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The Physical Stress Theory

3/20/2013

3 Comments

 
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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. 
3 Comments
holly wild link
4/9/2014 04:11:56 am

Thank you for breaking down how nerves respond to physical stresses.

Reply
Calvin
6/20/2022 02:03:21 am

How do you maintain a specific adaptation

Reply
Ethan Mitchell, CSCS, SPT
7/6/2022 12:54:05 pm

Hi, it seems to me that you are twisting the words of the hallmark study. The authors of the study do not state and actually deemphasize your claim that "Postural deviations are one of the most common causes of musculoskeletal pain."

Direct quote from the article:

"Some studies33–37 have questioned, and even refuted, a large relationship between ideal posture in people with and without back pain. Rather than emphasizing an ideal standard of posture and hypothesizing that there is a large relationship among specific postures, impairments, and pain patterns, the PST proposes that pain is caused by excessive tissue stress and that postural deviations are one of *many* potential variables that contribute to the excessive stress levels that result in pain. We commonly observe people with “poor” posture who are pain-free and other people with “good” posture who have pain. The types of activities performed by people varies widely, resulting in different stress demands on tissues of the body."

Reply



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  • Home
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  • Resources
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    • Special Tests >
      • Cervical Spine >
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        • Bakody's Sign
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        • Deep Neck Flexor Endurance Test
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        • Sharp-Purser Test
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        • Lumbar Quadrant Test
        • POSH Test
        • Posteroanterior Mobility
        • Prone Knee Bend Test
        • Prone Instability Test
        • Resisted Abduction Test
        • Sacral Clearing Test
        • Seated Forward Flexion Test
        • SIJ Compression/Distraction Test
        • Slump Test
        • Sphinx Test
        • Spine Rotators & Multifidus Test
        • Squish Test
        • Standing Forward Flexion Test
        • Straight Leg Raise Test
        • Supine to Long Sit Test
      • Shoulder >
        • Active Compression Test
        • Anterior Apprehension
        • Biceps Load Test II
        • Drop Arm Sign
        • External Rotation Lag Sign
        • Hawkins-Kennedy Impingement Sign
        • Horizontal Adduction Test
        • Internal Rotation Lag Sign
        • Jobe Test
        • Ludington's Test
        • Neer Test
        • Painful Arc Sign
        • Pronated Load Test
        • Resisted Supination External Rotation Test
        • Speed's Test
        • Posterior Apprehension
        • Sulcus Sign
        • Thoracic Outlet Tests >
          • Adson's Test
          • Costoclavicular Brace
          • Hyperabduction Test
          • Roos (EAST)
        • Yergason's Test
      • Elbow >
        • Biceps Squeeze Test
        • Chair Sign
        • Cozen's Test
        • Elbow Extension Test
        • Medial Epicondylalgia Test
        • Mill's Test
        • Moving Valgus Stress Test
        • Push-up Sign
        • Ulnar Nerve Compression Test
        • Valgus Stress Test
        • Varus Stress Test
      • Wrist/Hand >
        • Allen's Test
        • Carpal Compression Test
        • Finkelstein Test
        • Phalen's Test
        • Reverse Phalen's Test
      • Hip >
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        • Dial Test
        • FABER Test
        • FAIR Test
        • Fitzgerald's Test
        • Hip Quadrant Test
        • Hop Test
        • Labral Anterior Impingement Test
        • Labral Posterior Impingement Test
        • Long-Axis Femoral Distraction Test
        • Noble Compression Test
        • Percussion Test
        • Sign of the Buttock
        • Trendelenburg Test
      • Knee >
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        • Dial Test (Tibial Rotation Test)
        • Joint Line Tenderness
        • Lachman Test
        • McMurray Test
        • Noble Compression Test
        • Pivot-Shift Test
        • Posterior Drawer Test
        • Posterior Sag Sign
        • Quad Active Test
        • Thessaly Test
        • Valgus Stress Test
        • Varus Stress Test
      • Foot/Ankle >
        • Anterior Drawer
        • Calf Squeeze Test
        • External Rotation Test
        • Fracture Screening Tests
        • Impingement Sign
        • Navicular Drop Test
        • Squeeze Test
        • Talar Tilt
        • Tarsal Tunnel Syndrome Test
        • Test for Interdigital Neuroma
        • Windlass Test