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Connective tissue: A body-wide signaling network?
Abstract
Unspecialized "loose" connective tissue forms an anatomical network throughout the body. This paper presents the hypothesis that, in addition, connective tissue functions as a body-wide mechanosensitive signaling network. Three categories of signals are discussed: electrical, cellular and tissue remodeling, each potentially responsive to mechanical forces over different time scales. It is proposed that these types of signals generate dynamic, evolving patterns that interact with one another. Such connective tissue signaling would be affected by changes in movement and posture, and may be altered in pathological conditions (e.g. local decreased mobility due to injury or pain). Connective tissue thus may function as a previously unrecognized whole body communication system. Since connective tissue is intimately associated with all other tissues (e.g. lung, intestine), connective tissue signaling may coherently influence (and be influenced by) the normal or pathological function of a wide variety of organ systems. Demonstrating the existence of a connective signaling network therefore may profoundly influence our understanding of health and disease.
... It is likely that bone tissue also belongs to this functional entity (Langevin and Huijing, 2009;Bordoni et al., 2018;Bordoni, 2019). We often forget that the connective tissue not only surrounds and encapsulate organs, thus differentiating it from other tissue and fulfilling a support and mechanical function; it also surrounds all cells and thus forms one holistic system that allows for an exchange of information, substrate and transport of waste products and nourishment, fulfilling a communicative and exchange function (Langevin, 2006;Tozzi, 2015a,b). Due to the emphasis on the single cell as the subject and object of health and disease, the holistic properties of organic subsystems and the regulatory mechanisms that govern them have come under closer scrutiny only recently. ...
... This means that there is a very fine tuned mechanic-electric communication system within the connective tissue that is mediated via collagen and its fibrillary structures (Huang and Greenspan, 2012;Langevin et al., 2013). Therefore, the connective tissue has been called a signaling network (Langevin, 2006;Oschman, 2012;Schleip, 2012). We know from collagen that it can exhibit electric semiconductor and photoconductor properties in vitro. ...
... Whether this is also true in vivo we do not know currently. But we do know that it has piezoelectric properties (Vos et al., 2003;Langevin, 2006;Liu et al., 2012). Piezoelectric ion channels in the human organism are responsible for mechanotransduction and mechanoreception, as well as for the sensitivity of baroreceptors (Schrenk-Siemens et al., 2015;Nonomura et al., 2017;Zeng et al., 2018;Burke et al., 2019). ...
Objective: We describe a potentially new physiological reflex path that has so far been
neglected but which could be used for a novel therapeutic approach: The vegetative
receptor-vascular reflex. This is a physiological response that starts from the connective
tissue and influences the whole organism. We cross-fertilized various research areas
with each other.
Key Findings: The matrix or the connective tissue forms a passive reservoir of substrate
for the growth and development of cells, and functions as the primordial communication
system of all living systems. It contains a continuous network of cells, such as
fibroblasts, along with protein bundles made up of collagen that support electrical
exchange through piezoelectric effects. This archaic vegetative system surrounds all
cells, including neurons, and can thus be viewed as the primordial coordinating system
in every organism. It is very likely the basis for a reflex which we describe here for the first
time: the vegetative receptor vascular reflex. We also indicate some potential practical
applications and test procedures.
Conclusion: The vegetative receptor vascular reflex describes the pathway from stimuli
that originate in the connective tissue or the extracellular matrix toward organ systems.
They might be chemical in nature or electrical via piezo-electric effects stimulating nerve
endings, and thus can influence higher order processes such as regeneration or healing
of tissue. Thus, this reflex lends itself to a novel therapeutic approach via certain types
of manipulation of the connective tissue.
... Similarly, fascia is an important component that covers all the body's components responsible for movement and other work in a web-like structure [26]. According to evidence from the literature, fasciae can aid in venous return, dispersion of tensional stress at the site where a muscle, ligament, or tendon inserts into a bone [3], explaining the etiology of pain [16], and smooth interaction between muscles of the limb. Fascia is an important component in the maintenance of human posture and mobility. ...
... Fascia is an important component in the maintenance of human posture and mobility. Finally, some research suggests that the continuity of the fascial system has a function in proprioception and conveys the organ sensations throughout the body [3,16]. Trainers, coaches, and physiotherapists constantly encounter new challenges and use their knowledge to develop new exercise protocols aimed at improving performance and reducing injury and its risk factors in the sports population, as modern-day athletes are subjected to intense training programs to achieve an optimal level of performance in the competitive era of sport [5]. ...
Introduction. Muscle imbalance is frequently observed according
to research findings. Muscles that have been shortened for
a lengthy period become tight. Modalities, posture changes, and
releases can all be used to treat this condition. Muscle soreness
is a myogenic condition that results from deep releases. A joint’s
range of motion is reduced and pain is experienced as a result
of adhesions and inflammation caused by the rupture of taut
bands because of excessive pressure. Aim of Study. The aim
was to examine the effects of active myokinetic chain release
therapy (AMRT) and stretching on physical performance
amongst adolescent racquet sport players with misalignment
of fascial tissue. Material and Methods. Eighty racquet sports
players having muscle imbalance as tested by the Bunkie test
were randomly divided into two groups receiving AMRT and
stretching, respectively. They were tested for different biomotor
abilities, targeting lower back and hamstring flexibility,
agility as well as endurance, with functional ability, speed of
the racquet, pulse rate, and oxygen saturation used to assess
physical performance. Results. AMRT resulted in better results
in improving the biomotor abilities as compared to stretching in
different biomotor abilities, but there was a significant change
from pre- to post-assessment. Conclusions. While AMRT can
increase biomotor and physical performance in elite athletes,
there is no key procedure to apply this intervention to any
player, yet this appears to be a very easy and adequate protocol
for the athletic population to generate the immediate effect.
... Effects on one part of the system can and do spread to others" [9]. This connective tissue continuum appears to serve as a body-wide, mechanosensitive signaling network [16] and is present at all levels, i.e., from molecules to cells, tissues, and the entire human form (from the cell to the organism as a whole) [17]. ...
... The focus is now shifting towards research into the ECM and the fascial system and the mechanisms by which cells interact with the ECM. This is a two-way dialogue that can be adversely affected by mechanical issues and disturbed structure-function relationships within living tissues [39,58], thereby making it important for the health and survival of the organism [15,16]. ...
Progress in technologies, notably in vivo and in situ methods, has equipped scientists with the necessary skills to explore the living human body in increasingly minute detail. This has led to a better understanding of the dynamic interplay between the various elements that make up the living human body. To further understand the interplay, this research focuses on the insights and observations of the founders of osteopathy, who placed great importance on the role of fascia in the body. Modern anatomical investigation still relies heavily on dissection to describe the structural organization of living organisms. Therefore, at present, a major challenge faced by modern anatomists is to move towards a more holistic and integrative understanding of the unity, continuity, and dynamic interplay between the various elements that come together to create the living human form.
... If any part of this structure is deformed or distorted, negative stresses may be imposed on distant structures (body-wide), and on the structures that it divides, and connects (44). This evidence suggests that any tendency to think of a local dysfunction as existing in isolation should be discouraged as body structures are tightly and symbiotically interrelated, and given shape, cohesion and functional ability by the fascia (45). In addition, there is evidence to suggest that fascia accommodates to chronic stress patterns and deforms itself; something that often precedes deformity of osseous and cartilaginous structures in chronic diseases (44,45). ...
... This evidence suggests that any tendency to think of a local dysfunction as existing in isolation should be discouraged as body structures are tightly and symbiotically interrelated, and given shape, cohesion and functional ability by the fascia (45). In addition, there is evidence to suggest that fascia accommodates to chronic stress patterns and deforms itself; something that often precedes deformity of osseous and cartilaginous structures in chronic diseases (44,45). ...
Low back pain (LBP) is one of the most frequently occurring conditions, affecting many individuals worldwide. The best ways to manage LBP usually contradict the thoughts of the professionals, the patients, and the general public. No musculoskeletal pain is more burdened with serious misconceptions than LBP and the persistence of these misconceptions can impede the way treatment is being administered, which may also impair recovery and promote unnecessary suffering and disability. Given the myths about low back pain, there is the need to acknowledge some of its riddles particularly those pertaining to treatment and look for positive solutions. As professionals, each physiotherapist uses his or her own guiding principles and choices as evidence. However, our guiding principles and choices are important, but they usually bring partiality in decision making. It is essential to examine and identify our core values so that they do not subdue other sources of evidence.
... If any part of this structure is deformed or distorted, negative stresses may be imposed on distant structures (body-wide), and on the structures that it divides, and connects (44). This evidence suggests that any tendency to think of a local dysfunction as existing in isolation should be discouraged as body structures are tightly and symbiotically interrelated, and given shape, cohesion and functional ability by the fascia (45). In addition, there is evidence to suggest that fascia accommodates to chronic stress patterns and deforms itself; something that often precedes deformity of osseous and cartilaginous structures in chronic diseases (44,45). ...
... This evidence suggests that any tendency to think of a local dysfunction as existing in isolation should be discouraged as body structures are tightly and symbiotically interrelated, and given shape, cohesion and functional ability by the fascia (45). In addition, there is evidence to suggest that fascia accommodates to chronic stress patterns and deforms itself; something that often precedes deformity of osseous and cartilaginous structures in chronic diseases (44,45). ...
... The deep fascia is connected to the underlying muscles thanks to many myofascial expansions, and it represents a parallel pathway for force transmission beyond the muscle, tendon, and bone [19][20][21][22] through which more than 30% of the mechanical forces are transmitted. These myofascial connections create a continuity among the muscles involved in the same movement, representing the anatomical base of the myofascial chain. ...
The “motor unit” or the “muscle” has long been considered the quantal element in the control of movement. However, in recent years new research has proved the strong interaction between muscle fibers and intramuscular connective tissue, and between muscles and fasciae, suggesting that the muscles can no longer be considered the only elements that organize movement. In addition, innervation and vascularization of muscle is strongly connected with intramuscular connective tissue. This awareness induced Luigi Stecco, in 2002, to create a new term, the “myofascial unit”, to describe the bilateral dependent relationship, both anatomical and functional, that occurs between fascia, muscle and accessory elements. The aim of this narrative review is to understand the scientific support for this new term, and whether it is actually correct to consider the myofascial unit the physiological basic element for peripheral motor control.
... When the spine is considered with all the muscles, joints, ligaments, and dura mater structures from the head to the coccyx, for example, as a result of the stimulation of the trigeminocervical junction, the neck region, which is the continuation of the chain, may also be affected by pain. There may be pain or movement limitations in this region, and neck stiffness may be reported by patients [24][25][26]. Stability and strength are required to sustain neck-related activity [10,27]. Considering the parameters evaluated in the neck disability questionnaire, weightlifting, reading, sleep, driving, work, self-care, and recreation activities require the strength and stability of the neck [13]. ...
Chronic migraine (CM) patients who report a high frequency and intensity of headaches also report neck pain (NP) and neck disability (ND) in neck activities that require stability. In this context, CM patients may report different headache intensities at different levels of ND. Our aim in this study is to investigate whether the intensity of headaches differs according to the level of ND in CM patients. Headache intensity and NP intensity were evaluated with the Visual Analog Scale (VAS), and ND was evaluated with the Neck Disability Index (NDI). A total of 142 patients who met the inclusion criteria were included in the study. The mean age was 53.24 ± 12.08 years. The median number of monthly headache days was 20. According to VAS, the median headache intensity was 10(4–10) cm and the median of NP intensity was 9(1–10) cm. The mean NDI was 28.45 ± 10.28. There was a difference in headache intensity between mild and severe disability levels (p = 0.007, Z = −3.289); headache intensity between mild and complete disability levels (p = 0.000, Z = −4.421); and headache intensity between moderate and complete disability levels (p = 0.004, Z = −2.212). Although the difference in headache intensity between ND levels is small, a median increase of 2 cm in headache intensity at mild ND levels may result in complete ND. A median increase of 1 cm in headache intensity at the moderate ND level may cause complete disability in the neck. According to our results, the intensity of headaches of CM patients differed according to the level of ND. We consider our results to be clinically important in this context.
... Ihre kontraktilen Eigenschaften resultieren aus einzelnen Myofibroblasten, die Aktin-Myosin-Filamente enthalten und belastungsabhängig Kollagen produzieren. Die unterschiedliche Ausprägung der tiefen Faszien beruht auf der Adaptation durch die von Langevin et al.(Langevin, 2006) nachgewiesenen Fähigkeit der Fibroblasten zur Genexpression, Signalübertragung und Zellmatrixanpassung, abhängig von der mechanischen Beanspruchung. Diese Belastung wird von einer großen Anzahl von Mechanorezeptoren detektiert(Kumka & Bonar, 2012). ...
1.1 Hintergrund und Ziele Foam Rolling (FR) ist eine zunehmend populäre Methode zur myofaszialen Eigenbehandlung mit verschiedensten Indikationen und therapeutischen Zielsetzungen. Die hervorgerufenen Gewebereaktionen sind jedoch weitestgehend ungeklärt, sodass die Anwendung im Wesentlichen erfahrungsbasiert erfolgt. Das Ziel dieser Studie war es, die Effekte einer standardisierten FR-Intervention auf die passive Gewebesteifigkeit des Muskel- und des Fasziengewebes erfahrener und unerfahrener Sportler/-innen mittels einer objektivierbaren Diagnostik zu untersuchen. 1.2 Material und Methoden Insgesamt wurden 40 gesunde Sportler/-innen in die vorliegende Studie einbezogen. Hierunter befanden sich: 20 erfahrene Sportler/-innen (EA, 25±2 Jahre, BMI: 22±2 kg/m2; FR-Anwendung: seit 3,4 ± 2,5 Jahre, für 35 ± 26 min/Woche) mit regelmäßiger FR-Ausübung (> 6 Monate, min. 15 min, verteilt auf mindestens zwei Anwendungen pro Woche); und 20 unerfahrene Sportler/-innen (UEA, 25±4 Jahre, BMI: 23±2 kg/m2) ohne vorherige FR-Anwendung. Die Proband/-innen führten eine standardisierte FRIntervention des lateralen Oberschenkels mit fünf Sätzen bestehend aus jeweils 45 s Belastung und 20 s Pause durch. Die viskoelastischen Gewebeeigenschaften wurden mittels Acoustic Radiation Force Impulse (ARFI) Elastosonographie als intrafaszialeund intramuskuläre Scherwellengeschwindigkeit (SWV) erfasst. Die Datenerhebung erfolgte jeweils in oberflächlicher und tiefer Muskelgewebeschicht (M. vastus lateralis, MVL; M. vastus intermedius, MVI), sowie im faszialen Bindegewebe (distaler Ansatz des Tractus iliotibialis, TI). Der Messort wurde zunächst mittels B-Bild Sonographie (Acuson S2000; Siemens Healthineers, 9L4 Schallkopf) determiniert, gefolgt von 10 quantitativen Messungen der SWV jeder untersuchten Struktur. Die unter Ruhebedingungen ermittelten Werte wurden mit Nachuntersuchungszeitpunkten nach 0 min, 30 min, 6 h und 24 h verglichen. Das Signifikanzniveau wurde auf p<0,05 festgelegt. 1.3 Ergebnisse In beiden Gruppen wurden keine signifikanten Unterschiede in Bezug auf ihre anthropometrischen Daten (p≥0,28) und die Gewebesteifigkeit unter Ruhebedingungen des 2 MVL, MVI und TI (p≥0,09) festgestellt. Im Fasziengewebe konnte für die EA eine kurzfristige signifikante Abnahme der SWV des TI unmittelbar nach der Intervention (0 min) erfasst werden (-13%, p<0,01). In der UEA-Gruppe wurde hingegen zum gleichen Messzeitpunkt (0 min) ein nicht-signifikanter Anstieg der SWV des TI detektiert (+6%, p=0,16). Ebenso ergaben die Messungen nach 6 h einen signifikanten Abfall (-12%, p=0,02) für die EA. Für alle weiteren Nachuntersuchungszeitpunkte konnten für beide Gruppen keine signifikanten Änderungen der SWVs des TI nachgewiesen werden (p≥0,08). Im Muskelgewebe des MVL und MVI zeigten sich zu allen Messzeitpunkten für beide Gruppen keine signifikanten Änderungen der SWV (p≥0,11). 1.4 Schlussfolgerung Unsere Studie liefert Erkenntnisse über akute Effekte des FRs auf die viskoelastischen Eigenschaften des Muskel- und Fasziengewebes. Die vorliegenden Ergebnisse konnten erstmalig nachweisen, dass (a) sich die Ruhesteifigkeit des Muskel- und Fasziengewebes zwischen EA und UEA nicht unterscheidet, (b) das Fasziengewebe direkt nach einer FR-Intervention unterschiedliche Gewebereaktionen bei EA und UEA zeigt und (c) keine signifikante Veränderung der Gewebesteifigkeit im Muskel resultiert. Die kurzfristige Abnahme der Fasziensteifigkeit nach der FR-Intervention in EA könnte nicht nur für die Therapie lokaler Gewebeverhärtungen, sondern insbesondere auch bei bevorstehenden schnellkräftigen Bewegungsmustern von biomechanischer Bedeutung sein. Im Fokus stehen hier z.B. Sprints, Richtungswechsel oder Sprünge, für die eine erniedrigte Gewebesteifigkeit negative Auswirkungen auf Energiespeicherung und -rückgewinnung im Rahmen des Dehnungs-Verkürzungs-Zyklus zur Folge haben könnte. In Anbetracht der erstmalig nachgewiesenen unterschiedlichen faszialen Gewebereaktion in Abhängigkeit der FRErfahrung müssen zuvor publizierte Studien in Hinblick auf die Trainingsgewohnheiten der einbezogenen Proband/-innen hinterfragt werden. Um die zugrundeliegenden Mechanismen der aufgezeigten Unterschiede identifizieren zu können, sind weitere Studien notwendig.
... [2] The fascial system in the body is also thought to function as a proprioceptive/communicating organ, it has been demonstrated recently through new research findings. [14][15][16] structure o f fAscIA Fibrous connective tissue is properly called fascia if its layers are well defined, but it is inappropriate to use this word to describe any connective tissue in the body. From the skin to the muscular plane, the human body typically has three basic layers of fibrous connective tissue: superficial fascia, deep fascia, and epimysium, as well as all visceral fasciae. ...
This paper synthesized the available published literature on myofascia, its structure, myofascial disorder, causative factors, scientific methods for evaluation and treatments, etc. The importance of myofascial in chronic and acute musculoskeletal pain is overlooked. According to Waller et al., mention in their article, up to 85% of people will experience myofascial pain at least once during their life. The myofascia is a musculoskeletal cell matrix that supports muscular connective tissue, it is essential for generating forces between muscles and also provides better flexibility. Myofascial pain syndrome is described as sensory, motor, and autonomic signs and symptoms that are produced by trigger points or taut bands of skeletal muscle or fascia. A myofascial trigger point is painful on compression and can give rise to referred pain, motor dysfunction, and automatic event, it restricts the range of motion and force generation capacity. Therefore, it is utmost importance to know about myofascial disorders, their prevention techniques, diagnosis, and treatment.
... Fascia is densely innervated with mechanoreceptors and nociceptors (Langevin, 2006, Schleip, 2003a, Schleip, 2003b. The mechanoreceptors, such as Pacini corpucles, Ruffini organs and free-nerve endings, maintain muscular coordination via the constant feedback from ligaments. ...
Postural disorders are common among preschool and school-age children. In regard to gen�der and age distribution, children are characterized by different indicators of body posture. Posture
for different professionals has different importance, and from a standpoint of one physiatrist it rep�resents a measure of the efficiency of muscular balance and neuromuscular coordination. Bad pos�ture represents a functional deviation from normal posture status without structural changes to the
spine or lower extremities. Evaluation and treatment of postural disorders requires knowledge of
basic principles related to the conduct of individual body segments, joints and muscles. The com�bined physical training programmes that include strength and muscle stretching exercises, particu�larly with regard to the postural antigravity muscles, should help in the prevention of health prob�lems that could occur later in life. Future research on the impact of early school-based back pos�ture promotion in relation to the integration of back posture principles according to biomechanical
favourable lifestyle and back pain prevalence later in life is essential.
Keywords: posture, assessment, exercise, scoliosis
... In 2006, Langevin proposed a body-wide signalling system via the connective-tissue network that could be affected by pain from injury, posture and tissue damage [52]. It is conceivable that changes in the cell or the extracellular matrix could disrupt mechanotransduction and lead to altered tissue states and disease [53]. ...
Reflexology is a complementary therapy focusing mainly on the application of pressure on the feet, hands and ears. A small but growing evidence base suggests that positive outcomes can be gained in the management and improvement of symptoms across a range of conditions. Biological plausibility is a key concept in the determination of the usefulness of therapies. Research which tests for safety and efficacy alongside the underpinning mechanism of action are therefore important.
This paper explores the potential mechanism of action for the outcomes associated with reflexology treatment as reflected in the current evidence. The influences of therapeutic touch, relaxation, placebo effects and the similarities with other therapeutic methods of structural manipulation are considered. The lack of clarity around the precise definition of reflexology and the challenges of researching the therapy as a treatment tailored to individual need are discussed.
A deeper understanding of the mechanism of action for reflexology may help to further develop research into safety and efficacy. Such an understanding may lead to the integration of knowledge which may provide both symptomatic support and longer term preventative health benefits.
... 1 East Asian medicine system therapies such as CHM and acupuncture are used to address a wide variety of symptoms, reflecting interrelated effects on neurological, endocrine, digestive, circulatory, muscular, and immune function; they are also used for wellness, health promotion, and disease prevention. [2][3][4][5][6] Whole Systems Research 7 is a phenomenological approach introduced early in the 21st century, diverging from the related concept of Complex Interventions Research. 8 Whole Systems of medicine such as EAM, Ayurveda, European herbal medicine, and naturopathy may be studied as complex interventions within biomedical health care, 9 but themselves apply a discrete body of knowledge and/or practice to the patient's goals of mental and physical health restoration, and do not necessarily require mediation by biomedical concepts. ...
Introduction
East Asian Medicine (EAM) is a Whole System medicine that includes Chinese herbal medicine (CHM). Chinese herbal medicine has been utilized to reduce symptom burden in infectious disease, with notable theoretical reformulations during pandemics of the 3rd, 13th, and 17th centuries. Today, Licensed Acupuncturists trained in CHM have utilized it to treat symptoms and sequelae of COVID-19. However, little is known about its use or efficacy by the public and health practitioners. Understanding and evaluating whole medicine systems of healthcare is inherently complex; there is international consensus for a descriptive, pragmatic approach. We are conducting a feasibility pilot study using a prospective, pragmatic, observational design using Whole Health and Whole Person perspectives. The complexity of COVID-19 reflects the impact on multiple homeoregulatory systems and provides a unique opportunity to assess the impact of interventions such as EAM on whole health. Observation of these EAM encounters will provide valuable qualitative and quantitative data on the interface of an extant Whole System medicine with a novel complex illness as a precursor to a randomized clinical trial.
Methods
This ongoing study observes a CHM clinic offering telehealth consultations to a diverse patient population since April, 2020. Patients who report symptoms potentially related to COVID-19 disease are consented for standardized collection and analysis of demographic and clinical data from each clinical encounter.
Results
To date, 61 patients engaged in 195 consultations (mean 3.3) with 49 reporting symptom resolution sufficient to complete treatment, and 4 withdrawals. Just over half (62%) were female, with an average age of 45.7 years. A wide variety of CHM formulas and EAM dietary and lifestyle modifications were provided.
Discussion
Adequate recruitment and retention suggest feasibility of the intervention and data collection. The rich dataset may facilitate the construction of Whole Health models of CHM’s clinical impact, as well as integrative inquiry into CHM’s effects on symptoms.
... If the disturbances of the Earth's magnetic field are an obvious causal factor, then we are tormented by doubts about its first target (acceptor). Accepting the hypothesis of Limansky [4,5] and the concept of nervousness, we conclude that caused by geomagnetic disturbances changes in the conductivity of APs in one way or another (through afferent cutaneous nerves or liquid crystalline collagen fibers of the connective tissues [30,31]) reach medullary, subcortical and cortical structures of CAN, exciting some neurons and inhibiting others, thus triggering well-studied mechanisms of neuro-immune, neuro-endocrine and endocrine-immune modulation [32][33][34][35][36][37][38][39][40][41][42] documented in our study. ...
Background. Recently, on the example of two cohort of patients, we found that disturbances of the geomagnetic field cause a significant immediate modulating effect on the level of immune parameters in the blood. The data available in the literature give grounds for assumptions about the direct effect of disturbances of the geomagnetic field on immunocytes, and indirectly, through immunotropic neurotransmitters and hormones. Our hypothesis is as follows. Disturbances of the geomagnetic field are perceived by acupuncture points (APs). The information obtained is transmitted to neurons and endocrinocytes, the mediators of which, in turn, affect immunocytes. The purpose of this study is to test this hypothesis.
Methods. The object of observation were 21 men (24-63 y) and 20 women (30-72 y) with neuroendocrine-immune complex dysfunction. Each patient was tested twice with an interval of 4 days. We recorded the ongoing electroencephalogram (EEG). Retrospectively we recorded the geomagnetic Ap-Index on the day of testing and during the previous 7 days, using resource https://www.spaceweatherlive.com/.
Results. The canonical correlation between Ap-indices for 7 days before and on the day of testing, and EEG parameters is 0,886; immunity parameters is 0,921. In turn, the immune parameters are closely related to the EEG parameters (R=0,944).
Conclusion. Disturbances of the geomagnetic field (Ap-index) causes a significant immediate modulating effect on the parameters of immunity as well as EEG, apparently through acupuncture points as polymodal receptors of the ecoceptive sensitivity system.
... If the disturbances of the Earth's magnetic field are an obvious causal factor, then we are tormented by doubts about its first target (acceptor). Accepting the hypothesis of Limansky (1990;2003), we conclude that caused by geomagnetic disturbances multidirectional and asymmetric changes in the conductivity of a limited constellation of APs in one way or another (through afferent cutaneous nerves or liquid crystalline collagen fibers of the connective tissues (Ho et Knight, 1998;Langevin, 2006)) reach medullary, subcortical and cortical structures of CAN, exciting some neurons and inhibiting others, thus triggering well-studied mechanisms of neuro-immune, neuro-endocrine and endocrine-immune modulation (Tracey, 2007;Thayer et Sternberg, 2010;Popovych et al, 2013;Babelyuk et al, 2017;Kul'chyns'kyi et al, 2017;Gozhenko et al, 2019; documented in our study. ...
Background. Recently, on the example of two cohort of patients, we found that disturbances of the geomagnetic field cause a significant immediate modulating effect on the level of immune parameters in the blood. The data available in the literature give grounds for assumptions about the direct effect of disturbances of the geomagnetic field on immunocytes, and indirectly, through immunotropic neurotransmitters and hormones. Our hypothesis is as follows. Disturbances of the geomagnetic field are perceived by acupuncture points. The information obtained is transmitted to neurons and endocrinocytes, the mediators of which, in turn, affect immunocytes. The purpose of this study is to test this hypothesis. Material and methods. The object of observation were 21 men (24-63 y) and 20 women (30-72 y) with neuroendocrine-immune complex dysfunction. Each patient was tested twice with an interval of 4 days. Retrospectively we recorded the geomagnetic Ap-Index on the day of testing and during the previous 7 days, using resource https://www.spaceweatherlive.com/. Recorded the heart rate variability (HRV) parameters, determined the plasma level of cortisol, triiodothyronine and testosterone. Results. During the week, the average level of Ap-index ranged from 7 to 13 nT. Maximum coefficients of multiple correlation with HRV&Hormonal parameters were detected for Ap-index on 2 (R=0,506) and 7 (R=0,403) days before testing. The canonical correlation between Ap-indices for 7 days before and on the day of testing, and the HRV&Hormonal parameters is 0,766. In turn, the immune parameters are closely related to the HRV&Hormonal parameters (R=0,714). Conclusion. Disturbances of the geomagnetic field (Ap-index) causes a significant immediate modulating effect on the immune, HRV and endocrine parameters, apparently through acupuncture points as polymodal receptors of the ecoceptive sensitivity system.
... This junction provides the ability to transfer tensegrity in the kinematic chain over greater distances than in the case of the musculotendinous system itself, acting locally [7,10]. The integrated concept of the kinetic chain suggests that muscle pathways are connected to each other and form a large network of myofascial chains, which may transfer force between its components [2,[11][12][13]. The myofascial force transmission was suggested based on cadaveric research [7,14] and in vivo studies [15,16]. ...
Abstract
The foot arches are responsible for proper foot loading, optimal force distribution, and transmission throughout the soft tissues. Since the foot arch is an elastic structure, able to adapt to forces transmitted by the foot, it was reported that low arch is related to excessive foot pronation, while high arched foot is more rigid and inflexible. Therefore, it is also probable, that foot arch alterations may change the force transmission via myofascial chains. The objective of this study was to evaluate the effect of symmetrical and asymmetrical excessive feet arching on muscle fatigue in the distal body parts such as the lower limbs, trunk, and head. Seventy-seven women (25.15 ± 5.97 years old, 62 ± 10 kg, 167 ± 4 cm) were assigned to three groups according to the foot arch index (Group 1—both feet with normal arch, Group 2—one foot with normal arch and the other high-arched, Group 3—both feet with high-arch). The bioelectrical activity of the right and left hamstrings muscles, erector spine, masseter, and temporalis muscle was recorded by sEMG during the isometric contraction lasting for 60 s. The stable intensity of the muscle isometric contraction was kept for all the time during the measurement. Mean frequency difference (%), slope (Hz), and intercept (Hz) values were calculated for muscle fatigue evaluation. No differences were observed in fatigue variables for all evaluated muscles between the right and left side in women with symmetrical foot arches, but in the group with asymmetric foot arches, the higher muscle fatigue on the normal-arched side compared to the high-arched side was noted. Significantly greater values of the semitendinosus—semimembranosus muscle frequency difference was observed on the normal-arched side compared to the high-arched side (p = 0.04; ES = 0.52; −29.5 ± 9.1% vs. −24.9 ± 8.4%). In the group with asymmetric foot arches, a significantly higher value of lumbar erector spinae muscle frequency slope (p = 0.01; ES = 1.32; −0.20 ± 0.04 Hz vs. −0.14 ± 0.05 Hz) and frequency difference (p = 0.04; ES = 0.92; −7.8 ± 3.1% vs. −4.8 ± 3.4%) were observed on the high-arched foot side compared to the side with normal foot arching. The thoracic erector spine muscle frequency slope was significantly larger in women with asymmetrical arches than in those with both feet high-arched (right side: p = 0.01; ES = 1.25; −0.20 ± 0.08 Hz vs. −0.10 ± 0.08 Hz); (left side: p = 0.005; ES = 1,17; −0.19 ± 0.04 Hz vs. −0.13 ± 0.06 Hz) and compared to those with normal feet arches (right side: p = 0.02; ES = 0.58; −0.20 ± 0.08 Hz vs. −0.15 ± 0.09 Hz); (left side: p = 0.005; ES = 0.87; −0.19 ± 0.04 Hz vs. −0.14 ± 0.07 Hz). In the group with asymmetric foot arches, the frequency difference was significantly higher compared to those with both feet high-arched (right side: p = 0.01; ES = 0.87; −15.4 ± 6.8% vs. 10.4 ± 4.3%); (left side: p = 0.01; ES = 0.96; 16.1 ± 6.5% vs. 11.1 ± 3.4%). In the group with asymmetric foot arches, a significantly higher value of the masseter muscle frequency difference was observed on the high-arched side compared to the normal-arched side (p = 0.01; ES = 0.95; 6.91 ± 4.1% vs. 3.62 ± 2.8%). A little increase in the longitudinal arch of the foot, even though such is often not considered as pathological, may cause visible changes in muscle function, demonstrated as elevated signs of muscles fatigue. This study suggests that the consequences of foot high-arching may be present in distal body parts. Any alterations of the foot arch should be considered as a potential foot defect, and due to preventing muscle overloading, some corrective exercises or/and corrective insoles for shoes should be used. It can potentially reduce both foot overload and distant structures overload, which may diminish musculoskeletal system pain and dysfunctions.
... The retinacular system or fascial system has these functions: the venous return [10], dissipation of tensional stress concentrated at the sites of entheses [11], etiology of pain [12,13], interactions among limb muscles [14][15][16][17] and movement perception and coordination [18][19][20][21][22], due to their unique mechanical properties and rich innervation. ...
The study of the structure of the skin and fascia in recent years has made important advances with respect to the "dynamic anatomy" that they present, that is, the anatomical relationships and tissue interconnections that you share through different tissues. In the same way fascias have been recognized as important sources of origin of different pathologies in the last years, so the greater knowledge of their function and structure is indispensable. The aim of this article is to review the last advances in the anatomic terminology of the soft superficial tissues as advances and recent anatomical discoveries.
... Subcutaneous fascia is connected to and a part of the fascial system. It has been shown that the local injury that changes the tension in subcutaneous fascia could spread the fibrotic responses by activating quiescent fibroblasts via mechanotransduction in otherwise remote locations [96] and potentially affect the health status of the visceral organs and the entire body. Many chronic conditions, such as heart failure and chronic obstructive pulmonary disease (COPD), often show fibrotic alterations in the fascial system. ...
Mammals rapidly heal wounds through fibrous connective tissue build up and tissue contraction. Recent findings from mouse attribute wound healing to physical mobilization of a fibroelastic connective tissue layer that resides beneath the skin, termed subcutaneous fascia or superficial fascia, into sites of injury. Fascial mobilization assembles diverse cell types and matrix components needed for rapid wound repair. These observations suggest that the factors directly affecting fascial mobility are responsible for chronic skin wounds and excessive skin scarring. In this review, we discuss the link between the fascia’s unique tissue anatomy, composition, biomechanical, and rheologic properties to its ability to mobilize its tissue assemblage. Fascia is thus at the forefront of tissue pathology and a better understanding of how it is mobilized may crystallize our view of wound healing alterations during aging, diabetes, and fibrous disease and create novel therapeutic strategies for wound repair.
... Bienfait (286), Stecco (287), Myers (288), Langevin (289). Esta red de tejido conectivo es estirada por la contracción de músculos que están por debajo y que pueden transmitir la tensión a distancia (290,291). ...
Effects of diaphragm muscle treatment in shoulder pain and mobility in subjects with rotator cuff injuries.
Introduction: The rotator cuff inflammatory or degenerative pathology is the main cause of shoulder pain. The shoulder and diaphragm muscle have a clear relation through innervation and the connection through myofascial tissue. In the case of nervous system, according to several studies the phrenic nerve has communicating branches to the brachial plexus with connections to shoulder key nerves including the suprascapular, lateral pectoral, musculocutaneous, and axillary nerves, besides, the vagal innervation that receives the diaphragm and their connections with the sympathetic system could make this muscle treatment a remarkable way of pain modulation in patients with rotator cuff pathology. To these should be added a possible common embryological origin in some type of vertebrates. Considering the connection through myofascial system, the improving of chest wall mobility via diaphragm manual therapy could achieve a better function of shoulder girdle muscles with insertion or origin at ribs and those that are influenced by the fascia such as the pectoralis major muscle, latissimus dorsi and subscapularis.
Objectives:
• Main objective:
To compare the immediate effect of diaphragm physical therapy in the symptoms of patients with rotator cuff pathology regarding a manual treatment over shoulder muscles.
• Specific objectives:
1. To evaluate the immediate effectiveness of each of the three groups in shoulder pain using a numerical pain rating scale (NPRS) and compare between them.
27
2. To evaluate the immediate effectiveness of each of the three groups in shoulder range of motion (ROM) using an inclinometer and compare between them. 3. To evaluate the immediate effectiveness of each of the three groups in pressure pain threshold (PPT) using an algometer and compare between them.
Material and method: A prospective, randomized, controlled, single-blind (assessor) trial with a previous pilot study in which a final sample size of 45 subjects was determined to people diagnosed with rotator cuff injuries and with clinical diagnosis of myofascial pain syndrome at shoulder. The sample were divided into 3 groups of treatment (15 subjects per group):
1. A direct treatment over the shoulder by ischemic compression of myofascial trigger points (MTP) (control / rotator cuff group).
2. Diaphragm manual therapy techniques (diaphragm group).
3. Active diaphragm mobilization by hipopressive gymnastic (hipopressive group).
The pain and range of shoulder motion were assessed before and after treatment in all the participants by inclinometry, NPRS of pain in shoulder movements and algometry. The data obtained were analyzed by an independent (blinded) statistician, who compared the effects of each one of the treatments using the Student’s t-test for paired samples or the Wilcoxon signed rank test, and calculated the post -intervention percentage of change in every variable. An analysis of variance (ANOVA) followed by the post-hoc test or a non-parametric Kruskal-Wallis test for non-parametric multiple-groups comparisons were performed to compare pre- to post-intervention outcomes between groups. Effect-size estimates of each intervention and between groups were calculated to allow interpretation of results in a more functional and meaningful way.
Results:
Both the control group and diaphragm group showed a statistically (p< 0.005) and clinically significant improvement, as well as a significant effect size (moderate to strong), on the NPRS in shoulder flexion and abduction movements. Regarding NPRS in shoulder external rotation, only the control group obtained a significant effect size. There was a significant increase in shoulder abduction and external rotation ROM (p<
Efectos del tratamiento del músculo diafragma en el dolor y la movilidad del hombro en sujetos con patología del manguito rotador.
28
0.001) with a significant effect size in the control group. The PPT at the xiphoid process of the sternum showed a statistically (p< 0.001) and clinically significant improvement in the diaphragm group. The hipopressive gymnastic treatment was found to be no clinically effective in the shoulder pain and mobility, and showed a less efficacy than the other two groups.
Conclusion:
Both the shoulder non-direct treatment by a protocol of diaphragm manual therapy techniques and the rotator cuff MTP intervention showed been clinically effective in reducing pain (NPRS) immediately in shoulder flexion and abduction movements. The ROM assessment improvements obtained post- intervention by the diaphragm group have not been enough to consider them as clinically significant. The control group has obtained a significant effect size in shoulder abduction and external rotation ROM improvement. Both the control group and the diaphragm group treatments have been more effective in improving shoulder pain and mobility than the hipopressive group. The control group intervention has been the most effective in improving shoulder external rotation pain and mobility. The diaphragm group intervention was more effective in improving PPT at the xiphoid process than the other groups. Neither the effect size nor clinical significance proves the short-term benefit of the hipopressive gymnastic treatment in shoulder pain and mobility. Future studies are necessary to show the effectiveness of the diaphragm manual therapy applied in several sessions to determine its long-term effects in shoulder pain and mobility.
... From the vantage point of the present, it is commonly assumed that fascia is not only essential for balancing and transferring forces among muscles (Schuenke et al., 2012) but functions as a body-wide mechanosensitive signalling network (Langevin, 2006). This in turn makes it a key player in mechanotransduction (Humphrey et al., 2014), allowing cells such as fibroblasts to perceive and react to mechanical stimuli (Cao et al., 2015). ...
Background: Low back pain (LBP) is a major health issue in most industrialised countries. Lumbodorsal fascia
has been advocated as a potential source of pain in the lumbopelvic region. Myofascial release constitutes a
manual therapeutic approach focussing on the restoration of altered soft tissue function. No previous study
has focused on quantifying neuromechanical effects of myofascial release on LBP patients through tensiomyography
. The purpose of this study was to quantify immediate neuromechanical alterations of myofascial release
on patients with LBP and healthy controls through tensiomyography parameters.
Methods: The participants' (n = 30) bilateral lumbar erector spinae muscles were assessed via tensiomyography
before and after a 6-min myofascial release treatment of the lumbodorsal fascia to evaluate
the muscles' mechanical characteristics. Subjects with LBP (n = 15) were eligible to partake if they reported
having had LBP for most days in the past 12 weeks. Muscle displacement (Dm [mm]), velocity of
contraction (Vc [mm/s]), and lateral symmetry (Ls [%]) were assessed through tensiomyography testing.
Findings: Statistical analyses revealed a significant increase for velocity of contraction in the right (p = .021)
and left (p = .041) lumbar erector spinae for the subjects with LBP but not for the healthy controls (both
p > .14).
Interpretation: We suggested that myofascial release alters neuromechanical characteristics in subjects with
LBP. Tensiomyography may be implemented in clinical settings to monitor intervention effects of the myofascial
system, especially the tensiomyography parameter velocity of contraction.
... All the chemical and physiological reactions within the supportingstoring system are happening inside the fascia at a molecular level, within macroscopic tissue spaces. Langevin (2006) suggests that the connective tissue network forms a communications network for the whole body. The meridian pathways have certainly been previously linked to nervous, circulatory and lymphatic systems (Wang et al. 2010;Chang 2012). ...
Over the last 20 years there have been advances in understanding the biochemical reactions involved in acupuncture, and attempts made to link traditional Chinese medical theories to scientific findings. The meridians have been linked to tissues in the body including perfora-tor blood vessels, the primo vascular system, the interstitial space and fascia. These tissues have, in the main, been linked to meridian theory independently, with discussion of overlapping areas in a few articles. This article attempts to describe these structures and tissue systems and analyze the similarities between them, linking them to Chinese concepts around acupuncture such as the meridians. This paper theorizes that the substrate of the meridians and flow of Blood and Qi is due to a combination of all these tissue structures working together, because they are significantly interlinked.
... 118 It is postulated that fascial stimulation by physical therapy or acupuncture needles may trigger modulation of cellular processes not only in surrounding tissue but also in distant sites through connecting fascial planes. 119,120 The precise nature of these interactions remains vague, but their existence is often invoked to explain the therapeutic basis for acupuncture, itself a controversial treatment modality. 121,122 Nevertheless, preclinical animal studies of electroacupuncture indicate that it is capable of blocking inflammatory, neuropathic, and visceral pain, and that this is neurally mediated through peripheral, spinal, and supraspinal mechanisms involving the release of endogenous opioids, serotonin, norepinephrine, and other neurotransmitters. ...
The erector spinae plane (ESP) block is an emerging regional anesthetic technique with significant potential for clinical benefit. Nevertheless, its exact mechanism(s) of action has been much debated. We reviewed the available literature to explore the possible mechanisms of analgesia for the ESP block. These include neural blockade and central inhibition from direct spread of local anesthetic to the paravertebral or epidural space; analgesia mediated by elevated local anesthetic plasma concentrations due to systemic absorption; immunomodulatory effects of local anesthetics; and an effect mediated through the mechanosensory properties of thoracolumbar fascia. Based on evidence from clinical, human cadaveric, animal, and mechanistic laboratory studies, the most probable primary mechanism is a direct effect of local anesthetic via physical spread and diffusion to neural structures in the fascial plane deep to the erector spinae muscles and adjacent tissue compartments. Biological plausibility of this primary mechanism is confirmed by injectate spread to the ventral rami of spinal nerves (though quite variable) in most studies. There is consistent involvement of dorsal rami; epidural spread is a less commonly observed phenomenon. A systemic effect of local anesthetic is also plausible, but unlikely to be a major contributor to clinical analgesic efficacy. The evidence for significant analgesia due to other proposed mechanisms, such as fascia-mediated analgesia or lymphatic spread, are currently limited and thus remain speculative. Understanding the mechanisms of action could assist clinicians in further investigating and refining ESP block performance, with the ultimate goal of optimizing analgesic efficacy and improving postoperative patient outcomes.
... 19 These channels were later visualized with isotope tracing and histologic staining studies. 20,21 In fact, recent research by Langevin et al. hypothesized 22,23 that it is the connective tissue manipulation through the ''grasp'' of the needle by the fascia and subsequent stimulation that transmits a mechanical signal to connective tissue cells through mechanotransduction. 24 Further physiologic studies revealed that acupoints and meridians had lower electrical resistance, altered acoustic conduction, and higher skin potential, compared with surrounding tissues that were not on the meridians. [25][26][27] Consistently, Li et al.'s histologic study of acupoints suggests that they are excitable muscle/skinnerve complexes with high density of nerve endings. ...
Acupuncture is increasingly being used in the management of a wide range of symptoms. Despite decades of acupuncture research, a significant gap remains in translating evidence into specific and clear clinical guidelines for acupuncture practice. In this article, the authors discuss the gap between acupuncture research and clinical practice and exploring options to overcome the limitations of current clinical research of acupuncture.
... These results can be explained on the basis of the schematic map (Anatomic map) and tensegrity principle. The tensegrity principle emphasizes the presence of continuity and connectivity between anatomically distant fasciae or muscles [21,22], and a schematic map underlines that tension in certain areas has a detrimental effect on the overall flexibility [6]. Therefore, in this study, we postulated that flexibility of the hamstrings would be improved by applying sole SMR in subjects with short hamstring. ...
... As a typical biological soft matter, the extracellular matrix (ECM) is widespread in various extracellular spaces in the muscles, tendons, and other tissues [1]. The ECM is a hierarchical porous medium composed of fibril bundles (at a micrometer scale) and a filled gel-like matrix (at a nanometer scale), which keeps organs in place and attaches epithelial tissues to other underlying tissues [2]. ...
Although there have been many studies on using hydrogels as substitutes for natural extracellular matrices (ECMs), hydrogels that mimic the structure and properties of ECM remain a contentious topic in current research. Herein, a hierarchical biomimetic fiber hydrogel was prepared using a simple strategy, with a structure highly similar to that of the ECM. Cell viability experiments showed that the hydrogel not only has good biocompatibility but also promotes cell proliferation and growth. It was also observed that cells adhere to the fibers in the hydrogel, mimicking the state of cells in the ECM. Lastly, through a rat skin wound repair experiment, we demonstrated that this hydrogel has a good effect on promoting rat skin healing. Its high structural similarity to the ECM and good biocompatibility make this hydrogel a good candidate for prospective applications in the field of tissue engineering.
... Cartilage as a strong supportive connective tissue is found in many areas of the human body including ribs, nose, ear, trachea, and IVD and is an important component of the joints [184][185][186]. It has dense and highly organized ECM embedding chondrocytes. ...
Skeletal disorders are among the leading debilitating factors affecting millions of people worldwide. The use of stem cells for tissue repair has raised many promises in various medical fields, including skeletal disorders. Mesenchymal stem cells (MSCs) are multipotent stromal cells with mesodermal and neural crest origin. These cells are one of the most attractive candidates in regenerative medicine, and their use could be helpful in repairing and regeneration of skeletal disorders through several mechanisms including homing, angiogenesis, differentiation, and response to inflammatory condition. The most widely studied sources of MSCs are bone marrow (BM), adipose tissue, muscle, umbilical cord (UC), umbilical cord blood (UCB), placenta (PL), Wharton’s jelly (WJ), and amniotic fluid. These cells are capable of differentiating into osteoblasts, chondrocytes, adipocytes, and myocytes in vitro. MSCs obtained from various sources have diverse capabilities of secreting many different cytokines, growth factors, and chemokines. It is believed that the salutary effects of MSCs from different sources are not alike in terms of repairing or reformation of injured skeletal tissues. Accordingly, differential identification of MSCs’ secretome enables us to make optimal choices in skeletal disorders considering various sources. This review discusses and compares the therapeutic abilities of MSCs from different sources for bone and cartilage diseases.
... The development of fascial tissues precedes bone development in an embryo, during the so-called gastrulation or embryonic folding in weeks 2-3, and together with blood, it may be seen as the 'organ of innerness ' (van der Wal, 2017). Together with the nervous system, fascias form a body-wide mechanosensitive integrating signalling system (Langevin, 2006). The outermost layer is known as the hypodermis or 'superficial fascia' and has a spongy quality and yellow colour. ...
This commentary introduces fascia, our bodily connective tissue, as a contribution to thinking body as process beyond mind–body dualisms. Research in the field of Fascia Studies has shown that fascias’ core qualities are shifting and sliding in tensional responsiveness and that its both/and tissue- and-system features challenge clear-cut definitions. Acknowledging these characteristics of human physiology in novel ways, and in particular fascia as our largest sensory organ, becomes relevant to ontologies, alterities and research methodologies emphasizing experience and transdisciplinarity. Importantly, the notion is never to theorize fascia as model or metaphor but as quotidian processual responsive proposition.
... The neural pathways and communication patterns between the fascia and the brain are not fully understood to date [153,159], with most scientific focus being on the afferent input from fascia. Research has pointed to the role fascia may play in musculoskeletal injuries [7] and pain [10,14], including in delayed onset muscle soreness [160] and central sensitization [161], through providing a nociceptive input to the dorsal horn neurons [13]. ...
Mental imagery (MI) research has mainly focused to date on mechanisms of effect and performance gains associated with muscle and neural tissues. MI's potential to affect fascia has rarely been considered. This paper conceptualizes ways that MI might mutually interact with fascial tissue to support performance and cognitive functions by, among others, positively affecting pain and body schema. Drawing on cellular, physiological, and functional similarities and associations between muscle and fascial tissues, we propose that MI has the potential to affect and be affected by fascial tissue. We suggest that fascia-targeted MI (fascial mental imagery; FMI) can therefore be a useful approach for scientific as well as clinical purposes. We use the example of fascial dynamic neuro-cognitive imagery (FDNI) as a codified FMI method available for scientific and therapeutic explorations into rehabilitation and prevention of fascia-related disabling conditions.
... Their work also showed that the needle grasping phenomenon necessitated more pull-out force to withdraw the needle, and increased the tissue volume around the needle insertion site [17,18]. The needle grasping or tissue winding induced by needle movements stimulates the local tissues, such as the connective tissue, thereby delivering a mechanical signal that leads to downstream effects [19,20]. This includes a change in the gene expression or alteration of the composition of the extracellular matrix. ...
The objective of this study was to evaluate the biomaterial properties of nano-modified surface acupuncture needles and the effect of such needles on human pain perception by using pressure pain threshold (PPT) measurements. It is known that changing a material’s surface nano-topography or nanostructure has strong effects on its physical, chemical, and biological surface properties. However, there is no information in the literature about the stimulation characteristics of acupuncture needles with nano-topography or nanostructured surfaces. Based on the knowledge on nanostructured surfaces, it may be possible to potentiate the effects of acupuncture needle stimulation. The pressure pain sensitivity of the masseter muscle in the orofacial region was studied in 21 healthy volunteers in two randomized, double-blinded sessions: an active session of manual acupuncture manipulation with nano-modified surface needles, and an inactive session of sham acupuncture stimulation to control for possible placebo effects. Three acupuncture points were selected from classical Chinese medicine literature: LI4 (Hegu) on the hand, ST6 (Jiache) on the lower masseter region, and ST7 (Xiaguan) on the upper masseter region. PPT measurements, perceived sensations, and pain from the acupuncture were recorded. The results showed discrete yet significant differences in PPT values between the active and inactive acupuncture treatments and significantly higher pain scores from active acupuncture stimulation than from sham acupuncture. These results indicate subtle but significant effects of acupuncture stimulation with nano-modified surface needles, compared to sham acupuncture in healthy participants.
... Specifically, it has been supported that application of pressure (i.e. through rolling) or heat (which is also could be provoked by pressure) can alter the viscoelasticity and trixotrophy of muscle and fascia [21,22]. A change in the viscoelastic and trixotrophic properties means that the tissue changes in stiffness [23] and viscosity [24], it becomes softer, more malleable [25] and less resistant when a stretch is applied, permitting, in this way, the achievement of a greater ROM [24]. These effects in the tissues' plasticity should be seen not only in relation to their mechanistic properties, since they alone would fail to totally explain the immediate effects, but also taking into account the contribution of the nervous system. ...
... It was thought to simply define and delineate boundaries, but studies now suggest it is more about connection than delineation, and acts as a crucial means of force transmission. [42][43][44] Fascial fibers surround each myocyte and create a fine, three-dimensional network of crisscrossing strands that connect many structures in the body and are constantly being remodeled. Fascial pathways connect the right and left sides of the body, upper and lower limbs, and all internal organs, including the brain, which helps to explain many previously unexplained symptoms. ...
This chapter explores the imperative to and the challenges we face in transforming the health system from a disease based system to one based on salutogenesis: creating health.
As its hallmark, complementary integrative pain management (CIPM)
offers patient- centered care that is inclusive of and collaborative
with all appropriate disciplines and strategies— conventional and
complementary— for the benefit of the patient. It then follows that it is multidisciplinary and team based. Patient self- actualization and self- care is essential. Its goal is health creation, and it is driven by patient priorities.
The aerobic capacity determines muscular and cognitive functions, the tissue milieu, and all restorative and regenerative processes. Inactive musculature is the source of systemic low-grade inflammation (myokines). Deficient microcirculation is typical of cerebral maladaptation, inactivity-related sarcopenia, myofascial pain, and maladaptation. The environment of the extracellular matrix is a key element of cellular function, the activation of nociceptors, and neurogenic inflammation. Musculoskeletal pain reflects neuromuscular dysfunction and metabolic alteration, also in the brain. The pain is based on impaired function of the fascial system, altered afference patterns, and a nociceptive biochemical interstitial milieu. A rarified microcirculation network is a precursor to dynapenia (loss of strength), which in turn precede sarcopenia, muscle degradation, and muscle remodeling. This, from a contractile and metabolic perspective, generates pain. Antinociceptive training is always strength and endurance training.
Background and Aims: The purpose of the present research was to compare the effect and follow up of eight-week corrective exercises with and without the myofascial release forward head and forward shoulder deformity in young adults. Methods: A total of 45 male students suffering from abnormal forward head more than 46° and forward shoulder more than 52° deformity with the Mean±SD age of 22.12±2.88 years, height of 175.44±6.80 cm, and weight of 71.21±7.31 kg were selected and randomly distributed in three groups: corrective exercises, combinational exercises (corrective and myofascial release), and control. These groups performed the exercises for eight weeks under the direct observation of the researcher. Prior to starting the exercises, after the end of eighth week, and four weeks after the end of the exercises, the angles of the forward head and forward shoulder of the participants were measured using a photography method. Then, the collected data was analyzed using the variance analysis tests with repeated measurements and ANCOVA. Results: The results showed that the degree of forward head and forward shoulder after eight weeks of exercises in both training groups in post-test and follow-up test was significantly lower than those of the pretest. The ANCOVA test results also demonstrated that the forward shoulder degree in corrective exercises group with myofascial release in post-test and follow-up test was significantly lower than that of the corrective exercises (P≤0.05). However, the forward head degree did not show a significant difference between the intervention groups in post-test and follow-up tests (P≥0.05). Conclusion: According to the results, it can be stated that the corrective exercises program with myofascial release is more effective than the corrective exercises in correcting the forward shoulder deformity.
El presente libro proviene de la motivación del Programa de Fisioterapia de la Universidad Santiago de Cali en contribuir a la comunidad académica y profesional con un texto que compile los principales paradigmas teóricos que aportan al desarrollo disciplinar, y que han permitido abordar diversas problemáticas de investigación y de la práctica en diferentes contextos de desempeño del fisioterapeuta en el entramado de lo clínico y social.
El presente libro proviene de la motivación del Programa de Fisioterapia de la Universidad Santiago de Cali en contribuir a la comunidad académica y profesional con un texto que compile los principales paradigmas teóricos que aportan al desarrollo disciplinar, y que han permitido abordar diversas problemáticas de investigación y de la práctica en diferentes contextos de desempeño del fisioterapeuta en el entramado de lo clínico y social.
During pregnancy, the expectant mother provides a new human life with the ideal conditions to grow, mature and develop to its maximum genetic potential. This extra effort requires adaptive changes in her system, initially her immune function, but after embryo implantation, also various other organs, particularly in the cardiovascular/renal systems and metabolism. Some adaptations only consist of a reset of a particular setpoint (e.g. blood pressure and osmolality), whereas others (e.g. cardiovascular and metabolic adaptations) require the utilization of some of the maternal ‘normal’ reserve capacity (described in chap. 1). Chapter 2 consists of two sections. The first section describes frequently observed pathophysiologic developments in pregnancy in seemingly healthy women resulting from maladaptation of the maternal hemodynamic-, renal-, immune- and metabolic functions. The impact is usually a disruption of pregnancy course and outcome, because of the development of a (1) Placental syndrome, (2) Spontaneous preterm birth, or (3) Gestational diabetes. The second section describes less common pathophysiologic events that primarily affect maternal wellbeing, in conjunction with (4) side-effects of placental hormones, (5) abnormal placental morphology or insertion site in the uterus, and (6) distressing mechanical effects, caused by the rapidly growing pregnant uterus.
Fu’s subcutaneous needling (FSN) is a novel acupuncture approach. Although it has been popularized and widely used by acupuncture practitioners, theoretical research on its mechanism of action remains lacking. This study establishes an immunological hypothesis for the efficacy of FSN basis existing knowledge in biomedical science, histology and physiology, and traditional acupuncture mechanisms. The theoretical inference indicates that FSN treatment may affect the body's immune system through subcutaneous connective tissue, similar to triggering a cobweb-like system. This article also proposes possible clinical implications of this theory, which require further studies to validate.
Objective
To compare the mobility of neck and back flexor and extensor muscle chains in women with migraine, chronic migraine and headache-free.
Methods
This is a cross-sectional study. The muscle chain test was performed based on the theoretical assumptions of the Busquet method, in women with migraine (MG, n=24), chronic migraine (CMG, n=36) and headache-free (CG, n= 27). The evaluation of neck and back mobility was performed by an examiner expert in the Busquet method with the aid of cervical range of motion (CROM®) device (neck muscles) and the Tiltmeter® application (back muscles).
Results
Compared to woman headache-free, women with migraine (MD= -12º [CI95%= -19º, -5º] and chronic migraine (MD= -15º [CI95%= -21º, -8º] present reduced mobility in the neck extensor muscle chain. Also, in the back extensor muscle chain, migraine vs headache-free (MD= -9º [CI95%= -15º, -2º]) and chronic migraine vs headache-free (MD= -10º [CI95%= -16º, -4º]) and in the back flexor muscle chain, migraine vs headache-free (MD= -6º [CI95%= -10º, -0.1º]) and chronic migraine vs headache-free (MD= -7 [CI95%= -11º, -2º]), with an effect sizes varying between 1.19 e 2.38. No difference was found between groups for neck flexor muscle chain. Conclusion: Women with migraine and chronic migraine have hypomobility of the neck and back extensor muscle chains, and of the back flexor chain.
Though contemporary research meta-analyses and large randomized controlled trials of acupuncture demonstrate its efficacy and efficiency in pain and non-pain conditions, the lack of a defined mechanism for how needling an acupuncture point produces beneficial clinical effects has hindered acupuncture’s integration into allopathic medical practices.This paper provides a neuroanatomic model of acupuncture signaling that is consistent with acupuncture basic and clinical studies, and that may also potentially provide answers to 2000 year-old paradoxes contained in the Huangdi Neijing treatise.
Urethral pain syndrome (UPS) is still a pathology in which the diagnosis is formulated as a "diagnosis of exclusion". The exact pathogenetic mechanisms are not yet fully understood and clear recommendations for the prevention and treatment of UPS are absent. The goal of the study was to assess the condition of the tissues in the female urethra in UPS, by using transvaginal ultrasound (TVUS) and cross-polarization optical tomography (CP OCT). TVUS showed an expansion in the diameter of the internal lumen of the urethra, especially in the proximal region compared with the norm. Compression elastography revealed areas with increased stiffness (presence of fibrosis) in urethral and surrounding tissues. When studied with CP OCT it was shown that with UPS, the structure of the tissues in most cases was changed: trophic alterations in the epithelium (hypertrophy or atrophy) and fibrosis of underlying connective tissue were observed. The proximal fragment of the urethra with UPS underwent changes identical to those of the bladder neck. This paper showed that the introduction of new technology — CP OCT — in conjunction with TVUS will allow verification of structural changes in tissues of the lower urinary tract at the level of their architectonics and will help doctors understand better the basics of the UPS pathogenesis.
Background
Continuous and porous low hydraulic resistance channels (LHRCs) are important structures of meridians in traditional Chinese medicine (TCM). In this study, based on the previous research on LHRCs along meridian paths (LHRCMs)in mini-pig, we aimed to detect the low hydraulic resistance point (LHRP) and display the LHRCMs in rats.
Methods
A technique for measuring interstitial hydraulic resistance (Rh) in rats was established to detect and measure the Rh along the conception vessel (CV) in TCM, and Alcian Blue (AB) solution was injected into the LHRP along the CV. The interstitial fluid pressure (IFP) of the LHRP was measured before and after AB injection. Then, the distribution characteristics of the AB solution were investigated to explore the relationship between AB tracks and meridian paths in TCM.
Results
The positions of the LHRPs coincided with the low impedance points (LIPs) of the rat skin along the CV. The Rh value along the CV (10.37±1.26, × 10⁶ dyne s cm⁻⁵) was significantly lower than that in the non-meridian area (19.13±1.37, × 10⁶ dyne s cm⁻⁵, P<0.01). After AB injection, the IFP of the LHRP was 2.52 mmHg, which was higher than that before AB injection. The AB tracks (ABT) along the CV, spleen meridian, and kidney meridian appeared in one or two directions, with single or multiple paths and uneven thickness and length. The appearance rate was 73.33%.
Conclusions
LHRCMs existed not only in minipigs but also in rats. The LHRCMs could be observed after AB injection into the LHRP in the subcutaneous connective tissues of rats.
Introduction:
Urethral pain syndrome (UPS) is still a pathology in which the diagnosis is formulated as a "diagnosis of exclusion". The exact pathogenetic mechanisms are not yet fully understood and clear recommendations for the prevention and treatment of UPS are absent.
Methods and participants:
A clinical and laboratory evaluation of 55 patients with established UPS included history taking, basic laboratory tests (e.g., complete blood count and clinical urine test), physical examination, uroflowmetry, and cystourethroscopy. Additionally, transvaginal ultrasound (TVUS) with compression elastography and cross-polarization optical tomography (CP OCT) were performed in 24 and 33 patients with UPS, respectively. The control group consisted of 14 patients with no complaints from the urinary system.
Results:
TVUS showed an expansion in the diameter of the internal lumen of the urethra, especially in the proximal region compared with the norm. Compression elastography revealed areas with increased stiffness (presence of fibrosis) in urethral and surrounding tissues. The performed CP OCT study showed that in UPS, the structure of the tissues in most cases was changed: trophic alterations in the epithelium (hypertrophy or atrophy) and fibrosis of underlying connective tissue were observed. The proximal fragment of the urethra with UPS underwent changes identical to those of the bladder neck.
Conclusion:
This paper showed that the introduction of new technology-CP OCT-in conjunction with TVUS will allow verification of structural changes in tissues of the lower urinary tract at the level of their architectonics and will help doctors understand better the basics of the UPS pathogenesis.
Background
The anterolateral thigh (ALT) flap is one of the most useful flaps in reconstruction because of its reliability, large skin flap territory, and versatility. The relatively small number of side effects is a common reason for preferring this flap. Primary repair is usually performed at the donor site closure; however, this requires substantial tension and causes many donor site morbidities, including pain. We attempted to use acellular dermal matrix graft to overcome these problems.
Methods
We analyzed a total of 41 cases (41 flaps) in this study. Among these flaps, we conducted donor fascia suture with artificial dermis in 20 cases (study group) and primary fascial suture in 21cases (control group). Post-operative ambulation recovery times, pain scores, drainage removals, and wound problems of the donor site were recorded.
Results
There were no serious complications, including infection, at the donor sites of all 41 cases. Of 20 cases using the acellular dermal matrix, seroma occurred in 2 cases and partial skin necrosis occurred in 2 cases. In 1 case of skin necrosis, the acellular dermal matrix was removed. However, in comparison to the control group, the group using the artificial dermis recovered ambulatory ability 3.9 days earlier and had a 1.8-point lower visual analogue scale score 5 days post-operatively.
Conclusions
Our study suggested that, if used selectively, the acellular dermal matrix may play an effective role in donor site closure in cases with procedures involving the ALT flap.
Muskelaktivität prägt den eutroph-hypertrophen, antiinvolutiven, antientzündlichen und antinozizeptiven Körper. Lern-, Ausdauer- und Krafttraining führen zu nicht austauschbaren Anpassungen. Aus der Sicht des Schmerzes werden die Mikrozirkulation, die zentrale Schmerzhemmung, die Schmerzschwellen und die Schmerztoleranz entwickelt. Nur die aktive Muskulatur ist ein endokrines, para- und autokrines Organ und der Hauptregulator systemischer antientzündlicher Prozesse. Physische Inaktivität als globaler Faktor der Atrophie, Degeneration und proentzündlicher Prozesse bedeutet Dekonditionierung mit dem Hauptmerkmal permanente chronische systemische sterile Low-grade-Entzündung. Ergebnis sind die Erkrankungen der „diseasome of physical inactivity“ und die primären Arthrosen. Sie repräsentieren eine inaktivitätsbedingte atrophisch-degenerative, involutive, proentzündliche, pronozizeptive Struktur. Chronische Schmerzen inklusive peripherer und zentraler Sensibilisierung beruhen darauf.
Die ubiquitäre Präsenz des faszialen Bindegewebes kann bereits grundsätzlich als Erklärungsansatz für einen Erfolg versprechenden Einsatz multimodaler Behandlungskonzepte, wie z. B. der Akupunktur, dienen. Wegen der spezifischen, biomechanischen Eigenschaften des faszialen Bindegewebes kann es in concreto durch mechanische Reizsetzungen (Mechanotransduktion) zu einer Deformierung der Extrazellularmatrix (ECM) kommen mit der Folge, dass die die ECM in diesem Bereich umgebenden Fibroblasten biochemische Signalmoleküle in die ECM entlassen. Hierdurch ausgelöste, weitreichende und nachhaltige Effekte könnten durch eine Akupunkturbehandlung erreicht werden. Hierfür sprechen aus systemischer Sicht auch Beobachtungen, wonach eine weitreichende Kongruenz topografisch paralleler Verläufe von Faszienstrukturen einerseits und von Akupunkturpunkten- und -meridianen andererseits gegeben ist. Als neurophysiologisches Erklärungsmodell für die schmerzlindernde Wirkung einer Nadelakupunktur insbesondere auf chronische Schmerzen im unteren Rücken könnte die belegte Freisetzung faszialer Neuropeptide dienen, die den schmerzassoziierten Neuropeptiden Substanz P und CGRP entgegenwirken. Infolge der engen Verknüpfung des Faszientonus mit dem vegetativen Nervensystem könnte möglicherweise zudem eine stressinduzierte Sympathikusaktivierung mit einer hiermit einhergehenden Gewebesteifigkeit durch eine Akupunkturbehandlung gedämpft werden. Im Ergebnis ist das Behandlungskonzept der Akupunktur daher möglicherweise geeignet, sowohl die biomechanischen Eigenschaften und den Metabolismus von faszialen Strukturen nachhaltig zu verändern als auch die Vasomotorik und Sensorik (einschließlich Propriozeption und Interozeption) sowie die Sympathikustonizität positiv zu beeinflussen.
Objective
To summarize the research status of the changes in local microenvironment of acupoints caused by acupuncture, provide theoretical guidance for the initiation mechanisms of local acupuncture effect at acupoints.
Methods
Using acupuncture, acupoint as key words to search China National Knowledge Infrastructure (CNKI), Wanfang Academic Journal Full-text Database (Wanfang), Chongqing VIP Database (CQVIP), PubMed and other databases, the representative articles were selected for review.
Results
Acupuncture could excite afferent nerves, activate cells, and promote the release of chemical substances like neuropeptide, hormone, cytokines, etc. in the local site of acupoints. Besides, it may cause mechanical deformation of connective tissues, and change chemical ions as well as ion channels.
Conclusion
The microenvironment changes around acupoints are crucial to acupuncture effect; the concept of ‘acupoints network’ can be used to objectively describe the local changes around the acupoints after acupuncture.
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:. To assess the effects of acupuncture on chronic neck pain, with a focus on pain, disability, quality of life, patient satisfaction, and global perceived effect. Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
The conversion of physical signals, such as contractile forces or external mechanical perturbations, into chemical signaling events is a fundamental cellular process that occurs at cell-extracellular matrix contacts, known as focal adhesions. At these sites, transmembrane integrin receptors are associated via their cytoplasmic domains with the actin cytoskeleton. This interaction with actin is mediated by a submembrane plaque, consisting of numerous cytoskeletal and signaling molecules. Application of intrinsic or external forces to these structures dramatically affects their assembly and triggers adhesion-mediated signaling. In this review, we discuss the structure-function relationships of focal adhesions and the possible mode of action of the putative mechanosensor associated with them. We also discuss the general phenomenon of mechanosensitivity, and the approaches used to measure local forces at adhesion sites, the cytoskeleton-mediated regulation of local contractility, and the nature of the signaling networks that both affect contractility and are affected by it.
Exposure of quiescent MRC-5 human fibroblasts to growth factors such as epidermal growth factor, basic fibroblast growth factor or embryonal carcinoma-derived growth factor resulted in the induction of mRNA transcripts encoding the metalloproteinases collagenase and stromelysin and the specific metalloproteinase inhibitor TIMP, whilst expression of collagen and fibronectin was relatively unaffected. Exposure of quiescent cells to growth factors in the presence of transforming growth factor beta (TGF-beta) resulted in inhibition of collagenase induction and a synergistic increase in TIMP expression. TGF-beta alone did not significantly induce metalloproteinase or TIMP expression. These effects on mRNA transcripts were reflected in increased secretion of TIMP protein and collagenase activity. Nuclear run-off analysis of growth factor-induced transcription revealed that the TGF-beta modulation of TIMP and collagenase expression was due to transcriptional mechanisms. The observations suggest that TGF-beta exerts a selective effect on extracellular matrix deposition by modulating the action of other growth factors on metalloproteinase and TIMP expression.
The main objective of this study is to determine the nature of electric fields inside articular cartilage while accounting for the effects of both streaming potential and diffusion potential. Specifically, we solve two tissue mechano-electrochemical problems using the triphasic theories developed by Lai et al. (1991, ASME J. Biomech Eng., 113, pp. 245-258) and Gu et al. (1998, ASME J. Biomech. Eng., 120, pp. 169-180) (1) the steady one-dimensional permeation problem; and (2) the transient one-dimensional ramped-displacement, confined-compression, stress-relaxation problem (both in an open circuit condition) so as to be able to calculate the compressive strain, the electric potential, and the fixed charged density (FCD) inside cartilage. Our calculations show that in these two technically important problems, the diffusion potential effects compete against the flow-induced kinetic effects (streaming potential) for dominance of the electric potential inside the tissue. For softer tissues of similar FCD (i.e., lower aggregate modulus), the diffusion potential effects are enhanced when the tissue is being compressed (i.e., increasing its FCD in a nonuniform manner) either by direct compression or by drag-induced compaction; indeed, the diffusion potential effect may dominate over the streaming potential effect. The polarity of the electric potential field is in the same direction of interstitial fluid flow when streaming potential dominates, and in the opposite direction of fluid flow when diffusion potential dominates. For physiologically realistic articular cartilage material parameters, the polarity of electric potential across the tissue on the outside (surface to surface) may be opposite to the polarity across the tissue on the inside (surface to surface). Since the electromechanical signals that chondrocytes perceive in situ are the stresses, strains, pressures and the electric field generated inside the extracellular matrix when the tissue is deformed, the results from this study offer new challenges for the understanding of possible mechanisms that control chondrocyte biosyntheses.
Tissue remodeling often reflects alterations in local mechanical conditions and manifests as an integrated response among the different cell types that share, and thus cooperatively manage, an extracellular matrix. Here we examine how two different cell types, one that undergoes the stress and the other that primarily remodels the matrix, might communicate a mechanical stress by using airway cells as a representative in vitro system. Normal stress is imposed on bronchial epithelial cells in the presence of unstimulated lung fibroblasts. We show that (i) mechanical stress can be communicated from stressed to unstressed cells to elicit a remodeling response, and (ii) the integrated response of two cell types to mechanical stress mimics key features of airway remodeling seen in asthma: namely, an increase in production of fibronectin, collagen types III and V, and matrix metalloproteinase type 9 (MMP-9) (relative to tissue inhibitor of metalloproteinase-1, TIMP-1). These observations provide a paradigm to use in understanding the management of mechanical forces on the tissue level.
Astrocytes are capable of widespread intercellular communication via propagated increases in intracellular Ca2+ concentration. We have used patch clamp, dye flux, ATP assay, and Ca2+ imaging techniques to show that one mechanism for this intercellular Ca2+ signaling in astrocytes is the release of ATP through connexin channels (“hemichannels”) in individual cells. Astrocytes
showed low Ca2+-activated whole-cell currents consistent with connexin hemichannel currents that were inhibited by the connexin channel inhibitor
flufenamic acid (FFA). Astrocytes also showed molecular weight-specific influx and release of dyes, consistent with flux through
connexin hemichannels. Transmembrane dye flux evoked by mechanical stimulation was potentiated by low Ca2+ and was inhibited by FFA and Gd3+. Mechanical stimulation also evoked release of ATP that was potentiated by low Ca2+ and inhibited by FFA and Gd3+. Similar whole-cell currents, transmembrane dye flux, and ATP release were observed in C6 glioma cells expressing connexin43
but were not observed in parent C6 cells. The connexin hemichannel activator quinine evoked ATP release and Ca2+ signaling in astrocytes and in C6 cells expressing connexin43. The propagation of intercellular Ca2+ waves in astrocytes was also potentiated by quinine and inhibited by FFA and Gd3+. Release of ATP through connexin hemichannels represents a novel signaling pathway for intercellular communication in astrocytes
and other non-excitable cells.
"Loose" connective tissue forms a network extending throughout the body including subcutaneous and interstitial connective tissues. The existence of a cellular network of fibroblasts within loose connective tissue may have considerable significance as it may support yet unknown body-wide cellular signaling systems. We used a combination of histochemistry, immunohistochemistry, confocal scanning laser microscopy (confocal microscopy), and electron microscopy to investigate the extent and nature of cell-to-cell connections within mouse subcutaneous connective tissue. We found that fibroblasts formed a reticular web throughout the tissue. With confocal microscopy, 30% of fibroblasts' processes could be followed continuously from one cell to another. Connexin 43 immunoreactivity was present at apparent points of cell-to-cell contact. Electron microscopy revealed that processes from adjacent cells were in close apposition to one another, but gap junctions were not observed. Our findings indicate that soft tissue fibroblasts form an extensively interconnected cellular network, suggesting they may have important and so far unsuspected integrative functions at the level of the whole body.
Cytoskeleton-dependent changes in cell shape are well-established factors regulating a wide range of cellular functions including signal transduction, gene expression, and matrix adhesion. Although the importance of mechanical forces on cell shape and function is well established in cultured cells, very little is known about these effects in whole tissues or in vivo. In this study we used ex vivo and in vivo models to investigate the effect of tissue stretch on mouse subcutaneous tissue fibroblast morphology. Tissue stretch ex vivo (average 25% tissue elongation from 10 min to 2 h) caused a significant time-dependent increase in fibroblast cell body perimeter and cross-sectional area (ANOVA, P < 0.01). At 2 h, mean fibroblast cell body cross-sectional area was 201% greater in stretched than in unstretched tissue. Fibroblasts in stretched tissue had larger, "sheetlike" cell bodies with shorter processes. In contrast, fibroblasts in unstretched tissue had a "dendritic" morphology with smaller, more globular cell bodies and longer processes. Tissue stretch in vivo for 30 min had effects that paralleled those ex vivo. Stretch-induced cell body expansion ex vivo was inhibited by colchicine and cytochalasin D. The dynamic, cytoskeleton-dependent responses of fibroblasts to changes in tissue length demonstrated in this study have important implications for our understanding of normal movement and posture, as well as therapies using mechanical stimulation of connective tissue including physical therapy, massage, and acupuncture.
The evidence for solid state physical processes in diverse biological systems is reviewed. Semiconduction of electrons across the enzyme particles as the rate-limiting process in cytochrome oxidase is evidenced by the peculiar kinetic patterns of this enzyme and by microwave Hall effect measurements. PN junction conduction of electrons is suggested by kinetics of photobiological free radicals in eye and photosynthesis. Superconduction at physiological temperatures may be involved in growth and nerve. Phonons and polarons seem likely to be involved in mitochondrial phosphorylation. Piezoelectricity and pyroelectricity may be involved in growth and nerve. Infrared electromagnetic waves may transmit energy in lipid bilayers of nerve and mitochondria. Complexed sodium and potassium ions in structured cell water may be analogous to valence band electrons in a semiconductor, and the free cations may be considered analogous to conduction band electrons. Ionic processes in cell water therefore resemble electronic conduction processes in solid semiconductors, which leads to kinetic predictions in agreement with experiment. The future of solid state biology depends on the development of new experimental methods able to measure solid state physical properties in biological materials which are non-crystalline, impure, particulate, and wet.
No coherent theories currently explain connective tissue stability (i.e. 'memory') as well as spatial and temporal adaptability in the face of continual flux of its constituents. Furthermore, explanations of stability based exclusively upon DNA raise certain inherent problems, particularly with the spatial concordance of somatic tissues. As an alternative explanation, it is hypothesized that while connective tissue cells produce extracellular protein precursors through DNA-dependent processes, the assembly, location, orientation and configuration of the extracellular macromolecules as well as their degree of cell attachment depend primarily upon local micro-environmental conditions and/or self-organization rather than strictly cellular processes. The resulting extracellular matrix (ECM) serves as a time- and spatially-variable filter about each cell to afford a relatively consistent micro-environment for all similar cells, regardless of the more variable macro-environment. By insuring a consistent set of signals to the cell, the filter provides a non-genetic memory complementary to genetic memory. The half-lives of constituent molecules define the duration of the filter, allowing the filter to adapt to new environmental demands, yet to maintain a consistent milieu for the cell. The cell/matrix construct permits local, self-optimizing, non-deterministic tissue autonomy obviating the need to postulate certain intricate mechanisms coordinating spatial morphology and temporal behavior.
The effects of streaming potential, fluid flow and hydrostatic pressure on chondrocyte biosynthesis were studied by comparing the spatial profiles of these physical stimuli to the profiles of biosynthesis within cartilage disks subjected to dynamic unconfined compression. The radial streaming potential was measured using compression frequencies and disk sizes relevant to studies of physical modulation of cartilage metabolism; a general analytical solution to the unconfined compression of a poroelastic cylinder with impermeable, rigid, adhesive platens was derived using potential theory. The solution with adhesive platen boundary conditions, using measured values of cartilage material properties, predicted streaming potentials that were much closer to experimental results between 0.001 and 1 Hz than a solution using frictionless platen boundary conditions. The predicted radial profiles of streaming potential gradient and fluid velocity (but not hydrostatic pressure) were similar to the previously reported radial dependence of proteoglycan synthesis induced by dynamic unconfined compression. Changes in stiffness associated with reduction of disk diameter suggested that the relative contributions of collagen and proteoglycans to cartilage mechanical properties may be a function of loading frequency in unconfined compression; such anisotropies may explain the remaining discrepencies between measured stiffness and stiffness predicted by the present model.
There is increasing experimental evidence that the neurologic system can directly participate in cutaneous inflammation and wound healing. Recent studies indicate that neuropeptides released by cutaneous nerves such as c-fibers can activate a number of target cells including keratinocytes, Langerhans cells, mast cells, and endothelial cells. One such neuropeptide, substance P (SP), is able to specifically bind to murine and human keratinocytes and induce the release of cytokines such as interleukin 1 (IL-1). Other studies demonstrate that SP can also activate mast cells to produce the potent pro-inflammatory cytokine tumor necrosis factor α (TNFα). More recently, we examined the effect of cutaneous neuropeptides on human dermal microvascular endothelial cell (HDMEC) activities. Our studies indicate that the c-fiber-derived calcitonin gene-related peptide (CGRP) is capable of stimulating HDMEC to secrete the neutrophil chemotactic factor interleukin 8 (IL-8). In addition, SP is able to directly activate HDMEC to express high levels of the important cellular adhesion molecule vascular cellular adhesion molecule 1 (VCAM-1). Thus, these studies support the role that the neurologic system may play in mediating the biologic processes that occur during inflammation and wound healing in the skin. Journal of Investigative Dermatology Symposium Proceedings 2:23–26, 1997
Cells from diverse tissues detect mechanical load signals by similar mechanisms but respond differently. The diversity of responses reflects the genotype of the cell and the mechanical demands of the resident tissue. We hypothesize that cells maintain a basal equilibrium stress state that is a function of the number and quality of focal adhesions, the polymerization state of the cytoskeleton, and the amount of extrinsic, applied mechanical deformation. A load stimulus detected by a mechano-electrochemical sensory system, including mechanically sensitive ion channels, integrin-cytoskeleton machinery, and (or) a load-conformation sensitive receptor or nonreceptor tyrosine kinase, may activate G proteins, induce second messengers, and activate an RPTK or JAK/STAT kinase cascade to elicit a response. We propose the terms autobaric to describe a self-loading process, whereby a cell increases its stress state by contracting and applying a mechanical load to itself, and parabaric, whereby a cell applies a load to an adjacent cell by direct contact or through the matrix. We predict that the setpoint for maintaining this basal stress state is affected by continuity of incoming mechanical signals as deformations that activate signalling pathways. A displacement of the cytoskeletal machinery may result in a conformational change in a kinase that results in autophosphorylation and cascade initiation. pp60Src is such a kinase and is part of a mechanosensory protein complex linking integrins with the cytoskeleton. Cyclic mechanical load induces rapid Src phosphorylation. Regulation of the extent of kinase activation in the pathway(s) may be controlled by modulators such as G proteins, kinase phosphorylation and activation, and kinase inhibitors or phosphatases. Intervention at the point of ras-raf interaction may be particularly important as a restriction point.
Extracellular matrix (ECM) is the substrate for cell adhesion, growth, and differentiation, and it provides mechanical support to tissues. It is well known that connective tissue cells adapt their ECM to changes in mechanical load, as seen, e.g. during bone remodeling or wound healing. A feedback mechanism must exist by which cells that sense mechanical stress via their substrate respond by an altered pattern of protein expression, and thus remodel the ECM to meet changing mechanical requirements. What signals are triggered in connective tissue cells by mechanical stress, and how do such stimuli affect the expression of specific ECM proteins? The evidence will be reviewed that integrins, the transmembrane adhesion and signaling receptors which physically link ECM to the cytoskeleton, might be key players in transducing mechanical signals, presumably via MAP kinase and NF-kappaB pathways. At the far end of the response, there is evidence for regulation at the level of gene transcription. For example, the production of tenascin-C and collagen XII, two ECM proteins typical of tendons and ligaments, is high in fibroblasts attached to a stretched collagen matrix, but suppressed in cells on a relaxed matrix. The response to a change in stretch is rapid and reversible, and is reflected on the mRNA level. Both the tenascin-C and the collagen XII gene promoters contain 'stretch-responsive' enhancer regions with similarity to 'shear stress response elements' in other genes. The precise signal pathways converging on these mechano-responsive enhancer elements remain to be elucidated.
The goal of this study was to expand understanding of strain-generated potential (SGP) in ligamentous or tendinous tissues. Most SGP studies in the past have focused on cartilage or bone. Herein, rabbit patellar tendon (PT) was used as a model. Each patellar tendon had two Ag/AgCl electrodes inserted at axial positions of 1/4 and 1/2 from patellar to tibial insertions. Each specimen was electrically isolated, gripped in a servohydraulic test system, and then subjected to a short session of uniaxial haversine tension (2.5 percent maximum strain) at a frequency of 0.5, 1.0, 2.0, or 5.0 Hz. A cyclic (sinusoidal) electrical potential superimposed upon a larger transient (exponentially asymptotic) potential was consistently observed. Upon termination of loading, the cyclic SGP ended, and the shifted baseline of the SGP exponentially decayed and asymptotically returned to a residual potential which over all specimens was not different than the original potential. The transient and cyclic SGPs were frequency dependent (P < 0.001, P = 0.06, respectively). To our knowledge, this transient portion of the SGP, although theoretically predicted by Suh (1996, Biorheology, 33, pp. 289-304) and Chen (1996, Ph.D. thesis, University of Wisconsin-Madison) has not been observed in other experiments using different protocols. Additional PTs were dehydrated and the rehydrated in solution at different pH levels. The magnitude of SGPs increased in basic solution (pH 9.5) but diminished in pH 4.7 buffer. This pH dependency suggests that electrokinetics is the dominant mechanism for the transient and cyclic responses of the SGPs, although this study does not provide direct evidence.
Acupuncture meridians traditionally are believed to constitute channels connecting the surface of the body to internal organs. We hypothesize that the network of acupuncture points and meridians can be viewed as a representation of the network formed by interstitial connective tissue. This hypothesis is supported by ultrasound images showing connective tissue cleavage planes at acupuncture points in normal human subjects. To test this hypothesis, we mapped acupuncture points in serial gross anatomical sections through the human arm. We found an 80% correspondence between the sites of acupuncture points and the location of intermuscular or intramuscular connective tissue planes in postmortem tissue sections. We propose that the anatomical relationship of acupuncture points and meridians to connective tissue planes is relevant to acupuncture's mechanism of action and suggests a potentially important integrative role for interstitial connective tissue.
Tendon and other connective tissue cells are subjected to diverse mechanical loads during daily activities. Thus, fluid flow, strain, shear and combinations of these stimuli activate mechanotransduction pathways that modulate tissue maintenance, repair and pathology. Early mechanotransduction events include calcium (Ca2+) signaling and intercellular communication. These responses are mediated through multiple mechanisms involving stretch-activated channels, voltage-activated channels such as Ca(v)1, purinoceptors, adrenoceptors, ryanodine receptor-mediated Ca2+ release, gap junctions and connexin hemichannels. Calcium, diacylglycerol, inositol (1,4,5)-trisphosphate, nucleotides and nucleosides play intracellular and/or extracellular signaling roles in these pathways. In addition, responses to mechanical loads in tendon cells vary among species, tendon type, anatomic location, loading conditions and other factors. This review includes a synopsis of the immediate responses to mechanical loading in connective tissue cells, particularly tenocytes. These responses involve Ca2+ signaling, gap junctions and intercellular communication.
Dense connective tissue sheets, commonly known as fascia, play an important role as force transmitters in human posture and movement regulation. Fascia is usually seen as having a passive role, transmitting mechanical tension which is generated by muscle activity or external forces. However, there is some evidence to suggest that fascia may be able to actively contract in a smooth muscle-like manner and consequently influence musculoskeletal dynamics. General support for this hypothesis came with the discovery of contractile cells in fascia, from theoretical reflections on the biological advantages of such a capacity, and from the existence of pathological fascial contractures. Further evidence to support this hypothesis is offered by in vitro studies with fascia which have been reported in the literature: the biomechanical demonstration of an autonomous contraction of the human lumbar fascia, and the pharmacological induction of temporary contractions in normal fascia from rats. If verified by future research, the existence of an active fascial contractility could have interesting implications for the understanding of musculoskeletal pathologies with an increased or decreased myofascial tonus. It may also offer new insights and a deeper understanding of treatments directed at fascia, such as manual myofascial release therapies or acupuncture. Further research to test this hypothesis is suggested.
Remodeling of dense connective tissue in normal adult tissues Dynamics of human biologic tissues Contemporary perspectives in rehabilitation
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- Dp Currier
- Nelson
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Nan-ching: the classic of difficult issues: with commentaries by Chinese and Japanese authors from the third through the twentieth century
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Remodeling of dense connective tissue in normal adult tissues
- Cummings
Cummings GS, Tillman LJ. Remodeling of dense connective
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Mechanical stress is communicated between different cell types to elicit matrix remodeling
- Ma Swartz
- Dj Tschumperlin
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Swartz MA, Tschumperlin DJ, Kamm RD, Drazen JM.
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Mechanical stress is communicated between different cell types to elicit matrix remodeling
- Swartz