Traumatic muscle fibrosis: From pathway to prevention

mountain bike
Cholok, D., Lee, E., Lisiecki, J., Agarwal, S., Loder, S., Ranganathan, K., Qureshi, A.T., Davis, T.A., Levi, B. (2017). Traumatic muscle fibrosis: From pathway to prevention. J Trauma Acute Care Surg.

Cholok, D., Lee, E., Lisiecki, J., Agarwal, S., Loder, S., Ranganathan, K., Qureshi, A.T., Davis, T.A., Levi, B. (2017). Traumatic muscle fibrosis: From pathway to prevention. J Trauma Acute Care Surg.

This is a great research paper to follow up my last post - Sports Massage - The Science is Emerging. My last post was a brief look at the psychological & physiological responses to massage therapy.

In this post I wanted to share some excerpts from a recent review of traumatic muscle fibrosis published in The Journal of Trauma and Acute Care SurgeryThis paper may provide some insights for therapists wanting to learn more about the interconnected adaptive responses within the nervous system and soft tissue structures. 


"Skeletal muscle is a dynamic organ that mediates voluntary movement and aids in the protection of vital structures. The unique functional demands placed upon skeletal muscle confer susceptibility to frequent and persistent injury. Accordingly, skeletal muscle exhibits significant regenerative capacity, and is capable of repair and replacement of injured or damaged myofibers with little to no decrement in function."

Traumatic Musculoskeletal Injury and Repair

"Traumatic injury is often sufficient to disrupt the regenerative capacity of skeletal muscle, and the resulting fibrosis remains an often overlooked sequelae of pathologic healing."

Current and Novel Therapeutics

"Skeletal muscle is a tissue innately responsive to mechanical force. The specificity of directionality and magnitude of mechanical forces perceived by muscle tissue modulate multifactorial responses including attenuation of inflammatory response, glucose uptake, and activation of satellite cells. It is no surprise, then, that mechanical manipulation of injured and regenerating muscle can augment healing; the use of massage and other therapeutic manipulation of muscle after injury has been shown to improve outcomes. .... Taken together, the use of focused mechanical manipulation, uncomplicated by biologic, can serve as a translatable treatment modality to improve muscle healing after trauma."


"increased knowledge into the cellular mechanisms that drive fibrosis can be used to optimize treatment protocols for patients suffering from fibrotic muscle and guide specific prophylactic therapies for those who have suffered traumatic injury. More generally, the elucidation of the cellular effectors and responsible signaling pathways in the development of muscle fibrosis will not only help to develop nascent therapy after traumatic injury, but will also establish a paradigm through which the balance of stromal and parenchymal healing following injury can be better understood."

Link to the pubmed listing:

Links for the Curious

Berrueta, L., Muskaj, I., Olenich, S., Butler, T., Badger, G. J., Colas, R. A., . . . Langevin, H. M. (2016). Stretching Impacts Inflammation Resolution in Connective Tissue. Journal of Cellular Physiology.

Best, T., Gharaibeh, B., & Huard, J. (2012). Stem cells, angiogenesis and muscle healing: A potential role in massage therapies? British Journal of Sports Medicine.

Best, T. M., & Crawford, S. K. (2016). Massage and postexercise recovery: The science is emerging. British Journal of Sports Medicine.

Butterfield, T.A., Best, T.M., Merrick, M.A. (2006). The dual roles of neutrophils and macrophages in inflammation: a critical balance between tissue damage and repair. J Athl Train.

Bove, G., Harris, M., Zhao, H., & Barbe, M. (2016). Manual therapy as an effective treatment for fibrosis in a rat model of upper extremity overuse injury. Journal of the Neurological Sciences.

Cezar, C.A., Roche, E.T., Vandenburgh, H.H., Duda, G.N., Walsh, C.J., Mooney, D.J. (2016). Biologic-free mechanically induced muscle regeneration. Proc Natl Acad Sci U S A.

Chaitow, L. (2016). Dosage and manual therapies – Can we translate science into practice? Journal of Bodywork and Movement Therapies.

Cholok, D., Lee, E., Lisiecki, J., Agarwal, S., Loder, S., Ranganathan, K., Qureshi, A.T., Davis, T.A., Levi, B. (2017). Traumatic muscle fibrosis: From pathway to prevention. J Trauma Acute Care Surg.

Fisher, P., Zhao, Y., Rico, M., Massicotte, V., Wade, C., Litvin, J., . . . Barbe, M. (2015). Increased CCN2, substance P and tissue fibrosis are associated with sensorimotor declines in a rat model of repetitive overuse injury. Journal of Cell Communication and Signaling. (Open Access)

Gilbert, P.M., Weaver, V.M. (2016). Cellular adaptation to biomechanical stress across length scales in tissue homeostasis and disease. Semin Cell Dev Biol.

Laumonier, T., & Menetrey, J. (2016). Muscle injuries and strategies for improving their repair. Journal of Experimental Orthopaedics. (Open Access)

Rand, E., Gellhorn, A.C. The Healing Cascade: Facilitating and Optimizing the System. Phys Med Rehabil Clin N Am.

Thompson, W. R., Scott, A., Loghmani, M. T., Ward, S. R., & Warden, S. J. (2016). Understanding Mechanobiology: Physical Therapists as a Force in Mechanotherapy and Musculoskeletal Regenerative Rehabilitation. Physical Therapy. (Open Access)

Tiidus, P.M. (2015). Alternative treatments for muscle injury: massage, cryotherapy, and hyperbaric oxygen. Curr Rev Musculoskelet Med. (Open Access)

Waters-Banker, C., Dupont-Versteegden, E. E., Kitzman, P. H., & Butterfield, T. A. (2014). Investigating the Mechanisms of Massage Efficacy: The Role of Mechanical Immunomodulation. Journal of Athletic Training. (Open Access)

Weerapong, P., Hume, P.A., Kolt, G.S. (2005). The mechanisms of massage and effects on performance, muscle recovery and injury prevention. Sports Med.