New targets for fascial, ligament and tendon research: a perspective from the Utah paradigm of skeletal physiology.

Here an octogenarian voice from the past argues that the physiology of fascia, ligaments and tendons has strong and useful analogs in some general features of bone physiology, including the latter's tissue-level mechanostat. Such analogs could provide unusually important targets for future collagenous-tissue research. Even by 2002, this field's authorities seldom discussed those analogs so this text concerns them. How well the above research proceeds could depend partly on A) making collagenous- tissue physiologists aware of those analogs (hence this article), B) on following a four-step analytical strategy, C) on "connecting the dots" between evidence and ideas from many clinical and basic-science fields to find larger "messages" and patterns hidden in mountains of lesser things, D) and on combining (i), cell- and molecular-biologic work, expertise and insights, (ii) with live-animal research and expertise and insights of the Utah paradigm of skeletal physiology. Why the "in vitro/in vivo collaboration" in "D" above? Partly because few, if any, skeletal tissue-level mechanisms function normally in current cell, tissue and organ culture systems. Consequently and historically an agent's in vitro effects seldom predicted correctly its in vivo effects, although the former effects may help to explain the latter ones after other studies revealed the latter ones. Things summarized in this article provide a foundation on which to build in the future. Since aging and other things took me out of that "building game", younger people will do that building when and how, and if, they wish to. The directions for that building suggested in this article differ enough from currently accepted "wisdom" that it may take years for most physiologists to concede their merit and begin that building in earnest. If so, so be it.