Connect 13 – Day One
8:30 AM: Perhaps it's my inner geek, but the excitement is palpable as the first ever conference on connective tissue and sports medicine is about to begin. This is a big deal. BTW – during this conference the term "connective tissue" will be interchangeable with "fascia', so my writing will also follow this convention. 9:05 AM: "The connective tissue tells the muscle what to do." : Prof. Dr. Dr. Jürgen Steinacker, Sports Medicine and Rehabilitation, Ulm University. Dr. Steinacker is the co-chair of this event and kicks things off with a bold statement.
9:20 AM: "We need to get rid of the diagnosis 'non-specific low back pain'." – Andry Vleeming continues, laying out his argument that "topographical anatomy" doesn't work for understanding low back because it's about the relationship of the lumbodorsal fascia to the pelvic ring, and associated muscles, fascia and interabdominal pressure all working together, or not as the case may be.
I've seen Andry many times, but hearing him and watching his research and reasoning continue to evolve is always a pleasure.
9:50AM: Holger Schmitt gives and orthopedic surgeons perspective on connective tissue and the healing process. He sites study after study that clearly show that cortocosteroid injections are useful in the short term immediately after the injury but physiotherapy is better for the long term.
He also explains the challenge of being a surgeon having to to tendon repairs, for example in a debridement, where there is deterioration that manual means cannot restore: " We don't know which fibers are good and which fibers are bad." and alludes to such surgery being as much an art as a science.
10:10AM: the very engaging and animated Klaus Eder of the ATOS Clinic in Heidelberg walks us through exactly what happens when an athlete is injured on the field and what he and his team of first responders actually do. Did you know there is such a thing as a herniated trigger point? I do now.
He also talked about taping: "Taping here is not so much for the ankle (or other structure) as it is for the athlete's brain." That dovetails with my theory that kinesiotaping is really about stimulating very fine propriception via the interstitial mechanoreceptors. I'll have to ask him about this if I get the chance.
11:30 AM: "Pain is not a reason for surgery. Pain must be treated conservatively," so speaks Gregor Antoniadis, from the Department of Neurosurgery here at Ulm University. Again the message repeats that surgery is a measure only when the deterioration is such that there is no other recourse.
I am sure that in some medical circles this is heresy but to the almost 200 attendees it is exactly the kind of stimulation and validation that we have been seeking. To see this level of scientific thinking and conviction about fascia and connective tissue in relation to sports medicine could be the paradigm shift we have all been waiting for.
Time for a stretch break. And a coffee break.
4:20PM: – after a panel discussion from the morning's speakers, lunch and some equipment - based workshops, it's back to lectures that go to the micro place (compared with this morning's more macro view) with specific looks at tendon, loading and tendon formation).
Michael Kjaer admits that there is much about tendon that is uncertain, but he lays out the data that shows that tension is absolutely necessary to make collagen type 1and tenomodulin (a glycoprotein necessary for tendon maturation). Adamantios Arampatzis took us deeper into tendon development that ended with the highly interesting conclusion that there is not necessarily a coordinated adaptation between muscle and tendon during exercise-based loading. This makes me wonder if mindful, slow loading of muscle and tendon (like Feldenkrais or yoga) is better than fast in a rehab situation.
Then Boris Hinz closed the afternoon with more new information about myofibroblasts than I could possibly comprehend, it just went over up and around my head an into orbit somewhere around Saturn (and those of you who know me know I'm entranced by mfbs, and not just cos' they're pretty to look at). Perhaps my brain pan is just too full right now.
So a full and heady day here. Now you do know that your tendons are ⅔ water, right? I'm going to be mindful of that on my walk home. Standing behind the camera all day definitely gives me static loading stiffness. Or perhaps it's upright unipositional compressive strain hardening. Either way, I need to walk.
(photo of Divo Müller leading the stretch break, by Mike )