The document details a lecture that reviews advances in the field of mechanotransduction and its relevance to anatomy, tendinopathy, and treatment methods such as acupuncture and exercise therapy. It references numerous studies and online resources, aiming to deepen understanding of tendon repair and rehabilitation. Future directions in research, along with implications for clinical practice and health promotion, are also discussed.

1. Much Ado About Tendons: No Drama References
Mark Sexton MISCP May 2014
One of the main aims of the lecture was to whet the appetite for more detail
this clinical and research area of mechanotransduction, I hopeyou find the
references and links useful.
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.
Useful Web Links
Lecture Slides
The Lecture Slides are on Slideshare.net
http://www.slideshare.net/Mark_Sexton/tendinopathy-
mechanotransduction-bioplasticity-physiotherapy-acupuncture-and-
rehabilitation
Google Scholar
http://scholar.google.com/
Mechanotransduction Lectures
Prof Helene Langevin AACP Conference 2011
https://www.youtube.com/watch?v=2i04RQq9KX4
Prof Donald E. Ingber "From Cellular Mechanotransduction to Biologically Inspired
Engineering" 2014
http://vimeo.com/94458584
Fascia Research Lecture
Dr. Robert Schleip (University of Ulm, Germany) held at the 3rd Fascia Research Congress,
Vancouver, 2012.
https://www.youtube.com/watch?v=miIIGLLmXIc
Body in Mind Lorimer Moseley
http://www.bodyinmind.org/time-to-embrace-bioplasticity/
Tendon Mechanotransduction Article
http://bjsm.bmj.com/content/43/4/247.full?sid=35823251-3be6-4180-bdfb-
2208946f7844

2. More Useful Web Links
Tendinopathy podcast 1
https://soundcloud.com/bmjpodcasts/bjsm-podcast-
mechanotherapy?utm_source=soundcloud&utm_campaign=wtshare&utm_medium=
Twitter&utm_content=https://soundcloud.com/bmjpodcasts/bjsm-podcast-
mechanotherapy
Tendinopathy podcast 2
http://physioedge.com.au/pe-005-tendons-and-tendinopathy-with-jill-cook/
Shoulder Community UL
http://www.shouldercommunity.com/
Fibroblast remodelling
https://www.youtube.com/watch?v=KyoAhyN97ZM
Key Lecture references
Langevin HM, Churchill DL, Cipolla MJ. Mechanical signalling through connective tissue: a
mechanism for the therapeutic effect of acupuncture. FASEB J. 2001 Oct, 15 (12): 2275-82.
Langevin H.M. et al. Pathophysiological model for chronic low back pain integrating connective tissue
and nervous system mechanisms. Medical Hypotheses (2006), doi:10.1016/j.mehy.2006.06.033
Zusman, Max. There’s something about passive movement. Medical Hypotheses 75 (2010) 106-110
Khan K.M. Scott, A. Mechanotherapy: How physical therapists’ prescription of exercise promotes
tissue repair. Br J Sports Med 2009; 43:247-251. doi:10.1136/bjsm.2008.054239
Langevin H.M. Connective tissue: A body-wide signalling network? Medical Hypotheses (2006)
Benjamin, Mike. The fascia of the limbs and back – a review. J. Anat. (2009) 214, pp1-18
Fu, Sai-Chuen et al. Deciphering the pathogenesis of tendinopathy: a three-stages process. Sports
Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2010 2:30
Langevin H.M. et al. Ultrasound evidence of altered lumbar connective tissue structure in human
subjects with chronic low back pain. BMC Musculoskeletal Disord. 2009; 10:151
McCreesh, Karen & Lewis, Jeremy. (2013) Continuum model of tendon pathology – where are we
now? International Journal of Experimental Pathology. 94:242-247. Doi: 10.1111/iep.12029
Cook, J.L & Purdam, C.R. Is tendon pathology a continuum? A pathology model to explain the clinical
presentation of load-induced tendinopathy. Br J Sports Med 2009; 43:409-416. Doi:
10.1136/bjsm.2008.051193
Cook, J.L & Purdam, C. Is compressive load a factor in the development of tendinopathy? Br J Sports
Med 2012; 46:163-168. Doi:10.1136/bjsports-2011-090414

3. Key Lecture references Contd.
Stecco, Carla et al. The paratendineous tissues: an anatomical study of their role in the pathogenesis
of tendinopathy. Surg Radiol Anat doi 10.1007/s00276-013-1244-8
Torres-Rosas, Rafael et al. Dopamine mediates vagal modulation of the immune system by
electroacupuncture. Nature Medicine February 2014; doi:10.1038/nm.3479
Magnan, Bruno MD et al. The pathogenesis of Achilles tendinopathy: A systematic review. 2014
European Foot and Ankle Society. Pub. Elsevier Inc.
Rees, Jonathan D, et al. Tendons – time to revisit inflammation. Br J sports Med. oi:10.1136/bjsports
2012-091957
Dos Santos de Almeida, Marcos, et al. A hypothesis for the anti-inflammatory and
mechanotransduction molecular mechanisms underlying acupuncture tendon healing. Published
online 11 December 2013
Molsberger, Albrecht F. et al. German Randomized Acupuncture Trial for chronic shoulder pain
(GRASP) – A pragmatic, controlled, patient-blinded, multi-centre trial in an outpatient care
environment. Pain 151(2010) 146-154
Scott, Alex et al. Sports and exercise-related tendinopathies: a review of selected topical issues by
participants of the second International Scientific Tendinopathy Symposium (ISTS) Vancouver 2012.
Br J Sports Med 2013; 47:536-544, doi: 10.1136/bjsports – 2013-092329
HC Diener, K Kronfeld, G Boewing, M Lungenhausen… - The Lancet Neurology, 2006 Efficacy of
acupuncture for the prophylaxis of migraine: a multicentre randomised controlled clinical trial.
H Walach - The Journal of Alternative & Complementary Medicine, 2001The efficacy paradox in
randomized controlled trials of CAM and elsewhere: beware of the placebo trap.
K Dideriksen - Connective tissue research, 2013. Muscle and Tendon Connective Tissue Adaptation
to Unloading, Exercise, and NSAID.
RL Marcos, G Arnold, V Magnenet, R Rahouadj… - Journal of the mechanical. 2014 Biomechanical
and biochemical protective effect of low-level laser therapy for Achilles tendinitis
KG Silbernagel - Journal of Orthopaedic & Sports Physical Therapy, 2014. Does One Size Fit All
When It Comes to Exercise Treatment for Achilles Tendinopathy?
M Stevens, CW Tan - Journal of Orthopaedic & Sports Physical Therapy, 2013. Effectiveness of the
Alfredson's Protocol Compared With a Lower Repetition Volume Protocol for Mid-portion Achilles
Tendinopathy: A Randomized Controlled Trial
Ford, E.S. et al. Lifestyle factors and mortality among adults with diabetes: findings from the
European Prospective Investigation into Cancer and Nutrition–Potsdam study* Journal of Diabetes
2.2 (2010) 112-117
Ford, E.S. et al Healthy living is the best revenge: findings from the European Prospective
Investigation into Cancer and Nutrition-Potsdam study. Archives of Internal Medicine 169.15 (2009):
1355

4. Recommended Reading
Langevin H.M. Subcutaneous Tissue Fibroblast Cytoskeletal Remodelling Induced by Acupuncture:
Evidence for a Mechanotransduction-based Mechanism. Journal of Cellular Physiology 207:767-774
(2006)
Langevin H.M. Relationship of Acupuncture Points and Meridians to Connective Tissue Planes. The
Anatomical Record (New Anat) 269:257-265, 2002
Langevin HM, Churchill DL, Fox JR, Badger GJ, Garra BS, Krag MH. Biomechanical response to
acupuncture needling in humans. J Appl Physiol. 2001 Dec; 91 (6):2471-8.
Davis Robert T et al. A new method for quantifying the needling component of acupuncture
treatments. Acupunct Med. 2012 June 1: 30(2): 113-119
Langevin HM, Bouffard NA, Fox JA, Palmer BM, Wu J, Iatridis JC, Barnes WD, Badger GJ, Howe AK.
Fibroblast cytoskeletal remodeling contributes to connective tissue tension. Journal of Cellular
Physiology. May 2011; 226(5):1166-75. doi:10.1002/jcp.22442.
Berman BM, Langevin HM, Witt CM, Dubner R. Acupuncture for Chronic Low Back Pain. New
England Journal of Medicine 363: 454-61, 2010.
Langevin HM, Storch KN, Snapp RR, Bouffard NA, Badger GJ, Howe AK and Taatjes DJ. Tissue
stretch induces nuclear remodeling in connective tissue fibroblasts. Histochemistry and Cell Biology
133:405-15, 2010.
Bouffard NA, Cutroneo K, Badger GJ, White S, Buttolph T, Ehrlich HP, Langevin HM. Tissue stretch
decreases soluble TGF ß1 and Type-1 pro-collagen in mouse subcutaneous connective tissue:
evidence from ex vivo and in vivo models. J Cell Physiol 214 (2) 389-395, 2008.
Langevin H.M., Bouffard N.A., Badger G.J., Iatridis J.C. Howe A.K. Dynamic fibroblast response to
subcutaneous tissue stretch ex vivo and in vivo. American Journal of Physiology-Cell Physiology
288:C747-C756, 2005.
R. Schleip, W. Klingler, F. Lehmann-Horn, Fascia is able to contract in a smooth muscle-like manner
and thereby influence musculoskeletal mechanics. Liepsch, D: Proceedings of the 5th World Congress
of Biomechanics, Munich, Germany 2006, pp 51-54
Carla Stecco, Andrea Porzionato et al., A Histiological study of the deep fascia of the upper limb. It.
J. Anat. Embryol. Vol. 111, n 2: 2006
Tersarz J. et al. Sensory innervation of the thoracolumbar fascia in rats and humans. Neuroscience.
2011 Oct 27; 194:302-8. Epub 2011 Aug 2.
Corey SM et al. Sensory Innervation of the nonspecialised connective tissues in the low back of the
rat. Cells Tissues Organs. 2011 Mar 18.

5. More Recommended Reading
Schleip R. et al. The fascial network: an exploration of its load bearing capacity and its potential role
as a pain generator. Vleeming A et al.: Proceedings of the 7th Interdisciplinary World Congress on
Low Back Pain & Pelvic Pain, Los Angeles, November 9-12, 2010. ISBN 978-90-816016-1-0, page
215-218
Langevin H.M. et al. Fibroblasts form a body-wide cellular network. Histochem Cell Biol (2004) 122:7-
15.
Langevin H.M. et al. Reduced thoracolumbar fascia shear strain in human chronic low back pain.
BMC Musculoskeletal Disord. 2011; 12:203
Langevin H.M. et al. Connective Tissue Fibroblast Response to Acupuncture: Dose-Dependent Effect
of Bidirectional Needle Rotation. J. Altern Complement Med. PMC 2011 March 29.
Corey Sarah et al. Stretching of the back improves gait, mechanical sensitivity and connective tissue
inflammation in a rodent model. PLoS One. 2012; 7(1):
Sullivan, Michael J.L. et al. Catastrophizing and Perceived Injustice: Risk Factors for the Transition to
Chronicity after Whiplash Injury. SPINE Vol.36, No.25S, pp.S244-S249
Sterling Michele et al. Physical and psychological factors maintain long-term predictive capacity post-
whiplash injury. Pain 122 (2006) 102-108
Curatolo M et al. Central hypersensitivity in chronic pain after whiplash injury. Clin J Pain 2001 Dec
17(4): 306-15.
Smart K.M et al. Self-reported pain severity, quality of life, disability, anxiety and depression in
patients classified with nociceptive, peripheral neuropathic and central sensitisation pain. The
discriminant validity of mechanism-based classification of low back (+-leg) pain. Manual Therapy
2012: 17; 119-125.
Vitaly Napadow, Andrew Ahn, John Longhurst, Lixing Lao, Elisabet Stener-Victorin, Richard Harris,
and Helene M. Langevin. The Status and Future of Acupuncture Mechanism Research.The Journal of
Alternative and Complementary Medicine. September 2008, 14(7): 861-869.
Langevin H.M. Peter M.Wayne, Hugh MacPherson, Rosa Schnyer, Ryan M. Milley, Vitaly Napadow,
Lixing Lao, Jongbae Park, Richard E. Harris, Misha Cohen, Karen J. Sherman, Aviad Haramati and
Richard Hammerschlag. Paradoxes in Acupuncture Research: Strategies for Moving Forward.
Hindawi Publishing Corporation. Evidence-based Complementary and Alternative Medicine, Vol 2011,
Article ID 180805, 11 pages. doi:10.1155/2011/180805
Langevin H.M. and Peter A. Huijing. Communicating About Fascia: History, Pitfalls, and
Recommendations. Int J Ther Massage Bodywork. 2009; 2(4): 3-8.
Van Oosterwijck, J et al. Evidence for central sensitization in chronic whiplash: A systematic literature
review. Eur J Pain 2012 Sep 25
Davis Charles G. Mechanisms of chronic pain from whiplash injury. Journal of Forensic and Legal
Medicine 4 July 2012
Nijs, J et al. Recognition of central sensitization in patients with musculoskeletal pain: application of
pain neurophysiology in manual therapy practice. Manual Therapy 2010: 15; 135-141.

6. Even More Reading!
Nijs, J et al. From acute musculoskeletal pain to chronic widespread pain and fibromyalgia:
application of pain neurophysiology in manual therapy practice. Manual Therapy 2009: 14; 3-12.
Aliodoust, Morteza et al. Evaluating the effect of low-level laser therapy on healing of tentomized
Achilles tendon in streptozotocin-induced diabetic rats by light microscopical and gene expression
examinations. Lasers in Medical Science doi: 10.1007/s10103-014-1561-0
Ultra-low-level laser therapy. Lasers in Medical Science January 2011, Vol 26, Iss 1, pp103-112
Sharifi, Davood et al. Histomorphological evaluation of low level laser therapy in dog Achilles tendon
injuries. European Journal of Experimental Biology, 2014, 4(2):143-147
Langevin, Helene. 2011 The Science of Stretch. The study of connective tissue is shedding light on
pain and providing new explanations for alternative medicine. www.acupuncturistvictoria.ca/the-
science-of-stretch.html
Langevin H.M., Konofagou E.E., Badger G.J., Churchill D.L., Fox J.R., Ophir J., Garra B.S. Tissue
displacements during acupuncture using ultrasound elastography techniques. Ultrasound in
Medicine and Biology 30(9): 1173-1183, 2004.
Langevin H.M. et al. Electrical impedance of acupuncture meridians: The relevance of subcutaneous
collagenous bands. PLoS One. 2010; 5(7): e11907
Frederick Grinnell, Fibroblast Mechanics in three dimensional collagen matrices. J Bodyw Mov Ther,
2008 July: 12(3): 191-193
Nachbur, Jennifer. The Acupuncture Connection. UVM. The View. Dec 5, 2006.
______________________________________________________________________________
Reading with ‘Quality Issues’ (in my view)
Yu Bai et al. Review of evidence suggesting that the fascia network could be the anatomical basis for
acupoints and meridians in the human body. Evid based Complement Alternat Med. 2011;
2011:260510.
Ahn, Andrew C. et al. Electrical impedance along connective tissue planes associated with
acupuncture meridians. BMC Complementary and Alternative Medicine 2005, 5:10