Osher Center for Integrative Medicine

Connective Tissue and Inflammation with Helene Langevin

Dr. Helene Langevin received her medical degree from McGill University and did a post doctoral research fellowship in Neurochemistry in Cambridge, England. Her residency in Internal Medicine and fellowship in Endocrinology and Metabolism was at Johns Hopkins Hospital. She is a Professor in Residence of Medicine at Harvard Medical School, Brigham and Women's Hospital and is also a part-time Professor of Neurology, Orthopedics and Rehabilitation at the University of Vermont College of Medicine. She was appointed as Director of the Osher Center for Integrative Medicine at Harvard Medical School and Brigham and Women's Hospital in November 2012.

As if that weren’t enough to keep a person busy… In our worlds she is best known as the Principal Investigator of NIH-funded studies investigating the role of connective tissue in low back pain and the mechanisms of manual and movement based therapies and acupuncture.

Today she joins me to talk about her research- specifically how stretching impacts inflammation resolution in connective tissue, how connective tissue is a critical component of the immune system, how movement influences immune processes, and what this all might mean for both prevention and resolution of both chronic pain and cancer.




Conversation highlights

  • Why her research focuses on the role of connective tissue in chronic pain, and the mechanisms of movement and manual based therapies as well as acupuncture.
  • Her first NIH grant in which they designed a robotic arm to manipulate acupuncture needles and found that the cause of the force was greatly increased when the needle was rotated. This was due to the mechanical stimulation delivered to the connective tissue.
  • How this got her interested in the effects of stretching tissue.
  • Research suggests acupuncture needles interact with different pathways in the nervous system. The connective tissue can simply be the mechanical link between needle and sensory nerves.
  • They found that there are cells within connective tissue- the fibroblasts- which change shape. They expand and remodel internally. So the needle might be having an effect on the connective tissue in addition to what happens in the nervous system.
  • When the fibroblasts change shape they secrete ATP. It's a molecule we think of in terms of energy in production in the cell. However, ATP can be used in a different way and can function as a signaling molecule outside the cell. Release of ATP from cell is necessary for the cell to change shape.
  • There is research being done at The University of Rochester by Dr. Nedergaard and Dr. Takano (in resources) on the effect ATP downstream- showing an analgesic effect on sensory nerves.
  • Dr. Langevin clarifies her 2002 paper Relationship of acupuncture points and meridians to connective tissue planes (in resources) saying, “We have to be careful here when we talk about correlation of acupuncture meridians and fascial planes." and "it’s not surprising the channels aroe found between a bone and a muscle or between two fascicles of a muscle... does that mean that fascial planes are the same as meridians? I wouldn’t say that”
  • Cancer is not just a collection of tumor cells growing out of control> They need a base and that base is the connective tissue- the stroma. The cancer takes the connective tissue hostage.
  • Dr. Patricia Keely at The University of Wisconsin has studied that cancer is likely to spread along places where the connective tissue matrix forms these railroads where the cancer can spread. (in resources)
  • Dr. Langevin's paper Stretching Impacts Inflammation Resolution in Connective Tissue (resources). She defines inflammation and what it means for both cancer and chronic pain.
  • In musculoskeletal pain it’s not always clear where the tissues are that are creating the pain. In low back pain for years the belief was that it was coming from the spine.
  • How does fascia generate pain? The soft tissues of the back can be the source of pain if they have a source of persistent inflammation in the tissues.
  • Dr. Langevin defines stretching and the protocol they used with the rats at UVM in the research study.
  • Viscoelastic changes in fascia can happen fairly quickly, but the fibroblasts are much slower and didn't start changing until about the 10 minute mark.
  • I ask Dr. Langevin to differentiate between movement and stretching.
  • Static vs. dynamic stretching is a very important differentiation.
  • In the studies of athletes and static stretching, "I’m not convinced athletes weren’t stretching too much? Stretching beyond the limits is ripping the tissue, and the idea more is better may not apply. Achieving the right and specific force of the tissue may be very important."
  • The connective tissue is really the home of the immune system.
  • In her current research she is pursing the aspect of inflammation resolution with respect to the dose of stretching. She also wants to see the role of connective tissue in back pain and the response to body based treatments- both manual and movement based.
  • She is also interested in looking at longitudinal studies- observing back pain over time. Children and adolescents that are getting back pain at an earlier and earlier age- do changes in connective tissue precede the development of back pain?


Dr. Helene Langevin on Brigham and Women's website

Osher Center for Integrative Medicine- a partnership between Harvard University and Brigham and Women's Hospital

Dr. Langevin's paper Stretching Impacts Inflammation Resolution in Connective Tissue

Dr. Nedergaard and Dr. Takano research at the University of Rochester

Dr. Langevin's paper Relationship of acupuncture points and meridians to connective tissue

Dr. Patricia Keely's research at the University of Wisconsin on how cancer spreads along "lines" in the connective tissue 

If you’re inspired to leave a review on iTunes or Stitcher I would be oh so grateful. If technology isn’t your thing however you can just tell your favorite body nerds about the show. It keeps the show rolling and connects us more as a community. Body nerds unite!

Acupuncture, Oncology, and Fascia

1930280_24664191023_8914_nThis is Brooke here- I wasn't able to attend the recent joint conference on Acupuncture, Oncology, and Fascia which was held at the Osher Center for Integrative Medicine at Harvard Medical School. However the delightful Leah Rachocki did attend! Leah is a Rolfer in Cleveland Ohio, and a member of the Fascia Research Society. She attended the last two FRCs in addition to attending the event at Harvard, is a Liberated Body listener and supporter and, naturally, an enthusiastic Body Nerd. Having met her at the Fascia Research Congress I knew she would do a bang up job of reporting on the event for all of us here at Liberated Body. Please note that these are brief sketches of the talks and research, all of which have links to pages where you can read the papers of that researcher if you want to dive in more deeply. Without further ado- here's Leah:

One day of presentations was held at Harvard Medical School in Boston, several weeks after the Fourth International Fascia Research Congress in Reston, VA. For the first time, three Societies came together - Fascia Research Society, Society for Acupuncture Research, and the Society for Integrative Oncology to explore the relationship between fascia and cancer. Approximately 575 people attended, more than anticipated by organizers.

A total of ten presenters from the three Societies led discussions through this loop of relationships (graphic). Presenters were not limited to their own research; instead they wove together research with their experience. Each presentation was related to the prior. Every presenter had 30 minutes; the day closed with a panel discussion. Posters were accessible throughout the day.


Here are some highlights from each presenter. Note: this is not a detailed reporting of the lectures, but do click on the link at the name of each researcher to access a list of their publications which will take you deeper into their work.

Dr. Gary Deng, MD, PhD. Dr Deng is Interim Chief, Integrative Medicine Service, and Attending Physician at Memorial Sloan-Kettering Cancer Center. He discussed the Integrative Oncology approach to cancer, including the responsibility of the practitioners to be in good health, so that patients are helped to the greatest potential. Integrative Oncology engages the whole person, from body-mind-spirit through family, society and environment. He also told us about Memorial Sloan Kettering Cancer Hospital’s About Herbs smartphone app designed to guide people to using herbal remedies for safe self-use. Dr Deng was the first presenter of the day to mention self-care as an important tool in a patient’s disease response. He also described cancer survivors as ambassadors of healthy living to family and friends, suggesting a personal responsibility of sharing health.

Dr Suzanna Zick, ND, MPH Dr. Zick is Research Associate Professor, Department of Family Medicine at the University of Michigan Health System. She discussed cancer-related fatigue, psycho-oncology, and the usefulness of patients self-administering acupressure to relieve fatigue and sleep disruption. She noted that higher levels of inflammatory cytokines increase fatigue symptoms. She discussed the usefulness of tailored treatment, matching the patient with the specific care tools for best outcome.

Dr Beverly de Valois Dr de Valois is Research Acupuncturist at Mount Vernon Cancer Center in the United Kingdom. She offered a comprehensive discussion about lymphedema. This condition can occur years after cancer diagnosis and treatment. She brought attention to the gap between treatment standards and research. The skin barrier is critically important to preventing this terrible condition, yet our standard medical practices do not protect skin integrity. PhD

Dr. Jun Mao, MSCE Dr. Mao is Associate Professor, Perelman School of Medicine at University of Pennsylvania. He encouraged innovative trial designs to tease out reproducible approaches to cancer treatment. He also mentioned research that shows very little outcome difference between sham acupuncture and pills.

Dr Helene Langevin, MD Dr Langevin is the Director of the Osher Center for Integrative Medicine at Harvard Medical School & Brigham and Women’s Hospital. She discussed the similar effects of acupuncture and manual therapy, pointing out that both result in the mechanical movement of tissue. She discussed the immune function of Connective Tissue as the conduit by which water, proteins and immune cells return to the blood via lymph system. The lymph system has a more significant role in the body than we have known. She also noted that stretching reduces inflammation.

Dr Melody Swartz PhD Dr Swartz is the William B. Ogden Professor at the Institute of Molecular Engineering at University of Chicago. She gave a riveting presentation about how the lymphatic system manages cancer, inflammation and expanded on Dr Langevin’s discussion. The lymph system has a role in regulating the environment of the tumor; poor lymph flow may increase chances of developing autoimmunity problems. The lymph system also regulates salt on the skin, and provides tolerance maintenance. She reported that cancer-associated fibroblasts provide a matrix of connective tissue for the tumor environment. Dr Swartz explained a good deal of the body’s self-regulating system in her discussion of the lymph system.

Dr Boris Hinz, PhD Dr Hinz is Professor in the Matrix Dynamics Group at the University of Toronto. He discussed tissue stiffness. He noted that the tumor environment has stiffer stroma and connective tissue; when the cell stiffens, there is an increase in growth factors including stimulation of myofibroblasts.

Dr Patricia Keely, PhD Dr Keely is Professor an Chair, Department of Cell Regenerative Biology at the University of Wisconsin-Madison. She told us that the environment of the cell instructs the cell how to behave. If a cell contracts in environment that is stiff, the environment prevents the cell from properly releasing actin and myosin, making the cell stiff. She also noted that when tumor cells metastasize and migrate, they create the environment that best suits them.

Dr Thomas Findley MD, PhD Dr Findley is a Professor of Physical Medicine and Rehabilitation, Rutgers University Medical School, VA New Jersey Health Care System. He closed the day with an elegant discussion of Andrew Taylor Still’s work to remind us of the progress made in 100 years, and to link the pieces presented earlier into a cohesive body. He also showed the massive increase in fascia-related published papers, and encouraged participants to be creative when designing research. Dr Findley left us with optimism, motivation and enthusiasm, a perfect close.

The Osher Center for Integrative Medicine, a sponsor, will make available recordings of the day’s proceedings. If you aren’t a member of the Fascia Research Society, the Society for Integrative Oncology or the Society for Acupuncture Research, join one today!