2nd MuscleTech Network Workshop. From translational Research to translational Medicine. CONCLUSIONS AND CLOSING REMARKS Dr.

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1 2nd MuscleTech Network Workshop. From translational Research to translational Medicine. CONCLUSIONS AND CLOSING REMARKS Dr. Carles Pedret

2 MUSCLE AND TENDON WORKSHOP HEALTH AND GENERAL POPULATION SPORTS MEDICINE ORTHOPEDICS MUSCLE AND TENDON MORE KNOWLEDGE MORE APPLICATIONS RESEARCH!!! TISSULAR ENGINEERING

3 MTN 2010 PROJECTS Induced intermittent hypoxia and its role in muscular recovery and function Muscle and tendon injury biomarkers MTN Longitudinal studies of hamstring muscle injuries in athletes Research on the use of platelet rich plasma and mesenchymal cells

4 FROM MOLECULAR GENETICS TO PROTEIN EXPRESSION One of the final goals of the muscle diseases treatment is the Cell therapy. The research with expanded Stem Cells (SC) has to be very accurate specially in relation of the SC quality and its dose. PRPs are still misunderstood.

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6 inflammation degeneration regeneration fibrosis 1 w 2 w 3 w

7 FROM MOLECULAR GENETICS TO PROTEIN EXPRESSION There is a need for more studies in the different pathways of the stem cells therapy specially to differentiate the appropriate cell line. We are still in early stages of knowledge and obviously we have to take care about possible ethic considerations.

8 FROM PROTEIN EXPRESSION TO SARCOMERE What are the studies searching? New therapeutic approaches to prevent skeletal muscle wasting and to repair it. Diagnostic tools to find the expression of biomarkers. Novel relevant mechanisms of injury.

9 FROM PROTEIN EXPRESSION TO SARCOMERE Biomarkers as dysferlina which is a promoter of the muscular membrane reparation and DOR which participates in the adaptative regulatory mechanisms in insulin resistance patients. Really useful for improve the treatment in muscular diseases such as dystrophies. Most probably treatment in a near (?) future Cell therapy.

10 FROM SARCOMERE TO MUSCULAR FIBRES Great potential of the tissue engineering treatment. Use increase vascularity more regeneration less fibrosis In sports medicine we need to block the fibrosis to accelerate the muscle regeneration.

11 FROM SARCOMERE TO MUSCULAR FIBRES In general population with muscular diseases (also in sport medicine) has to be studied new approaches such as hyperbaric exposure and training of the respiratory muscles. HBO in acute injury seems to make a oedema reduction, inhibits lactic acid, stimulate angiogenesis, enhance of SC mobility

12 FROM SARCOMERE TO MUSCULAR FIBRES The respiratory muscles training can be very important in muscular respiratory diseases but also in cardiopathies and athletes. It increases the mitochondria number, the fibre size, the capillary content, the aerobic fibres and the metabolic capacity. No drugs that improve the pulmonary function as training does.

13 FROM MUSCULAR FIBRES TO MUSCLE-TENDON JUNCTION The most important risk factor for a muscular injury is to has a previous muscle injury. The muscle-tendon junction is where the injury occurs more frequently. Cadaveric studies and new methods to monitoring the muscle activity let us know more about the structure and behavior of the muscle (tensiomiography )

14 EVOLUTION AND ADAPTABILITY OF MUSCLES DISEASES AND DISORDERS From molecular research to patients. A failure in the muscle adaptation probably lead to an injury. To prevent injuries we need to know the risk factors: Past history of injury, increasing age, low strength (ratios)

15 EVOLUTION AND ADAPTABILITY OF MUSCLES DISEASES AND DISORDERS Injuries normally occur in warm up or at the end of the match/training session due to fatigue. Fatigue: The muscle absorbs less energy during the contraction. Avoid fatigue is an important prevention

16 EVOLUTION AND ADAPTABILITY OF MUSCLES DISEASES AND DISORDERS PREVENTION Eccentric exercises (not only) Train as play Fatigue resistance Correct RHB treatment TRAINING MUSCULAR ADAPTATION IS THE KEY OF INJURY PREVENTION

17 THE TENDON Tendons can suffer many types of injuries and sometimes are a bit forgotten. Tendon can be hypertrophied Tendon hypertrophy with exercises can protect tendons against overuse due to a reduced tensile loading and lowered tendon strain. The tendon hypertrophy allows high acceleration and elevated muscle power production during rapid movements

18 THE TENDON Tendon can adapt to loading specially with eccentric and/or HSR training. Load management for treatment (ecc-hsr-con depending on the age, sport ). Neovascular in-growth in chronic tendinopathy is well described, but treatment decisions should always be based in clinical findings. Future try to standarize a treatment or an exercise rehabilitation protocol for the tendon.

19 FROM MUSCLE-TENDON JUNCTION TO NEURO-BIOMECHANICS Knowing the injury biomechanics is a critical point for preventing it. Try to screen for patient specific risk. We need to consider as much factors as possible ligament laxity, bone morphology, age, sex, joint kinematics The process of hamstring injury at the fiber level is unclear.

20 FROM MUSCLE-TENDON JUNCTION TO NEURO-BIOMECHANICS The biceps muscle performs more work in maintaining the action of the hamstring muscles and this may make it more vulnerable to injury. Increasing biomechanical load and decreasing muscle load tolerance is the mechanism by which injury can occur.

21 BIOMECHANICS OF MUSCLE INJURIES Skeletal muscle is a biomechanical tissue. Understanding the biomechanics can lead to make better exercise prescription. The inflammatory response is involved in the injury and in the regeneration process.

22 BIOMECHANICS OF MUSCLE INJURIES Potential adaptive mechanisms evoked by ECCENTRIC muscle-tendon training. ECM-muscle fiber stress MTJ stress / strain concentrations Tendon and Muscle Fiber Strain rehabilitation

23 BIOMECHANICS OF MUSCLE INJURIES The study and the knowledge of muscular imbalances (agonist-antagonist) allows us to understand the injury mechanism so we can prepare more accurate prevention and rehabilitation protocols.

24 TAKE IT HOME There are very promising muscle and tendon workgroups at this moment not just in sports medicine also in health. We are in preliminary phases and we need to focus efforts to find useful and applicable results MTN 2011, 2012 Some studies and results need further scientific evidence.

25 TAKE IT HOME Share Information between work groups. Cases, patients, results, methods Cooperate in studies Write scientific articles Remember Apunts.Medicina de l esport (

26 2nd MuscleTech Network Workshop D From Translational Research to Translational Medicine THANK YOU ALL