Connective tissue in relation to Connective tissue in relation to joint immobilizationjoint immobilization

Subjects:Subjects:

Connective tissueConnective tissue

Immobilization of jointsImmobilization of joints

Connective tissueConnective tissue

Where do we find connective tissue?Where do we find connective tissue? BoneBone TendonsTendons LigamentsLigaments Capsula Capsula SkinSkin VeinsVeins CartilageCartilage FasciaFascia

Connective tissueConnective tissue

What is the main function of connective What is the main function of connective tissue?tissue?

Resist mechanical load & stress (e.g. Resist mechanical load & stress (e.g. stretch or compression)stretch or compression)

Two important types of connective Two important types of connective tissue:tissue:

Collagen fibersCollagen fibers

Ground substance (or Matrix) Ground substance (or Matrix)

Collagen fibersCollagen fibers

Different types of collagenDifferent types of collagen

Type I: Bone, tendons, skin, ligaments, Type I: Bone, tendons, skin, ligaments, fascia, veins fascia, veins

Type II: Hyaline joint cartilage, inter-Type II: Hyaline joint cartilage, inter-vertebral discvertebral disc

Type III: Skin, synovial membrane, veins Type III: Skin, synovial membrane, veins Type IV: Basal membranes Type IV: Basal membranes

Characteristics of collagen:Characteristics of collagen:

They act in bundles/chains.They act in bundles/chains. Very strong, high tensile strength (1mm Very strong, high tensile strength (1mm

fiber can resist 10kg)fiber can resist 10kg) Little possibilities to deform (length)Little possibilities to deform (length) Made out of different amino acids. Made out of different amino acids. Needs Vit. C for synthesis.Needs Vit. C for synthesis. Turn over time: 300-500 days (low)Turn over time: 300-500 days (low) Cross-links between the collagen fibers.Cross-links between the collagen fibers.

Cross-linksCross-links

Ground substance or Matrix Ground substance or Matrix

Characteristics of matrix:Characteristics of matrix:

They look like a caterpillar, but they act like a They look like a caterpillar, but they act like a sponge.sponge.

One caterpillar is called a proteoglycan.One caterpillar is called a proteoglycan. Proteoglycans are made of hyaluron-acid and Proteoglycans are made of hyaluron-acid and

glycosamin-glycans.glycosamin-glycans. Glucosamin-glycans attract water (cartilage can Glucosamin-glycans attract water (cartilage can

exist for 80% out of water)exist for 80% out of water) Nutrition of matrix due to a osmotic process Nutrition of matrix due to a osmotic process

(sponge-effect) (sponge-effect) Turn over time: 2-3 weeks (high)Turn over time: 2-3 weeks (high)

Our caterpillarOur caterpillar((hyaluron-acid with proteoglygans)hyaluron-acid with proteoglygans)

Connective tissue Connective tissue synthesissynthesis

The FibroblastThe Fibroblast

The spiderman-cel of the bodyThe spiderman-cel of the body

Spiderman in action:Spiderman in action:

The fibroblast can multiply itself.The fibroblast can multiply itself. The fibroblast can multiply throughout our live The fibroblast can multiply throughout our live

(except from cartilage tissue)(except from cartilage tissue) The fibroblast produces collagen and matrix.The fibroblast produces collagen and matrix. The fibroblast composes the quality of the The fibroblast composes the quality of the

connective tissue. connective tissue. After training or tissue damage the fibroblast After training or tissue damage the fibroblast

gets activated.gets activated. Fibroblasts can move themselves (1 Fibroblasts can move themselves (1 µm/hour) to µm/hour) to

the damaged tissue.the damaged tissue.

There he goes….There he goes….

Summery of the characteristics of Summery of the characteristics of the fibroblast:the fibroblast:

StabilityStability MobilityMobility CommunicationCommunication ProductionProduction CleaningCleaning

Maybe Spiderwoman is a better name??Maybe Spiderwoman is a better name??

Clinical importance:Clinical importance:

The fibroblasts react on specific signals The fibroblasts react on specific signals from their surrounding area.from their surrounding area.

Specific signals in the local tissue lead to Specific signals in the local tissue lead to useful adjustment of this tissue.useful adjustment of this tissue.

Training and exercises must be specific!! Training and exercises must be specific!!

Immobilization of joints.Immobilization of joints.

Negative effects after Negative effects after immobilization:immobilization:

Muscle atrophy Muscle atrophy Tendon-attachment atrophyTendon-attachment atrophy Bone atrophyBone atrophy Cartilage atrophyCartilage atrophy Weakness of ligamentsWeakness of ligaments Dysfunctional scar tissue Dysfunctional scar tissue The fibroblast activity changes from an The fibroblast activity changes from an

anabolic process to a katabolic process.anabolic process to a katabolic process.

anabolic anabolic → katabolic→ katabolic

Mainly a decrease of proteoglycans and Mainly a decrease of proteoglycans and water.water.

Little decrease of collagen (5%)Little decrease of collagen (5%) Decrease of glucosamin-glycans (50%)Decrease of glucosamin-glycans (50%) Decrease of hyaluron-acid (40%)Decrease of hyaluron-acid (40%)

Bio-mechanical consequences of Bio-mechanical consequences of immobilization: immobilization:

Change in the teamwork between ligaments and Change in the teamwork between ligaments and musclesmuscles

Disturbance in the function of synovial fluids in Disturbance in the function of synovial fluids in the joint.the joint.

More rolling and less gliding of the joint, causing More rolling and less gliding of the joint, causing contractures.contractures.

Forming of dysfunctional cross-links in capsular Forming of dysfunctional cross-links in capsular tissue, causing contractures.tissue, causing contractures.

Forming of adhesions with the cartilage, causing Forming of adhesions with the cartilage, causing contractures.contractures.

Clinical consequences:Clinical consequences:

After 8-12 weeks of P.O.P recovery of the After 8-12 weeks of P.O.P recovery of the connective tissue changes can take months to a connective tissue changes can take months to a year.year.

Try to limit the duration of P.O.P as much as Try to limit the duration of P.O.P as much as possible!possible!

Rest causes rust, so resting will cause more Rest causes rust, so resting will cause more damage that good!damage that good!

As soon as the proliferation phase starts As soon as the proliferation phase starts (fibroblast phase) start progressive rehabilitation (fibroblast phase) start progressive rehabilitation training (functional information to the fibroblast)training (functional information to the fibroblast)

Use it or loose it!!!!Use it or loose it!!!!

Thank you!Thank you!

Questions?Questions?