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S. Rogan1,2,3, E. Luijckx1, J. Taeymans1,2
1Bern University of Applied Sciences, Department of Health Professions, Bern, Switzerland, 2Vrije Universiteit Brussel, Faculty of Physical Education and Physiotherapy, Brussel, Belgium, 3Akademie für Physiotherapie und Trainingslehre, Grenzach-Wyhlen, Germany
Background: Physical therapy focuses primarily on the repairment of the injured structure (e.g. bone tissue) to restore functional capacity. However, recent findings in mechanobiology research showing effects of physical forces on the cellular level have led to the realization that the mindset in physical therapy should be updated. The conversion of a mechanical stimuli on the cell into a biochemical intracellular signal, is known as “mechanotransduction”. The latter includes translocation of stimuli towards the cell nucleus, transcription on the nuclear level and the translation on the cytoplasmatic level. This mechano-biochemical signalling pathway seems to be a key factor in promoting protein synthesis in cells.
Purpose: The aim of this review was to provide an overview of the current scientific evidence underpinning how mechanical load can be used in a physical therapy setting to build tissue or to repair tissue.
Methods: A systematic literature search in the EMBASE and PubMed databases was conducted. Two independent reviewers screened all eligible abstracts. Full texts from the included articles were read by the same two reviewers independently. The same researchers extracted data and study characteristics independently.
Results: Mechanotransduction has been defined as a process in which cells convert mechanical load into a biochemical response. Mechanotherapy describes usage of mechanical forces to promote tissue healing. Mechanotherapies activate specific biological responses in cells to induce tissue repairment and increase healing after tissue damage. Cell membrane integrins along with mechanosensitive ion channels and additional mechanoreceptors are involved in the cellular primary transduction pathways. Internal mechanical load is produced by a physiological reaction during endurance training, strength exercise or stair climbing, through an increase of heart rate or blood flow.
Conclusion(s): Physical therapy interventions elicit extrinsic and intrinsic forces that results in mechanical stimuli to encourage responses on molecular and cellular levels leading to repairment mechanisms after tissue damage.
Implications: To stimulate mechanotransduction in human cells, mechanical forces such as shear stress, tensile strain or compressive force should be applicated on the body. Physical therapists can apply an external stimulus via
1) soft tissue mobilization/manipulation (e.g. manual therapy, therapeutic massage)
2) instrumented-assisted soft tissue mobilization (e.g. ultrasound, shockwave)
3) active mobilization (e.g. strength training).
1) soft tissue mobilization/manipulation (e.g. manual therapy, therapeutic massage)
2) instrumented-assisted soft tissue mobilization (e.g. ultrasound, shockwave)
3) active mobilization (e.g. strength training).
Funding, acknowledgements: None
Keywords: physical therapy modalities, mechanoreceptors, rehabilitation
Topic: Professional practice: other
Did this work require ethics approval? No
Institution: BFH
Committee: Kantonale Ethikkommission Bern, Switzerland
Reason: Review
All authors, affiliations and abstracts have been published as submitted.
