adhesed fascia, fibrosis, stretching, and chronic pain

We always think of stretching as beneficial, and in most cases it is.  For instance, I cannot begin to tell you the numbers of my patients who start doing yoga stretches or similar, that have improved.  However, there have been lots of recent studies (the past five years) showing that stretching prior to exercise not only provides no real benefit, but can actually be harmful.  This is not what we are covering today, as the internet is absolutely chocked full of those sorts of articles.  Today we are going to cover stretching specifically as it pertains to Chronic Pain and Tissue Remodeling.

I deal with lots of people from AROUND THE COUNTRY, and even AROUND THE WORLD that are struggling with some degree of CHRONIC PAIN that limits their ability to live life normally.  The standard medical fare for these people is, of course, drugs — PAIN MEDS, NSAIDS, MUSCLE RELAXERS, CORTICOSTEROID INJECTIONS, ANTIDEPRESSANTS, and who-knows-what else.  And if these individuals end up in therapy, they will undoubtedly go through intensive stretching and exercise protocols.  While this is wonderful for the average person, for the person dealing with severe FASCIAL ADHESIONS and MICROSCOPIC SCAR TISSUE, it can prove devastating — particularly when it comes to stretching the pelvic girdle (i.e. for problems such as PIRIFORMIS SYNDROME).  The two pictures below will help you understand why.

Normal soft tissue (in this case, we are talking about FASCIA) is represented by the ropes above left.  Good, healthy tissue is going to line up in a parallel fashion that not only provides strength, but flexibility as well (HERE are several great pics).  INJURED, ADHESED, FIBROTIC, THICKENED, or DENSIFIED fascia, tends to be MORE TANGLED microscopically (pic on right).  Stretching unhealthy fascia can sometimes be likened to pulling on the ends of the loosely knotted rope above.  You might gain a bit of ROM, but ultimately you are not only not getting rid of the adhesion, you could actually be making it worse by tightening it (HERE). 

Sometimes — especially in the more severe cases — it takes some ‘umph‘ to break fouled up and adhesed tissue (HERE).  Our goal is to BREAK UP THE PROBLEMATIC TISSUE, then give you a stretching protocol to pull the tissue apart in order to make it more like the pic on the left before it can re-heal in its previous state (clump / wad / tangle).  For things like SHOULDER PROBLEMS, NECK PAIN, etc, overstretching is rarely a problem.  However, when it comes to problems of the pelvic girdle area (I mentioned BUTT PAIN / PS earlier) the stretching can, in some people, fire up the SCIATIC NERVE or bony attachment points (most commonly the Ischial Tuberosities or “sits” bones — the knobs of bone underneath your gluteal muscles).   This is why we want you to do your stretches often for the first few days, but not with great intensity.  It’s a frequency thing more than a forcefulness thing.

Make sure to come back and read the next post as it will be something along the lines of Scar Tissue Remodeling and its relationship to CENTRAL SENSITIZATION.  Be sure to take a quick peek at how well this method of treatment works for many of the patients I treat (HERE).  And if you know someone who could benefit, a great way to reach them is by liking, sharing, or following on FACEBOOK.