CHRONIC NECK PAIN
DRUGS KILL WHETHER PUSHED OR PRESCRIBED
SUGAR IS PUBLIC
SCAR TISSUE OR FIBROSIS?
(THE MICROSCOPIC STRUCTURE OF SCARRED FASCIA)
"Scar tissue is composed of the same protein (collagen) as the tissue that it replaces, but the fiber composition of the protein is different; instead of a random basketweave formation of the collagen fibers found in normal tissue, in fibrosis the collagen cross-links and forms a pronounced alignment in a single direction. This collagen scar tissue alignment is usually of inferior functional quality to the normal collagen randomized alignment."
The first thing I want to do is discuss the word 'random'. When I look at Webster's 1828, I see that the word's definition is, "A roving motion or course without direction; hence, want of direction, rule or method; hazard; chance; used in the phrase, at random that is, without a settled point of direction; at hazard. Done at hazard or without settled aim or purpose; left to chance; as a random blow. Without previous calculation...." Wikipedia itself defines randomness as, "the lack of pattern or predictability in events. A random sequence of events, symbols or steps has no order and does not follow an intelligible pattern or combination. Individual random events are by definition unpredictable."
Now; take a good look at the microscopic pictures above and tell me what you see. Is the basket on the left woven in a manner that could, in any rational sense of the word, be considered "random"? Absolutely not. And not only is it not random, it is highly ordered / organized. I would argue that rather than the purposeless of randomness when healthy, soft tissues become random after injury and / or insult. But.........
A perfect example of this is Scar Tissue itself. Although you might debate me; I would argue that the model I use to explain SCAR TISSUE to my patients, whether right or wrong, has no real bearing on the results of their treatment. The proof? Take a look at our TESTIMONIAL PAGE. But because testimonials are anecdotal and I don't blame you for wanting cold hard facts, allow me to give you just a few.
- Active Recovery Boston has a fantastic primer on Scar Tissue and the harm it's capable of. "Scar tissue. Adhesion. Fibrosis. The words are different, but the concepts are the same. This dense, fibrous tissue affects us all and is an underlying factor in many injuries. Scar tissue binds up and ties down tissues that need to move freely. As scar tissue builds up, muscles become shorter and weaker. Tension on tendons causes tendinosis. Nerves can become trapped. All these problems can cause reduced range of motion, loss of strength, and pain as well as tingling, numbness, and weakness."
- Physical Therapist Brett Sears wrote a piece called Scar Tissue: Physical Therapy Management. In it he presented an excellent overview of the entire process (cherry-picked of course). "The cellular makeup of collagen makes it very strong due to the alignment of collagen cells. It can resist tensile forces, such as stretching and pulling, without tearing or breaking. After injury to a muscle, tendon, skin, or ligaments in the body, the inflammatory process starts to heal the injury site. Unfortunately, the body does not know exactly how to arrange the collagen cells so that they become healthy tissue that can resist tensile and stretching forces. The collagen cells become a balled-up clump of tissue called scar tissue. The scar tissue can become stronger and better able to tolerate stretching forces through a process called remodeling. Remodeling scar tissue is a must to ensure that the muscle, tendon, skin, bone, or ligament becomes normal, healthy tissue again. Scar tissue remodeling occurs as you start to stretch and pull on it. The stretching of the scar tissue helps to align the collagen fibers to allow them to return to normal. This realignment of the collagen fibers makes the tissue better able to tolerate the forces that are placed on it during the day."
- When we look at pictures of Scar Tissue that were taken under a microscope, they always seem to look more random than normal tissue. Case in point, HERE.
- The website Microscopy U carries a picture of Scar Tissue that was taken at a magnification of 10X. The caption states, "The most familiar scars appear on the surface of the skin, though they also can develop on tissues located inside the body. Scar formation is a natural process that results from replacement tissue being somewhat structurally and functionally different than the original tissue that was injured. The poor elasticity of scar tissue can limit movement in areas of the body that were extensively damaged."
- Writing for the April, 2003 edition of a magazine for HORSE ENTHUSIASTS, Equus, Ruth Ann Mosby wrote, "Only a never-injured horse is an unscarred horse, for the inalterable reality of mammalian life is that repaired tissue is inferior to the original."
- Plastic surgeon David Sherris wrote in an article called Management Of Scar Contractures, Hypertrophic Scars, and Keloids that, "Wound contraction is a normal phase in cutaneous wound healing by which the edges of a wound are pulled toward the center of the wound itself." I extensively dealt with this phenomenon HERE.
- Another plastic surgeon, Dr. Mark Gold, writes in Scars: Why They Form and How to Treat Them, "Every wound takes up to two years to heal. The process is the same for a scratch and a tummy tuck. The wound seals it self in 24-48 hours... From six moths to two years the final collagen organization is taking place". This is critical to understand if you have been WHIPLASHED in an MVA, as insurance companies will tell you that these sorts of injuries should be healed in 6-8 weeks. The truth is, they should be --- all but the final and most important of the phases' the 'Remodeling Phase'. CLICK HERE for information about the various stages of the healing process for soft tissues.
- Breast Cancer dot org (Scar Tissue Formation) said on their site that, "Scar tissue can cause its own side effects. Nerve pain or numbness if scar tissue forms around nerves. A lump of scar tissue forms in the hole left after breast tissue is removed. If scar tissue forms around a stitch from surgery it's called a suture granuloma and also feels like a lump." I have seen any number of THESE over the years in any number of anatomical places. The article above, however, was geared specifically at those who have had BREAST SURGERY.
The bottom line is that no matter what it actually looks like under a microscope, Scar Tissue does not function as well as normal tissue on any level. It is essentially the body doing the best it can with what it's got to work with. The problem is, there will always be, at least to some degree, consequences. For one, there will always be a loss of ROM. Often this is obvious to the patient, but in almost as many cases, they have no idea they have lost as much range of motion as they have (and some people --- particularly younger women or girls, can have scar tissue building up with a normal ROM --- HERE).
In similar fashion to the way that Scar Tissue "blocks off cell communication and regeneration," it hinders the flow of oxygen as well. A failure to oxygenate is known as hypoxia and because it causes ACIDITY, is a known cause of tissue damage and subsequent Scar Tissue (not to mention NUMEROUS DISEASE STATES). As you can see, a very vicious cycle. Furthermore, hypoxia promotes the accumulation of FREE RADICALS in the soft tissues themselves. But not even this is where it ends.
The loss of function (the fifth sign of Inflammation known as "Functio Laesa") promotes even more injury. Because much of said injury is relatively quiet (mechanical stresses over time), it can slowly accumulate until it is as significant as a traumatic injury. I like to describe this phenomenon in terms of splitting a piece of wood by hand. To split said piece of wood you can pick up your 15 lb Monster Maul and take one massive lick, blowing the one piece apart into two pieces with a violent force. Or you can use wedges that you gently tap with a three pound hammer for weeks on end. The end result is the same. The only difference is that the first piece of wood split instantly.
Finally, according to Dr. Chan Gunn, the famed neurologist and clinical professor at University of Washington, the result can be extreme hypersensitivity to pain (HERE). "The definition used by the International Association for the Study of Pain is: “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described by the patient in terms of such damage”. But this definition can be misleading because pain, the central perception of noxious input, is not just one, but at least three distinct entities, and pain can also arise when there is no apparent tissue damage." If you are struggling with Chronic Pain, I would suggest you read his article in its entirety (WHAT IS PAIN?). BTW, Gunn is an expert in acupuncture and widely considered the father of modern DRY NEEDLING.
What does pain, inflammation, altered reflexes, loss of motion, and loss of function always lead to? Degeneration (HERE). This degeneration is multifaceted. I showed you right at a year ago that the number one way to stimulate your nervous system is via exercise (HERE). Although Gunn talks about neurodegeneration in his article above, a loss of function is also going to cause bony / joint degeneration (HERE). The problem is, degeneration, no matter where its found, always leads to diminished function, which in turn causes more degeneration. The secret is finding the right monkey wrench to throw in the right gears that will stop the machine from turning.
There are any number of ways to help beat this process. EXERCISE, TISSUE REMODELING, DRY NEEDLING, CHIROPRACTIC ADJUSTMENTS, THERAPY, ACUPUNCTURE, LASER THERAPY, FUNCTIONAL NEUROLOGY, NUTRITIONAL SUPPLEMENTS, etc, etc, etc. However, I tend to think that there is one area that is overlooked the majority of the time --- probably because it is the most difficult on the list. To truly have a prayer at getting better, you are probably going to have to address the Chronic Inflammation in your life (HERE).
The crazy thing is, this Inflammation might be coming at you in any number of ways, as it can take the form of PARASITES, BLACK MOLD, CHEMICAL EXPOSURE, SUBCLINICAL INFECTIONS, DENTAL ISSUES, GUT HEALTH ISSUES, HEAVY METAL TOXICITY, etc, etc, etc. However, besides studying and learning everything you can about your condition, the first thing you can do for yourself is to radically change your diet (HERE). Fortunately, this alone will solve huge numbers of cases (HERE is an example). HERE is a more comprehensive protocol.
SCAR TISSUE OR FIBROSIS?
DOES IT REALLY MATTER WHAT WE CALL IT?
Although it's never patients that are guilty, people sometimes take me to task for talking or writing about "Scar Tissue". Need an example? Here is a recent email I got from an Orthopedic Surgeon somewhere on the East Coast (name will remain anonymous). "Dr. Schierling, Having read some of your material on scar tissue I feel I must set the record straight by telling you how wrong you are to confuse it with fibrosis or what you refer to as "Fascial Adhesions". He went into more detail, talking about things like Keloids, and telling me that I was setting the practice of medicine back by oversimplifying and mixing some of these terms. Although he could potentially be correct, I doubt it. And to prove my point, I'll use that pinnacle of academia --- Wikipedia.
"Scars are areas of fibrous tissue (fibrosis) that replace normal skin (and other tissues) after injury of the body. Thus, scarring is a natural part of the healing process. With the exception of very minor lesions, every wound (e.g., after accident, disease, or surgery) results in some degree of scarring."
Sometimes in the practice of medicine, a tissue that is exposed to injury, surgery, or disease processes, is referred to in a strange-sounding manner. Said tissue is said to have experienced an "insult" or been "embarrassed". Often times these sorts of things have to do with the sort of tissue damage that causes INFLAMMATION. It is critical for understanding this post that you understand Inflammation. Mostly because Inflammation always leads to Fibrosis (HERE). Doctors realize this and attempt to squelch this most common of Immune System responses by prescribing drugs to block it (usually NSAIDS and / or CORTICOSTEROIDS). As we move forward we see that....
"Scar tissue is composed of the same protein (collagen) as the tissue that it replaces, but the fiber composition of the protein is different. This collagen scar tissue alignment is usually of inferior functional quality to the normal collagen alignment."
"An injury does not become a scar until the wound has completely healed; this can take many months, or years in the worst pathological cases.... To begin to patch the damage, a clot is created; the clot is the beginning process that results in a provisional matrix. Over time, the wounded body tissue then overexpresses collagen inside the provisional matrix to create a collagen matrix. This collagen overexpression continues and crosslinks the fiber arrangement inside the collagen matrix, making the collagen dense. This densely packed collagen, morphing into an inelastic whitish collagen scar wall, blocks off cell communication and regeneration; as a result, the new tissue generated will have a different texture and quality than the surrounding unwounded tissue."
The way I like to think of it is that when you are injured, the area bleeds (microscopically and maybe very minimally) into the surrounding tissues, which in turn causes tissue to be laid down for repair. Via use and normal mechanical stresses, this tissue aligns itself in as an elastic manner as it can, going through a process known as the "Remodeling Phase". This is the fourth and final stage of the soft tissue repair process, and not surprisingly, is not only the least talked about but the longest lasting (see previous link).
Although Inflammation abounds (see previous link on inflammation as the chemicals whose purpose is to provide communication between cells and tissues in order to get the body to start its tissue healing process), the resultant Scar Tissue prevents said communication. Furthermore, not only does Inflammation hypersensitize nerve endings to pain (HERE), it always leaves the resultant tissue of a "different" (poor, weak, inelastic) quality; the reason that things are never quite the same after an injury (HERE). The entry also spent a great deal of time discussing FIBROBLASTIC PROLIFERATION --- something needed, at least initially, for healing to take place. It's also why hardcore soft tissue problems must sometimes be addressed with the same mindset as playing a carnival game (HERE).
As a side note to this, the Scar Tissue entry also mentioned STRETCH MARKS. "Stretch marks (technically called striae) are also a form of scarring. These are caused when the skin is stretched rapidly (for instance during pregnancy, significant weight gain, or adolescent growth spurts), or when skin is put under tension during the healing process, (usually near joints)." Although it does not happen on a daily basis, I have seen any number of patients who not only have this issue, but it actually causes significant pain and restriction (pictures in link above) --- usually in the THORACOLUMBAR FASCIA (HERE is a recent example). Now we are going to discuss Wiki's entry for Fibrosis.
"Fibrosis is similar to the process of scarring, in that both involve stimulated fibroblasts laying down connective tissue, including collagen. The process is initiated when immune cells such as macrophages [a type of white blood cell] release soluble factors that stimulate fibroblasts. The most well characterized pro-fibrotic mediator is TGF beta [Cytokine -- inflammation], which is released by macrophages as well as any damaged tissue between surfaces called interstitium. Other soluble mediators of fibrosis include CTGF, platelet-derived growth factor (PDGF), and Interleukin 4 (IL-4) [Inflammation]. These ultimately lead to the proliferation and activation of fibroblasts, which deposit extracellular matrix into the surrounding connective tissue."
What did you see here? You saw that whether it came from an injury or some sort of disease process, Fibrosis was always (or at least almost always) preceded by one of the numerous chemicals responsible for intercellular communication that we collectively refer to as INFLAMMATION. Are you starting to see why I am such a stickler for number one, EATING AN ANTI-INFLAMMATORY DIET, and number two, figuring out what things other than your injury might be driving inflammatory processes in your body (HERE)?
The difference between Scar Tissue and Fibrosis? I'm not totally sure myself. Although it is mostly a matter of semantics, I would assume that people who specialize in this field would say that "scarring" is a normal physiological process, while "fibrosis" is much more likely to be pathological (caused by some sort of disease process or genetic abnormality).
Couple this with the fact that excepting the THORACOLUMBAR FASCIA and PLANTAR FASCIA, you can't see it on MRI (HERE). And on top of everything else, Scar Tissue itself is known to potentially be as much as 1,000 times more pain sensitive than normal tissue. As you contemplate these facts, it's not difficult to see a "PERFECT STORM" of Chronic Pain (not to mention the accusations of being a malingerer or drug seeker) looming on the horizon of many people's lives. for those of you already living this nightmare, I have an article called TWENTY REASONS WHY FASCIA that might be very helpful.
Truthfully, I don't really care what you want to call it. Call it 'Banana Boat' for all I care. It's essentially the same stuff. Although the medical community would probably prefer the word "Fibrosis," I usually use the term "Scar Tissue" when talking to patients, as it is something they can understand and easily relate to since everyone has scars. Regardless of terminology, I use pictures to describe what I am talking about. Truthfully, it can be virtually impossible to tell them all apart and doesn't really matter at all as far as treating the patient is concerned (HERE). Speaking of treating......
It is almost impossible to get rid of Scar Tissue (HERE), but it can be "remodeled" if it can be accessed (HERE or HERE). When dealing with simple injuries, sometimes STRETCHING can be enough to solve them (and as the link reveals, sometimes not). Getting rid of hardcore Fascial Adhesions / Scar Tissue / Fibrosis is going to require some degree of "controlled trauma" in order to break the unorganized tissue matrix and 're-start' the healing process (TISSUE DEFORMATION). Depending on the amount of Scar Tissue present, this process must sometimes be, at least to some degree, harsh (HERE). The awesome thing is, even if you've had your problem for decades, you'll know after one treatment whether or not this approach will prove helpful for you (HERE).
PART II: THE MICROSCOPIC STRUCTURE OF THE SCAR
NEW RESEARCH ON CHOLESTEROL DRUGS (STATINS), THE WORLD-WIDE OBESITY EPIDEMIC, AND SLEEP AIDS
As astounding as it may sound, Sleeping Pills are probably related to as many deaths in America as any drug out there. Case in point, the short post I wrote over four years ago called SLEEPING PILL DEATH TOLL MAY TOP HALF A MILLION. A recent piece by Johnathan Cohn for HuffPo (Drugs You Don't Need For Problems You Don't Have: Inside the Pharmaceutical Industry's Campaign to Put Us All to Sleep) shows once more why you simply cannot trust the FDA to protect you from a pharmaceutical industry who views you as a commodity -- a living, breathing, dollar sign (HERE). But there's more.
STATINS are one of the most-prescribed classes of drugs in America. For almost as long as I can remember, people have been complaining that these drugs cause muscle and joint pain. In this study from the latest issue of JAMA (Efficacy and Tolerability of Evolocumab vs Ezetimibe in Patients With Muscle-Related Statin Intolerance), a Statin was compared against a placebo. Nearly 43% of those who had previously had pain reactions against Statins showed pain reactions in this study. This not only tells us how widespread this problem is, it provides a glimpse into the reality of SIDE EFFECT UNDER-REPORTING ---- something estimated to be in the 95% range, meaning that only 5% of side effects ever make it into physician's notes or get reported to the proper authorities. The author's solution to this problem? Injectable Statins
The study went on to compare injectable anti-cholesterol drugs against standard pill-form Statin drugs. Although the injectables worked better than the pills and resulted in significantly less muscle pain, there was a huge cost increase associated with them. Try 1,400%) on for size. Gulp! Another new study pulled back the curtains to reveal just how bad things really are when it comes to a related problem ---- the OBESITY EPIDEMIC.
The latest issue of the oldest medical journal on the planet (Lancet) published a study in their April issue called Trends in Adult Body-Mass Index in 200 Countries From 1975 to 2014. This study concluded that, "Over these four decades, age-standardized global prevalence of underweight decreased from 13.8% to 8.8% in men, and from 14.6% to 9.7% in women." During that same time frame, "Global age-standardized mean BMI increased from 21.7 kg/m2 in 1975 to 24.2 kg/m2 in 2014 in men, and from 22.1 kg/m2 in 1975 to 24.4 kg/m2 in 2014 in women." In other words, we have a much smaller percentage of the earth's population that is underweight, and a much greater percentage of the earth's population that is overweight than we did when I was in grade school. Just how bad is this problem?
"If post-2000 trends continue, the probability of meeting the global obesity target is virtually zero. Rather, by 2025, global obesity prevalence will reach 18% in men and surpass 21% in women; severe obesity will surpass 6% in men and 9% in women."
What does all this mean folks? Remember what I said recently about SUSTAINABILITY IN HEALTHCARE (it's not)? We are there. We simply do not have the financial wherewithal to continue on our current path. The day is rapidly approaching when you are going to be largely on your own as far as chronic health issues are concerned. If you are interested in seeing what it would take to start pulling you out of the pit that is your health, HERE is where you start creating your own "Exit Strategy".
TISSUE REMODELING AND THE VASOVAGAL RESPONSE
The Vagus Nerve is the tenth Cranial Nerve (CN X) and arises from the brain itself as opposed to the Spinal Cord like most nerves do. It makes its way down to the colon, regulating and helping to control all the structures it crosses PARASYMPATHETICALY. Although it supplies some motor input from the brain, it is mostly a sensory nerve that provides feedback to the brain concerning what's going on in the organs.
Because the Vagus Nerve travels through the neck (not too distant from the SCM) running with the carotid artery, there is the potential to 'stimulate' it when I treat patients. No big deal for most, but several times a year this causes a random patient to have a vasovagal response (there is no way to predict who it will be). These responses are extremely similar across the board, virtually always involving the patient telling me they feel two distinct things; hot and faint (sometimes they report feeling queasy as well, although I have only had one or two patients actually vomit).
Because I almost always do Tissue Remodeling of the C-spine (neck) with the patient in a sitting position as opposed to laying down; if a patient starts complaining of any of these things, I will immediately stop treating, lay the patient down on the table in a supine (face up) position with their feet propped up, and use a towel to fan them while explaining to them (and whoever may be with them) exactly what's going on. I always move the trash can next to the table for the patient to vomit in. After thirty seconds or so, the brunt of the episode is over.
The vasovagal reflex is completely gone within a couple of minutes, with no short term or long term effects. Although it will usually happen pretty early in the treatment, sometimes the vasovagal response did not happen until well into the treatment. About 15 years ago, I had a FEMALE PATIENT whose three-decade Migraine problem was hugely improved / largely solved with Tissue Remodeling. She had the vasovagal response the first time I treated her, but not until I was probably 5 minutes or so into the treatment. Despite this, she ended up getting treated two or three more times because she got such good results. But each time I treated her, she had the response.
My experience is that if a patient has had the response once, they will have it again if you try and treat them again. Is a vasovagal response similar to a seizure or concussion-like loss of consciousness? In a word, no. WebMD says on their site that, "Vasovagal syncope is usually harmless and requires no treatment." Wikipedia says that, "Episodes of vasovagal response are typically recurrent and usually occur when the predisposed person is exposed to a specific trigger." What do they list as the most common triggers? Although the list is extensive, the one that would be most related to what I do in my clinic is, "painful or unpleasant stimuli." Which itself begs the question......
How painful and unpleasant is Tissue Remodeling? While it is certainly not fun to have done, for the average person, neither is it terrible. But because Scar Tissue is potentially 1,000 times more pain-sensitive than normal tissue (HERE), there are some people for whom treatment is more intense than others. What's interesting is that to the best of my memory, I have never had a patient have a patient have a vasovagal response unless I was working in the cervical spine.
In order to break down the SCAR TISSUE and FASCIAL ADHESIONS (the medical community refers to this as "FIBROSIS"), treatment must sometimes be relatively intense (HERE). My opinion though, is that "pain" is not the reason for these responses. Instead, there is evidence that in a small number of people, stimulating the area of the neck around the SCM automatically stimulates the Vagus Nerve, which in turn causes the response.
Fortunately, not only are vasovagal reactions quite rare, you will know after one treatment if Tissue Remodeling will help your particular condition. To see hundreds of testimonials from people who have successfully undergone Tissue Remodeling, HERE is the place to look.
This post was specifically written for a patient who had a vasovagal response, as well as being a resource for me to send anyone who might have one in the future.
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).
Brain Based Therapy
Can You Help
Cardio Or Strength
Cold Laser Therapy
Death By Medicine
Degenerative Joint Disease
D's Of Chronic Pain
Evidence Based Medicine
Gluten Cross Reactivity
Ice Or Heat
Jacks Fork River
Leaky Gut Syndrome
Number One Health Problem
Platelet Rich Therapy
Post Surgical Scarring
Re Invent Yourself
Rib And Chest Pain
Scar Tissue Removal
Sleeping Pills Kill
Stay Or Go
Stretching Post Treatment
Tensegrity And Fascia
The Big Four
Thoracic Outlet Syndrome
Whole Body Vibration