BibliographyHow does water flow help musculoskeletal health?
Brinkman, J. E. (2023). Physiology, Body Fluids. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.StatPearls. (2017). Body Fluids. Available from: Aneskey.comCenaj, O., Ramalho, A., Han, A., et al. (2021). Evidence for continuity of interstitial spaces across tissue and organ boundaries in humans. Communications Biology, 4, 702.Yao, W. & Weiss, J. A. (2012). “Interstitial Fluid Flow: The Mechanical Environment of Cells in Soft Tissue.” Frontiers in Bioengineering and Biotechnology, 4 : 41.Wei, F., Flowerdew, K., Kinzel, M., Perotti, L. E., Asiatico, J., Omer, M., Hovell, C., Reumers, V., & Coathup, M. J. (2022). Changes in interstitial fluid flow, mass transport and the mechanobiology of tissues. Bone Research, 10, 14.Stewart, R. H. (2020). A modern view of interstitial space in health and disease. The Journal of Physiology, 598(24), 5611–5622.Liu, W-T. (2022). Interstitial Fluid Behavior and Diseases. Advanced Science, 9(1), 2100617.Liu, T., Xiong, B., Cui, X., & Zhang, C. (2025). Numerical study of interstitial fluid flow behavior in osteons under dynamic loading. BMC Musculoskeletal Disorders, 26(1), 187.
Diagram: https://www.resolvedanalytics.com/fluid-dynamics/fluid-dynamics-in-the-human-bodyWhat Lies Beneath
Cenaj, O., Allison, D. H. R., Imam, R., Zeck, B., Drohan, L. M., Chiriboga, L., Llewellyn, J., Liu, C. Z., Park, Y. N., Wells, R. G., Theise, N. D., & Ning, W. (2021). Evidence for continuity of interstitial spaces across tissue and organ boundaries in humans. Communications Biology, 4, Article 436.Stewart, R. H. (2020). A modern view of the interstitial space in health and disease. Journal of Physiology, 598(16), 3459‑3477.Liu, W.-T. (2022). Interstitial behavior and diseases. *Advanced Science, 9(14), 2100617.Suzuki, Y., Nakamura, Y., & Igarashi, H. (2024). Interstitial fluid flow decreases with age, especially after 50 years. Neurobiology of Aging, 141, 14‑20.Wiedenmann, C. J., Gottwald, C., Zeqiri, K., Frömmichen, J., Bungert, E., Gläser, M., Ströble, J., Lohmüller, R., Reinhard, T., Lübke, J., & Schlunck, G. (2023). Slow interstitial fluid flow activates TGF‑β signalling and drives fibrotic responses in human Tenon fibroblasts. Cells, 12(17), 2205.Yao, W. & Weiss, J. A. (2012). “Interstitial Fluid Flow: The Mechanical Environment of Cells in Soft Tissue.” Frontiers in Bioengineering and Biotechnology, 4 : 41.Galie, P. A., Nguyen, A. H., & Stevens, K. R. (2011). Interstitial fluid flow and cyclic strain differentially regulate cardiac fibroblast phenotype and matrix remodelling. American Journal of Physiology‑Heart and Circulatory Physiology, 301(5), H1380‑H1390.Zhang, Z., Cai, Y., & Xu, Y. (2025). Mechanical effects in aging of the musculoskeletal system. *Mechanisms of Ageing and Development, 198, 111844.
ScarTalk
Cenaj, O., Allison, D. H. R., Imam, R., Zeck, B., Drohan, L. M., Chiriboga, L., Llewellyn, J., Liu, C. Z., Park, Y. N., Wells, R. G., Theise, N. D., & Ning, W. (2021). Evidence for continuity of interstitial spaces across tissue and organ boundaries in humans. Communications Biology, 4, Article 436.Stewart, R. H. (2020). A modern view of the interstitial space in health and disease. Journal of Physiology, 598(16), 3459‑3477.Liu, W.-T. (2022). Interstitial behavior and diseases. Advanced Science, 9(14), 2100617.Suzuki, Y., Nakamura, Y., & Igarashi, H. (2024). Interstitial fluid flow decreases with age, especially after 50 years. Neurobiology of Aging, 141, 14‑20.Keane, T. J., & Stevens, M. M. (2018). Scarring vs. functional repair: Matrix‑based strategies to regulate tissue repair. Biomaterials Science, 6(1), 20‑31.Moretti, L., Santos, L., Ribeiro, N., & Orzechowski, A. (2022). The interplay of fibroblasts, the extracellular matrix, and inflammation in fibrogenic progression. Journal of Biological Chemistry, 297(1), 100839.Kohlhauser, M., Mayrhofer, M., Kamolz, L.-P., & Smolle, C. (2024). An update on molecular mechanisms of scarring — A narrative review. International Journal of Molecular Sciences, 25(21), 11579.Watson, S.-L., Fowler, A. J., Dias, P., Biccard, B., Wan, Y. I., Pearse, R. M., & Abbott, T. E. F. (2024). The lifetime risk of surgery in England: A nationwide observational cohort study. *Annals of Surgery. Advance online publication.Fuller, A. M., Bharde, S., & Sikandar, S. (2023). The mechanisms and management of persistent postsurgical pain. Frontiers in Pain Research, 4, Article 1154597. The mechanisms and management of persistent postsurgical pain. *Frontiers in Pain Research, 4, Article 115459.Bruce, J., Pergolizzi, J. V., Magnusson, P., & Kaye, A. D. (2011). Chronic post‑surgical pain. Journal of Pain Research, 4, 79–87.Weir, S., Samnaliev, M., Kuo, T.-C., Ni Choitir, C., Tierney, T. S., Cumming, D., Bruce, J., Manca, A., Taylor, R. S., & Eldabe, S. (2017). The incidence and healthcare costs of persistent post‑operative pain following lumbar spine surgery in the United Kingdom: a cohort study using the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES). BMJ Open, 7(9), e017585.Keter, D. L., Rolff, H.-G., & Cook, C. (2025). The mechanisms of manual therapy: A living review of systematic, narrative, and scoping reviews. *PLOS ONE, 20(3), e0319586.Ajimsha, M. S., Al‑Mudahka, N. R., & Al‑Madzhar, J. A. (2015). Effectiveness of myofascial release: Systematic review of randomized controlled trials. Journal of Bodywork and Movement Therapies, 19(1), 102‑112.Verzella, M., Affede, E., Di Pietrantonio, L., Cozzolino, V., & Cicchitti, L. (2022). Tissutal and fluidic aspects in osteopathic manual therapy: A narrative review. Healthcare, 10(6), 1014.Klein, P., Adams, S. A., Haupt, B. J., Uelzmann, A., & McCaffrey, T. (2017). Meditative Movement, Energetic, and Physical Analyses of Qigong and Tai Chi. Evidence‑Based Complementary and Alternative Medicine, 2017, 8354071.Bai, Y., Zhang, C., Chen, J., Xu, X., & Luo, X. (2011). A review of evidence suggesting that the fascia network may be the physical substrate represented by the meridians of Traditional Chinese Medicine. Journal of Bodywork and Movement Therapies, 15(3), 344–353.Li, H., Yin, Y., Hu, J., Li, H., Wang, F., Ji, F., … Ma, C. (2020). An insight into acupoints and meridians in the human body based on interstitial fluid circulation. arXiv preprint.Wang, F., Li, X., Wang, X., & Jiang, X. (2020). Efficacy of topical silicone gel in scar management: A systematic review and meta‑analysis of randomized controlled trials. International Wound Journal, 17(3), 765–773.Monstrey, S., Middelkoop, E., Vranckx, J. J., Bassetto, F., & Ziegler, U. E. (2014). Updated scar management practical guidelines: Non‑invasive and invasive measures. Journal of Plastic, Reconstructive & Aesthetic Surgery, 67(8), 1017–1025.Ai, J. W., Liu, J.-T., Pei, S.-D., Liu, Y., Li, D.-S., Lin, H.-M., … & Lin, Z. (2017). The effectiveness of pressure therapy (15–25 mmHg) for hypertrophic burn scars: A systematic review and meta‑analysis. Scientific Reports, 7, 40185.The effectiveness of pressure therapy (15‑25 mmHg) for hypertrophic burn scar prevention and treatment. Scientific Reports, 7, 40185.Fu, X., Ma, L., & Chen, H. M. (2019). Advances in the treatment of traumatic scars with laser: A systematic review. Burns & Trauma, 7, 29.Mony, M. P., Harmon, K. A., Hess, R., Dorafshar, A. H., & Shafikhani, S. H. (2023). An updated review of hypertrophic scarring: Pathophysiology and emerging therapeutic strategies. Cells, 12(5), Article 678.An, J. K., Shim, W., Lee, D. G., & Lee, J. H. (2024). Clinical application of self‑adherent silicone scar care: Mepiform and Mepiform Ultra Scar Gel in postoperative scar management. Journal of Wound, Ostomy & Continence Nursing, 51(2), 147‑156.De Decker, I., van den Broek, S., & van der Marel, E. (2023). Pressure therapy for scars: Myth or reality? A systematic review of pressure garment therapy for scar management. Burns and Trauma, 49(6), 1453‑1462.Wiedenmann, C. J., Gottwald, C., Zeqiri, K., Frömmichen, J., Bungert, E., Gläser, M., Ströble, J., Lohmüller, R., Reinhard, T., Lübke, J., & Schlunck, G. (2023). Slow interstitial fluid flow activates TGF‑β signalling and drives fibrotic responses in human Tenon fibroblasts. Cells, 12(17), 2205.Yao, W. & Weiss, J. A. (2012). “Interstitial Fluid Flow: The Mechanical Environment of Cells in Soft Tissue.” Frontiers in Bioengineering and Biotechnology, 4 : 41.Galie, P. A., Nguyen, A. H., & Stevens, K. R. (2011). Interstitial fluid flow and cyclic strain differentially regulate cardiac fibroblast phenotype and matrix remodelling. American Journal of Physiology‑Heart and Circulatory Physiology, 301(5), H1380‑H1390.Zhang, Z., Cai, Y., & Xu, Y. (2025). Mechanical effects in aging of the musculoskeletal system. Mechanisms of Ageing and Development, 198, 111844.Bordoni, B., Marelli, F., & Morabito, B. (2018). A New Concept of Biotensegrity Incorporating Liquid Tissues. Journal of Multidisciplinary Healthcare, 11, 603‑614.Blottner, D. (2019). The fascia: Continuum linking bone and myofascial bag for whole‑body tensional support. Journal of Bodywork & Movement Therapies, 23(2), 408‑417.Langevin, H. M. (2006). Connective tissue: A body‑wide signaling network? Medical Hypotheses, 66(6), 1074‑1077.Stecco, A., Macchi, V., Stecco, C., Porzionato, A., Day, J. A., Delmas, V., & De Caro, R. (2009). Anatomical study of myofascial continuity in the anterior region of the upper limb. Journal of Bodywork & Movement Therapies, 13(1), 53‑62.Wilke, J., Krause, F., Vogt, L., & Banzer, W. (2016). What is evidence‑based about myofascial chains: A systematic review. Archives of Physical Medicine and Rehabilitation, 97(3), 454–461.Benias, P.C., Wells, R.G., Sack, K.D., Klifa, C., Wang, H., Gambhir, S.S., … Theise, N. D. (2018). Structure and distribution of an unrecognized interstitium in human tissues. Scientific Reports, 8(1), 4947.Hedley, G. (2013). The Integral Anatomy Series [Video series]. GilHedley.com. https://www.gilhedley.comHedley, G. (2013). The Integral Anatomy Series [Video series]. GilHedley.com. https://www.gilhedley.com
Research Proposal
Watson, S.-L., Fowler, A. J., Dias, P., Biccard, B., Wan, Y. I., Pearse, R. M., & Abbott, T. E. F. (2024). The lifetime risk of surgery in England: A nationwide observational cohort study. British Journal of Anaesthesia, 133(4), 768–775Sharma, A., Bajpai, M., & Kumar, P. (2023). Regulation of collagen I and collagen III in tissue injury and scarring: A review. Frontiers in Bioengineering and Biotechnology, 11, 9912297.Sun, L., Zhao, L., & Peng, R.-Y. (2021). Research progress in the effects of terahertz waves on biomacromolecules. Military Medical Research, 8, 28.Wei, F., Flowerdew, K., Kinzel, M., Perotti, L. E., Asiatico, J., Omer, M., Hovell, C., Reumers, V., & Coathup, M. J. (2022). Changes in interstitial fluid flow, mass transport and the mechanobiology of tissues. Bone Research, 10, 14.Nikitkina, A. I., Bikmulina, P. Y., Gafarova, E. R., Kosheleva, N. V., Efremov, Y. M., Bezrukov, E. A., Butnaru, D. V., Dolganova, I. N., Chernomyrdin, N. V., Cherkasova, O. P., Gavdush, A. A., & Timashev, P. S. (2021). Terahertz radiation and the skin: A review. Frontiers in Public Health, 9, 7881098.Wang, Q., Pei, S., Lu, X. L., Wang, L., & Wu, Q. (2019). On the characterization of interstitial fluid flow in skeletal muscle endomysium. Journal of Biomechanics, 83, 117–124.Peralta, X. G., Lipscomb, D., Wilmink, G. J., Echchgadda, I., Chen, X., Khandelwal, G., Pickwell‑MacPherson, E., & Taday, P. F. (2019). Terahertz spectroscopy of human skin tissue models with different pigmentations. IEEE Access, 7, 24425‑24432Ke, L., Yang, Q., Wu, S., Zhang, N., Liu, H. W., Teo, E. P. W., Mehta, J. S., Liu, Y.‑C., & Liu, Y.‑C. (2021). Ex vivo sensing and imaging of corneal scar tissues using terahertz spectroscopy. Scientific Reports, 11, 23344. Ex vivo sensing and imaging of corneal scar tissues using terahertz spectroscopy. Scientific Reports, 11, 23344.
References in alphabetical order APA style with relevance
Ai, J. W., Liu, J.-T., Pei, S.-D., Liu, Y., Li, D.-S., Lin, H.-M., … & Lin, Z. (2017). The effectiveness of pressure therapy (15–25 mmHg) for hypertrophic burn scars: A systematic review and meta‑analysis. Scientific Reports, 7, 40185.Synopsis: This pooled‑analysis of pressure therapy for hypertrophic scars found only mild improvements in height but limited effect on global scar appearance scores, highlighting the limitations of standard therapies. Demonstrates that while visible scars receive targeted treatment (e.g., pressure), the outcomes are often modest - supporting the idea of limited deeper tissue effect.Ajimsha, M. S., Al‑Mudahka, N. R., & Al‑Madzhar, J. A. (2015). Effectiveness of myofascial release: Systematic review of randomized controlled trials. Journal of Bodywork and Movement Therapies, 19(1), 102‑112.Synopsis: This systematic review found mixed and variable evidence for myofascial release techniques (a common manual therapy) in reducing pain and improving function. The authors conclude that more high‑quality trials are needed and point out that deeper tissue changes and fluid dynamics are seldom addressed.An, J. K., Shim, W., Lee, D. G., & Lee, J. H. (2024). Clinical application of self‑adherent silicone scar care: Mepiform and Mepiform Ultra Scar Gel in postoperative scar management. Journal of Wound, Ostomy & Continence Nursing, 51(2), 147‑156.Synopsis: This prospective study found that consistent use of silicone gel and sheet products resulted in measurable improvements in scar vascularity, height, and overall scar assessment scores over 12‑24 weeks. The study highlights that while surface appearance improved, deeper tissue healing and long‑term functional restoration remained uncertain. Reinforces that visible scar therapies (here silicone gels/sheets) are widely used and improve surface metrics, but deeper tissue dysfunction remains unaddressed.Bai, Y., Zhang, C., Chen, J., Xu, X., & Luo, X. (2011). A review of evidence suggesting that the fascia network may be the physical substrate represented by the meridians of Traditional Chinese Medicine. *Journal of Bodywork and Movement Therapies, 15(3), 344–353. Synopsis: This review explores how fascia networks may correspond with the meridian channels in TCM, thereby linking connective tissue/interstitial fluid frameworks with traditional approaches. Supports the statement about Chinese channel theory engaging interstitial‑connective tissues.Benias, P.C., Wells, R.G., Sack, K.D., Klifa, C., Wang, H., Gambhir, S.S., … Theise, N. D. (2018). Structure and distribution of an unrecognized interstitium in human tissues. Scientific Reports, 8(1), 4947. Synopsis: Through fresh‐frozen human tissue histology, the authors identified fluid‐filled interstitial spaces bounded by thick collagen bundles across multiple organs (skin, gut, bladder, fascia) and showed that fixation in conventional processing underestimated those spaces (they collapsed). They suggest this network may underlie long‑distance fluid transport and could facilitate propagation of mechanical or biochemical signals through the body’s connective matrix. This supports your concept of long‑range interstitial/adhesion networks.Blottner, D. (2019). The fascia: Continuum linking bone and myofascial bag for whole‑body tensional support. Journal of Bodywork & Movement Therapies, 23(2), 408‑417.Synopsis: Blottner presents anatomical and biomechanical evidence that the superficial and deep fascia form a continuous network linking muscle, tendon, bone, and joint structures. The work underlines that connective tissue can transmit tensional force longitudinally and laterally through the body, lending support to the idea that scars and adhesions may propagate beyond a localised region.Bordoni, B., Marelli, F., & Morabito, B. (2018). A New Concept of Biotensegrity Incorporating Liquid Tissues. Journal of Multidisciplinary Healthcare, 11, 603‑614.Synopsis: The authors propose a revised model of biotensegrity that integrates both the “solid fascia” (dense connective tissue) and “liquid fascia” (blood, lymph, interstitial fluids). They describe a continuous three‑dimensional matrix of connective tissues enveloping muscles, nerves, bones, and organs, as well as bodily fluids that carry mechanical and biochemical signals. This work supports the concept of a body‑wide interstitial network through which tissue interactions and scar propagation could occur.Brinkman, J. E. (2023). Physiology, Body Fluids. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.Bruce, J., Pergolizzi, J. V., Magnusson, P., & Kaye, A. D. (2011). Chronic post‑surgical pain. *Journal of Pain Research, 4, 79–87. Synopsis: This article states that between 10% and 30% of patients report some degree of chronic pain one year after surgery. It supports the assertion that many people remain with long‑term stiffness or pain, often treated symptomatically rather than mechanically or fluid‑dynamically.Cenaj, O., Allison, D. H. R., Imam, R., Zeck, B., Drohan, L. M., Chiriboga, L., Llewellyn, J., Liu, C. Z., Park, Y. N., Wells, R. G., Theise, N. D., & Ning, W. (2021). Evidence for continuity of interstitial spaces across tissue and organ boundaries in humans. Communications Biology, 4, Article 436.Synopsis: Cenaj and colleagues investigated whether human interstitial spaces—fluid‑filled networks of connective tissue—are structurally continuous across tissue and organ boundaries. Using two orthogonal approaches (tracking non‑biological particles such as tattoo pigment and colloidal silver, and visualising hyaluronic acid within interstitial spaces), they demonstrated movement of particles between skin, colon, mesenteric fascia, and other compartments, suggesting a body‑wide interconnected network of interstitial spaces. Their findings challenge the notion of isolated tissue compartments and highlight the potential significance of the interstitial system as a global fluid and signal network. De Decker, I., van den Broek, S., & van der Marel, E. (2023). Pressure therapy for scars: Myth or reality? A systematic review of pressure garment therapy for scar management. Burns & Trauma, 49(6), 1453‑1462. Synopsis: This systematic review critically evaluates the effectiveness of pressure garment therapy (PGT) for managing hypertrophic scars and keloids, particularly in burn patients. The authors assess multiple studies and conclude that while PGT is widely used in clinical practice, the evidence supporting its efficacy is inconsistent and of variable quality. Some studies show modest benefits in scar height and pliability, while others report no significant difference compared to alternative treatments or no treatment. The review calls for higher-quality, standardised clinical trials to determine the true effectiveness of pressure therapy. Supports the claim that visible scar treatments like pressure therapy are common and can influence superficial healing, but may not address deeper tissue dysfunction. Highlights the need for better understanding and evaluation of scar management strategies.Fu, X., Ma, L., & Chen, H. M. (2019). Advances in the treatment of traumatic scars with laser: A systematic review. Burns & Trauma, 7, 29. Synopsis: This guideline review covers the standard modalities in scar treatment including silicone, pressure therapy, laser treatments, and massage, noting their roles in reducing redness, height, and restoring flexibility to skin. Supports the statement that such treatments are widely used to manage visible scars and improve tissue flexibility.Fuller, A. M., Bharde, S., & Sikandar, S. (2023). The mechanisms and management of persistent postsurgical pain. Frontiers in Pain Research, 4, Article 1154597. Synopsis: This review examines how 10%–50% of surgical patients develop persistent postsurgical pain (PPP) lasting more than three months. It underscores that many people are left with long‑term pain or mobility issues after surgery, supporting the statement about long‑term outcomes being treated rather than addressed at the source.Galie, P. A., Nguyen, A. H., & Stevens, K. R. (2011). Interstitial fluid flow and cyclic strain differentially regulate cardiac fibroblast phenotype and matrix remodelling. American Journal of Physiology‑Heart and Circulatory Physiology, 301(5), H1380‑H1390.Synopsis: This experimental work shows that fibroblasts respond differently to interstitial fluid flow and mechanical strain, affecting their differentiation and matrix‑remodelling behaviour. Reinforces the idea that modulating IFF and tissue mechanics can influence deeper tissue remodelling rather than only superficial effects.Hedley, G. (2013). The Integral Anatomy Series [Video series]. GilHedley.com. https://www.gilhedley.comSynopsis: This four-volume dissection video series offers a detailed exploration of the human body's connective tissue continuity, challenging the compartmentalised view of anatomy. Through whole-body cadaver dissection, Hedley demonstrates that fascial and interstitial layers are part of a continuous, fluid-supported matrix - including what he terms the "fuzz" — a layer of loose connective tissue crucial to mobility and tissue health. The series supports a body-wide, systemic view of tissue structure and has influenced manual therapists, movement educators, and integrative health practitioners globally.Hedley, G. (2010). Notes on visceral adhesions as fascial pathology. Journal of Bodywork and Movement Therapies, 14(3), 255‑261. Synopsis: Hedley presents anatomical observations from cadaver dissections focusing on visceral adhesions and their classification as fascial pathology. He identifies four types of adhesions, discusses how these relate to normal interstitial connective tissue relationships, and proposes that these adhesions may propagate through the body’s fascial networks rather than remain strictly localized. This supports the concept of long‑range connective tissue continuity and supports your thesis regarding deep propagation of adhesions.Ke, L., Yang, Q., Wu, S., Zhang, N., Liu, H. W., Teo, E. P. W., Mehta, J. S., Liu, Y.‑C., & Liu, Y.‑C. (2021). Ex vivo sensing and imaging of corneal scar tissues using terahertz spectroscopy. Scientific Reports, 11, 23344. Ex vivo sensing and imaging of corneal scar tissues using terahertz spectroscopy. Scientific Reports, 11, 23344.Synopsis: This study explores the use of terahertz (THz) spectroscopy for detecting and imaging corneal scar tissue in ex vivo samples. The researchers demonstrate that THz waves can distinguish between healthy and scarred corneal tissue based on differences in water content and tissue structure, both of which affect THz absorption and reflection. Their findings suggest that THz imaging could offer a non-invasive method for evaluating tissue hydration and pathological changes in real time. This supports the idea that terahertz technology can sense differences in hydration and tissue state, aligning with the hypothesis that restoring interstitial fluid flows (IFF) may impact scar and fibrotic tissue. It also provides early evidence that THz could be used for monitoring deep tissue changes, not just surface-level pathology.Keane, T. J., & Stevens, M. M. (2018). Scarring vs. functional repair: Matrix‑based strategies to regulate tissue repair. Biomaterials Science, 6(1), 20‑31.Synopsis: This review outlines how scarring disrupts the extracellular matrix (ECM) by promoting dense, disorganised collagen deposition rather than functional regeneration. Scarring alters the connective environment through which cells communicate and rebuild.Keter, D. L., Rolff, H.-G., & Cook, C. (2025). The mechanisms of manual therapy: A living review of systematic, narrative, and scoping reviews. *PLOS ONE, 20(3), e0319586. Synopsis: This comprehensive “living review” of reviews shows that while manual therapy evokes various neurovascular, neuromuscular, and biomechanical responses, the quality of evidence for underlying mechanistic change remains low–moderate. It highlights the gap between immediate symptomatic relief and sustained structural or fluid‑dynamic change in tissue.Klein, P., Adams, S. A., Haupt, B. J., Uelzmann, A., & McCaffrey, T. (2017). Meditative Movement, Energetic, and Physical Analyses of Qigong and Tai Chi. *Evidence‑Based Complementary and Alternative Medicine, 2017, 8354071.Synopsis: This article discusses how Qigong and Tai Chi engage body-wide connective tissue networks - including fascia and interstitial systems - through continuous, multi‑planar movements. It links the practices to sensory‑based feedback and integrated whole‑body systems rather than purely muscular exercise. Supports the claim that Eastern systems engage interstitial/connective tissues through sensation and intention.Kohlhauser, M., Mayrhofer, M., Kamolz, L.-P., & Smolle, C. (2024). An update on molecular mechanisms of scarring - A narrative review. International Journal of Molecular Sciences, 25(21), 11579. Synopsis: This narrative review presents a comprehensive overview of the molecular pathways underlying scar formation, including collagen synthesis, fibroblast heterogeneity, and ECM remodelling. While mechanisms are studied, research remains largely centred on visible wounds rather than deep‑tissue dysfunction.Langevin, H. M. (2006). Connective tissue: A body‑wide signaling network? Medical Hypotheses, 66(6), 1074‑1077.Synopsis: Langevin hypothesises that connective tissue (fascia and interstitial matrix) acts as a mechanosensitive signalling network throughout the body, beyond its structural function. The article suggests that disruptions - such as from surgical interventions - could impair this system and contribute to pain, stiffness, or long‑term dysfunctional tissue behaviour.Li, H., Yin, Y., Hu, J., Li, H., Wang, F., Ji, F., … Ma, C. (2020). An insight into acupoints and meridians in the human body based on interstitial fluid circulation. *arXiv preprint. Synopsis: This work proposes that acupoints and meridians are part of a network of interstitial fluid pathways, mapping how interstitial fluid circulation may underlie classical meridian theory. Helps bridge how movement/sensation‑based Eastern practices might align with body-based sensory science of interstitial systems.Liu, T., Xiong, B., Cui, X., & Zhang, C. (2025). Numerical study of interstitial fluid flow behavior in osteons under dynamic loading. BMC Musculoskeletal Disorders, 26(1), 187. Synopsis: Tissue layers closer to the surface may yield greater responsiveness to flow‑stimulation, suggesting that therapies targeting accessible tissues (e.g., fascia, superficial connective layers) may benefit most.Liu, W-T. (2022). Interstitial Fluid Behavior and Diseases. Advanced Science, 9(1), 2100617.Synopsis: Liu provides an in‑depth review of how interstitial streams and fluid transport within the broader interstitial system relate to disease states. Healthy fluid dynamics are fundamental to overall tissue behaviour and that disruptions can lead to fibrosis and impaired healing.Monstrey, S., Middelkoop, E., Vranckx, J. J., Bassetto, F., & Ziegler, U. E. (2014). Updated scar management practical guidelines: Non‑invasive and invasive measures. Journal of Plastic, Reconstructive & Aesthetic Surgery, 67(8), 1017–1025. Synopsis: This guideline review covers the standard modalities in scar treatment including silicone, pressure therapy, laser treatments, and massage, noting their roles in reducing redness, height, and restoring flexibility to skin. Supports the statement that such treatments are widely used to manage visible scars and improve tissue flexibility.Mony, M. P., Harmon, K. A., Hess, R., Dorafshar, A. H., & Shafikhani, S. H. (2023). An Updated Review of Hypertrophic Scarring. Cells, 12(5), Article 678. Synopsis: This review summarises current treatments (silicone, pressure, laser) and highlights the gap in addressing the deeper tissue microenvironment - including altered extracellular matrix, abnormal fluid retention, and impaired interstitial flow - as contributors to scar persistence. Demonstrates scientific acknowledgment that while surface treatments exist, disruptions in deeper tissue structures and fluid dynamics are seldom addressed.Moretti, L., Santos, L., Ribeiro, N., & Orzechowski, A. (2022). The interplay of fibroblasts, the extracellular matrix, and inflammation in fibrogenic progression. Journal of Biological Chemistry, 297(1), 100839. Synopsis: This article details how activated fibroblasts and ECM remodelling contribute to stiff scar tissue formation and long‑term dysfunction, supporting the idea that molecular mechanisms of scar formation are well documented, yet often focus on surface injury rather than deeper tissue contexts.Nikitkina, A. I., Bikmulina, P. Y., Gafarova, E. R., Kosheleva, N. V., Efremov, Y. M., Bezrukov, E. A., Butnaru, D. V., Dolganova, I. N., Chernomyrdin, N. V., Cherkasova, O. P., Gavdush, A. A., & Timashev, P. S. (2021). Terahertz radiation and the skin: A review. Frontiers in Public Health, 9, 7881098. Synopsis: This comprehensive review examines the interaction between terahertz (THz) radiation and human skin, summarizing existing research on biological effects, safety, and potential applications. The authors note that THz radiation is non-ionizing and primarily interacts with water molecules in tissues, making it especially relevant for assessing hydration levels. The paper highlights that THz spectroscopy and imaging can detect changes in water content, tissue structure, and possibly early pathological alterations - making it a promising tool for non-invasive diagnostics. However, the review also emphasizes that more long-term safety data and clinical validation are needed before widespread use. Because THz interacts strongly with hydrated biological structures, it may offer unique insight into the interstitial environment, including scarring, fibrosis, and tissue hydration - all key to understanding how IFF supports or limits regeneration.Peralta, X. G., Lipscomb, D., Wilmink, G. J., Echchgadda, I., Chen, X., Khandelwal, G., Pickwell‑MacPherson, E., & Taday, P. F. (2019). Terahertz spectroscopy of human skin tissue models with different pigmentations. IEEE Access, 7, 24425‑24432. Synopsis: This study explores how terahertz (THz) spectroscopy interacts with human skin tissue models of varying pigmentation levels. The researchers used artificial skin models to analyze THz wave penetration and reflection across different melanin concentrations, aiming to understand how skin tone affects THz diagnostic accuracy. Key findings: THz signals are affected more by water content and structure than by pigmentation. The study confirms THz spectroscopy's non-invasive potential for probing hydration, tissue density, and possibly pathological changes in skin-like tissues. The results reinforce the idea that THz can detect variations in tissue hydration and structure, which are central to interstitial fluid dynamics (IFF) and tissue regeneration. It supports the potential of THz tools for assessing scar tissue and fluid distribution across skin types.Rehnke, R. D. (2024). Clinical Implications of the Fascial System: A Commentary on One Surgeon’s Journey. Life, 14(1), 89. Synopsis: In this commentary, plastic surgeon Robert D. Rehnke reviews a century of anatomical and clinical literature on the fascial (connective) system, emphasizing its structural continuity, fluid‑filled spaces (the interstitium), and significance in tissue form, function and repair. He draws on fresh cadaver dissections, intraoperative videos, and fractal principles to demonstrate how fascia is not inert “packing material” but an active, self‑organizing scaffold rich in interstitial fluid and collagen bundles. He argues that dysfunction of this system—through densification, scarring, impaired interstitial fluid flow - may underlie many chronic musculoskeletal and soft‑tissue problems. Importantly, the work supports the concept of large‑scale connectivity of interstitial tissues across the body, implying that local injuries or scars may propagate or impact distant tissues via this network.Sharma, A., Bajpai, M., & Kumar, P. (2023). Regulation of collagen I and collagen III in tissue injury and scarring: A review. Frontiers in Bioengineering and Biotechnology, 11, 9912297. Synopsis: This review explores the distinct yet interconnected roles of collagen types I and III in tissue injury, repair, and scarring. Collagen III is typically upregulated in the early phases of wound healing, providing a more flexible scaffold for tissue regeneration. Over time, it is replaced by collagen I, which is stronger and more rigid, leading to scar formation. The paper highlights the importance of maintaining an appropriate balance between the two to support healthy healing and minimize fibrosis. Dysregulation of this balance is linked to excessive scarring, impaired healing, and chronic tissue stiffness. This study provides foundational support for discussions around scar dynamics and interstitial tissue health. It reinforces the idea that long-term scarring and stiffness may reflect an imbalance in collagen remodeling - a process that could be influenced by therapies aimed at modulating IFF and enhancing tissue hydration.Stecco, A., Macchi, V., Stecco, C., Porzionato, A., Day, J. A., Delmas, V., & De Caro, R. (2009). Anatomical study of myofascial continuity in the anterior region of the upper limb. Journal of Bodywork & Movement Therapies, 13(1), 53‑62. Synopsis: Fifteen fresh, unembalmed cadavers were dissected to investigate anatomical “myofascial continuities” in the anterior upper limb region. The authors documented consistent fascial expansions originating from flexor muscles (pectoral major, biceps brachii, palmaris longus) that extended into surrounding deep fascia and interconnected distant muscle groups. These findings support the existence of a body‑wide fascial network capable of mechanically transmitting tension and possibly affecting pain and movement beyond the initial site of injury. This study provides anatomical evidence of large‑scale connective‑tissue continuity, which aligns with the concepts of scar propagation through the interstitial matrix.Stewart, R. H. (2020). A modern view of interstitial space in health and disease. The Journal of Physiology, 598(24), 5611–5622. Synopsis: This review outlines how the interstitial (fluid‑filled) spaces between tissues regulate volume, pressure, and fluid flow, and argues that dysfunction in interstitial fluid dynamics underpins many degenerative processes. It supports the view that an often‑ignored fluid system plays a central role in tissue health and aging.Sun, L., Zhao, L., & Peng, R.-Y. (2021). Research progress in the effects of terahertz waves on biomacromolecules. Military Medical Research, 8, 28. Synopsis: This review summarizes the known biological effects of terahertz (THz) radiation on biomacromolecules, particularly proteins, DNA, and collagen. It highlights how non-ionizing THz waves interact with molecular vibrations and hydrogen bonding networks without damaging tissue, offering insights into safe, functional stimulation of biological systems. Key points: THz radiation influences molecular dynamics by interacting with collective vibrational modes, potentially altering protein folding, stability, and enzyme activity. Collagen, a major structural protein in tissues, shows resonant responses in the THz range, indicating a possible pathway for targeted therapeutic effects on connective tissue. Effects are highly frequency-specific and dose-dependent, suggesting controlled THz exposure could modulate biological activity without harm. This paper supports the idea that THz resonance has a specific and non‑destructive interaction with structural proteins like collagen and with water‑bond networks, which aligns with the proposed mechanism behind Terahertz Hydrodynamic Therapy (THT).Suzuki, Y., Nakamura, Y., & Igarashi, H. (2024). Interstitial fluid flow decreases with age, especially after 50 years. *Neurobiology of Aging, 141, 14‑20. Synopsis: This study provides direct empirical evidence that interstitial fluid flow (IFF) declines with age, particularly beyond age 50. The system slows and may underlie stiffness, pain, and tissue decline in aging.Verzella, M., Affede, E., Di Pietrantonio, L., Cozzolino, V., & Cicchitti, L. (2022). Tissutal and fluidic aspects in osteopathic manual therapy: A narrative review. Healthcare, 10(6), 1014. Synopsis: This narrative review explores how connective tissues respond to osteopathic manual therapy by highlighting both tissue (tissutal) and fluidic (interstitial fluid) components. The authors propose that somatic dysfunction and related tissue‑texture changes may stem from low‑grade inflammation acting on the extracellular matrix (ECM) and cellular water structures, specifically "exclusion‑zone" (EZ) water. They argue that manual therapy may exert its effects by normalising these water structures and modulating interstitial fluid pressure. The work supports the concept that body‑wide interstitial fluid flow contributes to tissue health and mobility, and that disruption of fluid/tissue dynamics may underlie chronic dysfunction.Wang, Q., Pei, S., Lu, X. L., Wang, L., & Wu, Q. (2019). On the characterization of interstitial fluid flow in the skeletal muscle endomysium. Journal of the Mechanical Behavior of Biomedical Materials, 102, 103504.Synopsis: This meta‑analysis found that topical silicone gel showed significant improvement in scar height, pigmentation, and pliability after ~6 months of use, supporting the role of silicone therapies in reducing tissue stiffness and visibility of scars. Confirms that scars from surgery/injury receive consistent attention and that silicone gels are evidence‑based treatments.Watson, S.-L., Fowler, A. J., Dias, P., Biccard, B., Wan, Y. I., Pearse, R. M., & Abbott, T. E. F. (2024). The lifetime risk of surgery in England: A nationwide observational cohort study. British Journal of Anaesthesia, 133(4), 768–775Synopsis: This large‑scale epidemiological study found that the lifetime risk of undergoing first‑time surgery in England is approximately 60% for both men and women, establishing a major baseline for understanding how many people are affected by surgical interventions. It supports the statement that over 60% of people in England will undergo surgery in their lifetime.Wei, F., Flowerdew, K., Kinzel, M., Perotti, L. E., Asiatico, J., Omer, M., Hovell, C., Reumers, V., & Coathup, M. J. (2022). Changes in interstitial fluid flow, mass transport and the bone cell response in microgravity and normogravity. Bone Research, 10(1), 65. Synopsis:
This review examines how interstitial fluid flow (IFF) and solute transport within porous bone tissues are altered under conditions of microgravity compared to normal gravity. It highlights how fluid‐borne shear stress, mass transport of nutrients and waste, and cell–matrix interactions are significantly impacted when IFF is reduced. The authors detail how decreases in IFF lead to impaired mechanotransduction, reduced cellular activity (e.g., in osteocytes and bone‑lining cells), and accelerated tissue degeneration. These insights underscore the importance of fluid movement within interstitial spaces as a key driver of tissue health and repair. This paper bolsters the assertion that IFF is vital for tissue repair and homeostasis, and that disruptions can lead to dysfunction such as fibrosis or diminished regeneration. It supports the idea that therapies aiming to restore or enhance interstitial fluid movement - such as the proposed Terahertz Hydrodynamic Therapy - could influence deeper tissue mechanics and improve outcomes.Weir, S., Samnaliev, M., Kuo, T.-C., Ni Choitir, C., Tierney, T. S., Cumming, D., Bruce, J., Manca, A., Taylor, R. S., & Eldabe, S. (2017). The incidence and healthcare costs of persistent post‑operative pain following lumbar spine surgery in the United Kingdom: a cohort study using the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES). BMJ Open, 7(9), e017585. Synopsis: This retrospective population‑based cohort study used UK healthcare databases (CPRD and HES) to follow 10,216 adults who underwent lumbar spine surgery between 1997–98 and 2011–12. The authors found that approximately 20.8% of patients developed persistent post‑operative pain (PPP) within 2 years after surgery. The study also demonstrated that those with PPP incurred significantly higher healthcare costs: mean cost differences of £5,383 over two years, £10,195 over five years, and £14,318 over ten years compared to those without PPP. Extrapolated nationally, this data suggests that PPP after lumbar surgery represents a substantial burden on the UK health service.Wiedenmann, C. J., Gottwald, C., Zeqiri, K., Frömmichen, J., Bungert, E., Gläser, M., Ströble, J., Lohmüller, R., Reinhard, T., Lübke, J., & Schlunck, G. (2023). Slow interstitial fluid flow activates TGF‑β signalling and drives fibrotic responses in human Tenon fibroblasts. Cells, 12(17), 2205. Synopsis: This in‑vitro study shows that very slow rates of interstitial fluid flow (IFF) are sufficient to trigger pro‑fibrotic signalling (e.g., TGF‑β) and extracellular matrix deposition in human fibroblasts. It underlines that IFF influences tissue remodelling through fluid dynamics. Supports the statement that IFF is directly involved in scar/fibrosis remodelling and that modifying flow rates could influence tissue recovery.Wilke, J., Krause, F., Vogt, L., & Banzer, W. (2016). What is evidence‑based about myofascial chains: A systematic review. Archives of Physical Medicine and Rehabilitation, 97(3), 454–461. Synopsis: This systematic review examined the anatomical evidence for six proposed myofascial meridians (myofascial chains) using cadaveric dissection studies and in‑vivo experiments. The authors found strong evidence for structural continuity across the “superficial back line,” “back functional line,” and “front functional line,” and moderate evidence for parts of the spiral and lateral lines. The review highlights that many muscles previously considered to function independently are in fact linked by connective tissue networks. The authors also note that the majority of evidence comes from cadaver studies, and that functional implications (e.g., force transmission or fluid transport) require further research. This supports a claim about cadaver evidence for whole‑body connective tissue continuities which could underpin a scar‑propagation theory.Yao, W. & Weiss, J. A. (2012). “Interstitial Fluid Flow: The Mechanical Environment of Cells in Soft Tissue.” Frontiers in Bioengineering and Biotechnology, 4 : 41. Synopsis: This paper discusses how interstitial fluid flow (IFF) serves as a key mechanical cue within soft tissues, influencing cellular behavior such as proliferation, differentiation, and extracellular matrix remodelling. The authors emphasize that IFF is not merely passive but actively shapes tissue function and repair by generating shear forces and guiding biochemical transport. The interplay between fluid dynamics and tissue mechanics is framed as critical to understanding healing, fibrosis, and aging. This reference strongly supports the idea that dynamic IFF is central to tissue health and regeneration. It validates the concept that stagnant or disrupted flow may underlie chronic dysfunction and that therapies enhancing IFF could support healing at the interstitial level.Zhang, Z., Cai, Y., & Xu, Y. (2025). Mechanical effects in aging of the musculoskeletal system. *Mechanisms of Ageing and Development, 198, 111844. Synopsis: This article investigates how aging alters mechanical loading and fluid pressure gradients in musculoskeletal tissues. It supports the statement that musculoskeletal aging involves biomechanical and fluid‑dynamic change beyond what is visibly treated.