Manual therapy as an effective treatment for fibrosis
Repetitive use injuries of the upper extremity form a large proportion of work related injuries. To date the literature has been mixed on the efficacy of various modalities to treat and reverse the deleterious effects of these sorts of injuries. Due to symptoms of pain and motor dysfunction patients often neglect and fail to use there effected limb resulting in the development of tissue fibrosis. Tissue samples are shown to be associated with increased fibrogenic tissue markers. With this in mind, the authors of the present study investigated the roles manual therapy can have on repetitive use injuries on both behavior and at the cellular level. Overall it was shown that when compared to control, rats receiving modeled manual therapy (MMT) expressed fewer discomfort related behaviors and had less fibrotic tissue changes.
The authors used an animal model (rat) for the purposes of this study. Twenty four rats underwent task training to simulate the conditions of an overuse injury. All the subjects performed the same task every day for twelve weeks. Twelve rats acted as the control and received no intervention whereas eleven received MMT. Trained technicians monitored ongoing behavioral changes. Histological and biochemical assays were carried out to monitor the cellular and molecular effects of treatment.
It has been postulated that fibrosis in and around muscles and nerve alters the dynamic biomechanical properties resulting in adjacent tissue strain. This in turn has been linked to chronic nerve irritation and sensitivity which is associated with increased pain behavior. The current investigation demonstrated a decreased presence of TGF-β1 (pro-fibrotic marker) and type 1 collagen in both cross sectional assays and serum preparations when compared to untreated controls. Furthermore, lower fibrotic indicators were correlated with reduced pain avoidance and sensorimotor dysfunction. Taken together, the authors of the present study provide a compelling example of how manual therapy techniques can create measureable change at the cellular level in a mammalian model.
> From: Brianton et al., J Neurol Sci 368 (2016) 168-180. All rights reserved to Elsevier Ltd. Click here for the Pubmed summary.