Tendons: Mechanisms of pathogenicity and repair - movement, stretch and acupuncture as a basis of treatment and rehabilitation
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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.
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Tendons: Mechanisms of pathogenicity and repair - movement, stretch and acupuncture as a basis of treatment and rehabilitation
- 1. ISCP Much Ado About … Tendons CIG Day 2014 (No Drama) Mark Sexton Chartered Physiotherapist
- 3. Nothing is, All is becoming Lao Tzu
- 4. Helene Langevin Myers, Benjamin Khan, Scott Max Zusman Lorimer Moseley
- 5. Helene Langevin Myers, Benjamin Khan, Scott Max Zusman Lorimer Moseley Mechanotransduction
- 6. Helene Langevin Myers, Benjamin Khan, Scott Max Zusman Lorimer Moseley Mechanotransduction Bioplasticity
- 7. So What! Clinical Relevance Research Relevance Education Relevance
- 8. Physiotherapists get people moving
- 10. Tendon Structure and Function Mechanotransduction Tendinopathy Literature update Tendon Healing Treatment Rehabilitation
- 11. Brief Review
- 12. Body-Wide Integrative System Every Cell, Organ, System Homeostasis Local Repair Remote Effects The Meridial System
- 13. Connective Tissue and Meridial System
- 15. Langevin 2001
- 16. Langevin 2001
- 17. Langevin 2001
- 18. Tendon Structure and Function
- 34. Mechanotransduction 2-D Representation : Fibroblast in ECM Integrins Swartzlander 2011 (ZurichMinds)
- 36. Fibroblast remodelling Nuclear processes – mRNA Chemical Cascades Fibroblast Cell – ECM Traffic
- 37. Fibroblast Remodelling Nuclear processes – mRNA Chemical Cascades Fibroblast Cell – ECM Traffic Collagen Synthesis Tissue Repair
- 39. 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
- 40. 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
- 41. 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
- 42. 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
- 43. 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
- 44. 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
- 46. Fibroblast Response to Needling Langevin 2004, 2006, 2010, 2011a,b,c
- 47. Fibroblast Remodelling Langevin 2006
- 48. Fibroblast Network Less Dense Connective Tissue No Gap Junctions Connexin 43 present Langevin 2010
- 49. Langevin 2001
- 50. Acupuncture - Key Principle Remote/Systemic Local Adjacent Needle Grasp/De Qi
- 54. Tendinopathy
- 55. Tendinopathy • Continuum Model • Rective Tendinopathy • Tendon Disrepair • Degenerative Tendinopathy
- 57. Tendon Healing and Failed Healing
- 69. The Home Straight !!
- 70. To Conclude
- 71. Tendinopathy Research • Much Unknown • Low Statistical Power • Ongoing
- 72. Tendinopathy Research – Direction • Compression • Peritendinous structures • Paratendon • Neural
- 73. To Conclude Mechanotransduction – only one aspect Bioplasticity
- 75. To Conclude Bioplasticity Body-wide systems • Homeostasis • Health • Disease • Repair
- 77. Clinical Relevance - Bioplasticity Chronicity Tendon Healing Treatment Prevention
- 78. Bioplasticity Clinical Relevance Research Relevance Education relevance So What!
- 79. To Conclude Understanding research findings and its limitations, and remembering what is known to be uncertain allows clinicians to wisely inform clinical practice
- 82. Nothing is, All is becoming Lao Tzu
- 84. Physiotherapists get people moving
- 86. ISCP Much Ado About … Tendons CIG Day 2014 (No Drama) Mark Sexton Chartered Physiotherapist
- 88. Thank You! References and useful web resources on a separate file
- 89. Coming next…
- 90. …a lecture on the clinical implications of bioplasticity in Chronic Low Back Pain …here are a few preview slides
- 91. Langevin HM and Sherman KJ, Pathophysiological Model for cLBP Integrating Connective Tissue and Nervous System Mechanisms Med. Hyp. 2006
- 100. Movement Posture Exercise Treatment Tissue Pathology Dysfunction Direct Tissue Mechanical Stimulus Cognitive/Behavioural Movement Treatment Placebo Psychosocial Genetic Pathogenic Mechanism – Therapeutic interventions Langevin 2006
Editor's Notes
- 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 philosophy Essential dynamic to all aspects of life Represented by spindle complex pulling chromosomes apart.. Potential ----------------------------------------- This talk wiil connect Mechanics of Archim, Mvt + Effect on Fundamental cellular processes Repair, Remodelling, Health + Homeostasis, wellbeing
- Max Zusman 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 continually improve
- Meridial Theory
- Correlation with Myofascia apparent Anatomical Continuous Network Systems Integration Signalling Points –Sites of Convergence/Intersection PsychNeuroImmunology
- Acup point Conn Tissue
- Back out of the cell…
- Benjamin, Myers – advance our understanding on functional anatomy
- Story - Convergence
- Cells are 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).
- Tendon tissue provides an example of cell–cell communication. (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.
- Tendon tissue provides an example of cell–cell communication. (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.
- 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.
- Brief review Prof Langevin Research 2001 to date
- Interesting research ahead!
- All types of exercise, movement, posture Just getting out of the desk, jumping up and down Constant having effect on remodelling repair Homeostasis, bio - Psycho - emotional – Physical Helpful/Adverse, reversible
- Literature review/ Update
- Discussion
- Discussion of common PT treatments in light of research limitations, findings and direction
- Discussion of common PT treatments in light of research limitations, findings and direction
- Cook + Purdam Caution re blind application Tailor to person + stage
- Acup All movement therapies Two way cycle – Cognitive Reassurance Confidence
- All types of exercise, movement, posture Just getting out of the desk, jumping up and down Constant having effect on remodelling repair Homeostasis, bio - Psycho - emotional – Physical Helpful/Adverse, reversible