Treatment Flashcards
(8 cards)
Interstitial pump mechanism
The interstitial pump refers to the rhythmic movement of muscle and connective tissue (e.g., through manual therapy or exercise) that enhances lymphatic drainage and venous return.
This mechanism helps clear metabolic waste and brings in nutrients and oxygen to the healing area.
Contributes to reducing oedema and promoting optimal tissue healing by improving interstitial fluid dynamics.
Where Pts get stuck
Some patients become “stuck” in the proliferation or early remodelling phases of healing due to poor load management, chronic inflammation, or tissue hypoxia.
Without appropriate stimuli (e.g., loading or movement), tissues may fail to progress to proper collagen maturation and realignment, resulting in weaker or disorganised tissue.
Mechanotransduction
the process by which mechanical stimuli (e.g., exercise, manual therapy, loading) are converted into biochemical signals within cells.
In musculoskeletal tissue, mechanotransduction:
Stimulates fibroblasts (in tendons/ligaments) and myoblasts (in muscle) to proliferate and differentiate.
Promotes the transition from disorganised Type III collagen to organised Type I collagen, which has greater tensile strength.
Encourages muscle fibre regeneration and proper alignment of fibres under stress.
Facilitates angiogenesis (formation of new blood vessels), improving blood flow and nutrient delivery.
Controlled loading
A gradual and progressive load is critical to avoid reinjury while still stimulating tissue repair.
Controlled loading:
Encourages optimal collagen fibre orientation along lines of stress.
Promotes hypertrophy and functional tissue remodelling.
Supports the transition from inflammation to full tissue maturity.
Prevents muscle atrophy and reconditions neuromuscular function.
Remodelling Phase
In the remodelling phase, the body:
Replaces immature collagen (Type III) with mature Type I collagen.
Organises fibres in a linear pattern to restore tensile strength.
Enhances revascularisation of tissues to support long-term repair and function.
Controlled loading during this phase is essential for restoring a functional, resilient, and well-organised tissue structure.
Transsynovial pump
movement (especially weight-bearing and range-of-motion exercises) facilitates the exchange of synovial fluid between the articular cartilage and the joint capsule.
Facilitates nutrient exchange: Cartilage is avascular (no direct blood supply), so it relies on diffusion of nutrients from synovial fluid.
Promotes removal of metabolic waste products from the joint space.
Helps maintain hydration and viscoelastic properties of articular cartilage.
Inflammation phases in OA
OA involves low-grade chronic inflammation in the joint space.
This inflammatory environment can:
Disrupt synovial fluid composition.
Accelerate cartilage degradation.
Impair nutrient exchange and joint lubrication.
Gentle, controlled movement through the trans-synovial pump can help modulate inflammation by:
Encouraging anti-inflammatory cytokine activity.
Stimulating the production of high-molecular-weight hyaluronic acid, improving fluid quality.
Cartilage nutrition and remodelling
Regular joint movement stimulates chondrocyte activity (cartilage cells), supporting:
Maintenance of cartilage matrix.
Synthesis of proteoglycans and collagen, essential for cartilage integrity.
Mechanical loading via movement (not excessive) promotes adaptive remodelling of the cartilage, potentially slowing OA progression.
Helps preserve joint space, reduce stiffness, and maintain functional range of motion
