06: Mechanotherapy

“ Mechanotherapy” may not sound so familiar to many of you. The word ‘mechano’ means machine in English. Thus, in western societies, mechanotherapy is the treatment of disorders, injuries and disease by using mechanical devices.

Recently, Associate Professor Rei Ogawa of Department of Plastic, Reconstructive and Aesthetic Surgery at Nippon Medical School has expanded and redefined the concept of Mechanotherapy1). Not only would he use physiotherapy and rehabilitation treatment, which are the conventional treatment of Mechanotherapy, but also, he would use Mechanotherapy as “ treatment that would add physical stimulation at tissue, cell and molecular level.


Mechano-biology: Basic concept of Mechanotherapy

In order to understand the newly defined Mechanotherapy proposed by Dr. Ogawa, we need to know the concept of “ Mechano-biology” which is the foundation of Mechanotherapy .

Mechano-biology is, according to Dr. Ogawa, “an academic field that regards a cell, which is the smallest unit of a life activity is controlled and influenced greatly by “physical environment” such as, gravity, and atmospheric pressure.

Let me give you an example that would simplify this concept. The existence of gravity，for example, has an influence over the bones. You might recall the scene in which astronauts can hardly stand up when they are returning to earth due to their weakening of their bones as they were spending time in space with no gravity.

Also at cell level, cells are connected mutually by protein called “cell adhesion molecules”, such as integrins, and through these adhesion molecules, the cells pull one another and change morphologically. In addition, we also know that extracellular matrix (ECM) is a part of animal tissue that usually provides structural support to the cells in addition to performing various other important functions, such as regulating gene expression.

In other words, all cells function by pulling towards one another and from ancient days, cells have always been equipped with this ability to feel that “tension”. In this way, cells have always been reacting against various kinds of physical stimulations, and this as a result, will lead to regulation of gene expression and other phenomena that are indispensable to life activity.

Therefore, in this way Mechano-biology is the concept that coexists with “ Origin of Life”. According to Dr. Ogawa, “ We, the living creatures, have constantly been influenced by gravity, atmospheric pressure, water pressure ever since the birth of life for over 38 billions of years. Under these physical external environments that are invisible to our eyes, cells that constituted creatures have alternated dividing and multiplying repeatedly and these cells eventually evolved to a multicellular organism with three-dimensional structure.”


Clinical Application of Mechanotherapy

Here we would now like to talk about the possibility of how effective mechanothrapy is by showing the example of treating keloids.

Keloid is a tough heaped-up scar that rises quite abruptly above the rest of the skin. It usually has a smooth top and a pink or purple color. Keloids are irregularly shaped and tend to enlarge progressively

Department of Plastic, Reconstructive and Aesthetic Surgery delivers best results in treating Keloid scars in Japan, and at the same time, it does extensively research on applying mechano-biology and using mechanotherapy in treating keloids.

For example, the department was the very first department to show how the formation of keloid depends on how strong the tension is on the skin through computer simulation. With this computer simulation, it was able to prove that the size of keloid is determined by in which direction the skin was pulled 2).

By taking advantage of the research findings on the mechanism of keloid using mechano-biology, “we are able to aggressively apply the findings in treating keloid effectively”, says Dr. Ogawa. This process of using the results of the research and applying them clinically is called in English “ from bench to bedside” and is considered the best and most ideal process in the world of medicine.
From the research, Dr. Ogawa says he came to realize that “ we need to perform an operation that will not put tension on skin that may develop into keloid”. Thus, “ if keloid emerges due to the tension given on to the skin, then we just need to do away with the tension part ”, explains Dr. Ogawa. The mechanotherapy that is taking place here is: how to reduce the physical stimulation.

In addition, a new way of treatment has been developed based upon this concept. For example, Dr. Ogawa told us that “ when stitching up the skin, by stitching firmly at the tissue lower than the skin, we can avoid giving tension to the skin itself; as a result, it helps prevent keloids from developing. We tried to optimize this technique as much as possible and thanks to this method, we have managed not to leave scars.”

Accordingly, the department has been performing excision through operation and postoperative radiation therapy with intractable keloid and thickening related scars. Especially with radiation therapy, it was the very first time in the world to have a protocol to irradiate different dose of radioactivity in accordance with each part. This report has been published in many textbooks overseas as well.
Dr. Ogawa certainly hopes to continue with this effort to further achieve more in advanced mechanobiology research in the hope that they could apply the findings clinically. Lastly stated, “ There is so much potential in mechanobiology. There is a possibility that even with the disease that we currently do not yet understand the mechanism of its outbreak may be related to mechanobiology, too3). By solving this problem, we think that we could adopt mechanotherapy to treat the issue more effectively. We hope to bridge research and clinical application further and aim at establishing minimal invasive treatment in the near future.

1) Huang C, Holfeld J, Schaden W, Orgill D, Ogawa R. Mechanotherapy: revisiting physical therapy and recruiting mechanobiology for a new era in medicine. Trends Mol Med. 2013 Jun 18.
2) Akaishi S, Akimoto M, Ogawa R, Hyakusoku H. The relationship between keloid growth pattern and stretching tension: visual analysis using the finite element method. Ann Plast Surg. 2008 Apr; 60(4): 445-51.
3) Ogawa R, Hsu CK. Mechanobiological dysregulation of the epidermis and dermis in skin disorders and in degeneration. J Cell Mol Med. 2013 Jul; 17(7): 817-22.

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