Jon Trister MD.The Effect of Tension-Stress on the Genesis and Growth of Tissue
The Effect of Tension-Stress on the Genesis and Growth of Tissue
For a successful orthopaedic medicine physician, it is crucial to understand the mechanisms of connective tissue healing. While I will not cover all aspects of regenerative medicine, I would like to share a few thoughts with my colleagues.
Prolotherapy involves controlled injury of the enthesis. During injections, the extravasation of blood, mechanical injury, and osmotic effects of dextrose activate multiple physiological systems. These processes occur simultaneously in the tissues, working together to control and regulate complex physiological reactions. One such response to injury is the proliferation of fibroblasts, which transform into myofibroblasts. Myofibroblasts possess significant contractile abilities, generating tensile forces at the injection site, leading to elastic transformation.
Extensive medical, biological, and engineering studies have resulted in the discovery of a general biological law governing tissue growth and regeneration: The Law of Tension-Stress discovered by Gavriil Abramovich Ilizarov – Soviet Orthopedic Surgeon in 1954.
Gradual traction on living tissues creates stress that can stimulate and maintain the regeneration and growth of certain tissues. Slow, steady tension of tissue activates them metabolically, increasing their proliferative and biosynthetic functions. These processes depend on two main factors:
1. The quantity and quality of blood supply to the mechanically stressed tissue.
2. The stimulating effects of tensile forces along the lines of muscular contractions, as collagen fibers align parallel to the vector of tension-stress.
The clinical application of this biological law has allowed us to manipulate the healing process of soft tissue injuries, as well as certain diseases and disorders of the musculoskeletal system.
Numerous clinical and scientific observations confirm that tension-stress stimulates tissue growth, resembling the natural process of growth. Tension-stress stimulates osteogenesis and soft tissue histogenesis. The formation and growth of new tissue in adult organisms share similarities with tissue formation during embryonic and postnatal periods. For example, tension-stress induced by Myofibroblasts affects skeletal muscle, leading to changes in energy-supplying systems like mitochondria and protein-synthesizing systems like ribosomes and endoplasmic reticulum. Furthermore, tension-stress also stimulates the smooth muscle lining of blood vessels, increasing smooth muscle biosynthetic activity and proliferation, necessary for the healing of damaged ligaments and tendons.
Similar changes occur in connective tissue of fascia, tendons, dermis, as well as in the endomysium and perimysium of muscle, adventitia of blood vessels, and epineurium and perineurium of major nerve trunks.
Following an injury, the number of fibroblasts increases, and there is noticeable hypertrophy of the Golgi complex and enlargement of mitochondria, cytoskeletal microfilaments, and granular endoplasmic reticulum. These changes identify fibroblasts as type II collagenoblasts, which are typical of embryonic connective tissue. Tension-stress also stimulates elongation of nerve axons, eventually causing them to join one another.
These processes are not new; various healthcare practitioners utilize tension-stress in their practices. Major applications include orthopaedic surgery, prolotherapy, myofascial release, osteopathy, massage, and physical therapy. Combining different modalities will improve the success rate in managing patients with various musculoskeletal problems.
Jon Trister MD