Monday, February 27, 2012

The Fibroblast

Another brief rant on the fundamentals of understanding the role of fascia and connective tissue. Although there are many specific topics to uncover, there isnt a better place to start than getting familiar with the Fibroblast.

A fibroblast is a cell that essentially produces and maintains the Extracellular Matrix of the connective tissue...or to put it simply, the ¨caretakers¨ of the connective tissue. It does this by secreting precursors into the extracellular matrix which maintain the structural integrity of the entire system.

The most important characteristic to remember about the Fibroblast is that it is adaptive. They provide the architectural plan for the fascial system and therefore react and adapt to tensional / compressional (Tensegral) stress. Through Mechanotransduction (see previous post: Mechanotransduction), it can transmit forces within the cell as well as from cell to cell through tensional forces. Why is this so important? Fibroblasts provide the architectural framework for bones, nerves, blood, fascia, etc...and therefore all of the structures that depend on those structures.

It is important to remember that the specific adaptation exhibited by the fibroblast is dependant on the mechanical force applied...therefore rendering the type of intervention (also the mode of intervention) a critical consideration for the care-seeker.

In most disorders of movement and posture (Cerebral Palsy, etc) and even most chronic pain disorders, there is a significant weakness / dysfunction of the connective tissue system. This is manifest a a pure weakness of the tissue itself or in a symptomatic way (muscular tension as a result of connective tissue fatigue or failure).

In summary, understanding the fundamental ¨building blocks¨ provides valuable insight into the development, management, and maintenance of the megstructure.


Tuesday, February 14, 2012

The ¨SuperTendon¨ Concept

Once again, I have been bitten by the ¨nerd bug¨and have been plowing through some of the scientific articles that are continually piling up...with no end in sight. I consider this both a blessing and a curse: although it is obvious that I do not possess enough years in my lifetime to absorb everything, each new read sheds even more light and understanding.

I have recently been examining the ¨Form and Function¨relationship...more specifically, the concept that form (structure) IS function. With this in mind, I came to focus on a particular article that had previously gone unnoticed. Upon reading through it, I was pleasantly surprised to finally find a ¨user-friendly¨ article that captures the essence of the Transanatomical understanding of human form and function. To be precise, it exposes the limits of the popular Topographical Anatomy understanding when it comes to analyzing function...which therefore renders any rehabilitative strategy to something relatively simplistic.

It is through works like well as the mentioned Frederic Wood Jones and Buckminster Fuller...that we get a more comprehensive understanding of the intimate relationship between the ¨Bioengineering¨of the human organism (form) and our interaction with the environment (function). More to come on the works of Wood Jones and Fuller, but this article should provide an effective entry into the transanatomical mindset.

Structure-Function Relationships in Tendons

Thursday, February 9, 2012

Success in the Fascial Paradigm: Passive-Aggressive Therapy?

I have chosen this photo to lead off this post for a very straightforward reason: it is time for the "therapeutic world" to take off the noise-cancelling headphones and start to acknowledge the undeniable potential of the fascial paradigm in the treatment of Cerebral Palsy and other disorders of movement and posture.

I think it is EXTREMELY important to also acknowledge the generous and unselfish contribution of Nancy and Haroldo Guerrero who have given me permission to use the images of their child to further contribute to the overall good and education of families and professionals alike. It has been my honour and pleasure to have been able to work with them for the last 4 years...and I am humbled by their dedication, work ethic, and superior frame of mind. Therefore on behalf of myself and all of the readers of this post...GRACIAS, NANCY Y HAROLDO!

Although a comprehensive history is always recommended, I will abbreviate this particular history in an effort to remain within a "digestible" amount of information. Matias is a severely affected child who obviously manifests a great deal of musculoskeletal challenges. This manifestation is most easily observed as muscular tension, rigidity, and stiffness. Within the traditional musculoskeletal paradigm, this tension is considered the "problem" therefore it is given primary focus and is the target of selective intervention (stretching, Botox, surgery, tenotomy, etc). As mentioned before in this blog (see previous post "Spastic Muscles: Victim or Perpetrator"), the muscles are SYMPTOMATIC. Therefore, they REFLECT an underlying problem and are therefore considered victims. By definiton, it is unproductive to set them as the primary rehabilitative focus. The true "perpetrator" is the lack of compressional strength (postural strength) which is mediated by the fascial system. There will be a large number of people / professionals scratching their head at this statement..."that doesn't make any sense whatsoever". With all due respect to them, my simple reply would be that it doesnt make sense to them because that's not what they read in their textbooks! My best advice would be to close those books...look at things more analytically...and formulate your own conclusions. This in itself is a difficult task...therefore I propose a simpler approach which comes in the form of a simple fundamental question that you should ask yourself: IS IT POSSIBLE TO IMPROVE THE STRUCTURE OF A SEVERELY AFFECTED CP CHILD WITHOUT ATTACKING THE MUSCLES THEMSELVES? As you should have already answer is a resounding YES!

This simple fact leaves no denying that a more passive, less invasive / aggressive should always be considered first. I admit that simple words are rarely enough, so I am very happy to share some very positive results on what can be generally considered a difficult case.

For those who are not familiar with the Scribd program I use for posting documents: You must click the title (in blue) of the document to download it. You will likely be able to read it directly from my blog, just use the scroll bar on the right hand side. It may be small lettering for please be sure to click and have a look directly on Scribd if necessary!

Success in the Fascial Paradigm

Thursday, February 2, 2012

Mechanotransduction: Response to Manual Therapy

For the very few regular readers, I must apologize for the long delay between posts. My unofficial rule is to produce 3 or 4 posts per month...however it seems that newborn babies do not follow this rule! Now that I have had a few months to adjust, recharge, and refocus, I will begin my "re-entry" into the blogosphere with a short back to basics post.

I have recently been clicking through the Inger Lab web publications (a very good site for those fascia nerds like me) and I came to the realization that a great deal of information is right under our just requires some effort in "digging" for it. What do I mean by this? Most people have the obvious and instinctive understanding that "if I go to get manual therapy, I will feel better". For most, this basic understanding is sufficient...for example, I need not know HOW a touchpad on a computer works. I need only know that that it does indeed work. But for the more investigative mind (both care-giver and care-seeker), the question still remains "how does the active manipulation of tissue translate into an immediate (or long-term) response? The answer is MECHANOTRANSDUCTION. To put it simply, Mechanotransduction is the process by which cells (and therefore tissue itself) sense mechanical stress and convert these stresses into biochemical signals. On a cellular level, the signal is sent to the nucleus and thus affecting the tissue on a "macro" level by promoting healthy remodelling.

As the above image so elegantly illustrates, the cell itself is a Tensegral construction that intimately connects the entire organism. Depending on the type of stress (sheer, compression, tension, etc), the cell will respond differently. Therefore, the TYPE of manual application is vitally important as well as the MODE of delivery (light, aggressive, quick, slow, etc).

With respect to the Fascial Paradigm, this is a key understanding and fundamental principle. Remodelling of connective tissue is always the ultimate goal, however the promotion of HEALTHY remodelling is the key.

My parting message is simple: Even the smallest biological element (cell) can sense differences in mechanical stress. Therefore the focus on the characteristics of the application of the manual therapy technique become more than important...they are critical! Mechanotransduction shows us that there is true power in the effectiveness of manual therapy...the real "skill" comes with the understanding of the specific mechanisms of application and response.

Thanks for reading!