Tissue Adaptation to Physical Stress: a proposed "Physical Stress Theory" to guide Physical Therapy Practice, Education and Research, an article by Mueller and Maluf, is a must read for any physical therapy student. At SLU, I was required to read it during my first semester in the program. At the time, I did not fully understand the full extent or importance of the article. Mueller and Maluf touch on several key concepts that directly relate to our patient care.
The premise behind the Physical Stress Theory (PST) is "that changes in the relative level of physical stress cause a predictable adaptive response in all biological tissues." When stresses are placed on a particular structure due to movement or posture for example, our bodies tissues must adapt to these stresses. Stress can be defined by Magnitude x Time x Direction, and it is a combination of these 3 factors that will determine our bodies response. Our goal as physical therapists is to identify patterns that lead to excessive stresses and teach the patient proper movement strategies to prevent further tissue injuries. After identifying the problem, we need to decrease pain and perceived level of disability, and then focus on increasing activity tolerance in the new pain-free movement pattern. During any initial evaluation, think about a) What factors are causing excessive stress (environmental, behavioral, etc.) and b) How can these factors be modified?
A few crucial take-home points from the PST:
-Movement is a significant source of physical stress. Depending on how we move can have either detrimental or beneficial effects on tissue injury.
-4 Fundamental tissues that undergo stress regularly are Epithelial, Connective, Muscular, and Nervous tissue.
-5 Qualities of physical stress include: Decreased stress tolerance, Maintenance (homeostasis), Increased stress tolerance (tissue overload), Injury, and Death. The article goes into great detail on each of these points.
-Stress will have different effects on tissues whether it is tensile, compressive, shearing, or torsional stress. Regardless which type of stress is present, inflammation will occur immediately following tissue injury.
-Postural deviations are one of the most common causes of musculoskeletal pain.
-Tissues atrophy at a much faster rate than they hypertrophy. Muscle force production losses can be between 6-40% in 4-6 weeks time.
-Similar to muscles, nerves can become overused due to malalignment and postural deficits. This is commonly seen in carpal tunnel sydrome and lumbar spinal stenosis.
Bottom Line: Good Alignment + Good Movement = Good Musculoskeletal Health. Factors such as posture, age, movement patterns, psychological factors and environmental factors all influence this equation. It is our goal to identifty these factors to allow for normal movemen
Mueller and Maluf. Tissue Adaptation to Physical Stress: a proposed "Physical Stress Theory" to guide Physical Therapy Practice, Education and Research. Physical Therapy. 2002. 84.4: 383-403. Web. 2010.
James Heafner PT, DPT, OCS:
Owner and lead physical therapist at Heafner Health, cash-based physical therapy in Boulder, CO. Areas of expertise include orthopedic and manual therapy, functional movement, pain science, and movement science.
In May 2013, I earned my Doctorate in Physical Therapy from Saint Louis University. After graduating from the Harris Health Systems Orthopedic Residency in October 2014, I moved to Boulder, CO. Since living in Boulder, I have started my own cash-based PT practice, earned my OCS certification, and teach for the OPTIM Fellowship and COMT program in Houston TX and Scottsdale, AZ.
Chris Fox PT, DPT, OCS: Physical therapist at Foothills Sports Medicine & Physical Therapy in Scottsdale, AZ and regularly lectures at the Phoenix Campus for NAU's DPT program and for Optim Manual Therapy's COMT program. Completed multiple advanced manual therapy courses implementing aspects of biomechanical analysis. He received his DPT from Saint Louis University in 2013. Completed Scottsdale Healthcare's Orthopaedic Residency (now Honor Health) in July 2014. He became a Board Certified Orthopaedic Specialist in 2015. Level I Expert in FMS and SFMA , Kinetacore FDN Level 1 certification, and IASTM Technique course completion. He would like to pursue further education in McKenzie Technique, Dry Needling, Strength & Conditioning, Orthopaedic and Manual Therapy.
Brian Schwabe PT, DPT, SCS, CSCS:
- Board Certified Sports Physical Therapist (SCS) at Elite OrthoSport in Santa Monica, CA which specializes in treating collegiate/professional athletes and clientele from the Beverly Hills, Hollywood, and Santa Monica areas.
- USC Sports Residency Trained Physical Therapist (<1% of all PT's residency trained)
- DPT from Saint Louis University
- Future plans/interest include:
1. USAW, SFMA & Catapult Systems technology for NBA teams
2. Pursuing a position as a sports physical therapist &/or Strength coach for a Division 1 athletic medicine department or professional sport team.
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