Skin response to mechanical stress: adaptation rather than breakdown--a review of the literature

The abnormal loading of skin and other surface tissues unaccustomed to bearing large mechanical forces occurs under many circumstances of chronic disease or disability. A result of abnormal loading is breakdown of the body wall tissues. An effective rehabilitation program avoids the pathological processes that result in skin trauma and breakdown and encourages load-tolerance and adaptation, changes in the body wall so that the tissues do not enter an irreversible degenerative pathological process. In the past, prevention has been the principal approach to the challenge of maintaining healthy skin and avoiding breakdown; therefore, relatively little is described in the rehabilitation literature about skin adaptation. However, adaptation has been investigated in other fields, particularly biomechanics and comparative anatomy. The purpose of this paper is to assemble the research to date to present the current understanding of skin response to mechanical stress, specifically addressing load cases applicable to rehabilitation. Factors important to tissue response are considered and their effects on adaptation and breakdown are discussed.