There is an old saying that "movement heals." It is readily accepted that exercise benefits many musculoskeletal conditions by promoting repair and remodeling of tendon, muscle, articular cartilage and bone.1-2 This occurs by way of mechanotransduction, a physiological process wherein cells sense and respond to mechanical loads.
Local cells signal distant cells - for example, in bone, osteocytes are stimulated to create new bone; in tendons, growth factors and cytokines are stimulated, resulting in cellular proliferation and matrix remodeling; in muscles, mechanogrowth factors are stimulated; and in cartilage, even continuous passive motion has shown to stimulate chondrocytes for repair.1 Schleip reports that movement, compression and stretching stimulates receptors such as pacini, ruffini and mainly interstitial type III and IV receptors (which are found everywhere), creating changes in vasodilation and plasma extravasation from the blood vessels, causing changes in viscosity and the tonus of muscles.3
As Schleip states, "It commonly comes as a big surprise to many people to learn that our richest and largest sensory organ is not the eyes, ears, skin or vestibular system but is in fact our muscles with their related fascia. Our central nervous system receives its greatest amount of sensory nerves from our myofascial tissues."
All this suggests that the addition of motion, resistance, provocation and rehab while applying soft-tissue methods will improve results more rapidly, especially in difficult cases, and in fact, this treatment protocol is now being utilized and taught within our profession. The sensorimotor system is stimulated while applying mechanical load and proprioceptive stimulation. All manner of rehabilitation devices can be used, including exercise bands, exercise tubing, exercise balls, balance boards, weights, flexbars and vibratory equipment. Mechanical load during proprioceptive stimulation could consist of Graston Technique, gua sha, ART, Nimmo, friction massage and almost any other technique you can think of.
Normal motion is introduced while the skin, ligaments and myofascia are stimulated. Treatment is often directed to areas of pain created while the patient is in motion. It is possible that the breakdown of adhesions may be less important than the establishment of proprioceptive reflexes.
The concept of adding proprioceptive stimulation to load techniques agrees with present-day literature and is currently receiving rave reviews from many practitioners I have been in contact with (including myself).
- Khan KM, Scott A. Mechanotherapy: how physical therapists' prescription of exercise promotes tissue repair. Br J Sports Med, 2009;43:247-251.
- Smidt N, de Vet HC, Bouter LM, et al. Effectiveness of exercise therapy: a best-evidenced summary of systematic reviews. Aust J Physiother, 2005;51:71-85.
- Schleip R. Fascial plasticity - a new neurobiological explanation. J of Bodywork and Movement Ther, 2003,7(1):11-19.
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