Development of a technique to determine strains in tendons using the cell nuclei

Tenocytes detect mechanical stimuli in vivo, and respond through mechanotransduction pathways to initiate matrix remodelling in tendons. Due to the crimped nature of tendon fascicles, the strain field throughout is non-homogeneous. The present study has developed a means to quantify the local strain fields within a fascicle by monitoring the relative movement and deformation of fluorescently labelled tenocyte nuclei. A stage mounted test rig was designed to apply tensile strain to fascicles. Rat tail and bovine extensor tendons were harvested for analysis, and the cell nuclei stained and visualised using an inverted confocal microscope. As the fascicles were subjected to gross strains of up to 5%, the movement of selected tenocyte nuclei were recorded. Results from a series of cell nuclei from both tendon sources revealed that local strains were significantly less than the applied strain. The nuclei length to width ratio, an indicator of cell deformation, also increased with applied strain, most significantly between 2 and 3% applied strain.

Deformation properties of articular chondrocytes: a critique of three separate techniques

This paper presents a series of techniques, which examine the deformation characteristics of bovine articular chondrocytes. The direct contact approach employs well established methodology, involving AFM and micropipette aspiration, to yield structural properties of local regions of isolated chondrocytes. The former technique yields a non-linear response with increased structural stiffness in a central location on a projected image of the chondrocyte. A simple viscoelastic model can be used with data from the micropipette aspiration technique to yield a mean value of Young's modulus, which is similar to that recently reported (Jones et al., 1999). An indirect approach is also described, involving the response of chondrocytes seeded within compressed agarose constructs. For 1% agarose constructs, the resulting cell strain, yields a gross cell modulus of 2.7 kPa. The study highlights the difficulties in establishing unique mechanical parameters, which reflect the deformation behaviour of articular chondrocytes.

The measurement of interface pressure and its role in soft tissue breakdown

This paper describes the effect of applied pressure on soft tissue and its possible role in the development of pressure ulcers. It concentrates on the quantification of the applied pressure at the patient-support interface and the limitations and variability of current techniques, measurement systems and data presentation. It then describes the effects of interface pressures at the tissue and cellular level, and attempts that have been made to describe and model the tissue mechanics. Finally it sets a challenge to medical engineers to improve the present measurement systems and tissue models, thus increasing understanding, both clinically and at the cellular level, so that the incidence of pressure ulcers can be reduced.

Fatigue damage of human tendons

The study was designed to examine the effects of partial fatigue on specific mechanical parameters which characterise human tendons in vitro. Specimens prepared from 12 intact Extensor digitorum longus tendons of the foot were subjected to partial fatigue, equivalent to 25% of the median fatigue life, by a cyclic square tension-tension stress waveform at the physiological frequency of 4 Hz. The maximum stress was set at a value corresponding to 20% of the calculated ultimate tensile strength (UTS) of 100 MPa. The minimum stress was set at 1% of the UTS. Dynamic characterisation was performed at stress levels of 10% and 20% of the UTS prior to and following partial mechanical fatigue. Subsequent quasi-static tests were performed on some of the specimens. Comparative analysis of the damage ratios (DRs) of quasi-static and dynamic mechanical parameters suggested the use of the DR for dynamic tensile modulus as a good indicator of damage inflicted by mechanical fatigue. Such an approach might be used for an in vivo assessment of tendon damage.

Cell and nucleus deformation in compressed chondrocyte-alginate constructs: temporal changes and calculation of cell modulus

Mechanical loading is essential for the homeostasis of articular cartilage and may be necessary for achieving functional tissue engineered cartilage repair using isolated cells seeded in scaffolds such as alginate. Chondrocyte mechanotransduction is poorly understood, but may involve cell deformation and associated distortion of intracellular organelles. The present study used confocal microscopy to examine cell and nucleus morphology in isolated chondrocytes compressed in alginate constructs. Compression of 2% alginate resulted in cell deformation from a spherical to an oblate ellipsoid morphology with conservation of cell volume. Cell deformation was associated with deformation, to a lesser degree, of the nucleus. Despite constant cell deformation over a 25 min period of static compression, the nucleus deformation reduced significantly, particularly in the axis perpendicular to the applied compression. Constructs made of a lower alginate concentration exhibited a reduced compressive modulus with an altered cellular response to compression. In 1.2% alginate, compression resulted in cell deformation which was initially of a similar magnitude to that in 2% alginate but subsequently reduced over a 60 min period reflecting the viscoelastic behaviour of the gel. This phenomenon enabled the calculation of a stress-strain relationship for the cell with an estimated Young's modulus value of approx. 3 kPa.

Dynamic compression inhibits the synthesis of nitric oxide and PGE(2) by IL-1beta-stimulated chondrocytes cultured in agarose constructs

Both mechanical loading and interleukin-1beta (IL-1beta) are known to regulate metabolic processes in articular cartilage through pathways mediated by nitric oxide ((*)NO) and PGE(2). This study uses a well-characterized model system involving isolated chondrocytes cultured in agarose constructs to test the hypothesis that dynamic compression alters the synthesis of (*)NO and PGE(2) by IL-1beta-stimulated articular chondrocytes. The data presented demonstrate for the first time that dynamic compression counteracts the effects of IL-1beta on articular chondrocytes by suppressing both (*)NO and PGE(2) synthesis. Inhibitor experiments indicated that the dynamic compression-induced inhibition of PGE(2) synthesis and stimulation of proteoglycan synthesis were (*)NO mediated, while compression-induced stimulation of cell proliferation was (*)NO independent. The inhibition of (*)NO and PGE(2) by dynamic compression is a finding of major significance that could contribute to the development of novel strategies for the treatment of cartilage-degenerative disorders.

Establishing predictive indicators for the status of loaded soft tissues

Two complementary techniques were employed to assess the soft tissue response to applied pressure. The noninvasive methods involve the simultaneous measurement of the local tensions of oxygen and carbon dioxide (tcPo 2 and tcPco 2) and the collection and subsequent analysis of sweat collected from the sacrum, a common site for the development of pressure sores. All tests were performed on able-bodied subjects. Results have indicated that oxygen levels (tcPo 2) were lowered in soft tissues subjected to applied pressures of between 40 (5.3 kPa) and 120 mmHg (16.0 kPa). At the higher pressures, this decrease was generally associated with an increase in carbon dioxide levels (tcPco 2) well above the normal basal levels of 45 mmHg (6 kPa). There were also considerable increases, in some cases up to twofold, in the concentrations of both sweat lactate and urea at the loaded site compared with the unloaded control. By comparing selected parameters, a threshold value for loaded tcPo 2 was identified, representing a reduction of ∼60% from unloaded values. Above this threshold, there was a significant relationship between this parameter and the loaded/unloaded concentration ratios for both sweat metabolites. These parameters may prove useful in identifying those subjects whose soft tissue may be compromised during periods of pressure ischemia.

Chondrocyte deformation within mechanically and enzymatically extracted chondrons compressed in agarose

Within articular cartilage, the chondron microenvironment will influence chondrocyte behaviour and response to loading. Chondrons were extracted from intact cartilage using either mechanical homogenisation (MC) or enzymatic digestion (EC) and cell and matrix morphology in unstrained and compressed agarose constructs was examined. Isolated chondrocytes (IC) were used for comparison. Immunolocalisation of type VI collagen and keratan sulphate revealed differences in the structure of the pericellular microenvironment such that MC most closely resembled chondrons in situ. The unstrained cell diameters of IC and EC were larger than MC at day 1 and increased significantly over a 7 day culture period. In contrast, cell diameters for MC remained constant. Compression of constructs at day 1 resulted in cell deformation for IC and EC but not MC. The two chondron extraction methods yielded chondrons of differing matrix morphology and associated differences in cell size and cellular response to load. The results indicate that the pericellular microenvironment of MC initially possessed a greater mechanical integrity than that of EC. Although these differences may be reduced with time in culture, characterisation of mechanically isolated chondrons suggests that the stiffness of the chondrons in situ may be greater than previous estimates.

Temporal changes in cytoskeletal organisation within isolated chondrocytes quantified using a novel image analysis technique

This paper examines temporal changes in the organisation of the cytoskeleton within isolated articular chondrocytes cultured for up to 7 days in agarose constructs. Fluorescent labelling and confocal microscopy were employed to visualise microtubules (MT), vimentin intermediate filaments (VIF) and actin microfilaments (AMF). To quantify the degree of cytoskeletal organisation within populations of cells, a novel image analysis technique has been developed and fully characterised. Organisation was quantified in terms of an Edge Index, which reflects the density of 'edges' present within the confocal images as defined by a Sobel digital filter. This parameter was shown to be independent of image intensity and, for all three cytoskeletal components, was validated statistically against a visual assessment of organisation. Both MT and VIF exhibited fibrous networks extending throughout the cytoplasm, while AMF appeared as punctate units associated with the cell membrane. The use of the Edge Index parameter revealed statistical significant temporal variation, in particular associated with VIF and AMF. These findings indicate the possibility of cytoskeletal mediated temporal variation in many aspects of cell behaviour following isolation from the intact tissue. Furthermore, the image analysis techniques are likely to be useful for future studies aiming to quantify changes in cytoskeletal organisation.

Mechanical compression influences intracellular Ca2+ signaling in chondrocytes seeded in agarose constructs

Ca2+ signaling forms part of a possible mechanotransduction pathway by which chondrocytes may alter their metabolism in response to mechanical loading. In this study, a well-characterized model system utilizing bovine articular chondrocytes embedded in 4% agarose constructs was used to investigate the effect of physiological mechanical compressive strain applied after 1 and 3 days in culture. The intracellular Ca2+ concentration was measured by use of the ratiometric Ca2+ indicator indo 1-AM and confocal microscopy. A positive Ca2+ response was defined as a percent increase in Ca2+ ratio above a preset threshold. A significantly greater percentage of cells exhibited a positive Ca2+ response in strained constructs compared with unstrained controls at both time points. In strained constructs, treatment with either Ga3+ or EGTA significantly reduced the number of positive Ca2+ responders compared with untreated controls. These results represent an important step in understanding the physiological role of intracellular Ca2+ in chondrocytes under mechanical compression.

The influence of mechanical loading on isolated chondrocytes seeded in agarose constructs

Articular cartilage is subjected to dynamic compressive loading during normal activity which influences chondrocyte metabolism through various mechanotransduction pathways. A well characterised and reproducible model system, involving chondrocytes embedded in agarose gel, has been used to investigate the effects of mechanical compression on chondrocytes, isolated from full depth cartilage or separately from the superficial and deep zone tissue. The role of nitric oxide as a mediator of mechanical-induced effects has also been studied. Chondrocytes were isolated, separately, from full depth, superficial and deep zone cartilage and seeded in 3% agarose constructs. Dynamic compressive strain was applied to the constructs using a range of frequencies (0.3, 1 and 3 Hz). Glycosaminoglycan synthesis, cell proliferation and nitrite production were assessed. In further experiments, constructs were compressed in the presence of 1 mM L-NAME or 10 microM dexamethasone. Glycosaminoglycan synthesis by full depth chondrocytes was affected by compressive strain in a frequency dependent manner. Dynamic strain at all frequencies induced an increase in [3H]-thymidine incorporation. Glycosaminoglycan synthesis by deep zone cells was affected by the strain regimes in a similar fashion to full depth cells, while superficial cells exhibited a similar proliferative response to full depth cells. Dynamic compression inhibited nitrite production, the effect being reversed by L-NAME. Compression induced stimulation of [3H]-TdR incorporation was reversed by L-NAME. These studies demonstrate that glycosaminoglycan synthesis and proliferation are influenced by the dynamic strain regimes in a distinct manner. Indeed the data suggest that these processes occur in different chondrocyte sub-populations. It may be speculated that nitric oxide acts as a mediator of mechanotransduction processes affecting proliferation primarily in the superficial cell sub-population.

A system for monitoring the response of uniaxial strain on cell seeded collagen gels

The success of cell seeded constructs for the repair of collagenous tissues may be improved by the use of mechanical stimulation in vitro. A mechanical loading apparatus, termed the cell straining system, was developed according to a set of design criteria, to enable cell seeded constructs to be cyclically loaded in tension. A suitable cell seeded collagen gel model system was used to characterise the apparatus. These gels were subjected to a cyclic strain of 10% superimposed on two separate tare loads of 2 and 10 mN, while being maintained in cell culture conditions. The computer controlled apparatus was shown to be capable of monitoring the individual loads on six specimens simultaneously, to an accuracy of 0.02 mN. Results indicated a wide variability between individual specimens. Following cyclic loading, the cell seeded collagen gels exhibited an increase in structural stiffness compared with the unloaded controls. This novel and versatile apparatus will provide a means of enhancing structural and mechanical integrity of tissue engineered repair systems.

Determination of molecular changes in soft tissues under strain using laser Raman microscopy

The paper presents a non-contact technique to examine the molecular changes in a collagen fibre subjected to in vitro axial tension. Laser Raman microscopy was employed to monitor the vibrational changes in specific assignments of the Raman spectrum of collagen. Results were presented in the form of Raman wavenumber shift as a function of applied tensile strain. Two distinct responses were observed depending on whether the vibrations were axial to, or normal to, the collagen backbone. The former response produced a decrease in wavenumber values, indicating tension, whereas the latter produced an increase, indicating compression. The rate of wavenumber shift with applied strain was non-linear in form, with a marked increase at higher levels of applied strain, for example, a strain 4% in the case of axial vibrations. This technique can prove to be a powerful tool for examining deformation at the molecular level in collagenous tissues.

Confocal analysis of cytoskeletal organisation within isolated chondrocyte sub-populations cultured in agarose

This study reports the cytoskeletal organisation within chondrocytes, isolated from the superficial and deep zones of articular cartilage and seeded into agarose constructs. At day 0, marked organisation of actin microfilaments was not observed in cells from both zones. Partial or clearly organised microtubules and vimentin intermediate filaments cytoskeletal components were present, however, in a proportion of cells. Staining for microtubules and vimentin intermediate filaments was less marked after 1 day in culture however than on initial seeding. For all three cytoskeletal components there was a dramatic increase in organisation between days 3 and 14 and, in general, organisation was greater within deep zone cells. Clear organisation for actin microfilaments was characterised by a cortical network and punctate staining around the periphery of the cell, while microtubules and vimentin intermediate filaments formed an extensive fibrous network. Cytoskeletal organisation within chondrocytes in agarose appears, therefore, to be broadly similar to that described in situ. Variations in the organisation of actin microfilaments between chondrocytes cultured in agarose and in monolayer are consistent with a role in phenotypic modulation. Vimentin intermediate filaments and microtubules form a link between the plasma membrane and the nucleus and may play a role in the mechanotransduction process.

Chondrocyte deformation within compressed agarose constructs at the cellular and sub-cellular levels

Mechanotransduction events in articular cartilage may be resolved into extracellular components followed by intracellular signalling events, which finally lead to altered cell response. Cell deformation is one of the former components, which has been examined using a model involving bovine chondrocytes seeded in agarose constructs. Viable fluorescent labels and confocal laser scanning microscopy were used to examine cellular and sub-cellular morphology. It was observed that cell size increased up to day 6 in culture, associated with an increase in the contents of proteoglycan and collagen. In addition, the organisation of the cytoskeleton components, described using a simple scoring scale, revealed temporal changes for actin fibres, microtubules and vimentin intermediate filaments. The constructs on day 1 were also subjected to unconfined compressive strains. A series of confocal scans through the centre of individual cells revealed a change from a spherical to an elliptical morphology. This was demonstrated by a change in diameter ratio, from a mean value of 1.00 at 0% strain to 0.60 at 25% strain. Using simple equations, the volume and surface areas were also estimated from the scans. Although the former revealed little change with increasing construct strain, surface area appeared to increase significantly. However further examination, using transmission electron microscopy to reveal fine ultrastructural detail at the cell periphery, suggest that this increase may be due to an unravelling of folds at the cell membrane. Cell deformation was associated with a decrease in the nuclear diameter, in the direction of the applied strain. The resulting nuclear strain in one direction increased in constructs compressed at later time points, although its values at all three assessment times were less than the corresponding values for cell strain. It is suggested that the nuclear behaviour may be a direct result of temporal changes observed in the organisation of the cytoskeleton. The study demonstrated that the chondrocyte-agarose model provides a useful system for the examination of compression events at both cellular and sub-cellular levels.

The effects of design and configuration on the biomechanical response of an internal spinal fixator

This study examines the biomechanical performance of an internal spinal fixator and the effects of specific design features under a range of loading modes. The commercial device was mounted on plastic vertebrae in a corpectomy injury model and attached by a series of experimental jigs to an appropriate material testing machine and tested under axial compression, torsion and flexion and extension moments. Results from the torsional tests indicated that increasing the clamp tightening torque from 5 to 15 N m significantly increased the rigidity of the fixation system. The inclusion of the transverse elements resulted in a significant increase in the torsional stiffness, with the increase largely overriding the effect of clamp tightening torque. By contrast, under compressive and both flexion and extension loads, neither of the design features of the fixator had a marked effect on the overall measured stiffness of the system. However, under extension loads, there were specific interactions between the two design parameters. The present study clearly indicates the need for the optimization of the design of the clamps and for alternative configurations of the transverse elements to enhance their performance under sagittal loads.

Forces measured during spinal manipulative procedures in two age groups

OBJECTIVE

Manipulation techniques have a prominent, yet controversial, role in the treatment of back pain. Their use varies widely between the professional groups and between individual therapists, with no accurate method of standardizing or quantifying the treatment administered.

METHODS

An instrumented mobilization couch was developed to measure and characterize typical forces used during spinal manipulative therapy. The couch was used to measure the forces applied to the lumbar spine of 30 young healthy subjects during five mobilization techniques, and to a clinical sample of 31 patients, aged between 45 and 65 yr.

RESULTS

The magnitudes of the mobilization forces were found to be similar for the young and the older groups. Median forces of 164 and 168 N, respectively, were recorded during a Grade III procedure. However, the forces applied to the older group exhibited a smaller amplitude and higher frequency of oscillation than those applied to the young group (P < 0.001).

CONCLUSION

Objective measurements can be used to characterize manipulative forces for both evaluative and teaching purposes.

Measurement of the deformation of isolated chondrocytes in agarose subjected to cyclic compression

Mechanically induced cell deformation is one of a number of possible mechanotransduction pathways by which chondrocytes sense and respond to changes in their mechanical environment. The present study describes a system for measuring the deformation of isolated chondrocytes in agarose during both static and cyclic compression. A test rig mounted on the stage of an inverted microscope was used to apply precise levels of compressive strain to individual cell-agarose constructs bathed in culture medium. Images of the cells were recorded using a CCD video camera attached to the microscope. Cell deformation was quantified in terms of a deformation index (X/Y) representing the ratio of cell diameters measured parallel (X) and perpendicular (Y) to the axis of compression. Cyclic compression between 0 and 15% strain, at 0.3 Hz, resulted in cyclic deformation of the cells at the same frequency. However, during the unstrained phase the cells did not fully recover to their initially spherical morphology (X/Y = 1.0). During the strained phase, the level of deformation (X/Y = 0.59) was initially similar to that observed during static 15% strain. However, this level of cell deformation reduced over a 20 min period of cyclic compression (X/Y = 0.72), although during static compression the cell deformation remained constant. This system may be used to examine cellular events under a range of dynamic mechanical stimuli.

Response of chondrocyte subpopulations cultured within unloaded and loaded agarose

Although it is well known that the metabolism of chondrocytes can be altered by the application of mechanical strain, it is unclear whether chondrocytes from the superficial and deep zones of cartilage respond in a similar manner. In this study, chondrocytes from the uppermost 15-20% (superficial cells) and the remaining tissue (deep cells) from bovine articular cartilage were isolated separately and cultured in agarose constructs. Cell deformation on application of a 15% static compressive strain was identical for both subpopulations after 24 and 72 hours in culture. The constructs were incubated under static and dynamic (0.3, 1, and 3 Hz) strains of 15% amplitude. Glycosaminoglycan synthesis by deep cells was unaffected by static strain or 3 Hz dynamic strain, whereas 0.3 Hz produced a significant reduction and 1 Hz induced a highly significant 50% stimulation of glycosaminoglycan synthesis (p < 0.001). Superficial cells exhibited a general inhibition of glycosaminoglycan synthesis. By contrast, proliferation of superficial cells was stimulated by dynamic strain whereas deep cells were not influenced. It has been suggested previously that mechanotransduction-induced controls of glycosaminoglycan synthesis and proliferation in chondrocytes embedded in agarose are uncoupled. Data presented in this study demonstrate that the two processes do, in fact, occur in different subpopulations of chondrocytes within the full-depth cell isolate.

The influence of elaborated pericellular matrix on the deformation of isolated articular chondrocytes cultured in agarose

This study investigates the mechanical influence of pericellular matrix on the deformation of isolated articular chondrocytes compressed within 3% agarose specimens. After 1 day in culture, the cells were associated with minimal amounts of sulphated glycosaminoglycan (GAG) and hydroxyproline and exhibited substantial deformation from a spherical to an oblate ellipsoid morphology when subjected to 20% gross compressive strain. However, over the 6 day culture period, there was a reduction in cell deformation associated with an increase in matrix content. Treatment with testicular hyaluronidase at days 3 and 6 reduced sulphated GAG content to levels observed in untreated specimens at day 1. At day 3, the resulting cell deformation during 20% compression was equivalent to that in specimens compressed at day 1. However, at day 6 cell deformation was only partially restored, suggesting the presence of additional structural matrix components, other than sulphated GAG, which were not present at day 3. Dual scanning confocal microscopy indicated that the elaborated matrix formed a pericellular shell which did not deform during compression and was therefore stiffer than the 3% agarose substrate. Therefore, the elaboration of a mechanically functional pericellular matrix within 6 days, effectively limits the potential involvement of cell deformation in mechanotransduction within cell seeded systems such as those employed for cartilage repair.

Dynamic mechanical compression influences nitric oxide production by articular chondrocytes seeded in agarose

Nitric oxide (NO) has been implicated in the inhibition of cell proliferation in cytokine and lipopolysaccharide (LPS)-stimulated chondrocytes and is known to be influenced by physical forces in several tissues. In this study, a well-characterized model system utilizing bovine chondrocytes embedded in 3% agarose constructs has been used to investigate the effect of dynamic strain at 0.3, 1, or 3 Hz on NO production. LPS induced a significant increase in nitrite levels, which was reversed by both L-NAME and dexamethasone. Dynamic compressive strain produced a significant reduction in nitrite production. The effect was partially blocked by L-NAME but unaffected by dexamethasone. L-NAME also reversed dynamic compression-induced stimulation of [3H]-thymidine incorporation. NO appears to be a constituent of mechanotransduction pathways which influence proliferation of bovine chondrocytes seeded within agarose constructs. The inhibitor experiments also infer that alterations in cNOS activity primarily determine the response.

The viability of soft tissues in elderly subjects undergoing hip surgery

AIMS

To assess the viability of soft tissues in elderly patients subjected to prolonged support pressures.

DESIGN

measurements were performed on the soft tissues of patients undergoing surgery for fracture of the proximal femur.

METHODS

10 subjects, mean age 84 years, participated. Transcutaneous gas tensions were continuously monitored in an area adjacent to the contralateral greater trochanter, which was loaded with an external applicator. Subcutaneous interstitial pressures using a slit catheter were also measured.

RESULTS

Transcutaneous oxygen partial pressure fell in some patients to critically low levels, defined as below 2.7 kPa (20 mmHg), whilst they were subjected to normal interface pressures on the operating table. Transcutaneous partial carbon dioxide pressures rarely rose above 8.0 kPa (60 mmHg). The measured interstitial pressures could lead to local occlusion of skin microvessels.

CONCLUSIONS

This study confirms that tissue viability could be compromised in elderly patients undergoing surgical procedures. The methods employed may be of value in assessing support surfaces in the operating theatre to reduce the incidence of pressure sores in this high-risk patient group.

Variability of forces applied by experienced therapists during spinal mobilization

OBJECTIVE: To determine the variation in forces used by different therapists during mobilization of the lumbar spine and the repeatability and reproducibility of individual therapists. DESIGN: An instrumented mobilization couch was developed to measure the forces applied to the trunk during spinal mobilization. BACKGROUND: Due to limitations in equipment design and data analysis, previous related studies demonstrate equivocal results. METHODS: The system was used to collect data from a sample of 30 experienced therapists to evaluate variation, repeatability and reproducibility during the application of five mobilization procedures. RESULTS: The variation in forces used by different therapists when performing the same technique was substantial, ranging between 63 and 347 N for one technique. During this procedure, 30% of the therapists were found to be relatively consistent, repeating the magnitude of the force applied at the first session within 5%. Others demonstrated considerable variation, exhibiting a difference as great as 34%. CONCLUSIONS: The inconsistency between experienced therapists has considerable implications for clinical practice. Changes in the magnitude and rate of loading are likely to have different effects due to the inherent viscoelastic behaviour of soft tissues. RELEVANCE: Spinal mobilization and manipulation techniques are frequently used by manual therapists in the treatment of musculoskeletal disorders. Despite the reliance on these techniques in clinical practice, there is little scientific evidence to substantiate their use. Before progress in this area can be made, it is necessary to characterize the forces used during typical mobilization procedures. The results can be used to develop teaching strategies and as a basis for comparative research on the efficacy of these techniques.