Stretch Intensity and the Inflammatory Response: A Paradigm Shift

239 Pages·2018·7.258 MB·English

by  Nikos C. Apostolopoulos

Nikos C. Apostolopoulos
Stretch Intensity
and the
Infl ammatory
Response: A
Paradigm Shift
Stretch Intensity and the Inflammatory Response:
A Paradigm Shift
Nikos C. Apostolopoulos
Stretch Intensity
and the Inflammatory
Response: A Paradigm Shift
Nikos C. Apostolopoulos
University of Toronto
Toronto, ON, Canada
ISBN 978-3-319-96799-8 ISBN 978-3-319-96800-1 (eBook)
https://doi.org/10.1007/978-3-319-96800-1
Library of Congress Control Number: 2018961999
© Springer Nature Switzerland AG 2018
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microfilms or in any other physical way, and transmission or information
storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology
now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, express or implied, with respect to the material contained herein or for any errors
or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims
in published maps and institutional affiliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
I dedicate this book to my constant
companions, my daughters, Thalia Sofia
and Justine Francis.
Preface
“The true nature of knowledge is experiment…
What is now prove’d was once only imagin’d”
William Blake 1757–1827
Although nature may have buried her secrets deep, she has not entirely hidden them.
As scientists, we are curious, often investigating for information and insight in order
to enlighten ourselves with that which lies beyond her veil. In order to gain a
glimpse, we use imagination, intuition, and invention, but mostly enthusiasm and
perseverance, the qualities of an undying desire to make clear that which has so
often eluded us, but through intuition, we know truly exists. At times, we walk and
occupy the nether zone between reality and illusion in order to bridge the gap
between the outer and the inner worlds. This is a sensitive chaos that we attempt to
explain through the language of mathematics (numbers, equations, statistics, etc.),
believing that this will make the invisible visible. The belief is that, by solving the
formation of this now visible pattern, frozen in time and space through observation,
one will obtain a better idea into nature’s function and activity. Similar to Parzifal’s
quest for the Holy Grail and how he refused to be raised in the dark forest, we chal-
lenge ourselves to learn and discover the mysteries and the inner workings of the
human body. Parzifal was faced with the dilemma of whether to respond to the
plight of the fisher king, Astofar, or to hold steadfastly true to the code of the knights.
His adherence to the code cost him several more years of wondering before fulfill-
ing his task. Just seeing the Holy Grail is not enough; we have to ask about it, mak-
ing inquiries while approaching our task with an open and unbiased mind, breaking
old thought patterns and codes in order to advance, to be the biographers of a much-
needed paradigm shift.
Toronto, ON, Canada Nikos C. Apostolopoulos
vii
Acknowledgements
“Truth is the offspring of silence and meditation. I keep the subject constantly before me
and wait ‘til the first drawings open slowly, by little and little, into a full and clear light.”
– Sir Isaac Newton
While researching and writing this manuscript, I found myself meandering in and
out of numerous moments of contemplation, for such was the nature of the work at
hand. Bathed in silence, I had pensive periods that allowed for necessary reflections
as to how best to proceed. During these moments, my thoughts drifted to and about
those who had gone before, the pioneers who paved the way. Enquiring about the
property of things, the forming of hypotheses, and the designing of experiments,
they were responsible for making clear that which was observed or intuitively
believed. With enthusiasm, perseverance, and the need to know, they were instru-
mental in laying the foundation from which this manuscript was made manifest.
The quote by Sir Isaac Newton best sums up their influence: “If I have seen further
it is only by standing on the shoulders of giants…”. Although the opportunity has
yet to present itself to meet with these individuals, I would nonetheless like to
acknowledge their contributions to my thought processes and to science as a whole.
Distinguished Professors Donald E.  Ingber (Harvard University) and James
G. Tidball (UCLA) have had a profound influence on my knowledge and under-
standing of the response of the cell and muscle tissue. Professor Ingber’s compel-
ling work on the concept of mechanotransduction has been pivotal in formulating
my thoughts about the effect of mechanical force (i.e., stretching intensity) on mus-
cle tissue and cells. In other words, how the magnitude of the stretch can manifest a
biochemical response. Professor James G. Tidball provided the stepping stone from
which to relate the effects of this mechanical stress on the recovery and regeneration
of muscle tissue. For the inflammatory response, both acute and chronic, the cyto-
kines, and C-reactive proteins, I am indebted to the work of Professor Emeritus
Irving Kushner (Case Western University). His work has made these complex con-
cepts simple and coherent. The groundbreaking research on calpains by Professor
Angelo Belcastro (York University, Canada) was the keystone, connecting my
hypothesis with the magnitude of stretching intensity to inflammation. Moving
ix
x Acknowledgements
across the pond to Europe, two distinguished researchers stand out: Clinical
Professor Michael Kjaer (Institute of Sports Medicine, Copenhagen) and Professor
Dr. Matthias Chiquet (University of Bern). Their research has been immensely valu-
able in formulating thoughts regarding the response of the extracellular matrix
(ECM) to mechanical stress. The ECM provides the structural framework, contrib-
uting to the mechanical stability of tissues as well as acting as a substrate for cell
adhesion. When a mechanical stimulus is imparted on the body, this imparts infor-
mation to the cells, resulting in their subsequent response. However, a common
denominator to a lot of the material mentioned above is the work of the pioneer and
visionary, the late Buckminster Fuller. Science owes a major debt to this individual.
His abridgement of the concepts of tension and integrity, tensegrity, is the founda-
tion for the response of the cell to mechanical force(s). Continuous tensional behav-
iour, an interplay between tension and compression from the macro to the cellular
level, is the basis for how the magnitude of stretching affects muscle tissue and
cells, and is responsible for the significance of the inflammatory response.
In conclusion, no acknowledgement would be complete without mentioning
those who have had a direct impact on me. Besides my immediate family and clos-
est friends, a heartfelt gratitude goes out to Professor Emeritus Dr. Jack Taunton
(University of British Columbia, Canada) and Professor Michael J. Plyley (Brock
University, Canada). Both were instrumental in pushing me out of my comfort zone,
encouraging me to test the waters in order to grow as a scientist and therapist. To my
coach and mentor, Andy Higgins (University of Toronto), our numerous discussions
and his advice held me steadfast and true to my goals both professionally and per-
sonally. Finally, like everything, true friendship possesses a quality of its own. It is
unique, it listens openly, it is not afraid to speak the truth, and it is not envious but
selfless, with a great willingness to be truly present. These characteristics define my
oldest friend and esteemed colleague, Professor Peter Pericles Trifonas (University
of Toronto). During times of great trepidation, our numerous walks and talks were
the light at the end of the tunnel, and for this I am truly indebted.
Contents
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2 Literature Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
The Definition of Stretching and Its Measurement . . . . . . . . . . . . . . . . . . 6
Classification of Stretches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Static . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Ballistic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Dynamic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Proprioceptive Neuromuscular Facilitation (PNF) . . . . . . . . . . . . . . . . 11
Macroscopic and Microscopic Information Processing Levels:
Macroscopic—Muscle, Tendon, and Myotendon Unit (MTU) . . . . . . . . 12
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Muscles, Tendons, and MTU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Macroscopic and Microscopic Information Processing
Levels: Microscopic—Force, Cells, Tissue, and the Extracellular
Matrix (ECM) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Force, Cells, and Tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
The Extracellular Matrix (ECM) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
The Strain Factors of Stretching: Intensity, Duration,
and Frequency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Inflammation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Neutrophils, Macrophages, Cytokines, and Acute
Phase Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Inflammation and Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Mechanotransduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Stretching and Inflammatory Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
xi
xii Contents
3 Study One: Acute Inflammatory Response to Stretching . . . . . . . . . . 131
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Power Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Biomarkers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Statistical Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
RMANOVA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
Effect Sizes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
4 Study Two: Stretch Intensity vs. Inflammation:
Is There a Dose-D ependent Association? . . . . . . . . . . . . . . . . . . . . . . . 145
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
Power Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
Blood Biomarkers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Statistical Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
RMANOVA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
Effect Sizes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Secondary Analysis: Linear Regression (30–90 and 60–90%
Maximum ROM) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
5 The Effect of Different Passive Static Stretching Intensities
on Perceived Muscle Soreness and Muscle Function
Recovery Following Unaccustomed Eccentric Exercise:
A Randomised Controlled Trial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
Statistical Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166