Biological processes involved in mechanical force transmission in connective tissue: Linking bridges for new therapeutic applications in the rehabilitative field

Connective tissue is a dynamic structure that reacts to environmental cues to maintain homeostasis, including mechanical properties. Mechanical load influences extracellular matrix (ECM)-cell interactions and modulates cellular behavior. Mechano-regulation processes involve matrix modification and cell activation to preserve tissue function. The ECM remodeling is crucial for force transmission. Cytoskeleton components are involved in force sensing and transmission, affecting cellular adhesion, motility, and gene expression. Proper mechanical loading helps to maintain tissue health, while imbalances may lead to pathological processes. Active and passive movement, including manual mobilization, improves connective tissue elasticity, promotes ECM-cell homeostasis, and reduces fibrosis. In rehabilitation, understanding mechanical-regulation processes is necessary for ameliorating and developing treatments aimed at preserving tissue elasticity and preventing fibrosis. In this commentary, we aim to globally describe the biological processes involved in mechanical force transmission in connective tissue as support for translational studies and clinical applications in the rehabilitation field.