JORDAN KEYS D.O.ASSISTANT PROFESSOR

OSTEOPATHIC MANIPULATIVE MEDICINE DEPARTMENTTOURO UNIVERSITY CALIFORNIA

COLLEGE OF OSTEOPATHIC MEDICINE

Can Posture Change Your DNA? How The Principle of Biotensegrity is Progressing Our Understanding of Osteopathic Treatment

Objectives

Define biotensegrity, tensegrity and mechanotransduction; correlating the osteopathic tenet of structure and function interrelationship to these principles.

Describe the historical context of tensegrity, biotensegrity and mechanotransduction including important people who have developed these principles and their applications.

Describe how biotensegrity relates to the human body and how mechanical forces can be translated into chemical reactions through mechanotransduction.

Highlight how the concepts of tensegrity, biotensegrity and mechanotranductions are being used in research and development of new technologies.

Relate how through biotensegrity and mechanotransduction, postural changes and muscle imbalance can influence the function of the body on a molecular level.

Relate how the concepts of biotensegrity and mechanotransduction are relevant when using osteopathic treatment to diagnose and treat patients.

“the whole is greater than the sum of its part”Aristotle

Tenets of Osteopathic Medicine

1. The body is a unit: the person is a unit of body, mind and spirit.

2. The body is capable of self regulation, self healing and health maintenance.

3. Structure and Function are reciprocally interrelated.

4. Rational treatment is based upon an understanding of these basic principles.

History

1921:

First published record of tensegrity structure appears in collection of sculptures by artist Karl Ioganson.

Referred to as Spatial Constructions.

1960’s:

David Emmerich:

French Architect and Engineer.

Developed tensile and self-stressed structures.

Patent for structure that consisted of three struts and nine tensioned cables.

Buckminster Fuller:

Solutions in nature that were structurally and functionally efficient, lightweight and dynamic and adjust to their surroundings.

“All natural forms were the result of matter being acted upon by forces”- defined these as finite energy systems consisting of forces of tension and compression acting together.

Patent on tensegrity in 1962.

Kenneth Snelson:

Sculpture

“Master of Geodesic Dome”

Fuller recognized his model fit his ideas about energetic geometry.

Fuller “claimed ownership” of his work.

Also awarded patented tensegrity.

History

1970’s-Present:

David Robbie MD:

Proposed that the humans musculoskeletal system could be viewed as a tensegrity system.

Stephen M. Levin MD:

Coined the term biotensegrity.

Orthopedic surgeon.

Conventional mechanics did not explain the complexities of the human body (spine).

The accepted “lever” system would place enormous stress on tissues.

Snelson’s Tower: Kenneth Snelson’s sixty foot Needle Tower stimulated the idea that tensegrity might be a viable alternative to understanding biological structures

Donald E. Ingber MD PhD :

1975 while taking a sculpting class he was introduced to tensegrity structures.

He later became convinced that cells function mechanically as tensegrity structures.

Established his own lab (after being scrutinized) to prove theory.

Now a professor at Harvard Medical School and Harvard School of Engineering and Applied Sciences.

Founding director of the Wyss Institute for Biologically Inspired Engineering (https://wyss.harvard.edu/)

Tensegrity (“tension”+”integrity”) and Biotensegrity Models

A Structure with a distinct set of compression elements (struts) that appear to be floating within a network of tensioned cables.

Pre-stress stabilizes the entire structure.

Can be altered by either altering the tension or compression.

Can change shape with minimal effort.

Strong, lightweight and become stronger with increased load (non-linear stress/strain mechanics).

Provides flexibility while minimizing damage to structure.

Allow transfer of force throughout structure: “Responds to external forces by transmitting the force throughout the entire structure, and returning to its original shape after being released from it’s stressed state.”

Buckminster Fuller

Tensegrity (“tension”+”integrity”) and Biotensegrity Models

Two Models:

Pre-stressed Tensegrity Models

Geodesic Dome

Similar mathematical rules define both prestressed and geodesic tensegrity models (Robert Connelly, PhD and Allen Back PhD- Cornell University).

Geodesic Tensegrity Structures: self-stabilized because of their triangulation.

“Biotensegrity is an efficient, low-energy mechanical system that when applied to complex biological structures, overcomes many of the inconsistencies that were present in the old view of biomechanics.”

Stephen M. Levin (2014)

Buckminster Fuller

Traditional Forms of Architecture vs. Tensegrity

TraditionalTraditional

Blocks Piled on Blocks

Bricks and stone are good at supporting compressive load

Too much compression and stone cracks

Poor ability to account for rotational forces

Weight is always transmitted down to the ground in accumulating compression

Tensegrity/Geodesic DomeTensegrity/Geodesic Dome

Minimization of energy

Stabilization through continuous tension and local compression

Strong- stable- light- cheap- easy to build- relatively immune to surroundings

Mechanics vs. Biomechanics

MechanicsMechanics

Linear stress/strain effect

Square cube law- scale an object up in size -double the height of a building (surface area squared, volume cubed) leading to an eight fold increase in weight.

If this were true of large animals they would collapse under their own weight.

“While skyscrapers and bridges are relatively rigid and must be heavily reinforced against the effects of these stresses, living organisms are light and flexible, and can function the same in virtually any position, which means that they probably use a different system of mechanics all together.”

BiomechanicsBiomechanics

Non linear stress/strain effect.

Resist much higher strains- become stronger as force increases.

Bones and tendons can thus store much larger amounts of energy and return it like a spring.

Tensioned cables and compressed struts (Bone, muscles, fascia, ligaments, tendons, cartilage, etc.).

Strong, light, flexible, can change shape.

Integrated framework allows us to rapidly adjust to resist external forces and permits us to move freely.

Structural Hierarchies

Biotensegrity units inside of biotensegrity units (i.e. MSK system, muscles, ECM, cells, etc.)

An inherent capability of tensegrity configurations as well as being virtually ubiquitous in biology.

Reduce weight, provide energy efficiency and dissipate potential damaging stressors.

Functionally connect every structure from the simplest to the most complex.

The entire system acts as one unit.

Joints

Spine:

Able to move freely and dynamically.

Lightweight and self-stabilizing.

Provides sufficient protection for vital neurologic structures.

Prestress (proposed):

Ligaments

Small rotator muscles

Large erector spinae muscles

Joints

Knee:

Dr. Levin observed that in his patients, tightening up the cruciate ligament caused the bones to move apart (doesn’t fit with classical mechanics).

His own knee:

While in the OR for a surgery on his own knee, Dr. Levin asked the surgeon to perform some maneuvers to test his theory:

Continuous spacing of 1-3 mm between both the patella-femoral and femoro-meniscal articulations remained even with quadriceps contraction and when the foot was pushed towards the hips in simulated weight bearing.

A review of literature casts doubt on the ability of the menisci to act as shock absorbers (protective end-cushions rather than the major load bearer).

Tensioned muscles and connective tissue regulate the joint’s spacing and surface pressures (Suspended).

This prestress in the joint reduces “play” within the system and ensures immediate mechanical responsiveness reducing impact and fatigue on the joint.

Organs and Tissues

“In a tensegrity model, load bearing elements of the body induces physical distortion of the living tissues that comprise organs.”

Fascia:

Critical component that can function as either a compression-resistant component or a tension-generator element.

Fascia is irregular connective tissue of varying densities found throughout the body.

4 primary subdivisions (superficial, axial, meningeal and visceral)- hierarchically arranged.

Histological view:

Axial: After removal of fat globules reveals a geodesic arrangement of collagen fibers .

Organs and Tissues

Bone:

Compression resistant strut as part of the musculoskeletal system.

In isolation it is it’s on tensegrity unit.

Femur:

Because of the angulation and weight-bearing nature of the femur, the medial aspect of the bone is resisting compression while the lateral aspect is under tension.

Distal femur is cancellous bone which is organized around geodesic triangulations, with some struts resisting compression and some under tension.

Lung:

Tensegrity Structure

Under constant tension (prestress).

Fiber system has a geodesic arrangement.

Compression resistant elements are the ribs.

Extremely strong and efficient yet requires little space.

Cranial Considerations

Tensegrity helps to explain how the calvarial shape is maintained independent of any outward pushing of the brain.

Bones remain under tension from the dura mater.

Provides stability of the structure.

Explanation for how cranial base somatic dysfunction (sphenoid/occiput) could alter tension patterns and cause plagiocephaly.

Cranium: Resembles an icosahedron (energy efficiency).

“Cells of the dura mater respond to brain expansion and influence bone growth, allowing the cranium to match the spatial requirements of the developing brain, whilst remaining one step ahead and retaining a certain autonomy.”

Scarr, G. A model of cranial vault as a tensegrity structure, and its significance to the normal and abnormal cranial development. 2007.

Cells (mechanotransduction)

Cellular prestress allows the cell to respond to changing external forces by transmitting the forces throughout the cell.

Attachment to flexible extracellular substrate allows for transfer of prestress within the cell to the extracellular matrix (hierarchical organization).

Cytoskeleton Elements:

Microfilaments (tension)

Microtubules (compression)

“During the past decade, studies on cultured cells have confirmed that a direct connection from the ECM through the cytoskeleton and down to the nucleus exists and that mechanical forces applied to the ECM components are transmitted directly to the cell and nucleus as predicted in the hierarchical tensegrity model.”

Cells (mechanotransduction)

Mechanotransduction:

Dynamic mechanical information can be converted into biochemical changes (similar to hormones, cytokine and growth factor binding).

Mechanical signals occur much more quickly.

Tissues rearrange in response to stress and then return to normal once stress is released (tensegrity).

Prolonged or excessive stressremodeling

Scarr, Biotensegrity the structural basis of life

Cells (mechanotransduction)

Integrins:

Cluster together to form focal adhesion molecules.

Bind proteins of ECM and cytoskeleton (mechanical link).

Link between continuous tension elements and compression resistant struts.

Specifically integrins (not other transmembrane receptors).

Focal adhesions undergo self-assembly and grow in size with tension (disassemble when dissipates).

Cyclic adenosine monophosphate (cAMP):

Secondary Messenger (protein activation and transcription regulator).

Mechanical forces applied through focal adhesions can modulate production of cAMP activation of transcription factors in the nucleus.

**Mechanical forces play a key role in modulating cellular secondary messaging.

Scarr, Biotensegrity the structural basis of life

Cells (mechanotransduction)

Mechanical Rearranging of gene expression:

Mechanical forces may directly affect gene expression through opening and closing of nuclear pore complexes.

Ion Channels:

TRPV4: Ion channel directly linked to mechanical forces (ECM through focal adhesion complexes).

Scarr, Biotensegrity the structural basis of life

Applications/Research

ECM and Mechanical Forces:

Evidence is mounting that the ECM and mechanotransduction may be the most important factors in determining a cells fate.

Cultured endothelial cells either when through apoptosis, went quiescent, proliferated or differentiated based on the amount of ECM.

Modulation of cellular prestress was shows to alter in vivo mouse lung development.

Researchers have made dramatic progress in creating a bio-artificial lung by using native ECM and mechanical forces.

Research is showing that ECM and biomechanical forces may be just as important in proper tissue differentiation and normal function as soluble biochemical signals.

It has been show that malignant phenotype is reversible by correction of the altered cues of the ECM.

Applications/Research

Mechanopathologies:

Pathological states such as cardiomyopathy, osteoporosis, muscular dystrophy, asthma and atherosclerosis are now in part being attributed to mechanotransduction.

Cancer:

Possible alterations in mechanotransduction may lead to tumor formation by altering cell growth and proliferation.

The majority of tumors are surrounded by a stiffened and rigid ECM (extracellular vs. intracellular event).

Results in altered mechanotransduction (still to be determined if caused by mechanotransduction).

Tissue engineering to treat cancer (Dr. Ingber):Biomaterials that mimic embryonic ECM environment to aid cells to “morph” back in to precancerous cells.

Could restoration of normal physiologic motion have the same effect??

Applications/Research

Red Blood Cells:

Tensegrity-based models to begin to understand the cells ability to deform in circulation while maintaining function.

Nucleic Acid:

Tensegrity principles are being used to construct DNA 3D tensegrity based structures.

Exploring the possibility of using these self-assembling structures in nanotechnology applications.

Applications/Research

Osteoarthritis:

Leading cause of disability and pain in United States.

Exercise and physical therapy beneficial- why??

Imbalance between anabolic and catabolic activity.

Proteolytic enzymes overwhelm tissue inhibitors resulting in cartilage breakdown.

Successful therapy= inhibition/modulation of enzymes- how?

In vitro:

Dynamic compression of chondrocytes counteracts the production of inflammatory mediators.

Compression also antagonizes genes involved in cartilage catabolism.

In vivo:

Demonstrated anti-catabolic and anti-inflammatory effects of physiologic joint loading.

Synovial activity:

Mobilization may increase Hyaluronic Acid.

How Does OMT Integrate into this?

JAOA “In Vitro Biophysical Strain Model for Understanding Mechanisms of Osteopathic Manipulative Treatment”

Acyclically strained fibroblasts.

2 groups:

Strain Stimuli (10%, 20%, 30%)

Control Cells

Measurements:

Cell Shape

Proliferative Capacity

Cellular Protein Content

Protein/DNA ratio

NO secretion

Cytokine Secretion

Strain >10% induced major alteration in cell shape and viability.

Control Cells:

No significant changes in measured parameters.

Strained Cells:

Decrease in dsDNA (all magnitudes)

10%

Change in fibroblast shape, growth and cytokine production.

No change in cell viability after 72 hrs.

Increased NO, IL-6 and proliferation after 48 hrs.

Change in actin/elongated pseudopodia.

Strained cells aligned in response to applied strain

30% strain:

Loss of cell membrane

Decrease in protein to DNA ratio

“Human fibroblasts responds to in vitro strain by secreting inflammatory cytokines, undergoing hyperplasia, and altering cell shape and alignment.”

Control Strained

How Does OMT Integrate into this?

JAOA “Modeled Repetitive Motion Strain and Indirect Osteopathic Manipulative Techniques in Regulation of Human Fibroblast Proliferation and Interleukin Secretion”

5 groups

Basal Cell Secretion (BCS)

Repetitive mechanical strain (RMS)

24 RMS

24IOMT

24RMS +I OMT

Cell Proliferation and cytokine secretion:

24RMS: attenuation of cellular proliferation.

24RMS+IOMT and 24IOMT: Increase in cellular proliferation.

RMS: no change Measured IL and fibroblasts immediately after and 24h

24RMS- increase in IL and decrease in fibroblast

IOMT-decrease in IL (specifically IL-3)

RMS + IOMT-decrease IL and increased fibroblast proliferation.

IOMT appeared to have reversed the effects in cells that were repetitively strained.

“These results suggest that proliferation of fibroblasts and expression and secretion of pro- inflammatory and anti-inflammatory interleukins may contribute to the clinical efficacy of indirect OMT”

“In a human body. Support is not something solid. Support is a relationship.”

Ida Rolf

Anatomy Trains

Whole body patterning in posture, function and movement

“individual muscles acting on bones across joints’ simply does not adequately explain human stability and movement”

www.anatomytrains.com

Anatomy Trains by Thomas W. Myers

Human Resting Muscle Tone (HRMT)

“HRMT is the passive tonus or tension of the skeletal muscle that derives from its intrinsic (EMG-silent) molecular viscoelastic properties.”

Maintains relaxed standing posture with minimal increase in energy costs without fatigue.

HRMT is integrated with other passive and ligamentous tension networks of the body to form a biotensegrity system.

Normal resting muscles do not have reflex activation (not CNS driven).

Absence of EMG evidence of muscle contraction in normal resting muscles.

Active co-contractions (agonist/antagonist) not necessary until greater levels of mechanical stability or resistance are required.

Symptomatic MSK conditions lead to increase in resting muscle tone.

Tensegrity considerations for Poor Posture

Increased energy demands

Increased muscle contraction to counteract gravity

Gravitational stressors amplified

Functional capacity will be limited by less than ideal structure

Patterns that are compensated can decompensate

Loss of normal muscle firing patterns (UCS/LCS)

Bone Remodeling

Tissue Texture changes in Length and quality

Fascial Changes

Somatic Dysfunction

Why?Americans sit 8-10 hoursa day.

Upper Crossed Syndrome

Proximal or Shoulder Girdle Crossed Syndrome.

Somatic Dysfunctions:

OA

C4-C5

C7-T1

Glenohumeral joint

T4-T5

Lower Crossed Syndrome

Distal or Pelvic Crossed Syndrome.

Somatic Dysfunctions:

L4-L5

L5-S1

SI joint

Hip joint

“Move Your DNA”

“Most cells depend heavily on mechanical stimulation. The loads placed on the body via movement translate into loads on the cells themselves, which creates cellular data, and it is at this level that change- in the form of strengths, density, and shape- occurs.”

Epigenetics

How a cell’s environment can affect the behavior of the cell itself (gene expression).

Evolutionary Mismatch theory

Scientific hypothesis that the conditions under which human beings developed are similar to those necessary for biological function.

That human physiology has adapted to certain stressors, the absence of which results in disease.

Our current environment is a mismatch for our physiology

Movement vs. Exercise

Cardiovascular Disease

Plaques form at bifurcations of arteries or areas of sharp turns.

Our position shapes the flow pattern of our arteriescould this be increasing our plaque formation.

Motion restriction

Prolonged limited range of motion of a jointchange in range of motion.

Alterations in joint mechanics.

Osteopathic Manipulative Treatments

Somatic Dysfunction:

Restriction of normal physiological motion are transmitted to cells via ECM and through mechanotransduction alter cell function.

Restoring to normal physiological motion changes cell function.

Chronic somatic dysfunction lead to fibrosis and difficulty restoring normal cell function.

Treat Muscle Imbalance and Postural Abnormalities

Fascial Release (MFR/unwinding)

Conclusion

“In other words, our bodies are complex hierarchical structures, and hence mechanical deformation of whole tissues results in coordinated structural rearrangements on many different size scales.”

Donald E. Ingber MD PhD

“Physical therapy, dance, exercise and various forms of movement can indeed influence cellular activities, including cell growth, differentiation, and potentially even immune cell responses that are critical for human health.”

Donald E. Ingber MD PhD

Buckminster Fuller Institute

http://bfi.org/about-bucky/biography

Buckminster Fuller history

http://www.rwgrayprojects.com/rbfnotes/fpapers/tensegrity/tenseg01.html

Mechanotransduction

http://www.childrenshospital.org/research/ingber/PDF/1997/annurevphysiol- Ingber.pdf

Additional Resources

Tensegrity model

http://www.youtube.com/watch?v=8gtvxYZ0GIg&feature=related

Tensegrity degradation

http://www.youtube.com/watch?v=Y-Ny3BfhVdw

Tensegrity and Mechanotransduction

http://www.ncbi.nlm.nih.gov/pubmed/19083675

Stylized Osteopathic Seminars

Philosophy

http://www.omtsos.com/index.php?page=philosophy

Additional Resources

Nuclear Mechanotransduction

http://circres.ahajournals.org/content/102/11/1307.full

Cranial Vault

http://www.journalofosteopathicmedicine.com/article/S1746- 0689%2808%2900032-1/abstract

Wyss Institute projects

http://wyss.harvard.edu/viewpage/enabling-technology-platforms/enabling- technology-platforms

Additional Resources

Bibliography

1. Scarr, G. Biotensegrity the structural basis of life: United Kingdom: Handspring Publishing. 2014.

2. Chila, A et. al. Foundations for Osteopathic Medicine. 3rd edition. Lippincott Williams and Wilkins, 2011.

3. Ingber, D. Tensegrity and Mechanotransduction. J Bodyw Mov Ther 2008; 12(3):198-200.

4. Meyers, T. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. 3rd ed. Churchill Linvingston Elsevier. 2014.

5. Meltzer, K., Standley, P. Modeled repetitive motion strain and indirect osteopathic manipulative techniques in regulation of human fibroblast proliferation and interleukin secretion. JAOA, 2007;107:527-536.

6. Dodd, J. et.al. In Vitro Biophysical Strain Model for Understanding Mechanisms of Osteopathic Manipulative Treatment. JAOA, 2006; 106: 157-166.

7. Bowman, K. M.S. Move Your DNA Restor Your Health Through Natural Movement. 2nd ed. 2017.

8. Leong, D. et.al. Mechanotransduction and Cartilage Integrity. Ann N Y Acad Sci. 2011 December; 1240:32-37.

9. Scarr, G. A model of the cranial vault as a tensegrity structure, and its significance to normal and abnormal cranial development. International Journal of Osteopathic Medicine, 2008; 11: 80-89.

10. Swanson, R. Biotensegrity: A Unifying Theory of Biological Architecture With Application to Osteopathic Practice, Education, and Research—A Review and Analysis.” JAOA, 2013; 113 (1): 34-52.

11. Noguera, Rosa. Et.al. Extracellular Matrix, Biotensegrity and Tumor Microenvironment. An Update and Overview. Histology and Histopathology, 2012; 27: 693-705.

12. Alfonse, T. et.al. Human Resting Muscle Tone (HRMT): Narrative Introduction and Modern Concepts. Journal of Bodywork and Movement Therapies, October 2008; 12 (4): 320-332.

Bibliography (Pictures)

https://monoskop.org/Karl_Ioganson

http://tensegritywiki.com/Emmerich%2C+David+Georges

https://www.bfi.org/

http://www.magicalrobot.org/BeingHuman/2010/04/introduction-to- biotensegrity

https://musculoskeletalkey.com/biotensegrity-the-mechanics-of-fascia/

http://www.tensegrityinbiology.co.uk/publications/helix/

http://jaoa.org/article.aspx?articleid=2094459

https://yogamedicine.com/why-fascia-matters-by-krystyn-strother/

https://www.vexels.com/png-svg/preview/141930/muscular-system- anatomy-human-body