FIBROTIC CONNECTIVE TISSUES AND CHRONIC PAIN
"You've got this injury you just can't shake. You take time off. You ice and stretch and do all the right things but you're still limping home. You spend too much time trying to articulate your particular brand of hurt to those loved ones who still put up with you. You follow referrals to physical therapists and massage therapists. You try to diagnose yourself on WebMD. Don't give up yet. Under your skin, encasing your body and webbing its way through your insides like spider webs, is fascia. Fascia is made up primarily of densely packed collagen fibers that create a full body system of sheets, chords and bags that wrap, divide and permeate every one of your muscles, bones, nerves, blood vessels and organs. Every bit of you is encased in it. You're protected by fascia, connected by fascia and kept in taut human shape by fascia." Cherry picked from the June, 2011 issue of Runners World by Julia Lucas (Understanding Your Fascia Fascia may be the Missing Piece for your Lingering Injury)
What makes one athlete "Injury Prone," while another never seems to miss a practice, let alone a game? Why are some people always fighting nagging injuries or constantly struggling with a wide array of CHRONIC PAIN SYNDROMES, while others seem to cruise through life without any pain or problems? And maybe more importantly, why does the medical community seem to ignore their own peer-reviewed literature on the subject (CASE IN POINT)? The reasons are many, but today I will hopefully shed some light on this topic.
In my neck of the Ozarks most people either DEER HUNT, or have been exposed to it. If you've ever FIELD-DRESSED your own deer (or for that matter, butchered anything at all) you are familiar with Fascia. FASCIA is the clear, mucousy, cellophane-like membrane that is found under the skin. But not only does it cover muscles, groups of muscles, as well as groups of fibers within individual muscles, it covers (or becomes continuous with) nerve sheaths, bone sheaths, TENDONS, LIGAMENTS, and even organs. Fascia is loaded with MECHANORECEPTORS, and can actually act as ITS OWN NERVOUS SYSTEM ---- the very thing that makes it the most potentially pain-sensitive tissue in the body (HERE). Fascia's various functions within the body are so critical that from the time of DR. AT STILL (the father of Osteopathy), research is increasingly showing that large amounts of pain, sickness, disease, and disability, are related to it's dysfunction (HERE).
Even though it's referred to as "Deep Fascia," much of it is quite superficial (HERE). Because of this it is prone to sprains and strains, as well as bumps, bruises, and impacts of varying intensities (HERE). Because of the ACUTE INFLAMMATORY RESPONSE that is associated with any amount of bodily injury, one of the first things that begins to occur post-injury is something called "Fibroblastic Proliferation".
Any time you see the word "blast" in biology, think 'builder'. In other words, Fibroblasts are cells that build fibers or fibrous tissue. Fibroblasts are the most commonly found cells in Connective Tissue. Their job is to manufacture and excrete the stuff that essentially makes up all tissue (including SCAR TISSUE) --- extracellular matrix (ECM) and COLLAGEN. Collagen is the most abundant tissue in the body, and plays a critical role in the healing of wounds or injuries. The Inflammatory Response turns FIBROBLASTS on to do their thing and heal your body by creating a scar.
The thing we always want to see with the formation of a scar (even if the Scar Tissue is microscopic) is "Functionality". The hope is that the scar heals more like well-combed hair than a hairball (HERE). If everything in the tissue is working as it should, even though it is still considered a scar, it is more flexible and elastic, with better strength. However, if the scar heals in a microscopically tangled, twisted, THICKENED, wadded up configuration, we tend to refer to this as FIBROSIS. Sometimes these scars (Fibrosis) are visible to the naked eye --- like that nasty cut on your arm from the bike wreck you had when you were 10 years old. More often than not, they are invisible --- even with commonly used ADVANCED IMAGING TECHNIQUES. This is because what I am describing is frequently happening in tissue that's as thin as cellophane.
The cellular matrix that makes up Fascia is like a three dimensional net, or wire webbing. Although extremely tough and flexible when healthy, when injured it begins to create excess cross-links. In other words, in order to get stronger, the web gets thicker. Stronger can be good, but in the body, there's always a trade off. Unfortunately, as the tissue thickens, it loses it's ability to stretch and elast. Once this happens, even though the Fascia is thicker, the loss of elasticity actually makes it weaker --- or at least more prone to injury (re-injury). It can no longer help muscles TRANSMIT LOADS AND FORCES as it should, and it cannot accurately transmit nerve-like impulses (see previous link on Fascia as a Second Nervous System). Plainly stated, a derangement of FASCIAL STRUCTURE (aka tensgerity) will sooner or later cause a subsequent loss of Fascial Function that can begin a catastrophic downhill spiral.
This tangle of thickened and inelastic tissue binds both the nerve and vascular tissues causing both pain and hypoxia (diminished OXYGENATION). If this sounds bad, it's because it is. Furthermore, this microscopically jumbled mass of tissue often becomes hypersensitized. According to famed neurologist and researcher Dr. Chan Gunn of the Seattle / Vancouver region, this tissue now has the potential to be over 1,000 times more pain-sensitive than normal tissue. This can lead to either Hyperalgia or Allodynia (HERE). The end result is CHRONIC PAIN and a medical community that rarely provides you any sort of meaningful information as far as what's wrong with you, or more importantly how to get your life back.
Instead you get drugs. And tests. And more drugs, and more tests. As you spin around and around on the MEDICAL MERRY-GO-ROUND, you begin to realize that your doctors not only don't understand what's happening to you, you get the impression they think you are malingering. Furthermore, you are told that the solution to your problem is things like PAIN MEDS, MUSCLE RELAXERS, NSAIDS (anti-inflammatory meds), and CORTICOSTEROID INJECTIONS. If this approach fails, you move to "Pain Management". Most "Pain Management" involves more of the same, only now they add things like burning out your nerves (RFA's) and surgically-implanted spinal cord stimulators to the mix. Gulp.
Sooner or later someone will diagnose you with DEPRESSION --- you know, the old Depression-is-causing-your-chronic-pain trick. You're given ANTIDEPRESSANTS and referred to a psychiatrist, who gives you all sorts of drugs as well. Those of you who have been down this road know that it is rarely beneficial or effective. You're at the end of your rope and you don't know what to do. Many of you are thinking more frequently about ending it all. The following is a letter I received this weekend from Australia.
Dear Dr. Schierling,
All day long I have this unbearable burning tingling sensation and if knocked or pushed in any way, the pain brings me to tears like a big baby. The tendons have me on the brink of mental madness from trying to cope with the pain, and not being able to explain to anybody at all just how much &^%@(#&$^ agony I'm in actually in doc. For a good 20 hours a day my pain level is 10 out of 10 and the other 4 hours it's 8 out of ten. Put it this way mate - if you can't help ease my pain , then I truly don't want to keep soldiering on anymore. Please forgive what I'm about to say doc but - I have seriously considered suicide as an option because my pain is beyond anything I care to live with. But then I look at my beautiful kiddies and pregnant wife and could never go thru with it. Though I truly truly can't go on like this too much longer. I thank god that I've found your website and I pray I get a return email from yourself or your secretary asap. I can not even pick up my babies anymore to give them a cuddle or show them my love. I'm tired of my non-understanding wife telling me to harden up and that my pain could not be as severe as I make out. So reluctantly I tell her to find herself and my babies a new man. One that can still work and make a living . One that can still hold her the way a wife needs to be held. One that can still pick up my babies and love them and hug them the way they deserve to be loved and cuddled.
As is frequently the case, I suggest taking matters into your own hands. The very first thing you must do is understand INFLAMMATION and its relationship to Fibrosis / Scar Tissue and Chronic Pain. I have written four (as in 4) articles on this relationship in the last four months (HERE'S A GOOD ONE). Click on the link and start reading. It is absolutely critical for you to get a firm handle on Inflammation if you hope to get out of pain and get your life back. Fail to control Inflammation and you'll have a difficult time with both your health and your WEIGHT. It always amazes me how many people --- no matter what their health problems are --- get dramatically better just from taking THIS FIRST STEP. But regardless, you can't stop here.
The second step requires restoring joint motion. For some of you this might be accomplished with some CHIROPRACTIC ADJUSTMENTS and / or gentle massage or "MELT" therapy. For many -- no matter how clean and healthy your diet and lifestyle has become --- you'll have to GET AFTER IT in order to address said Fascial Adhesions and adhesed Connective Tissues that formed before these changes were made. Be aware that very frequently these restrictions can cause pain and symptoms in distant parts of the body. Furthermore, if your problem is CHRONIC NECK PAIN (rampant here in America) or some sort of RADICULAR PROBLEM (arm / hand issues), you'll likely need to work on restoration of your neck's NORMAL CURVE.
What are some of the many benefits of having Connective Tissue Adhesions and Fibrosis broken during our TISSUE REMODELING TREATMENTS?
In modern science / medicine, everything is about division. Allow me to explain. We have divided and sub-divided the practice of medicine into any number of specialties and sub-specialties who each deal with a small segment of the body. While this can be quite effective some of the time, it also tends to cause tunnel vision. The example I used on my "Fascia Page" was that sitting too close to a movie screen (i.e. the front row) makes it difficult to see the bigger picture.
When we think of the human body or other living organisms in terms of "machinery" we are making a mistake. The body is a whole organism, and to continually look at it's various parts independently of each other can prevent one from ever getting the BIG IDEA. Tom Meyers of Anatomy Trains fame put it like this. "Fascia is the missing element in the movement/stability equation. While every anatomy lists around 600 separate muscles, it is more accurate to say that there is one muscle poured into six hundred pockets of the fascial webbing. The 'illusion' of separate muscles is created by the anatomist's scalpel, dividing tissues along the planes of fascia. This reductive process should not blind us to the reality of the unifying whole." (more on ANATOMY TRAINS)
To understand why I sometimes end up spending 2-3 hours with LONG-DISTANCE PATIENTS, you have to understand how FASCIA CONNECTS EVERY PART OF YOU TO EVERY OTHER PART OF YOU. If you want to understand this better, take a look at Meyers' MYOFASCIAL MERIDAINS or "Anatomy Trains". He coined this term to describe the manner in which Fascia and other Connective Tissues support the body and transmit loads and forces throughout.
Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).