William Yang

The Biomechanics of Flexibility and Tissue Stiffness

Mechanical stimulation applied to tissues greatly impacts tissue plasticity and elasticity.
This can be seen by how increased or decreased mechanical stimulation of ligaments and joints,
skeletal muscles, and smooth muscle can affect the tissues physiological properties.
Understanding these relationships is essential to providing effective therapies for patients in a
clinical setting.
Perhaps the most observable parts of the body that exhibit a relationship between their
mechanical and physiological properties include ligaments and joints. In a clinical setting
consisting of patients with muscle spasticity due to stroke or cerebral palsy, it was observed that
the patients wrists were held uncontrollably in a flexed position. Hand-wrist orthoses were
prescribed to these patients in order to keep their wrists in a neutral position. The rationale
behind this prescription was as follows. By keeping the wrist in immobile flexion, the anterior
side of the wrist would be in constant flexion while the posterior side of the wrist would be in
constant extension. The ligaments on both sides, due to immobility, would stiffen, leaving the
wrist in permanent deformation and compromising the wrists range of motion. Many laboratory
studies have confirmed the positive relationship between joint immobility and ligament stiffness,
including Woos 1975 observations of knee ligament stiffness in rabbits after induced
immobilization of the subjects knees. Similar observations of increased ligament stiffness as a
result of immobility were made in Laros 1971 study on ligaments in the knees of dogs. This
observed behavior of ligaments is an expected property of all materials there exists an elastic
limit in stress and strain in which passing this limit will cause permanent plastic deformation. In
addition, the time-dependence of these applied forces imply that ligaments are also viscoelastic,

in which the tissues have viscosity (Weintraub 2003). These changes in mechanical properties
due to immobility can be explained by the physiological and structural changes that occur during
immobility. These changes include decreased water and proteoglycan content in the extracellular
matrix (ECM) as well as decrease in parallel fiber arrangement, which is explained in greater
detail in the second chapter of Weintraubs 2003 book. Thus, although the therapies that were
prescribed to the patients would prevent ligaments from deforming unevenly, daily physical
stretching and movement of the wrists would also be required to prevent joint stiffening, based
on the inherent properties of ligaments.
Similar relationships can be applied to the various types of muscle tissues. For skeletal
muscles, studies conducted by Fatouros et al. in 2002 on elderly test subjects have shown that
frequent use of muscles against external loading via resistance training can improve muscle
elasticity, range of motion, and strength. Thus, these studies demonstrate another example of
mechanical stimulation altering tissue structure and functionality. Likewise, smooth muscles also
exhibit viscoelastic properties. It was found in Tunas, Bakkers, and VanBavels 2012 study that
low distension and high contractile activity in blood vessels causes inward cytoskeletal
remodeling, ultimately leading to narrower blood vessel diameter, which in turn causes increased
mechanical stress on blood vessel walls; consequently, increased mechanical stress wears down
the elastin in the blood vessel walls, ultimately leading to stiffening. This is yet another instance
of mechanical environments affecting the physiological properties of tissues.
Although the biochemical mechanisms of muscle and connective tissue may differ in
many ways, the physiological responses of both types of tissues to mechanical stimuli highlight
their biomechanical similarities. It can be seen that unidirectional or immobile loading causes

deformation and stiffness, which holds important implications for diagnosing, treating, or
preventing disease. Indeed, the body seems to need to be dynamic in order to stay dynamic.

Works Cited
Fatouros I.G., Taxidaris K., Tokmakidis S.P., Kalapotharakos V., Aggelousis N., Athansopoulos
S., Zeeris I., Katrabasas I. (2002) The effects of strength training, cardiovascular training
& their combination of flexibility of inactive older adults. International Journal of Sports
Medicine 23, 112-119
Laros G. S., Tipton C. M., Cooper R. R. Influence of physical activity on ligament insertions in
the knees of dogs. J Bone Joint Surg Am. 1971;53(2):275286.
Tuna, B. G., Bakker, E. N. T. P. and VanBavel, E. (2012), Smooth Muscle Biomechanics and
Plasticity: Relevance for Vascular Calibre and Remodelling. Basic & Clinical
Pharmacology & Toxicology, 110: 3541. doi: 10.1111/j.1742-7843.2011.00794.x
Weintraub, W. (2003), Tendon and Ligament Healing: A New Approach to Sports and Overuse
Injury. Retrieved from http://www.paradigm-pubs.com/sites/www.paradigmpubs.com/files/active/0/TL_TOC.pdf
Woo S, Mathews J, Akeson W, Amiel D, Covery R. Connective tissue response to immobility.
Correlative study of biomechanical and biochemical measurements of normal and
immobilized rabbit knees.Arthritis Rheum. 1975;18(3):257264. doi:
10.1002/art.1780180311.