Hyaluronan homeostasis and its role in pain and muscle stiffness.
Adam Amir, Soo Kim, Antonio Stecco and 2 others
PMID 35077007WHAT IT FOUND
Hyaluronan in muscle tissue may drive pain and stiffness through increased viscosity and pressure on nerves.
While animal studies link low-molecular-weight hyaluronan to pain, human data suggests high accumulation causes stiffness. Hyaluronidase injections show promise in small trials, but evidence remains preliminary.
Key findings
01High-molecular-weight hyaluronan is associated with anti-inflammatory and pain-modulating effects, whereas low-molecular-weight hyaluronan is associated with pro-inflammatory and nociceptive signal transduction.
02Excessive accumulation of hyaluronan in the extracellular matrix of muscle can dramatically increase viscosity and alter lubricating properties, leading to muscle stiffness.
03Small clinical trials showed that intramuscular hyaluronidase injection in patients with post-stroke muscle stiffness resulted in significant improvement in stiffness and increase in passive and active movement.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
This is a narrative review, not a systematic review or meta-analysis, so it lacks rigorous bias control and may reflect author selection. Much of the mechanistic evidence comes from preclinical (animal) studies. Clinical evidence for hyaluronidase injections is based on small trials and case series, not large randomized controlled trials. The authors disclose significant conflicts of interest, including patents and founding a company related to the treatment discussed.
Declared interests
Drs Stecco and Raghavan are founders of Movease, Inc., and report patents issued and filed for the use of hyaluronidase for muscle stiffness. Dr Stecco is the president of the Fascial Manipulation Association. Dr Jankowski reports unrelated grants from NIH and DoD. The work was supported by NIH/NINDS.
The easy way to misread this
Do not interpret the promising results of hyaluronidase injections for muscle stiffness as established practice. The evidence is derived from small clinical trials and preclinical data within a narrative review authored by individuals with patents and financial ties to the intervention. Large double-blind controlled trials are still needed to confirm efficacy.