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Biological Mechanisms Underlying the Inflammatory and Healing Phases in Trauma of the Muscle-tendon Unit: What Have We Learned Recently?

Natcher Conference Center
National Institutes of Health
June 9–10, 2005

Claude H. Côté, Ph.D., CHUL Research Center and Laval University, Faculty of Medicine, Department of Rehabilitation, Québec, Canada

Acute trauma of the muscle-tendon unit can result from a variety of mechanical, metabolic, histotoxic or physiological insults, which can lead to chronic syndrome if not tightly managed. Aseptic tissue injury rapidly triggers a transient inflammatory reaction whose physiological significance is complex and still not completely understood. Normally, resolution of inflammation should set the ground for an efficient tissue repair. Inflammation is primarily a perturbation of the vascular homeostasis and it is widely believed that the nature of the inflammatory reaction induced by trauma does not vary with the type of insult and that inflammatory cells invade the injured tissue in a highly orderly sequence. Such dogma often constitutes the basis of the clinical approach for the management of inflammation. This presentation will review recent evidence obtained with various models of skeletal muscle and tendon injuries suggesting that this may not be the case. It will also make a case against the use of aggressive and prolonged anti-inflammatory modalities in acute trauma. The modulation of inflammatory cells trafficking in inflammation is under the control of complex signaling cascades, several originating from the vascular bed. Therefore any modality than can affect the physiology of vascular cells could theoretically influence inflammation and tissue healing. Further research aimed at identifying signals governing leukocyte migration in skeletal muscle, their specific role and endogenous anti-inflammatory molecules should undoubtedly help design therapeutic strategies accelerating muscle-tendon recovery following trauma and disease. This presentation should open avenues for discussion on the biological impact of complementary and manual therapies (CAM); it should also emphasize the need to select appropriate and significant outcome measures to measure the influence of CAM.

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