the best first line care that would most benefit their patients. When it comes to interventions that may not have strong evidence supporting them, if they are interventions that the patient reports pain reduction with, there is little harm in including them into your treatment, however overall treatment should still include evidence-backed intervention like exercise.
Dantas, L. O., Salvini, T. F., & McAlindon, T. E. (2021). Knee osteoarthritis: key treatments and implications for physical therapy. Brazilian journal of physical therapy, 25(2), 135–146. https://doi.org/10.1016/j.bjpt.2020.08.004
by Tyler Tice, PT, DPT, MS, ATC
The utilization of multimodal analgesia (MMA) injections during arthroscopic rotator cuff repairs has gained popularity after commonly being utilized in hip and knee surgeries. MMA injections are a mixture of analgesic (pain relieving) agents of various classes with the intention of reducing pain and improving post-operative function. One of the agents included in this MMA injection is corticosteroids due to their local anti-inflammatory effect and ability to reduce the stress response to surgery. Previous research has demonstrated utilization of an MMA injection combined with corticosteroid significantly reduced pain and patients utilized fewer opioid medications in the first 24 hours following rotator cuff surgery. In the acute stage, the utilization of corticosteroid injections to the rotator cuff are highly effective, but concern regarding infection, risk for tendon re-tear, and general long-term tendon health remains. The goal of this study was to investigate the impact of corticosteroid injections on tendon health 1 year after arthroscopic rotator cuff repair.
This study investigated 50 patients who were undergoing arthroscopic rotator cuff repair surgery. Patients were randomized into either the study group or control group. There were 25 patients in the study group and 25 patients in the control group. Inclusion and exclusion criteria for both groups can be found in the original article. Prior to surgery, all patients completed the Constant-Murley Score (CMS), American Shoulder and Elbow Surgeons Shoulder score (ASES), and Simple Shoulder Test (SST) and pain levels were recorded. The study group received a periarticular injection that consisted of ropivacaine, morphine, and methylprednisolone (corticosteroid) while the control group received a saline injection. Both groups followed the same post-operative rehabilitation regime. The day after surgery patients completed passive movements and pendulum exercises. Additionally, patients wore a splint that kept the affected arm in internal rotation for the first 4 weeks post-operatively. A standardized outpatient rehab program was supervised by a physical therapist where active motion was initiated at 6 weeks and strengthening exercises were initiated at 12 weeks. Patients were able to return to heavy manual work and sports 3 months after surgery. At 12-months post-op, pain levels and functional scores were remeasured, and an MRI was completed to determine tendon integrity.
Pain levels were significantly reduced in both groups 12-months following surgery.
CMS, ASES, and SST scores significantly improved within both groups 12-months following surgery. There were no significant differences in scores between groups 12-months following surgery.
MRI revealed supraspinatus tendon retears in 16% of patients in the study group and 36% in the control group.
There were no significant differences between groups in retear rates at 12-months following surgery.
Factors negatively impacting healing were determined to be advanced age, diabetes, and posterior extension of the tear. Receiving a corticosteroid injection was determined to not negatively impact healing.
Building on their previous study, the researchers of this study determined that MMA injections that included corticosteroids have no harmful effect on tendon healing and functional outcomes 1 year after surgery. However, the authors of this study noted that the potential harmful effects of corticosteroids must be balanced out when included in MMA injections as laboratory and animal studies continue to demonstrate harmful effects on tendons. Currently, there is mixed research regarding the impact of corticosteroids on tendon healing and integrity following rotator cuff surgery. Another finding from this study was that there was no significant difference between groups in functional scores at 1-year post-op. A similar result was found in a study where patients received a corticosteroid injection preoperatively or 1-month post-surgery. There were also no instances of infection in this study following the corticosteroid injection. The overall re-tear rate in this study was 14%, which is similar to re-tear rates observed in other research.
This study had a number of limitations that should be noted such as small sample size in both the study and control groups. Also, the MMA injection was a mixture of analgesics so it’s impossible to determine the sole effect of corticosteroids on tendon healing within the study, and the hyperglycemic effect of corticosteroids was no observed due to the controversial results related to type of corticosteroid, dosage, and injection site.
Take Home Messages:
While the results of this study may not appear drastically different compared to the control group, this can actually be interpreted as a good thing as the whole concern regarding the inclusion of corticosteroids in anesthetic injections is its negative impact on tendon healing. This study demonstrated virtually no differences between groups, which can be interpreted as there is no difference between receiving an MMA injection intra-operatively with or without corticosteroids. While this study did not explicitly demonstrate the effect of just corticosteroids on tendon healing when utilized intra-operatively, the results demonstrating little to no difference when it’s included in an MMA injection is positive. More research needs to be conducted regarding the effect of corticosteroids on tendon healing when individually utilized intra-operatively, but for the time being these research can put people’s minds at ease regarding the potential negative impact if received intra-operatively for rotator cuff repair surgery.
Perdreau, A., Duysens, C., & Joudet, T. (2020). How periarticular corticosteroid injections impact the integrity of arthroscopic rotator cuff repair. Orthopaedics & traumatology, surgery & research : OTSR, 106(6), 1159–1166. https://doi.org/10.1016/j.otsr.2020.05.009
by Tyler Tice, PT, DPT, MS, ATC
After a primary anterior cruciate ligament (ACL) reconstruction surgery, 25% of patients 25 years old or younger that return to high-risk sport sustain a second ACL injury. Currently, there is conflicting evidence surround the return to sport timeline following ACL reconstruction surgery. One study demonstrated no difference in strength and hop test performance between athletes that successfully returned to sport vs. athletes that sustained a second ACL injury. Another study demonstrated that athletes that had more symmetrical quadriceps strength and returned to sport less than 9 months after surgery had an 84% reduction in knee injury rates. Due to this, many questions regarding the protective effects of delaying return to sport and achieving symmetrical muscle function remain unanswered. The goal of this study was to investigate the association between sustaining a second ACL injury and 1) time to return to sport, 2) symmetrical muscle function, and 3) symmetrical quadriceps strength.
Patient demographics and results from 5 muscle function tests were obtained from a rehabilitation registry. Inclusion and exclusion criteria can be found in the original article. The 5 muscle function tests were the following: isometric or isokinetic knee extension, isometric or isokinetic knee flexion, single-leg vertical hop, single-leg hop for distance, and single-leg side of hop. A questionnaire was sent to athletes between the ages of 15 and 30 found on the rehabilitation registry who were involved in knee-strenuous sports prior to their injury and subsequent ACL reconstruction surgery. The questionnaire was utilized to determine time of return to knee-strenuous sport. The primary outcome for this study was whether or not the athlete sustained a subsequent ACL injury following their return to sport.
In this study, 159 athletes with a mean age of 21.5 years old were included. Of the participants, 64% were female.
Athletes who sustained a new ACL injury returned to knee-strenuous sport, on average, 10.1 ± 3.3 months after ACL reconstruction, compared with 12.7 ± 4.8 months for athletes with no new ACL injury.
Ten of the 33 athletes who returned to knee-strenuous sport earlier than 9 months after reconstructions sustained a new ACL injury.
Twelve (67%) of the second ACL injuries occurred in athletes who returned to knee-strenuous sports between 8 and 9 months after ACL reconstruction.
Athletes who returned to knee-strenuous sport at 9 months or later after surgery had a lower rate of new ACL injury compared with those who returned earlier than 9 months after ACL reconstruction.
Athletes who returned to knee-strenuous sport earlier than 9 months had an approximately 7 times higher rate of new ACL injury compared with those who returned at 9 months or later after surgery.
Achieving symmetrical muscle function in 5 tests or symmetry in quadriceps strength was not associated with new ACL injury.
Athletes who returned to sport before 9 months following ACL reconstruction surgery were 7 times more likely to experience a second ACL injury compared to athletes who returned to sport at 9 months post-surgery or later. Despite some athletes returning to less knee strenuous sport, findings in this study were similar to previous research. Additionally, there was no association between symmetrical quad strength and rate of re-injury, which contradicts previous research that has demonstrated a positive relationship between muscle function and re-injury rate. A few factors that may have affected this finding is the relatively small sample size, few athletes within the sample size having symmetrical muscle function, and different athlete populations being included in the study. An explanation that may support this finding is that all athletes in this study achieved a limb symmetry index (LSI) of 90% or greater which may have been protective against a second ACL injury, which is consistent with previous research. LSI is commonly measured in ACL rehabilitation to assess symmetry of quadriceps strength.
A key limitation of this study is that only 18 athletes included sustained a second ACL injury between both groups. This makes it difficult for in-depth analysis and assessment of multiple risk factors to be made.
Take Home Messages:
As youth athletes continues to become more competitive and the number of young athletes returning to sport following ACL reconstruction surgery, more concrete evidence regarding ideal milestones and return to sport timelines is needed to reduce re-injury rates. Over the years, research has demonstrated that delaying return to sport can benefit the athlete and reduce the likelihood of re-injury following return to sport, which this study supported as athletes who returned to sport before 9 months post-surgery were 7 times more likely to sustain a second ACL injury compared to athletes who returned after 9 months. Overall, for long-term knee health and to enable young athletes to be able to participate in their chosen sport for as long as their bodies can tolerate, delaying return to sport following a major injury like an ACL tear is more favorable compared to returning to sport earlier on in the recovery timeline.
Beischer, S., Gustavsson, L., Senorski, E. H., Karlsson, J., Thomeé, C., Samuelsson, K., & Thomeé, R. (2020). Young Athletes Who Return to Sport Before 9 Months After Anterior Cruciate Ligament Reconstruction Have a Rate of New Injury 7 Times That of Those Who Delay Return. The Journal of orthopaedic and sports physical therapy, 50(2), 83–90. https://doi.org/10.2519/jospt.2020.9071