Acupuncture and Manual Therapy: Parallels in Research and Clinical Practice - A lecture to the ISCP Conference 2011
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In clinical practice Acupuncture, Manual Therapies and Exercise Therapy are seamlessly integrated into treatment and rehabilitation. Globally, unconnected research into how each of these treatments may work is converging in the area of Cellular Mechanotransduction. This lecture explains this process, and the reviews research in the area of fibroblast mechanotransduction in the healing or maladaptation of connective tissue. The relevance of this research to clinical practice, education and research is considered. Research showing maladaption of connective tissue in chronic low back pain is explained. A published hypothesis integrating central nervous system and peripheral tissue plasticity is discussed in relation to the emergence, and to the integrated management of, chronicity.
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Acupuncture and Manual Therapy: Parallels in Research and Clinical Practice - A lecture to the ISCP Conference 2011
- 1. Acupuncture and Manual Therapy: Parallels in Research and Clinical Practice Mark Sexton MISCP
- 2. The Physios Enriching our wellbeing
- 3. Physiotherapists get people moving
- 4. The Plan
- 6. Nothing is, All is becoming Lao Tzu
- 7. Helene Langevin Thomas Myers Max Zusman Lorimer Moseley
- 8. Helene Langevin Thomas Myers Max Zusman Lorimer Moseley Mechanotransduction
- 9. So What! Clinical Relevance Research Relevance Education relevance
- 10. Acupuncture - Key Principle Remote/Systemic Local Adjacent Needle Grasp/De Qi
- 11. Body-Wide Integrative System Every Cell, Organ, System Homeostasis Local Repair Remote Effects The Meridial System
- 12. Meridial System and Connective Tissue
- 17. Langevin 2001
- 18. Langevin 2001
- 19. Connective Tissue Whorl Langevin 2001
- 20. Connective Tissue Whorl Langevin 2002
- 22. Langevin and Yandow 2002 Relationship of Acupuncture Points and Connective Tissue planes 80% Points Correlate CT Plane Points – Greater Access to CT 50% Meridian Intersections - CT Planes
- 23. Fibroblast Response to Needling Langevin 2004, 2006, 2010, 2011a,b,c
- 27. Mechanotransduction 2-D Representation : Fibroblast in ECM Integrins Swartzlander 2011 (ZurichMinds)
- 30. 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
- 31. 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
- 32. 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
- 33. 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
- 34. 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
- 35. 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
- 37. Fibroblast Remodelling Langevin 2006
- 38. Fibroblast Network Less Dense Connective Tissue No Gap Junctions Connexin 43 present Langevin 2010
- 39. Fibroblast remodelling Nuclear processes – mRNA Chemical Cascades Fibroblast Cell – ECM Traffic
- 40. Fibroblast Remodelling Nuclear processes – mRNA Chemical Cascades Fibroblast Cell – ECM Traffic Collagen Synthesis Tissue Repair
- 42. Langevin 2001
- 43. Langevin HM and Sherman KJ, Pathophysiological Model for cLBP Integrating Connective Tissue and Nervous System Mechanisms Med. Hyp. 2006
- 51. Movement Posture Exercise Treatment Tissue Pathology Dysfunction Direct Tissue Mechanical Stimulus Cognitive/Behavioural Movement Treatment Placebo Psychosocial Genetic Pathogenic Mechanism – Therapeutic interventions Langevin 2006
- 52. The Home Straight !!
- 53. Helene Langevin Thomas Myers Max Zusman Lorimer Moseley Mechanotransduction
- 54. So What! Clinical Relevance Research Relevance Education relevance
- 57. Physiotherapists get people moving
- 58. The Physios Enriching our wellbeing
- 59. Acupuncture and Manual Therapy: Parallels in Research and Clinical Practice Mark Sexton MISCP Thank You! Aisling Sexton Mary Pender Valerie Reilly Rowan Manahan Judy Murphy Brona Fullan Erica McMullan Damian Rice
Editor's Notes
- Thank you Appreciate you being here Appreciate being asked Title – All PT Ac CT Cell Healing Remodl. Repair Now PT Clin, Ed Res
- Cast of the Simpsons My take on the theme For PT Profession to enrich wellbeing of in a diverse world It Is the Physios… Relies on Diversity Celebrate, embrace, or at least tolerate our diversity In Planning this lecture..diversity of audience, Clinicians, Research, Education, Mx How? Many ways, but basically…(next Slide)
- Max Z Conclusion of my talk will be to reinforce Fundamental vitality of Movement importance of PT in HealthCare Know we are doing well Inspire us to When Asked…one foot…both feet in Research
- Composed title before reading the research! Had A good idea research was there, little certainty However , Plan..Begin with the research
- Archimedes…Give me a solid place to stand… To solidly clinically reason Give advice Educate Students Plan Research…. We need solid place, Knowledge
- To balance this need for certainty… Quote from eastern classic of phil Essential dynamic to all aspects of life Represented by spindle complex pulling chromo apart.. Potential ----------------------------------------- This talk wiil connect Mechanics of Archim, Mvt + Effect on Fundamental cellular processes Repair, Remodelling, Health + Homeostasis, wellbeing
- Time to insert brains! Overview to introduce One Particular line of research of interest… Langevin – Research into Acup Points, Meridians and Connective tissue 15 Yrs… At an anatomic Level, Parralels with Myers – Myo fasc… From anat….As res progresses to Cellular level of CT , ..Work of L and others Forming Mechanistic theories Now from the Pt side of things…Zusman Moseley Integrating with Moseley, Proposed By Max as potl basis for PT Mechanotransduction
- Time to insert brains! Overview of STORY to introduce One Particular line of research of interest… Langevin – Research into Acup Points, Meridians and Connective tissue 15 Yrs… At an anatomic Level, Parralels with Myers – Myo fasc… From anat….As res progresses to Cellular level of CT , ..Work of L and others Forming Mechanistic theories Now from the Pt side of things…Zusman Moseley Integrating with Moseley, Proposed By Max as potl basis for PT Mechanotransduction Story - Convergence
- So What Mechanotransduction has Major and important…C,R +E Will be a process that we will need to be familr in C,R, E One Mechanism, not the only Underpins PT + Ac Lit review prioritised
- Story Begins Acup Local, Adjacent Distal Needle grasp, De Qi – Fundamental to Tx Effect
- TCM Explns Health, Ill Health and Tx Eff of Acup Full Extent Of Meridial Sys Main, Organs, Brain Sp cord,
- Correln with Myofascia apparent Anatomical Continuous Network Systems Integration Signalling Points –Sites of Convergence/Intersection Rembr: Myofasc At level of principal/TM Langevin Hypth: CT:MeridSys Every cell system in the body Innervation of CT PsychNeurImm
- 3 Bodywide Communication regulatory Systems TCM Holds Merid Sys as Central If Merid Sys Correlated to CT sys…
- Acup point Conn Tissue
- Needle grasp/De Qi 18%> c Point 52%> c grasp Connective tissue Mechanical Coupling
- Needle Grasp 52%, 18% up at points(2001, 2002) Points of Convergence Meridians some correl, some join dots Inter or intramuscular
- If We want to understand the Effect on the Cells, We need to revise the cell structure Needle rotation (B) causes winding fibroblasts further away from the needle respond by changing shape, becoming large and ‘‘sheet-like’’ in marked contrasts with the small cell bodies and long branching processes (‘‘dendritic’’ morphology) seen without needle rotation (A). After needle rotation, a new tension equilibrium is achieved between actomyosin-driven intracellular tension (intracellular white arrows) and two types of opposing forces: extracellular matrix counter-tensional forces (extracellular black arrows) and intracellular compressive forces provided by the expanded cytoskeleton (intracellular black arrows). Gray dots represent focal contacts.
- Understand slide
- Not Passive Mechanosensitive
- Actin polymerisation
- Tendon tissue provides an example of cell–cell communication. (A) The intact tendon consists of extracellular matrix (including collagen) and specialised tendon cells (arrowheads). (B) Tendon with collagen removed to reveal the interconnecting cell network. Cells are physically in contact throughout the tendon, facilitating cell–cell communication. Gap junctions are the specialised regions where cells connect and communicate small charged particles. They can be identified by their specific protein connexin 43. (C–E) Time course of cell–cell communication from (C) beginning, through (D) the midpoint to (E) the end. The signalling proteins for this step include calcium (red spheres) and inositol triphosphate (IP3).
- Tendon tissue provides an example of cell–cell communication. (A) The intact tendon consists of extracellular matrix (including collagen) and specialised tendon cells (arrowheads). (B) Tendon with collagen removed to reveal the interconnecting cell network. Cells are physically in contact throughout the tendon, facilitating cell–cell communication. Gap junctions are the specialised regions where cells connect and communicate small charged particles. They can be identified by their specific protein connexin 43. (C–E) Time course of cell–cell communication from (C) beginning, through (D) the midpoint to (E) the end. The signalling proteins for this step include calcium (red spheres) and inositol triphosphate (IP3).
- Tendon tissue provides an example of cell–cell communication. (A) The intact tendon consists of extracellular matrix (including collagen) and specialised tendon cells (arrowheads). (B) Tendon with collagen removed to reveal the interconnecting cell network. Cells are physically in contact throughout the tendon, facilitating cell–cell communication. Gap junctions are the specialised regions where cells connect and communicate small charged particles. They can be identified by their specific protein connexin 43. (C–E) Time course of cell–cell communication from (C) beginning, through (D) the midpoint to (E) the end. The signalling proteins for this step include calcium (red spheres) and inositol triphosphate (IP3).
- Mechanical loading stimulates protein synthesis at the cellular level. (A) A larger scale image of the tendon cell network for orientation. We focus on one very small region. (B) Zooming in on this region reveals the cell membrane, the integrin proteins that bridge the intracellular and extra-cellular regions, and the cytoskeleton, which functions to maintain cell integrity and distribute mechanical load. The cell nucleus and the DNA are also illustrated. (C) With movement (shearing is illustrated), the integrin proteins activate at least two distinct pathways. (D) One involves the cytoskeleton that is in direct physical communication with the nucleus (ie, tugging the cytoskeleton sends a physical signal to the cell nucleus). Another pathway is triggered by integrins activating a series of biochemical signalling agents which are illustrated schematically. After a series of intermediate steps those biochemical signals also influence gene expression in the nucleus. (E). Once the cell nucleus receives the appropriate signals, normal cellular processes are engaged. mRNA is transcribed and shuttled to the endoplasmic reticulum in the cell cytoplasm, where it is translated into protein. The protein is secreted and incorporated into extracellular matrix. (F) In sum, the mechanical stimulus on the outside of the cell promotes intracellular processes leading to matrix remodelling.
- Mechanical loading stimulates protein synthesis at the cellular level. (A) A larger scale image of the tendon cell network for orientation. We focus on one very small region. (B) Zooming in on this region reveals the cell membrane, the integrin proteins that bridge the intracellular and extra-cellular regions, and the cytoskeleton, which functions to maintain cell integrity and distribute mechanical load. The cell nucleus and the DNA are also illustrated. (C) With movement (shearing is illustrated), the integrin proteins activate at least two distinct pathways. (D) One involves the cytoskeleton that is in direct physical communication with the nucleus (ie, tugging the cytoskeleton sends a physical signal to the cell nucleus). Another pathway is triggered by integrins activating a series of biochemical signalling agents which are illustrated schematically. After a series of intermediate steps those biochemical signals also influence gene expression in the nucleus. (E). Once the cell nucleus receives the appropriate signals, normal cellular processes are engaged. mRNA is transcribed and shuttled to the endoplasmic reticulum in the cell cytoplasm, where it is translated into protein. The protein is secreted and incorporated into extracellular matrix. (F) In sum, the mechanical stimulus on the outside of the cell promotes intracellular processes leading to matrix remodelling.
- Mechanical loading stimulates protein synthesis at the cellular level. (A) A larger scale image of the tendon cell network for orientation. We focus on one very small region. (B) Zooming in on this region reveals the cell membrane, the integrin proteins that bridge the intracellular and extra-cellular regions, and the cytoskeleton, which functions to maintain cell integrity and distribute mechanical load. The cell nucleus and the DNA are also illustrated. (C) With movement (shearing is illustrated), the integrin proteins activate at least two distinct pathways. (D) One involves the cytoskeleton that is in direct physical communication with the nucleus (ie, tugging the cytoskeleton sends a physical signal to the cell nucleus). Another pathway is triggered by integrins activating a series of biochemical signalling agents which are illustrated schematically. After a series of intermediate steps those biochemical signals also influence gene expression in the nucleus. (E). Once the cell nucleus receives the appropriate signals, normal cellular processes are engaged. mRNA is transcribed and shuttled to the endoplasmic reticulum in the cell cytoplasm, where it is translated into protein. The protein is secreted and incorporated into extracellular matrix. (F) In sum, the mechanical stimulus on the outside of the cell promotes intracellular processes leading to matrix remodelling.
- Fibroblasts in elongated tissue (B) have a "sheetlike" morphology produced by microtubule assembly balanced by microfilament tension. Fibroblasts in shortened tissue (A) have a "dendritic" morphology resulting from microtubule disassembly in the presence of residual microfilament tension
- Connex
- All types of exercise, movement Just getting out of the desk, jumping up and down Constant having effect on remodelling repair Homeostasis Psycho emotional – Physical
- Back out of the cell…
- So What Mechanotransduction has Major and important…C,R +E Will be a process that we will need to be familr in C,R, E One Mechanism, not the only Underpins PT + Ac Lit review prioritised
- Acup All movement therapies Two way cycle – Cognitive Reassurance Confidence
- Reach Potential
- All Ais Mary, Brona, Judy, Erica Damian