Tendons: Mechanisms of pathogenicity and repair - movement, stretch and acupuncture as a basis of...

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ISCP Much Ado About … Tendons CIG Day 2014 (No Drama Mark Sexton Chartered Physiotherapi st

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This lecture reviews and connects developments different areas of the published research: in the areas of Anatomy, Cellular Mechanotransduction, Connective Tissue (Histology, Innervation, differentiation, plasticity), Tendinopathy, Tendon Repair, Neural plasticity and Bioplasticity. These developments have implications for clinical practice, research, education and health promotion. This research was discussed as it informs common Treatment and Rehabilitation techniques (Exercise Therapy, Acupuncture, Manual Therapy, Low Level Laser, Biomechanics). Future directions in research were discussed. The slides are intended as support for those who were at the lecture, as they contain little information alone. An Aim of this lecture is to stimulate interest in the key publications and online resources in this clinical area, listed in a connected file on Slideshare.

Transcript of Tendons: Mechanisms of pathogenicity and repair - movement, stretch and acupuncture as a basis of...

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ISCP

Much Ado About …

TendonsCIG Day2014

(No Drama)

Mark SextonChartered Physiotherapist

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Nothing is,All is becoming

Lao Tzu

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Helene LangevinMyers, BenjaminKhan, ScottMax ZusmanLorimer Moseley

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Helene LangevinMyers, BenjaminKhan, ScottMax ZusmanLorimer Moseley

Mechanotransduction

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Helene LangevinMyers, BenjaminKhan, ScottMax ZusmanLorimer Moseley

Mechanotransduction

Bioplasticity

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So What!

Clinical RelevanceResearch RelevanceEducation Relevance

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Physiotherapists get people moving

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Tendon Structure and Function

MechanotransductionTendinopathy

Literature updateTendon Healing

TreatmentRehabilitation

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Brief Review

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Body-Wide Integrative System

Every Cell, Organ, System

HomeostasisLocal RepairRemote Effects

The MeridialSystem

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Connective Tissue and Meridial System

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Connective TissueSystem

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Langevin 2001

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Langevin 2001

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Langevin 2001

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Tendon Structure and Function

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Tendon HealingPhysiotherapyAcupuncture MechanotherapyLaser

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Mechanotransduction

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Fibroblast Cell Cytoskeleton

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Fibroblast Cell Cytoskeleton

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Cytoskeletal Tensegrity

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Mechanotransduction2-D Representation : Fibroblast in ECM

Integrins

Swartzlander 2011 (ZurichMinds)

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TGF -b 1

Mechanotransduction

Integrins

Swartzlander 2011 (ZurichMinds)

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Fibroblast remodelling

Nuclear processes – mRNAChemical Cascades

Fibroblast Cell – ECM Traffic

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Fibroblast Remodelling

Nuclear processes – mRNAChemical Cascades

Fibroblast Cell – ECM Traffic

Collagen SynthesisTissue Repair

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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

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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

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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

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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

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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

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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

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Fibroblast Response to NeedlingLangevin 2004, 2006, 2010, 2011a,b,c

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Fibroblast Remodelling Langevin 2006

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Fibroblast Network

Less Dense Connective Tissue

No Gap Junctions

Connexin 43 present

Langevin 2010

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Langevin 2001

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Acupuncture - Key Principle Remote/Systemic

LocalAdjacent

Needle Grasp/De Qi

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Mechanotransduction….

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Connective TissueSystem

Bioplasticity

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All Movement has Effect…

…and Vice-Versa

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Tendinopathy

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Tendinopathy

• Continuum Model

• Rective Tendinopathy• Tendon Disrepair• Degenerative Tendinopathy

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Tendinopathy Structure….

…..Dysfunction

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Tendon Healingand Failed Healing

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Tendon Treatment and Rehabilitation

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The Home Straight !!

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To Conclude

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Tendinopathy Research• Much Unknown• Low Statistical Power• Ongoing

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Tendinopathy Research – Direction• Compression• Peritendinous structures• Paratendon • Neural

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To ConcludeMechanotransduction – only one aspect

Bioplasticity

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Mechanotransduction….

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To ConcludeBioplasticityBody-wide systems• Homeostasis• Health • Disease • Repair

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Connective TissueSystem

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Clinical Relevance - BioplasticityChronicityTendon HealingTreatmentPrevention

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Bioplasticity

Clinical RelevanceResearch RelevanceEducation relevance So What!

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To ConcludeUnderstanding research findings

and its limitations, and remembering what is known to be uncertain allows clinicians to wisely informclinical practice

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Nothing is,All is becoming

Lao Tzu

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All Movement has Effect…

…and Vice-Versa

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Physiotherapists get people moving

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ISCP

Much Ado About …

TendonsCIG Day2014

(No Drama)

Mark SextonChartered Physiotherapist

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Thank You!

References and useful web resources on a separate file

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Coming next…

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…a lecture on the clinical implications of bioplasticity in

Chronic Low Back Pain…here are a few preview slides

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Langevin HM and Sherman KJ,

Pathophysiological Model for cLBPIntegrating

Connective Tissueand

Nervous System Mechanisms

Med. Hyp. 2006

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Connective Tissue

Plasticity

Pathogenic Mechanism

Langevin 2006

Neural Tissue

Plasticity

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Connective Tissue

Plasticity

Pathogenic Mechanism

Langevin 2006

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Connective Tissue

Plasticity

Pathogenic Mechanism

Langevin 2006

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Pathogenic Mechanism

Langevin 2006

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Pathogenic Mechanism

Langevin 2006

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Pathogenic Mechanism

Langevin 2006

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Pathogenic Mechanism

Langevin 2006

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MovementPostureExercise

Treatment

Tissue Pathology

Dysfunction

Direct Tissue Mechanical Stimulus

Cognitive/BehaviouralMovementTreatment

Placebo

PsychosocialGenetic

Pathogenic Mechanism – Therapeutic interventions

Langevin 2006


Acupunctur G acupuncture Acupunctur G acupuncture

Acupunctur G acupuncture Acupunctur G acupuncture

Mechanism of Pathogenicity

Mechanism of Pathogenicity

Imagerie des tendons

Imagerie des tendons

07 pathogenicity and_virulence

07 pathogenicity and_virulence

Identification of vibrio cholerae pathogenicity

Identification of vibrio cholerae pathogenicity

Mechanisms of Pathogenicity

Mechanisms of Pathogenicity

Microbial Mechanisms of Pathogenicity-sp10

Microbial Mechanisms of Pathogenicity-sp10

Chapter 12: Microbial Pathogenicity

Chapter 12: Microbial Pathogenicity

Tendons and Ligaments n Tendons-muscle to bone n Ligaments-bone to bone.

Tendons and Ligaments n Tendons-muscle to bone n Ligaments-bone to bone.

Microbial pathogenicity (5)

Microbial pathogenicity (5)

The Complexity and Diversity of the Pathogenicity Locus in ...researchrepository.murdoch.edu.au/id/eprint/33819/1/pathogenicity... · The Complexity and Diversity of the Pathogenicity

The Complexity and Diversity of the Pathogenicity Locus in ...researchrepository.murdoch.edu.au/id/eprint/33819/1/pathogenicity... · The Complexity and Diversity of the Pathogenicity

Fat2.chapter15 (pathogenicity)

Fat2.chapter15 (pathogenicity)

Microbial Mechanisms of Pathogenicity. Virulence is the degree of pathogenicity of an organism. Pathogenicity, Ability to cause disease.

Microbial Mechanisms of Pathogenicity. Virulence is the degree of pathogenicity of an organism. Pathogenicity, Ability to cause disease.

D- Microbial Mechanisms of Pathogenicity. Pathogenicity - ability to cause disease Virulence - degree of pathogenicity w Many properties that determine.

D- Microbial Mechanisms of Pathogenicity. Pathogenicity - ability to cause disease Virulence - degree of pathogenicity w Many properties that determine.

1B Pathogenicity Handouts

1B Pathogenicity Handouts

Life Cycle and Pathogenicity

Life Cycle and Pathogenicity

Tendons & Ligaments

Tendons & Ligaments

Acupuncture Long Island | Acupuncture Smithtown | smithtown acupuncture

Acupuncture Long Island | Acupuncture Smithtown | smithtown acupuncture

Chapter 8 Microbial Mechanisms of Pathogenicity. Pathogenicity: The ability to cause disease. Virulence: The extent of pathogenicity.

Chapter 8 Microbial Mechanisms of Pathogenicity. Pathogenicity: The ability to cause disease. Virulence: The extent of pathogenicity.

L’ESSENTIEL À CONNAÎTRE EN ÉCHOGRAPHIE MUSCULO ......Tendons et ligaments Tendons Les tendons sont des structures fibrillaires, échog ènes (Fig 1). Deux types de tendons sont

L’ESSENTIEL À CONNAÎTRE EN ÉCHOGRAPHIE MUSCULO ......Tendons et ligaments Tendons Les tendons sont des structures fibrillaires, échog ènes (Fig 1). Deux types de tendons sont