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J Neurol Sci. 2016 Feb 15;361:168-80. doi: 10.1016/j.jns.2015.12.029. Epub 2015 Dec 24.

Manual therapy as an effective treatment for fibrosis in a rat model of upper extremity overuse injury.

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Department of Biomedical Sciences, University of New England College of Osteopathic Medicine, 11 Hills Beach Rd, Biddeford, ME 04005, USA.
Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, PA, USA.
Department of Clinical Sciences and Biostatistical Consulting Center, Temple University School of Medicine, Philadelphia, PA, USA.
Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, PA, USA. Electronic address:


Key clinical features of carpal tunnel syndrome and other types of cumulative trauma disorders of the hand and wrist include pain and functional disabilities. Mechanistic details remain under investigation but may involve tissue inflammation and/or fibrosis. We examined the effectiveness of modeled manual therapy (MMT) as a treatment for sensorimotor behavior declines and increased fibrogenic processes occurring in forearm tissues of rats performing a high repetition high force (HRHF) reaching and grasping task for 12 weeks. Young adult, female rats were examined: food restricted control rats (FRC, n=12); rats that were trained for 6 weeks before performing the HRHF task for 12 weeks with no treatment (HRHF-CON, n=11); and HRHF task rats received modeled manual therapy (HRHF-MMT, n=5) for 5 days/week for the duration of the 12-week of task. Rats receiving the MMT expressed fewer discomfort-related behaviors, and performed progressively better in the HRHF task. Grip strength, while decreased after training, improved following MMT. Fibrotic nerve and connective tissue changes (increased collagen and TGF-β1 deposition) present in 12-week HRHF-CON rats were significantly decreased in 12-week HRHF-MMT rats. These observations support the investigation of manual therapy as a preventative for repetitive motion disorders.


Collagen; Cumulative trauma disorder; Fibrosis; Massage; Mobilization; Overuse injury; Repetitive strain injury; TGF-β1

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