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Proposed pathways include modulation of multiple neurotransmitter systems (influencing serotonin, dopamine, norepinephrine, GABA, glutamate levels), possible involvement of NMDA receptors, alpha-1 adrenergic signaling (e.g., potentiating pineal acetyltransferase activity), inhibition of somatostatin release via dopaminergic routes, reduced ACTH/cortisol for stress buffering, and stimulated growth hormone or somatoliberin secretion

The Chang study provides a mechanistic complement to the in vivo tendon-healing findings reported by Krivic and colleagues

These findings are in line with Stevenson's (2017) discussion on cultural capital and its impact on cultural participation