Post by Sam Donaldson (M.PhtySt, BAppSci(HMS), Physiotherapist APAM SMAM)
Justifying the physical approach to therapy in rehabilitation and performance.
Every fortnight at RHP Physiotherapy, we are fortunate to have implemented an in-service program, through which our therapists are afforded the opportunity to learn as a team and collaborate in the care of our patients.
This fortnight we took on the science behind Mechanotherapy.
Mechanotherapy is a term used to describe the therapeutic use of any modality that provides a mechanical stimulus to the tissue, which is directed towards rehabilitating or developing the body to return to, or improve activity. My personal favourite definition (from Huang et al 2013) is the “Therapeutic interventions that reduce and reverse injury to damaged tissues or promote the homeostasis of healthy tissues by mechanical means at the molecular, cellular or tissue level.”
What this whittles down to is that when a force is applied to any bodily tissue, that force stimulates a change. When jumping up and down, the muscles must stretch and contract; tension pulls and recoils in the tendons, the bones absorb vertical compression which also bends and twists them (ever so slightly). The cells in these tissues must deform under that force, which will stimulate a cascade of events within the cell, as well as between the cells. Ultimately, the cells of those muscles, tendons and bone, will stimulate DNA transcription (the building blocks of our bodies) and create new muscle, tendon and bone.
What is most interesting to us, is that each tissue type will respond to different types of forces. Not only that, but the cells of these tissues will respond at various amounts depending on how much force, the rate of repetition of that force and the recovery period between those forces that are applied. This means that we can potentially find an optimum amount of that mechanical force, that will stimulate change: with far too much being detrimental, a little too much being no better than the optimum, and too little not being effective enough to make the necessary adaptations.
Without going too much further into the dry science of it all, it is these cellular mechanisms that underpins every aspect of our physical approach to therapy; be it massage therapy, stretches, exercise therapy or even something like shock-wave therapy or low intensity pulsed ultrasound.
So, if you have ever wondered why you have been asked to do certain exercises or walking or running with explicit repetitions, sets and recovery times, this cellular response to that exercise is one justification for the specificity of that prescription.
Without a doubt, there is more at play than just the biological responses at a cellular level when we are considering how we might rehabilitate an injury. Pain and the nervous system is a whole other kettle of fish! However, the way the body can physically adapt to whatever it is we ask it to do, it seems we can achieve the most when we do just the right amount at just the right intensity, and allow certain rest times. Sometimes less is more, and more is less!
The human body is an amazing organism and one we are continually amazed by. Treat yours well and it will reward you!
If you would like to learn more or have any physical barriers to doing what you would like to be doing (injury, pain or other), then get in touch with our physiotherapists on 07 3856 5566.
References:
- Warden, S. J., & Thompson, W. R. (2017). Become one with the force: optimising mechanotherapy through an understanding of mechanobiology.
- Khan, K. M., & Scott, A. (2009). Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair. British journal of sports medicine, 43(4), 247-252.
- Huang, C., Holfeld, J., Schaden, W., Orgill, D., & Ogawa, R. (2013). Mechanotherapy: revisiting physical therapy and recruiting mechanobiology for a new era in medicine. Trends in molecular medicine, 19(9), 555-564.
