Since pre-Biblical days, the "laying on of hands" has been thought of as creating a healing life force. Science is slowly beginning to understand what is behind this life force, especially with regard to neuromusculoskeletal conditions.
Regular exercise facilitates extracellular matrix (ECM) processing of angiogenic molecules.2 From a scientific point of view, when a hand is placed on soft tissue, stress is created. Stress is defined as the amount of tension or load per unit in a cross-sectional area that is placed on a specimen.3 Strain is defined as the elongation of a structure or material that occurs in response to stress. Therefore all soft-tissue techniques represent some sort of stress, whether it's manipulation, deep massage or light contact as used in strain/counterstrain, or other stresses such as vibration, ground reaction forces, gravity and barometric pressure.
What is important is that the effect of all soft-tissue methods (including exercise) is deformation of the tissue. When the tissues are deformed, the resident cells are deformed.4 Cells in our body require deformations such as movement, tension and compression in order to function. Lying down without motion will eventually result in apoptosis (cell death). If tissue is injured, precise deformations can have a healing effect.
Deformation creating movement stimulates cells to detect "outside-in" mechanical signals, resulting in "inside-out" signaling. Cells immediately detect all types of mechanical deformation whether due to tension, compression, shear or even fluid flow. Chemical signals at the cell surface are stimulated by mechanical stress. In other words, mechanical forces are translated into chemical signals. This process is called mechanotransduction or the ability of cells to perceive and biochemically interpret the force.5
Every cell in our body is surrounded by plasma membranes that, when stressed (deformed) by tension or shear stress, become indented and activated. On the surface of these membranes are receptors called integrins and stretch-activated ion channels that connect the extracellular matrix to the cell cytoskeleton and its nucleus. When the integrin becomes deformed by outside pressure, it functions to provide a physical connection between the outside and inside of the cell, sending messages to the nucleus, back to the ECM and to other cells throughout the body. These attachments between cells and the ECM are essential for life.
When the connections are turned off, the connective tissue cells enter the apoptotic state and die if they become rounded for a prolonged period: "Thus, by connecting extracellular matrix components to intracellular signaling pathways and cytoskeletal elements, integrins and other type receptors appear to be ideally suited for the transduction of mechanical stimuli that result in alterations in cell shape or behavior."2
Growth factors are proteins that bind to receptors on the cell surface and are stimulated to action by outside stress. They stimulate cells to grow, survive and proliferate. For example, transforming growth factor beta stimulates type I collagen. Genes are stimulated (gene expression) to produce RNA or necessary proteins. Depending on the amount of mechanical load, fibroblasts can be stimulated to create inflammatory mediators such as prostaglandin-E2 and cyclooxygenase enzymes.6 It is possible that very light strain to fibroblasts can cause an anti-inflammatory reaction.
Every cell in our body requires movement to survive, and it appears that it is necessary for our cells to receive just the right amount of movement. With inadequate movement, there is a loss of ground substance (extracellular matrix), collagen disorganization, loss of collagen, increased cross-linking (fibrosis), increased muscular weakness and eventual apoptosis. With excessive movement, there is fibrosis, reduction in cellular oxygen and eventual cell apoptosis.7
Our application of soft-tissue methods is movement-based; an important question yet to be answered regards the optimum compression or friction necessary for optimum healing. Maybe the mechanical load (pressure) delivered should take into account the acuteness or chronicity of the tissue. In many chronic problems, palpation reveals excessive fibrosis that may require increased pressure to normalize tissue compared to recent acute events. Some say that light techniques can heal chronic problems.8
Healing requires movement. It has recently been shown that "incorporating therapeutic exercises during the first week after ankle sprain results in significant improvements in short-term ankle function compared with the standard PRICE intervention."9 Over the years, practitioners have reported the benefits of immediate soft-tissue therapy after injury. Science is now asserting the same.
References
- Veljkovic M, Dopsaj V, Stringer WW, et al. Aerobic exercise training as a potential source of natural antibodies protective against human immunodeficiency virus-1. Scand J Med Sci Sports, 2010;20:469-74.
- Suhr F, Rosenwick C, Vassiliadis A, et al. Regulation of extracellular matrix compounds involved in angiogenic processes in short- and long-track elite runners. Scand J Med Sci Sports, 2010;20:441-8.
- Lundon K. Orthopedic Rehabilitation Science. New York: Elsevier Science, 2003:119.
- Banes AJ, Lee G, Graff R, et al. Mechanical forces and signaling in connective tissue cells: cellular mechanisms of detection, transduction, and responses to mechanical deformation. Curr Opin Orthop, 2001;12:389-96.
- Langevin HM, Bouffard NA, Badger GJ, et al. Dynamic fibroblast cytoskeletal response to subcutaneous tissue stretch ex vivo and in vivo. Am J Physiol Cell Physiol, 2005;288:C747-56.
- Wang JH, Li Z, Yang G, Khan M. Repetitively stretched tendon fibroblasts produce inflammatory mediators. Clin Orthoped Rel Res, 2004;422:243-50.
- Falanga V, Kirsner RS. Low oxygen stimulates proliferation of fibroblasts seeded as single cells. J Cell Physiol, 1993;154(3):506-10.
- Personal communication with Leon Chaitow DO, ND.
- Bleakley CM, O'Connor SR, Tully MA, et al. Effect of accelerated rehabilitation on function after ankle sprain: randomized controlled trial. BMJ, 2010 May 10;340:c1964.
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