What happens when there are no GAGs in the tissue?

• A. No lubricant; collagen sticks to each other, leading to adhesions that the therapist must break.
• B. GAGs increase lubrication between fibers.
• C. No lubricant but no adhesions form.
• D. Joint becomes hypermobile.

Answer: (A)

Glycosaminoglycans in the extracellular matrix help bind water and create a slippery, gel-like environment that reduces friction between fibers during movement. When these GAGs are absent, the tissue loses that lubrication, so collagen fibers come into closer contact and rough surfaces rub against each other. This increased friction promotes the formation of adhesions as the tissue heals, which then restricts sliding and joint or tissue movement. That’s why the scenario described is no lubricant with adhesions forming, a situation therapists often address to restore glide. The idea that there would be more lubrication or that the joint would become hypermobile doesn’t fit with the absence of GAGs; lack of lubrication typically leads to sticking and stiffness rather than loosened, hypermobile joints.