Mechanotherapy: How to promote tissue healing
Mechanotherapy is the physiological process where cells sense and respond to mechanical loads, such as pressure or exercise, in order to facilitate healing after an injury.
Loading the tissue, as will be explained later, can be used therapeutically to stimulate repair and remodelling in tendons, muscles, cartilage and bone.
Through mechanotherapy, the body converts mechanical loading into cellular responses. These cellular responses, in turn, promote structural changes.
The key to mechanotherapy, is the direct or indirect physical perturbation (disturbance or agitation) of cells, which is transformed into a variety of chemical signals both within and among cells.
Interestingly, stimulus in one location leads to a distant cell registering a new signal even though the distant cell does not receive a direct mechanical stimulus.
Tendons are relatively avascular tissue, so can often be recalcitrant to repair/healing. Fortunately, tendons are a dynamic, mechanoresponsive tissue, meaning they respond quickly and remarkably after stimulation with the appropriate load.
Two examples are the use of Instrument Assisted Soft Tissue Mobilization (IASTM), which is akin to “scraping” the tissue overlying the tendon, followed by eccentric loading of the tendon with corrective exercises. These exercises focus on the lengthening part of the contraction, e.g. Using the biceps as an example, the focus would be on lowering of the weight from a flexed position for 4 seconds. Another area which has been the focus of research is the achilles tendon and plantar fasciitis. Here the focus would also be on the lower from being on the toes to having the calf slowly being stretched or lengthened.
Eccentric exercises can be used on any muscles. The key is where to place the emphasis with respect to the timing of the three primary phases (eccentric, isometric and concentric) of the contraction.
Last week I wrote about the significance of satellite cells on repair. Mechanical overload leads to the immediate, local upregulation of mechanogrowth factor (MGF), which in turn leads to muscle hypertrophy (growth and repair) via activation of satellite cells.
Controlled loading results in improved alignment and regeneration of muscles cells, while at the same time minimising atrophy and scar tissue formation
Cartilage and Bone
The current model of care for cartilage and bone injuries promotes immobilisation.
In one study, when intermittent compression delivered via an inflatable pneumatic cuff worn under the cast was included, the experimental group displayed significantly increased strength at the end of the immobilization period and these differences were maintained at 10 weeks.
So what do you do with this information?
Firstly, be aware that mechanotherapy is an active, not passive modality that is counter to the typical rest, ice, immobilization and NSAID approach/recommendations.
Secondly, get perturbed!
If you have an injury that is not healing or want to accelerate healing, there are a number of techniques you can start to use in order to pertubate the involved tissues. Some of these include:
1. Voodoo Flossing (see prior blogs)
2. Instrument Assisted Soft Tissue Mobilization (IASTM- AKA Gua Sha)
3. Specific corrective exercises
Lastly, check your alignment.
By alignment, I am referring to the optimum movement at the major joints. Poor alignment, characterized by muscle imbalances and faulty joint mechanics, will place abnormal and asymmetric stresses on tissues and over time result in abnormal and dysfunctional mechanical loading, tissue fatigue and injury.
Poor alignment does not mean poor posture, however, poor posture, ergonomics, habits and clothing, e.g. shoes, can over time, result in tissue deformation, alignment issues, injuries and pain.
Just like you check your car’s alignment to prevent unwanted wear and tear and potential damage (which is costly), your body warrants the same assessment and treatment, albeit by a “body mechanic.”