tendons: mechanisms of pathogenicity and repair - movement, stretch and acupuncture as a basis of...
DESCRIPTION
This lecture reviews and connects developments different areas of the published research: in the areas of Anatomy, Cellular Mechanotransduction, Connective Tissue (Histology, Innervation, differentiation, plasticity), Tendinopathy, Tendon Repair, Neural plasticity and Bioplasticity. These developments have implications for clinical practice, research, education and health promotion. This research was discussed as it informs common Treatment and Rehabilitation techniques (Exercise Therapy, Acupuncture, Manual Therapy, Low Level Laser, Biomechanics). Future directions in research were discussed. The slides are intended as support for those who were at the lecture, as they contain little information alone. An Aim of this lecture is to stimulate interest in the key publications and online resources in this clinical area, listed in a connected file on Slideshare.TRANSCRIPT
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ISCP
Much Ado About …
TendonsCIG Day2014
(No Drama)
Mark SextonChartered Physiotherapist
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Nothing is,All is becoming
Lao Tzu
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Helene LangevinMyers, BenjaminKhan, ScottMax ZusmanLorimer Moseley
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Helene LangevinMyers, BenjaminKhan, ScottMax ZusmanLorimer Moseley
Mechanotransduction
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Helene LangevinMyers, BenjaminKhan, ScottMax ZusmanLorimer Moseley
Mechanotransduction
Bioplasticity
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So What!
Clinical RelevanceResearch RelevanceEducation Relevance
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Physiotherapists get people moving
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Tendon Structure and Function
MechanotransductionTendinopathy
Literature updateTendon Healing
TreatmentRehabilitation
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Brief Review
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Body-Wide Integrative System
Every Cell, Organ, System
HomeostasisLocal RepairRemote Effects
The MeridialSystem
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Connective Tissue and Meridial System
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Connective TissueSystem
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Langevin 2001
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Langevin 2001
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Langevin 2001
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Tendon Structure and Function
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Tendon HealingPhysiotherapyAcupuncture MechanotherapyLaser
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Mechanotransduction
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Fibroblast Cell Cytoskeleton
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Fibroblast Cell Cytoskeleton
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Cytoskeletal Tensegrity
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Mechanotransduction2-D Representation : Fibroblast in ECM
Integrins
Swartzlander 2011 (ZurichMinds)
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TGF -b 1
Mechanotransduction
Integrins
Swartzlander 2011 (ZurichMinds)
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Fibroblast remodelling
Nuclear processes – mRNAChemical Cascades
Fibroblast Cell – ECM Traffic
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Fibroblast Remodelling
Nuclear processes – mRNAChemical Cascades
Fibroblast Cell – ECM Traffic
Collagen SynthesisTissue Repair
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Tendon tissue provides an example of cell–cell communication.
Khan K M , Scott A Br J Sports Med 2009;43:247-252
©2009 by BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine
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Tendon tissue provides an example of cell–cell communication.
Khan K M , Scott A Br J Sports Med 2009;43:247-252
©2009 by BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine
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Tendon tissue provides an example of cell–cell communication.
Khan K M , Scott A Br J Sports Med 2009;43:247-252
©2009 by BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine
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Mechanical loading stimulates protein synthesis at the cellular level.
Khan K M , Scott A Br J Sports Med 2009;43:247-252
©2009 by BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine
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Mechanical loading stimulates protein synthesis at the cellular level.
Khan K M , Scott A Br J Sports Med 2009;43:247-252
©2009 by BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine
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Mechanical loading stimulates protein synthesis at the cellular level.
Khan K M , Scott A Br J Sports Med 2009;43:247-252
©2009 by BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine
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Fibroblast Response to NeedlingLangevin 2004, 2006, 2010, 2011a,b,c
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Fibroblast Remodelling Langevin 2006
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Fibroblast Network
Less Dense Connective Tissue
No Gap Junctions
Connexin 43 present
Langevin 2010
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Langevin 2001
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Acupuncture - Key Principle Remote/Systemic
LocalAdjacent
Needle Grasp/De Qi
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Mechanotransduction….
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Connective TissueSystem
Bioplasticity
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All Movement has Effect…
…and Vice-Versa
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Tendinopathy
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Tendinopathy
• Continuum Model
• Rective Tendinopathy• Tendon Disrepair• Degenerative Tendinopathy
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Tendinopathy Structure….
…..Dysfunction
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Tendon Healingand Failed Healing
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Tendon Treatment and Rehabilitation
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The Home Straight !!
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To Conclude
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Tendinopathy Research• Much Unknown• Low Statistical Power• Ongoing
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Tendinopathy Research – Direction• Compression• Peritendinous structures• Paratendon • Neural
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To ConcludeMechanotransduction – only one aspect
Bioplasticity
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Mechanotransduction….
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To ConcludeBioplasticityBody-wide systems• Homeostasis• Health • Disease • Repair
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Connective TissueSystem
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Clinical Relevance - BioplasticityChronicityTendon HealingTreatmentPrevention
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Bioplasticity
Clinical RelevanceResearch RelevanceEducation relevance So What!
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To ConcludeUnderstanding research findings
and its limitations, and remembering what is known to be uncertain allows clinicians to wisely informclinical practice
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Nothing is,All is becoming
Lao Tzu
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All Movement has Effect…
…and Vice-Versa
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Physiotherapists get people moving
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ISCP
Much Ado About …
TendonsCIG Day2014
(No Drama)
Mark SextonChartered Physiotherapist
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Thank You!
References and useful web resources on a separate file
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Coming next…
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…a lecture on the clinical implications of bioplasticity in
Chronic Low Back Pain…here are a few preview slides
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Langevin HM and Sherman KJ,
Pathophysiological Model for cLBPIntegrating
Connective Tissueand
Nervous System Mechanisms
Med. Hyp. 2006
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Connective Tissue
Plasticity
Pathogenic Mechanism
Langevin 2006
Neural Tissue
Plasticity
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Connective Tissue
Plasticity
Pathogenic Mechanism
Langevin 2006
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Connective Tissue
Plasticity
Pathogenic Mechanism
Langevin 2006
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Pathogenic Mechanism
Langevin 2006
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Pathogenic Mechanism
Langevin 2006
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Pathogenic Mechanism
Langevin 2006
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Pathogenic Mechanism
Langevin 2006
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MovementPostureExercise
Treatment
Tissue Pathology
Dysfunction
Direct Tissue Mechanical Stimulus
Cognitive/BehaviouralMovementTreatment
Placebo
PsychosocialGenetic
Pathogenic Mechanism – Therapeutic interventions
Langevin 2006