These are references to articles on fascia and collagen motivating the conceptual model of "adhesions". They draw on research on the increase of cross-linkages with aging, adaptation of tissue to applied stress, and cumulative affects of microtrauma. Helene M Langevin author Karen J Sherman author 2007-01-01 Churchill Livingstone, continuing periodical academic journal Although chronic low back pain (cLBP) is increasingly recognized as a complex syndrome with multifactorial etiology, the pathogenic mechanisms leading to the development of chronic pain in this condition remain poorly understood. This article presents a new, testable pathophysiological model integrating connective tissue plasticity mechanisms with several well-developed areas of research on cLBP (pain psychology, postural control, neuroplasticity). We hypothesize that pain-related fear leads to a cycle of decreased movement, connective tissue remodeling, inflammation, nervous system sensitization and further decreased mobility. In addition to providing a new, testable framework for future mechanistic studies of cLBP, the integration of connective tissue and nervous system plasticity into the model will potentially illuminate the mechanisms of a variety of treatments that may reverse these abnormalities by applying mechanical forces to soft tissues (e.g. physical therapy, massage, chiropractic manipulation, acupuncture), by changing specific movement patterns (e.g. movement therapies, yoga) or more generally by increasing activity levels (e.g. recreational exercise). Non-invasive measures of connective tissue remodeling may eventually become important tools to evaluate and follow patients with cLBP in research and clinical practice. An integrative mechanistic model incorporating behavioral and structural aspects of cLBP will strengthen the rationale for a multidisciplinary treatment approach including direct mechanical tissue stimulation, movement reeducation, psychosocial intervention and pharmacological treatment to address this common and debilitating condition. 0306-9877 Langevin2007 10.1016/j.mehy.2006.06.033 http://linkinghub.elsevier.com/retrieve/pii/S0306987706004919 2007-01-01 68 1 74 80 Explaining the nanostructure of collagen fibrils Markus J Buehler author 2006-08-15 text continuing periodical academic journal Collagen is a protein material with superior mechanical properties. It consists of collagen fibrils composed of a staggered array of ultra-long tropocollagen (TC) molecules. Theoretical and molecular modeling suggests that this natural design of collagen fibrils maximizes the strength and provides large energy dissipation during deformation, thus creating a tough and robust material. We find that the mechanics of collagen fibrils can be understood quantitatively in terms of two critical molecular length scales {chi}S and {chi}R that characterize when (i) deformation changes from homogeneous intermolecular shear to propagation of slip pulses and when (ii) covalent bonds within TC molecules begin to fracture, leading to brittle-like failure. The ratio {chi}S/{chi}R indicates which mechanism dominates deformation. Our modeling rigorously links the chemical properties of individual TC molecules to the macroscopic mechanical response of fibrils. The results help to explain why collagen fibers found in nature consist of TC molecules with lengths in the proximity of 300 nm and advance the understanding how collagen diseases that change intermolecular adhesion properties influence mechanical properties. 10.1073/pnas.0603216103 Buehler2006 http://www.pnas.org/cgi/content/abstract/103/33/12285 2006-8-15 103 33 12285 12290 Fascia may be able to contract in a smooth muscle-like manner and thereby influence musculoskeletal dynamics R Schleip author W Klingler author F Lehmann-Horn author text 2005-01-01 Churchill Livingstone 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. continuing periodical academic journal 0306-9877 Schleip2005 http://linkinghub.elsevier.com/retrieve/pii/S0306987705001489 2005-01-01 65 2 273 277 10.1016/j.mehy.2005.03.005 Leon Chaitow author Judith DeLany author 2003-03 text continuing periodical academic journal Alternative medicine offers approaches to health care that are complementary to or integrative with conventional medicine. Many possibilities have emerged from this background, of methods that can enhance medical care, such as acupuncture and lymphatic drainage techniques. Another method is neuromuscular therapy, which considers both local or global causes of pain and dysfunction, as well as perpetuating factors that impact the musculoskeletal system. Neuromuscular therapy aims specifically to alter the ground substance of connective tissue, to deactivate myofascial trigger points and reduce ischemia, and to assess and beneficially modify postural alignment, musculoskeletal dysfunction, and neural entrapment. Additionally, nutritional awareness and emotional distress are considered in an effort to alter chronic pain and myofascial dysfunction. Chaitow2003 http://tinyurl.com/2se92k 2003-03 18 1 74 86 A Model for Understanding the Effects of Manipulation Judith A O'Connell author 2003-03 text continuing periodical academic journal Embryologically, the largest mesodermal derivative is connective tissue encompassing blood, cartilage, bone, and connective tissue proper. Collagen is a major component of connective tissue proper and more specifically white fibrous tissue. Fascia, the largest component of white fibrous tissue, contains linear sheets of collagen found in superficial, deep, and subserous layers. Collagen is piezoelectric, functioning as a transducer of mechanical and electrical energy. Electrical impulses are generated in the collagen by compressive and distraction forces within the musculoskeletal system. These impulses trigger a cascade of cellular, biomechanical, neural, and extracellular events as the body adapts to external stress. In response to internal stress, components of the extracellular fluid change in polarity and charge affecting fascial motion. This somatic dysfunction, whether caused by internal or external stress, is identified as tenderness, asymmetry, altered motion, and tissue texture changes. Somatic dysfunction is also caused by visceral somatic relationships mediated at the level of the spinal cord. Specific patterns of somatic dysfunction in the paraspinal connective tissue are related to specific organs and act as diagnostic markers. Osteopathic manipulative treatment is a manually applied procedure used to treat somatic dysfunction. Through the application of compressive and distraction forces, the physician identifies altered patterns of motion in the fascia. Physicians trained in osteopathic manipulative techniques are able to normalize the somatic dysfunction and in so doing encourage healing. Physicians able to integrate osteopathic manipulative treatment into standard medical and surgical care have an advantage in meeting the needs of their patients. OConnell2003 http://tinyurl.com/3b6xcb 2003-03 18 1 67 73 A Proposed "Physical Stress Theory" to Guide Physical Therapist Practice, Education, and Research Michael J Mueller author Katrina S Maluf author 2002-04-01 text continuing periodical academic journal The purpose of this perspective is to present a general theory--the Physical Stress Theory (PST). The basic premise of the PST is that changes in the relative level of physical stress cause a predictable adaptive response in all biological tissue. Specific thresholds define the upper and lower stress levels for each characteristic tissue response. Qualitatively, the 5 tissue responses to physical stress are decreased stress tolerance (eg, atrophy), maintenance, increased stress tolerance (eg, hypertrophy), injury, and death. Fundamental principles of tissue adaptation to physical stress are described that, in the authors' opinion, can be used to help guide physical therapy practice, education, and research. The description of fundamental principles is followed by a review of selected literature describing adaptation to physical stress for each of the 4 main organ systems described in the Guide to Physical Therapist Practice (ie, cardiovascular/pulmonary, integumentary, musculoskeletal, neuromuscular). Limitations and implications of the PST for practice, research, and education are presented. Mueller2002 http://www.ptjournal.org/cgi/content/abstract/82/4/383 2002-4-1 82 4 383 403 Allen J Bailey author 2001-05-31 text continuing periodical academic journal The outward manifestations of tissue ageing occurring in the elderly primarily involve the two major structural proteins of the body, collagen and elastin. The changes in these proteins are associated with intermolecular cross-linking and side-chain modifications. Cross-linking involves two different mechanisms, a precise enzymic process during development and maturation, and a subsequent non-enzymic adventitious reaction with glucose during ageing. The latter glycation reactions are the major cause of tissue dysfunction in the elderly due to cross-linking, which stiffens the tissues, and to side-chain modification, which alters normal cell-matrix interactions. Photoageing by UV involves two competing reactions, chain cleavage and cross-linking, the former predominating on long-term exposure. The molecular mechanisms involved are gradually being unravelled and will lead to the development of inhibitors of these deleterious effects of ageing. Bailey2001 10.1016/S0047-6374(01)00225-1 2001-05-31 122 7 735 755 H M Frost author 2000-Sep text continuing periodical academic journal 1108-7161 2000-Sep 1 1 5 5 Besides bringing problems, aging can let the mind's eye see more clearly than before, and it can let us express ourselves better. As age, experience and common sense examine today's skeletal medicine and surgery two questions keep popping up: A) How did we fail?; B) How to make it better? The Utah paradigm of skeletal physiology and the seminal ISMNI offer some answers, but exploiting them faces problems. Frost2000 http://www.ismni.org/jmni/pdf/1/frost.pdf Barry S Kraushaar author Robert P Nirschl author 1999-02-01 text continuing periodical academic journal KRAUSHAAR1999 http://www.ejbjs.org/cgi/content/full/81/2/259 1999-2-1 81 2 259 78 Allen J Bailey author Robert Gorden Paul author Lynda Knott author 1998-12-01 text continuing periodical academic journal The outward manifestations of tissue ageing occurring in the elderly primarily involve the two major structural proteins of the body, collagen and elastin. The changes in these proteins are associated with intermolecular cross-linking and side-chain modifications. Cross-linking involves two different mechanisms, a precise enzymic process during development and maturation, and a subsequent non-enzymic adventitious reaction with glucose during ageing. The latter glycation reactions are the major cause of tissue dysfunction in the elderly due to cross-linking, which stiffens the tissues, and to side-chain modification, which alters normal cell-matrix interactions. Photoageing by UV involves two competing reactions, chain cleavage and cross-linking, the former predominating on long-term exposure. The molecular mechanisms involved are gradually being unravelled and will lead to the development of inhibitors of these deleterious effects of ageing. Bailey1998 10.1016/S0047-6374(98)00119-5 1998-12-01 106 1-2 1 56 K A Piez author 1997-Aug text continuing periodical academic journal 0945-053X 1997-Aug 16 3 85 85 Before the early 1800s, the "fibers" of connective tissue were thought to be the basis of life, which arose by spontaneous generation. With the discovery of cells in connective tissue, the cellular theory became accepted as the basis of life in about 1850. Material outside cells, but presumably made by cells, was recognized as the extracellular matrix. In the period from 1930 to 1975, the components of extracellular matrix were characterized by physical chemical, chemical and cell biological methods. For the major collagen of skin, tendon and bone, the molecular and fibril structures were determined; the aldehydederived crosslinks were discovered; its polypeptide chains were sequenced; and its biosynthesis and degradation were defined. This collagen, now type I collagen, was shown to be one of many types. The events of this period are described from the author's perspective. Since 1975, molecular and cell biological techniques have shown that the extracellular matrix is not the passive residence of cells but is highly interactive and plays a major role in health and disease. Piez1997 10.1016/S0945-053X(97)90037-8 Andrus Viidik author Hanne Melgaard Nielsen author Monika Skalicky author 1996-07-17 text continuing periodical academic journal Regular physical exercise has been shown to have a number of benefits compared with sedentary behaviour, such as delaying a number of aging changes and increasing the life expectancy but not the maximum lifespan. The purpose of this paper is to analyze the effects of physical exercise on the connective tissues of the body, especially systemic efects. We trained male Sprague-Dawley rats in a treadmill from the age of 5 months to 23 months. We analyzed the effects of training on tail tendons with respect to thermal stability of collagen and biomechanical properties of tendon bundles. Although tail tendons are attached to muscles, the are not weight-bearing as limb muscle tendons and can. therefore, be considered to be subjected mainly to systemic effects. The thermal stability of tail tendon collagen was significantly lower or 'younger' for the trained group compared with the sedentary one. The biomechanical parameters were likewise 'younger' with respect to maximum stress, although considerably stiffer compared with a S-month-old base-line group. This suggests that there are several mechanisms, elicited by physical exercise, that act on the connective tissues. It can be concluded that life-long physical exercise has a beneficial influence on the connective tissues of the maturing and aging organism. Viidik1996 10.1016/0047-6374(96)01729-0 1996-07-17 88 3 139 148 Scapulocostal Syndrome R Vincent Davis author 1992-07-03 text continuing periodical academic journal Following trauma to the soft tissue components of the scapulocostal interface, traumatic edema is formed. Irrespective of where it occurs in the body tissues, the presence of inflammatory edema is the antecedent to adhesion formation. This is a well-recognized clinicopathological process. If allowed to progress, such adhesions formation will inevitably result in loss of motion of the scapula on the respective thoracic cage. Such loss of motion then complements pathological progression of this lesion to one of complete adhesive myofascitis of the scapulothoracic interface. References paper by Michele and Eisenberg (1968, Arch. Phys. Med. Rehabil. 49:383) also referenced by Travell and Simons. Davis1992 http://www.chiroweb.com/archives/10/14/23.html 1992-07-03 10 14 A J Threlkeld author 1992-12-01 text continuing periodical academic journal The purpose of this manuscript is to examine the known and theoretical mechanical effects of therapeutic manual techniques on the connective tissue (CT) of joints and fasciae. Typical CT structures that could be influenced by manual techniques will be discussed. The behavior of CT under loading and the influence of immobilization on CT will be examined. The forces developed during manual techniques will be described, and their potential effects on the physical properties of CT will be discussed. Research priorities regarding the effects of manual therapy on CT will be outlined. Threlkeld1992 http://www.ptjournal.org/cgi/content/abstract/72/12/893 1992-12-1 72 12 893 902 H Frost author 1991-07-08 text continuing periodical academic journal We are finding that structural microdamage plays important roles in many clinical problems, so this Editorial discusses it. Repeatedly loading and deloading wheels, bolts, beams, and crankshafts can cause microscopic cracks that increase in size and number as the loads and number of load-deload cycles increases. Eventually so little material remains undamaged that the structure suddenly breaks under an ordinary load. Engineers call that fatigue damage. All structural materials can develop it, including biologic structural materials of animals and plants. Named "microdamage" (MDx) in bone in 1963, several forms occur in woven and lamellar bone, hyaline cartilage, fibrocartilage, tendon, ligament, fascia, and teeth. 10.1007/BF02556207 Frost1991a http://dx.doi.org/10.1007/BF02556207 1991-07-08 49 4 229 231 H Frost author 1991-09-08 text continuing periodical academic journal When malfunction of one biologic activity can cause clinical diseases while other activities function normally, we may consider that activity differs from others and try to find how to control it for medical needs. The new skeletal paradigm names five fundamental tissue-level activities: growth, modeling, remodeling, repair, and inflammation. Each has its own functions, mediator mechanisms, and responses to drugs, hormones, mechanics, and other agents. We discuss the first three activities. 10.1007/BF02556248 Frost1991b http://dx.doi.org/10.1007/BF02556248 1991-09-08 49 5 301 302 An Ultrastrutural Stereologic Study Wm Timothy McGaw author A Richard Ten Cate author A role for collagen phagocytosis and intracellular degradation by fibroblasts during remodeling activity has been suggested by studies on several connective tissues characterized by high rates of collagen turnover and remodeling. The possible importance of such activity in the normal remodeling of scar tissue has been studied by a quantitative ultrastructural stereologic measure of collagen phagocytosis by fibroblasts at various post-wounding intervals in mouse skin scars. The results demonstrate a correlation between the peak periods of such phagocytic activity and the interval during which collagen fiber reorientation across the scar appears to take place. 1983-10 text continuing periodical academic journal 0022-202X McGaw1983 http://dx.doi.org/10.1111/1523-1747.ep12519983 1983-10 81 4 375 378 Marcel E Nimni author 1983-Aug text continuing periodical academic journal 0049-0172 1983-Aug 13 1 1 86 Collagen is the single most abundant animal protein in mammals accounting for about 30% of all proteins. The collagen molecules, after being secreted by the cells, assemble into characteristic fibers responsible for the functional integrity of tissues such as bone, cartilage, skin, and tendon (Fig. 1). They contribute a structural framework to other tissues such as blood vessels and most organs. Crosslinks between adjacent molecules are a prerequisite for the collagen fibers to withstand the physical stresses to which they are exposed. Significant progress has been made towards understanding the functional groups on the molecules that are involved in the formation of such crosslinks, their nature, and location. A variety of human conditions, normal and pathologic, involve the ability of tissues to repair and regenerate their collagenous framework. Nimni1983 10.1016/0049-0172(83)90024-0