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Become one with the force: optimising mechanotherapy through an understanding of mechanobiology
  1. Stuart J Warden,
  2. William R Thompson
  1. Department of Physical Therapy and Center for Translational Musculoskeletal Research, School of Health and Rehabilitation Sciences, Indiana University, Indianapolis, Indiana, USA
  1. Correspondence to Dr Stuart J Warden, Department of Physical Therapy, Indiana University, Indianapolis, IN 46202, USA; stwarden{at}

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The musculoskeletal system generates, absorbs and transmits force, enabling functional movement. Given this mechanical role, it follows that musculoskeletal tissues adapt to mechanical demands. Mechanical forces direct musculoskeletal cellular activities, altering tissue mass, structure and/or quality (figure 1).1 The net result is altered tissue-level stresses and strains to applied loads and, subsequently, altered injury risk.

Figure 1

Mechanical forces direct cellular activities to induce tissue adaptation. Extrinsically and intrinsically generated mechanical forces load musculoskeletal tissues, with the characteristics of the resultant tissue forces being dependent on the ability of the tissue to resist those forces. Tissue forces are transmitted to the micromechanical environment of resident cells, with cellular mechanical properties influencing the characteristics of the cellular forces. Cells can modify their micromechanical environment via cytoskeletal rearrangement, which feedbacks to alter cellular sensitivity to incoming forces. When cellular forces are sufficient, the cell initiates a molecular response, which ultimately alters synthesis and/or degradation of the extracellular matrix. The latter alters tissue mechanical properties, which feeds back to influence tissue forces. (Reprinted from Thompson et al,1 by permission of Oxford University Press and the American Physical Therapy Association.) 

Therapists have long identified the therapeutic potential of mechanical forces. Nearly every rehabilitation intervention introduces mechanical forces, irrespective of whether they are generated extrinsically (eg, via external modalities) or intrinsically (eg, via physical activity). These ‘mechanotherapies’ harness musculoskeletal mechanosensitivity to induce adaptation; however, how the adaptation occurs remains underappreciated.

Khan and Scott2 previously introduced readers of BJSM to the concept of mechanotransduction, whereby biophysical forces are converted into cellular and molecular responses. For …

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  • Contributors SJW and WRT provided initial writing, manuscript review and final approval.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.