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78 m a s s a g e & b o d y wo r k s e p te m b e r/o c to b e r 2 0 2 3 disease. However, what's most interesting to us is how they decide whether to produce more collagen or to secrete an enzyme— collagenase—to remove unneeded collagen. While this can be inf luenced by physiologic and metabolic functions, fibroblasts do this primarily through a non-neuronal process— no nervous system required. That's because fibroblasts are equipped with a primary cilium, a hair-like antenna whose job is to listen (or rather feel) for two mechanical messages: pressure and vibration. POWER IN NUMBERS Imagine you want to take up a new hobby of jumping on one leg, for which you practice every day. For one hour a day, seven days a week, your right knee is f lexed and you're bouncing up and down with your left leg. Over a 3- to 6-month period, you would strengthen quite a few muscles, but you would also completely remodel the fascial network in both legs and hips. For example, the fibroblasts in the fascia of your right leg would create more collagen in your right knee to support the constant f lexion, and the fascia surrounding the hamstrings, quadriceps, and hip f lexors would be affected too. The left side would be affected not only to allow for more bounce but also to create tougher collagen along the path up the left side from the foot to the spine, as a result of the constant mechanical pressure (or force transmission). And, of course, the bones would also be affected. Patterns of bone strength and formation follow Wolff's Law, which states that bone will adapt to regular loading, growing stronger over time. This is a lifelong process. It also explains why simple weight lifting (within reason) can halt or even reverse osteoporosis. The opposite is also true, like when astronauts in prolonged Resources Grinnell, F. "Fibroblast Mechanics in Three-Dimensional Collagen Matrices." Journal of Bodywork and Movement Therapies 12, no. 3 (July 2008): 191–3. https://doi. org/10.1016/j.jbmt.2008.03.005. Langevin, H. "Connective Tissue: A Body-Wide Signaling Network?" Medical Hypotheses 66, no. 6 (2006): 1,074–7. https://doi. org/10.1016/j.mehy.2005.12.032. Langevin, H., C. J. Cornbrooks, and D. J. Taatjes. "Fibroblasts Form a Body-Wide Cellular Network." Histochemistry and Cell Biology 122 (2004): 7–15. https://doi. org/10.1007/s00418-004-0667-z. Nelson, M. E., and S. Wernick. 2000. Strong Women Stay Young. New York: Bantam Books. microgravity actually lose bone mass and need to undergo a strengthening regimen upon their return to Earth. While I'm not aware of anyone measuring astronauts' soft tissue, fascia is thought to follow Davis's Law, which states that soft tissue also models and remodels based on physical loading and stresses. Davis's Law is named after Henry Gasset Davis, an orthopedic surgeon from the 1800s who developed a number of traction- based, nonsurgical therapies to induce changes in soft tissue. Given that fibroblasts respond to pressure and vibration, we can conclude they are also direction sensitive, so it's reasonable to extrapolate that certain forms of manual therapy and massage have the potential to affect the behavior of fibroblasts. The collagen changes are initially small, with recent estimates suggesting 1 cm of length change per month, but when you consider the body-wide interconnectedness of most people's compensation patterns, lengthening by a centimeter here and there can make a big difference. This difference recapitulates itself on the cellular level every time that person moves and bears weight slightly differently than before treatment, because your inner public works department—your fibroblasts—are on the job, receiving slightly different pressure signals than before the treatment and responding accordingly. David Lesondak is an allied health member in the Department of Family and Community Medicine at the University of Pittsburgh Medical Center, and is board- certified in structural integration. He is the author of Fascia: What It Is and Why It Matters, editor of Fascia, Function, and Medical Applications, and host of the podcast BodyTalk. Learn more at

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