Connective Issues – Hot off the Press

Firstly, I would like to congratulate and say thanks to Mary Biancalana and her fabulous team for putting together a great virtual conference last month. I was honoured to be included alongside her star-studied bunch of presenters from around the world. Mary has championed the highest standards of education for the NAMTPT for decades now, and is a huge part of the organization of the IMS Padua conference in June next year.

I want to bring your attention to two papers both published in October 2021. One of my patients, a doctor, sent me a link to an interesting short article published in the Harvard Gazette, titled Massage Helps Injured Muscles Heal Faster And Stronger’. Scientists at the Wyss Institute teamed up with soft robotics engineering experts at the Harvard Biodesign lab. They produced a small silicone tipped device that used sensors and actuators to monitor and control the force applied to the limb of a mouse.

Using ultrasound they compared treated and untreated tissue and could observe the strain injured muscles experienced during mechanical force over a period of fourteen days. They found that the reduction of damaged muscle fibers was more pronounced and the cross-sectional area of the fibers was larger in the treated muscle. This led them to believe that mechanical treatment had led to greater repair and strength recovery. 

But how? Their hunch was that this was all to do with inflammation-related chemicals called cytokines and chemokines. These chemicals attract neutrophils. Using a fluorescent dye they observed that force application helped flush out the chemicals and hence the neutrophils.

Whilst the presence of neutrophils is important in the initial stages of the inflammatory process, it is also important that inflammation is quickly resolved to enable the regenerative process to run its full course.  What is especially exciting is that the newly made muscle fibers grew bigger and stronger.

Clinically, this justifies our use of the body buffer, shock wave and any kind of mechanical massage gun (along with our fingers, thumbs and elbows) to positively influence the body’s immune system in a drug-free and non-invasive manner. Link below.

Also hot off the press, the second, well-designed study I want to bring to your attention is more about myofascial trigger points. It was published in the ‘Journal of Pain Research’ in October 2021 and comes out of the People’s Republic of China. The title is Pressing Intervention Promotes The Skeletal Muscle Repair Of Traumatic Myofascial Trigger Points In Rats’.

In this case 30 randomly chosen rats were divided into a Blank group, a Model group, and a Press group. Group two and three had myofascial trigger points induced by blunt striking (they were anaesthetized, you animal lovers) combined with eccentric exercise on a downward sloping treadmill the next day. This went on for 8 weeks, before 4 weeks of recovery.

In the Press group the anaesthetized rat legs were shaved and experts palpated for taut bands and nodules in the vastus medialis muscle. A pressing device was precisely set for force and angle and pressed 10 times per minute, for 7 ½ minutes, seven times in total in the muscle belly.

It is possible to measure pressure pain thresholds (PPT), and Soft Tissue Tension, and EMG in rats. Unfortunately for the rats they were later sacrificed to complete tissue staining, collagen analysis and measurements of COX-2, PGE-2, Substance P, and serotonin. Blank group were the control (no induced MTrPs), Model group had no intervention, and Press group had the mechanical soft tissue intervention.

The Press group had PPT back to control levels, the same for soft tissue tension and the EMG almost returned to normal. Tissue staining showed tissue collagen fiber layouts are improved, with inflammatory cells much reduced compared to the Model group. COX-2, PGE-2, SP, and 5-HT levels all reduced to close to control in the Press group.

The study has an extensive discussion section that describes many of the ‘pressing’ therapy techniques, that lead to changes in blood  flow, improved metabolic environment and enhanced metabolic metabolism; much like Shah’s milieu. It also mentions enhancement of the excitability of parasympathetic neurons, which I find interesting. It also revisits the Delphi survey of 2018, fibroblast proliferation, extracellular matrix, Myosin Heavy Chains and changes to collagen deposition. Further experiments will explore timing and dosage.

The first study is one of the first to combine mechanotherapy and the immune system, but doesn’t mention MTrPs. The second study puts flesh on the bones of the effectiveness of mechanotherapy for reduction of MTrPs, reduction of inflammation and fibrosis, pain relief and enhanced muscle repair. By using a robotic mechanical process both reduce many previously reported clinical variables.

These two ‘hot-off-the-press’ papers really make the case for manual trigger point therapy. Let’s press on.

Cheerio for now,