"We first have to understand when any soft tissue (muscle, tendons, nerves, fascia, ligaments) are damaged, the body produces scar tissue (also referred to as adhesions). In many patients, the scar response is amplified many times resulting in scarring like cobwebs enveloping the muscles, nerves and joints of the affected areas. This myofascial- bramble or cob-web suffocates the normal blood flow and nutrition to the area. Consequently, the tissues start to "dry-out", and the lubrication between the different structures decreases. This results in "rubbing" of the tissues, producing even more scar tissue and adhesions. The patient complains of stiffness, tightness, diffuse-multiple pain and trigger points. Their sleep patterns deteriorate. The body's ability to produce pain-killing endorphins and cortisoids is decreased. The patients own ability to modulate and control their own pain is further compromised if the "adhesions" or cob-webs" restrict the normal function of the nerve to the muscle. This can lead to occult neuropathy of the segmental nerves that supply the affected muscle. The muscle will then start to degenerate. Cannon's Law of Physiology states that nerve damage to a muscle produces an increase sensitivity to pain - i.e. trigger point tenderness. The Chronic pain cycle has begun." - Cherry picked from David Moffitt's article called Chronic Pain - The Adhesion / Scar Tissue Connection.
- MECHANICALLY: Scar Tissue is not nearly as elastic as is normal tissue. It is also much weaker. This is because the individual tissue fibers of normal connective tissue tend to line up in a nice, parallel fashion in relationship to each other (sort of like the picture at the top left --- think of well-combed hair). Likewise, Scar Tissue can have various degrees of 'tangledness'. This is simply connective tissues that due to some sort of injury (traumatic or repetitive) are running every conceivable direction in all three dimensions. In other words, it's a wadded up mess that is not nearly as "Functional" as is normal tissue (see picture at the top right and think of tangled and MATTED HAIR).
- ELECTRICALLY: Because injury frequently injures (stretches or tears) the tiny nerve branches that are found within the tissue itself, there can be and often times is hypersensitization that takes place. Stimulus that should not cause pain causes pain, and / or stimulus that should cause a little pain causes severe pain (Allodynia and Hyperalgia respecitively). In fact, according to neurologist and Scar Tissue expert Dr. Chan Gunn, Scar Tissue can be as much as 1,000 times more pain sensitive than normal tissue (HERE).
- BIOCHEMICALLY: As you might imagine, Scar Tissue is not as as metabolically active as is the normal tissue around it. Another reason that Scar Tissue is easier to be re-injured and slower to heal. This is one of the biggest reasons we often use COLD LASER THERAPY on chronically injured or chronically painful areas. Scar Tissue is also terribly affected by inflammation. You should be aware that the medical community realizes on some level that chronic inflammation always leads to what they call "fibrosis" (HERE). Although some people are offended by it, I refer to fibrotic tissue as "Scar Tissue" in my clinic because people understand the term better (HERE).
Now let's take this whole issue one step further. We already know that much of this Scar Tissue cannot be seen with the naked eye (particularly adhesed Fascia), but what would happen if it could not be seen with even the most technologically advanced imaging techniques such as MRI either? I'll tell you what can happen --- something I have written about several times previously. Chronic Pain's 'Perfect Storm'. A "PERFECT STORM" occurs when numerous factors, none of which is devastating in and of itself, fall into place at the same time to create what are known as "Super Storms".
Connective Tissues are defined as "biological tissues that support, connect, or separate different types of tissues and organs of the body". The most abundant connective tissue in your body is something called Fascia. Fascia is the ELASTIC, COLLAGEN-BASED TISSUE that you have seen if you do any amount of hunting or butchering (common in our area of the nation --- HERE). It is the clearish-yellow cellophane-like membrane that clings to muscle / meat (not to mention blood vessels, nerves, bones, etc). It also happens to be the most pain-sensitive tissue in the body.
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THE SCAR TISSUE RIDDLE
Due to traumatic injuries such as CAR CRASHES or SPORTS INJURIES, tissues can be stretched beyond their normal capacity to 'elast'. But there are other causes as well. I often times hear patients say things like, "but doc; I didn't do anything to hurt it". Many of the TISSUE-BASED PROBLEMS I commonly see in my clinic are not due to trauma --- or at least not a single trauma --- but to repetitive injuries such as those caused by certain jobs, sports, or POSTURES.
Think about it this way: you can move a mountain by blowing it up with one push of a button, or you can move it one spoonful at a time --- the only difference in the two methods is time. Injuries frequently occur in the same manner. In some cases, tremendous physical forces overcome tissue all at once. Just as often as not, the constant barrage of small physical forces (in many cases coupled with CHRONIC SYSTEMIC INFLAMMATION) breaks tissue down over time. Although both injuries were arrived at very differently, the results can be identical.
Think about it for a moment. You have FASCIA; the single most pain-sensitive tissue in the body --- but does not show up with standard tests. When you look at the image above of "Peter" from an 1863 issue of Harper's Weekly, the first thing you see is the incredible amount of Scar Tissue on his back. Now, imagine something similar going on in your body. But because it's occurring in a tissue as thin as cellophane --- often times at a cellular level, you can't see it with standard tests. To really grasp the seriousness of this, take another look at the side-by-side pictures at the top of the page. Notice closely how the tissue in the image on the left is organized in an orderly fashion, while the tissue on the right looks more like the "cobweb" described in the quote from the top of the page. If this is you, unfortunately, your problems are just getting started.
The restriction in joints surrounded by Scar Tissue (sometimes it can be extremely SUBTLE), will eventually cause serious (and visible) structural damage if not taken care of. Although there are other factors (a CRAPPY DIET is one of the biggest of these), possibly the biggest factor in developing something called DEGENERATIVE JOINT DISEASE (DJD, which used to be called DEGENERATIVE ARTHRITIS) is abnormal joint motion or loss of joint motion over time. This is why breaking the restricted Fascia and restoring range of motion is not only critical for helping people get rid of their pain, it is critical for potentially preventing degenerative situations that perpetuate the pain cycle, potentially destroying one's ability to enjoy their retirement years.
SCAR TISSUE, CHRONIC PAIN, AND STRETCH MARKS
Let me take just a moment to tell you a story that happened several years ago that really got me to thinking about this issue. I had a young woman come to me for an injury she received while in high school. While working out at school, a piece of heavy gym equipment was somehow pulled over and struck her in the middle part of her back. After spending 2-3 years on the MEDICAL MERRY-GO-ROUND (numerous specialists, lots of tests, several MRI's, therapy, pills, etc), her parents brought her in to see me. The problem had "Scar Tissue" written all over it. After examining her (her main finding was localized mid back pain with almost any movement she performed), I began to work.
What was interesting about this particular case was that this girl had no visible stretch marks in the middle of her back --- until I started working on her. The more I worked, the more visible and defined the STRETCH MARKS / TEARS became. The really cool thing was that after working on her, she could not reproduce pain with any amount of movement, including bending to touch her toes while I pushed her upper back towards the floor at the same time. It took a couple more treatments to totally resolve this case, of which I have seen dozens upon dozens of similar over the years. In fact, I can immediately think of several individuals (all quite thin) who wound up with hardcore stretch marks on their backs (like the picture above) after seriously wrecking four wheelers. In my mind, one of three things is true about these cases. Either........
- Adhesions in the dermal (middle) layer of the skin can cause incredible amounts of restriction and pain. I rather doubt this in light of the research that's out there, but the truth is, YOU CAN'T ALWAYS TRUST RESEARCH.
- Some cases of Stretch Marks run deeper than the dermal layer; possibly clear down into the Fasica. I also doubt that this is the case or it would have been discovered long ago.
- The Stretch Mark is not deep, but is indicative that there may be a deeper injury (i.e. Fascia) underneath it. This is probably the most plausible of the three.
What is the truth? I am not really sure. Since the what we do here works to help people overcome long-standing Chronic Pain and restriction, it does not really matter for our purposes which of these hypotheses is true. What's always true, however, is that your life will be better without Chronic Inflammation. If you are looking for solutions to your Chronic Pain or Chronic Illness, you might want to take a look at THESE POSTS.
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).
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