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Transcript of Tendons: Mechanisms of pathogenicity and repair - movement, stretch and acupuncture as a basis of...
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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