THE RELATIONSHIP BETWEEN SCAR TISSUE AND CHRONIC INFLAMMATION
"Fibrosis is the formation of excess fibrous connective tissue in an organ or tissue in a reparative or reactive process. Physiologically this acts to deposit connective tissue, which can obliterate the architecture and function of the underlying organ or tissue. Fibrosis can be used to describe the pathological state of excess deposition of fibrous tissue, as well as the process of connective tissue deposition in healing. Fibrosis is similar to the process of scarring." From Wikipedia's definition of "Fibrosis".
"Tissue repair. Following inflammation, injured tissue is usually replaced by new cells and extracellular materials, with undamaged surrounding cells proliferating and migrating to fill the void. Although some tissues can grow back quite efficiently, complex organization is seldom matched in the regenerated site. Gaps are quickly filled by collagen fibers. A mass of collagen which replaces tissue that has been destroyed is known as a scar. Scars in other organs also exist as firm masses of collagen in which normal organ function cannot occur. For example, cirrhosis of the liver represents extensive replacement by collagen of damaged liver cells." Cherry-picked from a lesson on "Inflammation" found on the website of Southern Illinois University Medical School's Histology Class.
"Estimates from various disease-specific registries suggest that chronic inflammatory and fibrotic disorders affect a large proportion of the world's population, yet therapies for these conditions are largely ineffective." From the first sentence of the abstract of a January 2013 study found in The Journal of Pathology (Inflammation, Wound Repair, and Fibrosis: Reassessing the Spectrum of Tissue Injury and Resolution).
"Inflammation and fibrosis are fundamental aspects of two rheumatic diseases - lupus and scleroderma - each having pathobiologic pathways relevant to many other diseases characterized by inflammation and fibrosis such as arthritis, heart disease, pulmonary fibrosis and chronic kidney disease." The opening sentence from the Medical University of South Carolina's Center for Inflammation and Fibrosis Research.
"Inflammation and fibrosis are connected to every major disease that takes down mammals." From The Number One Cause Of All Disease, Fibrosis & Inflammation & How To Prevent It Naturally --- a November 21, 2012 podcast by Dr. William Wong on Extreme Health Radio.
When the SCAR TISSUE is visible as in the picture at the top of the page, diagnosis is relatively easy. It's when the Scar Tissue (aka "FIBROSIS") decides to hang out in tissues that are not easily seen --- even with the most technologically advanced imaging techniques (HERE) --- that things start to get dicey. The best example of this is the tissue called FASCIA. What's imperative to understand about Scar Tissue is that wherever it occurs, it virtually always involves a process --- a process that will be described similarly by any pathology textbook that you care to open. I will over-simplify this process here, but the first step is.......
Scar Tissue or "Fibrosis" is not only different than normal tissue mechanically (it's weaker and less elastic), it's different neurologically as well. Nerves can get entrapped in Scar Tissue causing hypoxia (lack of oxygen), irritation, and even outright compression. And this is just for starters. As you might imagine, none of this is good; and the longer it goes on, the greater the chance of having the pain "locked" into your brain via a form of Chronic Pain that is said to be "CENTRALIZED". If you are interested in the specifics of this process from beginning to end, take a look at our COLLAGEN SUPER-PAGE.
Please understand that for the most part, these three steps represent normal physiology. Let me repeat. When you injure yourself, these steps are what are supposed to happen --- period. I can hear you asking the the question which this statement begs. "If Scar Tissue / Fibrosis and Inflammation are normal aspects of the body's healing process, why should we be concerned one way or another about either of them?" I am so glad you asked. Let's begin to unpack this by looking at a quote from one of the thousands of medical journals.
"Pathophysiologic fibrosis, which is essentially an excessive accumulation of extracellular matrix (ECM) components, particularly collagen, is the end result of a cascade of events proceeding from tissue injury via inflammation, and resulting in permanent scar formation. Fibrosis can impair tissue function and cause chronic diseases in a large variety of vital organs and tissues, including bone marrow (BM). Despite the diverse range of tissues susceptible to fibrosis, all fibrotic reactions share common cellular and molecular mechanisms, such as cell and tissue degeneration, leukocyte infiltration, persistent inflammation of the tissue, and proliferation of cells with a fibroblast-like [collagen forming] phenotype." From the May 2011 issue of The Skeletal Muscle Journal (Aberrant Repair and Fibrosis Development in Skeletal Muscle).
Through numerous statements such as the one above (not to mention those at the top of the page), we have established beyond the shadow of a doubt that Acute Inflammation is responsible for fibrotic scarring of any number of tissues. But what about Chronic Inflammation? In other words, when you hear the word "inflammation" bounced around today, it is almost always referring to "chronic" or long-standing Inflammation. The problem is, I find that almost no one has any real idea what Chronic Inflammation is or why it is so critical to deal with it properly (HERE or HERE). If you are one of these, read these short links before proceeding.
Here is where lies the problem. I can assure you that Chronic Inflammation leads to Fibrosis in much the same way that Acute Inflammation does (HERE). Chronic Inflammation leads to diverse problems over time such as fibrotic heart, lungs, kidneys, liver, and intestines. In fact, the paper mentioned above, while specifically dealing with neuro-degenerative diseases (MS, MD, etc) mentions "Chronic Inflammation" several times. Here's another one.
"Fibrosis in response to tissue damage or persistent [chronic] inflammation is a pathological hallmark of many chronic degenerative diseases. By using a model of acute peritoneal inflammation, we have examined how repeated inflammatory activation promotes fibrotic tissue injury. In this context, fibrosis was strictly dependent on interleukin-6 (IL-6)....... Thus, IL-6 causes compromised tissue repair by shifting acute inflammation into a more chronic profibrotic state through induction of Th1 cell responses as a consequence of recurrent inflammation." This study, from the January 2014 issue of Immunity (Interleukin-6 Signaling Drives Fibrosis in Unresolved Inflammation) kicks around the word "chronic" a number of times. What is IL-6? IL-6 (Interleukin 6) is one of the many chemicals made by the Immune System that we refer to collectively as "Inflammation". Furthermore, it is responsible for lots of bad things that go on in the body. Off the top of my head I will give you two (OSTEOPOROSIS and DEPRESSION / IBS). Allow me to show you yet another example proving just how serious this issue really is.
The April 2012 issue of Frontiers in Immunology published a study called Cellular and Molecular Mechanisms of Chronic Inflammation-Associated Organ Fibrosis. The study's abstract starts out by saying that, "Organ fibrosis is a pathological condition associated with chronic inflammatory diseases. In fibrosis, excessive deposition of extracellular matrix (ECM) severely impairs tissue architecture and function, eventually resulting in organ failure". Did you catch that? Forget about CHRONIC PAIN for a moment; this study says that Chronic Inflammatory Diseases are associated with fibrosis of one's organs. Bottom line; fibrosis kills --- slowly and painfully (HERE).
What causes the Inflammation that leads to fibrosis (Scar Tissue) throughout the body? When we are talking about the folks who see me for severe pain caused by FASCIAL ADHESIONS, it's invariably some sort of traumatic or repetitive injury, or postural situation over time (also, sometimes people are fooled --- HERE) . However, there are any number of other factors that can drive Inflammation in the body as well. Some of the more common are BLACK MOLD, DYSBIOSIS, poor GUT HEALTH, SUGAR, metals (MERCURY & ALUMINUM are two of the biggies), etc, etc, etc. OBESITY is a unique situation that both creates and is created by Inflammation. And lest we forget, GLUTEN is massively inflammatory for many people --- particularity Caucasians of Western European descent.
A 2009 issue of The Journal of Immunology (Novel Role of Tissue Transglutaminase (TG2) in Chronic Inflammatory Diseases) had something to say about this. Transglutaminases are enzymes that allow us to break down wheat protein, otherwise known as Gluten. In people with Celiac Disease (not to mention numerous people who do not have Celiac Disease --- HERE), the body makes anti-Transglutaminase antibodies. In other words, not only is the body attacking Gluten as though it were a foreign invader (HERE), it's attacking the enzyme that helps break down Gluten as well. The study mentioned at the top of the page revealed that, "Tissue transglutaminase (TG2) has a critical role in the pathogenesis of chronic inflammatory diseases." Not that I have time to get into it today, but Gluten is arguably the single biggest factor in developing AUTOIMMUNE DISEASES (HERE is a list of A.I. diseases). And how about this for a "fun fact"? The "Modern Pantry" website sells Transglutaminase for kitchen use. Listen to what they say about TG. "Transglutaminase (TG), aka Meat Glue, is a natural enzyme that has the ability to glue protein-containing foods together. When raw meats are bound with TG, they typically have the strength and appearance of whole uncut muscles."
The truth is, however, most people who are in severe Chronic Pain are not necessarily concerned about "diseases". In other words, they don't really care that their heart is fibrosing, they just want their NECK to stop hurting. The thing you have to remember is that in many ways, these two problems should be addressed in a similar fashion. if you want to get to the root of your problem --- whatever your problem may be --- you need to address Inflammation. There's no way around it. Listen to what Dr. Rick Loos of San Diego's Torrey Pines Chiropractic has to say about the link between CHRONIC NECK PAIN, SCAR TISSUE, and INFLAMMATION.
"Chronic neck pain can be explained by starting with scar tissue, or what we call Fibrosis. Fibrosis is scar tissue that develops inside of your body, on muscles, tendons or inside of a joint capsule. Fibrosis always occurs at the end stage of inflammation, or swelling. While scar tissue on the outside of the body doesn’t cause any problems, on the inside, like in your neck, it can lead to chronic pain and even future re-injury. Fibrosis works like glue. The problem with fibrosis is that it isn’t all neat and perfect, like a band-aid. It’s a big mess. The scar tissue grabs the connective tissue and the surrounding muscles, wrapping it all up together into a three dimensional blob. It happens because your body is trying to protect the injury and anchor it somehow, so you don’t injure it again. That’s a good thing, of course, but once you heal not all of it goes away. The problem is some of the fibrosis sticks around. (Pun intended.)"
Dr. Rick summed it up pretty well; Inflammation and Scar Tissue are huge factors in in a wide variety of PAIN SYNDROMES. One of the things that separates my practice from others, is the emphasis I place on understanding and getting rid of fibrosis (Scar Tissue). If you are one of those people trapped on the MEDICAL MERRY-GO-ROUND, start by watching some of our VIDEO TESTIMONIALS or creating your own EXIT STRATEGY from chronic pain and chronic illness.
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).