ISCP Much Ado About … Tendons CIG Day 2014 (No Drama Mark Sexton Chartered Physiotherapi st
May 29, 2015
ISCP
Much Ado About …
TendonsCIG Day2014
(No Drama)
Mark SextonChartered Physiotherapist
Nothing is,All is becoming
Lao Tzu
Helene LangevinMyers, BenjaminKhan, ScottMax ZusmanLorimer Moseley
Helene LangevinMyers, BenjaminKhan, ScottMax ZusmanLorimer Moseley
Mechanotransduction
Helene LangevinMyers, BenjaminKhan, ScottMax ZusmanLorimer Moseley
Mechanotransduction
Bioplasticity
So What!
Clinical RelevanceResearch RelevanceEducation Relevance
Physiotherapists get people moving
Tendon Structure and Function
MechanotransductionTendinopathy
Literature updateTendon Healing
TreatmentRehabilitation
Brief Review
Body-Wide Integrative System
Every Cell, Organ, System
HomeostasisLocal RepairRemote Effects
The MeridialSystem
Connective Tissue and Meridial System
Connective TissueSystem
Langevin 2001
Langevin 2001
Langevin 2001
Tendon Structure and Function
Tendon HealingPhysiotherapyAcupuncture MechanotherapyLaser
Mechanotransduction
Fibroblast Cell Cytoskeleton
Fibroblast Cell Cytoskeleton
Cytoskeletal Tensegrity
Mechanotransduction2-D Representation : Fibroblast in ECM
Integrins
Swartzlander 2011 (ZurichMinds)
TGF -b 1
Mechanotransduction
Integrins
Swartzlander 2011 (ZurichMinds)
Fibroblast remodelling
Nuclear processes – mRNAChemical Cascades
Fibroblast Cell – ECM Traffic
Fibroblast Remodelling
Nuclear processes – mRNAChemical Cascades
Fibroblast Cell – ECM Traffic
Collagen SynthesisTissue Repair
Tendon tissue provides an example of cell–cell communication.
Khan K M , Scott A Br J Sports Med 2009;43:247-252
©2009 by BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine
Tendon tissue provides an example of cell–cell communication.
Khan K M , Scott A Br J Sports Med 2009;43:247-252
©2009 by BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine
Tendon tissue provides an example of cell–cell communication.
Khan K M , Scott A Br J Sports Med 2009;43:247-252
©2009 by BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine
Mechanical loading stimulates protein synthesis at the cellular level.
Khan K M , Scott A Br J Sports Med 2009;43:247-252
©2009 by BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine
Mechanical loading stimulates protein synthesis at the cellular level.
Khan K M , Scott A Br J Sports Med 2009;43:247-252
©2009 by BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine
Mechanical loading stimulates protein synthesis at the cellular level.
Khan K M , Scott A Br J Sports Med 2009;43:247-252
©2009 by BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine
Fibroblast Response to NeedlingLangevin 2004, 2006, 2010, 2011a,b,c
Fibroblast Remodelling Langevin 2006
Fibroblast Network
Less Dense Connective Tissue
No Gap Junctions
Connexin 43 present
Langevin 2010
Langevin 2001
Acupuncture - Key Principle Remote/Systemic
LocalAdjacent
Needle Grasp/De Qi
Mechanotransduction….
Connective TissueSystem
Bioplasticity
All Movement has Effect…
…and Vice-Versa
Tendinopathy
Tendinopathy
• Continuum Model
• Rective Tendinopathy• Tendon Disrepair• Degenerative Tendinopathy
Tendinopathy Structure….
…..Dysfunction
Tendon Healingand Failed Healing
Tendon Treatment and Rehabilitation
The Home Straight !!
To Conclude
Tendinopathy Research• Much Unknown• Low Statistical Power• Ongoing
Tendinopathy Research – Direction• Compression• Peritendinous structures• Paratendon • Neural
To ConcludeMechanotransduction – only one aspect
Bioplasticity
Mechanotransduction….
To ConcludeBioplasticityBody-wide systems• Homeostasis• Health • Disease • Repair
Connective TissueSystem
Clinical Relevance - BioplasticityChronicityTendon HealingTreatmentPrevention
Bioplasticity
Clinical RelevanceResearch RelevanceEducation relevance So What!
To ConcludeUnderstanding research findings
and its limitations, and remembering what is known to be uncertain allows clinicians to wisely informclinical practice
Nothing is,All is becoming
Lao Tzu
All Movement has Effect…
…and Vice-Versa
Physiotherapists get people moving
ISCP
Much Ado About …
TendonsCIG Day2014
(No Drama)
Mark SextonChartered Physiotherapist
Thank You!
References and useful web resources on a separate file
Coming next…
…a lecture on the clinical implications of bioplasticity in
Chronic Low Back Pain…here are a few preview slides
Langevin HM and Sherman KJ,
Pathophysiological Model for cLBPIntegrating
Connective Tissueand
Nervous System Mechanisms
Med. Hyp. 2006
Connective Tissue
Plasticity
Pathogenic Mechanism
Langevin 2006
Neural Tissue
Plasticity
Connective Tissue
Plasticity
Pathogenic Mechanism
Langevin 2006
Connective Tissue
Plasticity
Pathogenic Mechanism
Langevin 2006
Pathogenic Mechanism
Langevin 2006
Pathogenic Mechanism
Langevin 2006
Pathogenic Mechanism
Langevin 2006
Pathogenic Mechanism
Langevin 2006
MovementPostureExercise
Treatment
Tissue Pathology
Dysfunction
Direct Tissue Mechanical Stimulus
Cognitive/BehaviouralMovementTreatment
Placebo
PsychosocialGenetic
Pathogenic Mechanism – Therapeutic interventions
Langevin 2006