Critically appraised paper: Zusman M. There's something about passive movements,..Medical Hypotheses 2010 (In press)

Original abstract: The recognised (funded) stand-alone clinical status for therapeutic methods of passive movement has become increasingly threatened in recent times as the preference for active treatment (speci c exercise) gains hold. This is in part due to the equivocal results for clinical trials of passive movement, queries regarding its cost-bene t and negative ndings for many of the fundamental claims and recommenda-tions of its clinical process. Linked to these issues has been the profession’s dif culty in demonstrating plausible science-based mechanisms for anything more than transient effects. The present proposal is that the manual application of graduated oscillatory tensile loading to healing (or unhealed) soft tissues in the form of passive movement could facilitate optimal repair and tissue integrity (and so protection against subsequent ‘stress’). The mechanism depends on the intrinsic ability for non-excitable connective tissue cells to ‘sense’ mechanical stimuli and to transduce mechanical into chemical signals. This leads to gene transcription and subsequent adaptive remodelling of the extracellular matrix (ECM). An outline of these events is given, emphasising their dependence on the effective interplay between internally (cellu-lar) and externally (matrix) generated mechanical forces. In principle, it ought to be possible to investi-gate the proposal and other clinical passive movement issues using modern soft tissue imaging and biological techniques with suitable human subjects and animal models. Extract of the appraisal: The author provides a constructive critique of the published paper by Zusman, adding valuable opinions from his experiences and published works.