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