Download - Tendons: Mechanisms of pathogenicity and repair - movement, stretch and acupuncture as a basis of treatment and rehabilitation

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Page 1: Tendons: Mechanisms of pathogenicity and repair - movement, stretch and acupuncture as a basis of treatment and rehabilitation

ISCP

Much Ado About …

TendonsCIG Day2014

(No Drama)

Mark SextonChartered Physiotherapist

Page 2: Tendons: Mechanisms of pathogenicity and repair - movement, stretch and acupuncture as a basis of treatment and rehabilitation
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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

Page 41: Tendons: Mechanisms of pathogenicity and repair - movement, stretch and acupuncture as a basis of treatment and rehabilitation

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

Page 43: Tendons: Mechanisms of pathogenicity and repair - movement, stretch and acupuncture as a basis of treatment and rehabilitation

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

Page 44: Tendons: Mechanisms of pathogenicity and repair - movement, stretch and acupuncture as a basis of treatment and rehabilitation

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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Page 86: Tendons: Mechanisms of pathogenicity and repair - movement, stretch and acupuncture as a basis of treatment and rehabilitation

ISCP

Much Ado About …

TendonsCIG Day2014

(No Drama)

Mark SextonChartered Physiotherapist

Page 87: Tendons: Mechanisms of pathogenicity and repair - movement, stretch and acupuncture as a basis of treatment and rehabilitation
Page 88: Tendons: Mechanisms of pathogenicity and repair - movement, stretch and acupuncture as a basis of treatment and rehabilitation

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


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