TISSUE REPAIR SUMMARY AND CONCLUSIONS

The most likely final outcome of these combined events is that the damaged tissue will be repaired with a scar which is not a ‘like for like’ replacement of the original, but does provide a functional, long term ‘mend’ which is capable of enabling quality recovery from injury. For most patients, this is a process that will occur without the need for drugs, therapy or other intervention. It is designed to happen, and for those patients in whom problems are realised, or in whom that magnitude of the damage is sufficient, some ‘help’ may be required in order to facilitate the process. The help – or therapy – provided should facilitate the repair events rather than be inhibitory and although it would be difficult to argue that therapy is ‘essential’ it can be beneficial if applied appropriately. The body has an intricately complex and balanced mechanism through which these events are controlled and playing to the strengths of this sys- tem seems much more logical than trying to change them.

If the tissue responses in a particular patient are not progressing ‘normally’, then bringing them back on track will certainly help. Ensuring the right events happen even in the normally responding tissue will be beneficial. Trying to make something different hap- pen is a difficult stance to support from the evidence.

THE AUTHOR Prof Tim Watson is a professor of physiotherapy and director of research at the University of Hertfordshire. He completed a degree in biomedical sciences followed by a PhD on the bioelectric correlates of musculoskeletal injury and repair. His main research areas are elec- trotherapy (mainly ultrasound, pulsed shortwave and microcurrent) and tissue repair. Author correspondence t.watson@herts.ac.uk For more information about Prof Watson’s work visit www.elec- trotherapy.org

References 1. Jarvinen TA, Jarvinen TL, et al. Muscle injuries: biology and treatment. American Journal of Sports Medicine 2005;33(5):745-64 2. Werner S, Grose R. Regulation of wound healing by growth factors and cytokines. Physiology Review 2003;83:835-870 3. Toumi H, Best HM. The inflammatory response: friend or enemy for mus- cle injury? British Journal of Sports Medicine 2003;37:284-286 4. Watson T. Soft Tissue Healing. In Touch 2003;104:2-9 5. Hill M, Wernig A, et al. Muscle satellite (stem) cell activation during local tissue injury and repair. Journal of Anatomy 2003;203:89-99 6. Neidlinger-Wilke, Grood CE, et al. Fibroblast orientation to stretch begins within three hours. Journal of Orthopaedic Research 2002;20(5):953-6 7. Lorena D, Uchio K, et al. Normal scarring: importance of myofibroblasts. Wound Repair and Regeneration 2002;10(2):86-92 8. Latey P. Aspects of inflammation. Journal of Bodywork and Movement Therapies 2001;5(2):124-131 9. Molloy T, Wang YH, et al. The roles of growth factors in tendon and lig- ament healing. Sports Medicine 2003;33:381-394 10. Merrick MA. Secondary injury after musculoskeletal trauma: A review and update. Journal of Athletic Training 2002;37(2):209-217 11. Wagner S, Coerper S, et al. Comparison of inflammatory and systemic sources of growth factors in acute and chronic human wounds. Wound Repair Regeneration 2003;11:253-260 12. Kobayashi S, Baba H, et al. Localization and changes of intraneural inflammatory cytokines and inducible-nitric oxide induced by mechanical compression. Journal of Orthopaedic Research 2005;23(4): 771-8 13. Li Z, Yang G, et al. Inflammatory response of human tendon fibroblasts to cyclic mechanical stretching. American Journal of Sports Medicine 2004;32(2):435-40 14. Ryan GB, Majno G. Acute inflammation. American Journal of Pathology 1977;86(1):185-277 15. Scott A, Khan KM, et al. What is "inflammation"? Are we ready to move

12

beyond Celsus? British Journal of Sports Medicine 2004;38(3):248-9 16. Hardy MA. The biology of scar formation. Physical Therapy 1989;69(12):1014-1024 17. Bhattacharyya T, Levin R, et al. Nonsteroidal antiinflammatory drugs and nonunion of humeral shaft fractures. Arthritis and Rheumatism Journal 2005;53(3):364-7 18. Hashimoto I, Nakanishi H, et al. Angiostatic effects of corticosteroid on wound healing of the rabbit ear. Journal of Medical Invest 2002;49(1- 2):61-6 19. Tsai WC, Tang FT, et al. Ibuprofen inhibition of tendon cell proliferation and upregulation of the cyclin kinase inhibitor p21CIP1. Journal of Orthopaedic Research 2004;22(3):586-591 20. Cook JL, Khan KM, et al. Achilles tendinopathy. Manual Therapy 2002;7(3):121-130 21. Evans NA, Stanish WD. The basic science of tendon injuries. Current Orthopaedics 2000;14:403-412 22. Fenwick SA, Hazelman BL, et al. The vasculature and its role in the dam- aged and healing tendon. Arthritis Research 2002;4:252-260 23. Forrest L. Current concepts in soft connective tissue wound healing. British Journal of Surgery 1983;70:133-140 24. Hildebrand KA, Woo SL, et al. The effects of platelet-derived growth fac- tor-beta on healing of the rabbit medial collateral ligament. An in vivo study. American Journal of Sports Medicine 1998;26(4):549-54 25. Blaney Davidson EN, Scharstuhl A, et al. Reduced transforming growth factor-beta signaling in cartilage of old mice: role in impaired repair capac- ity. Arthritis Research and Therapy 2005;7:R1338-R1347 26. Vanable J. Integumentary potentials and wound healing. Electric Fields in Vertebrate Repair. Borgens R. New York, Alan Liss Inc: 1989;171-224 27. Kubo K, Akima H, et al. Effects of 20 days of bed rest on the viscoelas- tic properties of tendon structures in lower limb muscles. British Journal of Sports Medicine 2004;38(3):324-30 28. Ahtikoski AM, Koskinen SOA, et al. Synthesis and degradation of type IV collagen in rat skeletal muscle during immobilization in shortened and lengthened positions. Acta Physiologica Scandinavica 2003;177(4):473- 481 29. Michaels JT, Dobryansky M, et al. Topical vascular endothelial growth factor reverses delayed wound healing secondary to angiogenesis inhibitor administration. Wound Repair and Regeneration 2005;13(5):506-12 30. Hopf HW, Gibson JJ, et al. Hyperoxia and angiogenesis. Wound Repair and Regeneration 2005;13(6):558-64 31. Li WW, Talcott K, et al. The role of therapeutic angiogenesis in tissue repair and regeneration. Advances in Skin Wound Care 2005;18(9):501-2 32. Bray RC, Leonard CA, et al. Vascular physiology and long-term healing of partial ligament tears. Journal of Orthopaedic Research 2002;20(5): 984-9 33. Petersen W, Varoga D, et al. Cyclic strain influences the expression of the vascular endothelial growth factor (VEGF) and the hypoxia inducible fac- tor 1 alpha (HIF-1alpha) in tendon fibroblasts. Journal of Orthopaedic Research 2004;22(4):847-53 34. Reher P, Doan N, et al. Effect of ultrasound on the production of IL-8, basic FGF and VEGF. Cytokine 1999;11(6):416-23 35. Zhao M, Bai H, et al. Electrical stimulation directly induces pre-angio- genic responses in vascular endothelial cells by signaling through VEGF receptors. Journal of Cell Science 2004;117(Pt 3):397-405 36. Kipshidze N, Nikolaychik V, et al. Low-power helium: neon laser irradi- ation enhances production of vascular endothelial growth factor and pro- motes growth of endothelial cells in vitro. Lasers Surgery Medicine 2001;28(4):355-64 37. Desmouliere A, Chaponnier C, et al. Tissue repair, contraction, and the myofibroblast. Wound Repair and Regeneration 2005;13(1):7-12 38. Gabbiani G. The myofibroblast in wound healing and fibrocontractive diseases. Journal of Pathology 2003;200(4):500-3 39. Culav EM, Clark CH, et al. Connective tissues: Matrix composition and its relevance to physical therapy. Physical Therapy 1999;79(3):308-319 40. Gomez MA, Woo SL, et al. Medical collateral ligament healing subse- quent to different treatment regimens. Journal of Applied Physiolgy 1989;66(1):245-52 41. Ingber DE. Mechanobiology and diseases of mechanotransduction. Annals of Medicine 2003;35:564-577 42. Frank C, Shrive N, et al. Optimisation of the biology of soft tissue repair. Journal of Science and Medicine in Sport 1999;2(3):190-210

www.sportex.net