For the Fascia Studies Reader ...

Fascia's Self-Healing Mechanisms?

Source: Leon Chatow Facebook September 11, 2016

Next Friday, at the Dutch Osteopathic Conference in Utrecht, I will be presenting on a topic related to treatment of fascial dysfunction. One element of that presentation will involve discussion of new research (Dittmore et al 2016) that has identified fascinating aspects of fascia's self-regulating/self-repair mechanisms.
A brief introduction to this is also given in my next Editorial in JBMT:
Here's a sneak mini-preview:
" Dittmore et al (2016) have described evidence that collagen operates a self-healing process involving what they term “cleavage-vulnerable binding regions”. These vulnerable sites are arrayed periodically at ∼1μm (one millionth of a meter) intervals, along collagen fibrils.

Summary
• Collagen fibrils contain billions of minute sites that are vulnerable to buckling – if internally or externally derived forces fail to maintain optimal tension.
• Buckling exposes collagen to specific enzymes (MMPs) at these cleavage site, allowing the enzyme-related degradation and subsequent repair process.
• Dittmore et al explain that these dynamic molecular changes in collagen structure – that were previously not detected by means of conventional structural investigation - were readily observed through tracking of enzyme binding, which “may be on the order of single atoms” 1
• The presence of strain-driven defects may have general and widespread regulatory repair and maintenance functions in self-assembled biological (collagen) filaments – with the possibility that externally applied load - via exercise, or the imposition of compression/shear force/stretching etc-being capable of influencing this apparently constant process.
• It is of interest to note that these self-regulating processes operate via mechanisms that are independent of the nervous system. In reality the process is dependent on force transmission/load transfer, fluid dynamics and mechanotransduction mechanisms (amongst others)
Significance
Dittmore et al describe the significance of their findings as follows:
“Collagen fibrils resemble nanoscale cables that self-assemble and constitute the most prevalent protein structure in the body. Our experiments reveal unanticipated defects that form along collagen fibrils. These defects are the initiation sites of collagenase activity and represent a strain-sensitive mechanism for regulating tissue remodelling. The emergence of defects, their spatial periodicity, and fluctuations are quantitatively accounted for with a buckling model in which defects spontaneously form, repulsively interact, and self-heal."

The Dittmore et al findings have important clinical implications for manual and movement therapies, and raise a number of questions, such as:
>>> In what ways may internally generated forces – for example – associated with rhythmic pulsations, contractions, peristalsis, respiratory activity etc – influence the tension-status of associated collagen?
>>> How does force transmission, via muscle-fascial connections, influence the tension status of associated collagen?
>>> In what ways might exercise, and/or movement therapies (Yoga, Tai chi, Pilates, Feldenkrais etc) influence the tension status of associated collagen?
>>> In what ways do externally applied loads, via manual therapies (massage, osteopathy, chiropractic, physiotherapy etc) influence the tension status of associated collagen?

Some answers are already emerging....

Chaitow L 2016 New evidence of a dynamic fascial maintenance and self-repair process http://dx.doi.org/10.1016/j.jbmt.2016.08.013

Dittmore, A et al. 2016 Internal strain drives spontaneous periodic buckling in collagen and regulates remodelling.
Proceedings of the National Academy of Sciences (2016): 201523228

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