more on the inflammation / fibrosis (scar tissue) connection

THE INFLAMMATION SCAR TISSUE CONNECTION
THE BEAT GOES ON

Scar Tissue Inflammation

I have shown you in the past how INFLAMMATION ALWAYS LEADS TO FIBROSIS.  And in my recent TWO PART SERIES, I showed you that despite some experts wanting to argue against, Fibrosis is essentially the same thing as Scar Tissue.  Although Scar Tissue can form anywhere, it is not uncommon to see it form ‘microscopically’ in the Fascia (some like to ARGUE THIS POINT as well). The resulting “FASCIAL ADHESIONS” are problematic not only because of their dramatically heightened pain sensitivity (HERE), but because doctors cannot see them with standard imaging such as MRI (HERE).

The first thing I want you to realize is that Scar Tissue is not all bad.  Your body is going to heal an injury one way or another, and Scar Tissue is how this is accomplished.  The key is how the Scar Tissue heals.  In order to understand what I am talking about, you have to understand Inflammation.  To show you how it all works, I am going to touch on some of the highlights of the pathology textbook I used in school (Basic Pathology: 4th Edition by Robbins and Kumar, 1987). 

The second chapter of the book clearly shows the intimate relationship between Inflammation and the healing process.  How do I know this?  Honestly it’s a no-brainer — it’s called Inflammation & Repair.  “The inflammatory process… paves the way for repair of the damaged site.”  In other words, Inflammation is critical to the healing process.  But it’s also important to remember that Inflammation is not all the same stuff, and is not always your friend.  Too much Inflammation (particularly “SYSTEMIC INFLAMMATION“) can cause problems (“in some instances the inflammatory-reparative process may be harmful“).  Remember that it’s typically the “chronic” (long-standing) or ‘whole body’ inflammation that causes the CRAZY NUMBER OF HEALTH-RELATED PROBLEMS.  

According to the text’s authors, repair occurs most, “often by fibroblastic scar-forming cells.”  These cells are the FIBROBLASTS I have spoken of any number of times.  Listen to their brief description of the dance that takes place between inflammation and repair.

“Although inflammation and repair are two somewhat distinct processes, they are closely interwoven in the response of tissues to injury.  Inflammation dominates the early events and repair assumes major importance later.  Nevertheless, repair begins early in the inflammatory response, although it reaches completion only after active inflammation has subsided.”

What does this really mean?  It means that if you are chronically inflamed, you will perpetually make Scar Tissue / Fibrosis (HERE).  If you don’t believe this is a big deal as far as both morbidity (sickness) and mortality (death) are concerned, take a look at these two quotes, the first from the website of pharmaceutical giant, Shanghai Genomics (R&D / Inflammation and Fibrosis), and the second from a podcast by Dr. William Wong, a naturopath with a Ph.D in Exercise Physiology (The Number One Cause Of All Disease, Fibrosis & Inflammation….).  Fibrosis remains the leading cause of death in the United Sates; approximately 45% of deaths are related to fibrosis, doubling the number of cancer related deaths.” (HERE is the source for this insane statistic.)  “Inflammation and fibrosis are connected to every major disease that takes down mammals.”  Robbins & Kumar would likely agree, going on to say that….

“Repair of destroyed cells therefore usually involves some connective tissue proliferation with the formation of a fibrous scar.  Although the anatomical continuity of the of the tissue may be restored, such repair is obviously imperfect since it replaces functioning parenchymal cells with non-specialized connective tissue.  Scarring diminishes the reserve of the organ or tissue involved.”

In plain English; although the organ or tissue may look OK to the naked eye, Scar Tissue has wreaked its havoc.  This ‘havoc’ is not only in the form of biomechanical dysfunction (“the loss of function can be explained on mechanistic grounds) or neuromechanical pain (“there is reason to believe that chemical mediators such as bradykinin and prostaglandins are also involved“), but in microscopic structural and functional damage to the organs as well.  That’s right, almost anything that goes wrong with an organ is related, at least to a large degree, to the process of Fibrosis (see previous link).  The text book’s authors go on to talk about some of the specifics of wound healing.

“Collagen content of the wound reaches normal levels by 60 to 70 days, at a time when the wound has recovered only 25 to 35% of its strength…..   There is a progressive increase in tensile strength up to day 100, during which 70 to 90% of the strength of unwounded skin is achieved…..   Both experimental and clinical observations indicate that severe protein depletion impairs wound healing.

This is an interesting quote on all levels.  First we see that regaining the strength of injured tissue takes a significant amount of time (at least three months, although current research shows that it sometimes takes significantly longer).  It also says that “skin” is only, at the very best, be 90% as strong as it was before the injury.   While strong skin is certainly a plus, it is not the tissue I am interested in for this post.  Strong skin is not nearly as big a deal as strong LIGAMENTS, FASCIA, MUSCLES, or TENDONS

Newer research says that at the very best, scars in these particular tissues will only heal to 60-70% of normal — a big reason it is always easier to re-injure said areas (i.e. SPRAIN AN ANKLE and it’s always easier to sprain it again).  And while I’m sure the “severe protein depletion” the authors are talking about here involves something more along the lines of starvation, the quote leaves something to think about for those who eat a vegan diet as opposed to something more akin to PALEO.  What do others say about these “weakened” Scar Tissues?

  • When ligaments, tendons and muscles are torn, the body replaces a rather neat, organized network of a combination of yellow elastic, and dense white non-elastic collagen fibers, with a rather haphazard array of dense white connective scar tissue. This scar tissue will help hold bones together (aka: Joints), but doesn’t have the same type and combination of strength and resiliency that the original connective tissue had.…..  Thus restricting range of motion and causing the patient to become more prone to re-injury.  Break a bone and it heals. Strain or sprain soft tissue and it’s like trying to glue a piece of plastic back together. It just never comes out as good as the original, is weaker and prone to breaking again.”   Dr. Todd Narson of Miami Beach Family and Sports Chiropractic (Why A Soft Tissue Injury Can Be Worse Than A Broken Bone).  I knew Dr. Todd, as well as his sister, from our days at Logan. 

  • John Miller of Physioworks (Soft Tissue Injury? What are the Healing Phases?) talks of the “Remodeling Phase” of soft tissue injury, splitting it up into two different phases.  “Your body does not magically just stop tissue healing at six week post-injury. Healing is a continuum. At six weeks post-soft tissue injury your healing tissue is reasonably mature but as you stretch, strength and stress your new scar tissue, it often finds that it is not strong enough to cope with your increasing physical demand. When your body detects that a repaired structure is still weaker that necessary, it will automatically stimulate additional new tissue to help strengthen and support the healing tissue until it meets the demands of your normal exercise or physical function…..   Ongoing repair and remodeling beyond three months is referred to as the chronic phase and probably refers mainly to pain that lasts more than 3 months.

  • And finally, from Brad Walker, widely know as the “Stretch Coach,” we have Pulled Muscles, Scar Tissue and Re-Injury.  “Scar tissue is made from a very tough, inflexible fibrous material. This fibrous material binds itself to the damaged soft tissue fibers in an effort to draw the damaged fibers back together. What results is a bulky mass of fibrous scar tissue completely surrounding the injury site. In some cases it’s even possible to see and feel this bulky mass under the skin.  When scar tissue forms around an injury site, it is never as strong as the tissue it replaces. It also has a tendency to contract and deform the surrounding tissues, so not only is the strength of the tissue diminished, but flexibility of the tissue is also compromised.” 

WHAT ABOUT STEROIDS & SIMILAR DRUGS?
Let’s head back to the text and see what the authors (both pathologists, Dr. Robbins from Harvard and Dr. Kumar from University of Texas) had to say clear back in 1987 about using corticosteroids for soft tissue injuries. 

“There is evidence that steroids impair formation of…. mature collagen.  Steroids seem to suppress virtually every step of the inflammatory reparative response.” 

Does anyone remember the article I wrote called  IMMUNE SYSTEM SUPPRESSION: AMERICA’S NUMBER ONE MEDICAL THERAPY?  In it I addressed both CORTICOSTEROIDS and NSAIDS (anti-inflammatory medications).  If you are interested in seeing the four phases of soft tissue healing, it can be found HERE.  Think for a moment about suppressing or inhibiting every step of said process(s) of healing.  Oh, you might have suppressed some of the pain all right — at least for the short term — but you’ve just set the table for future problems.  It’s not like Robbins and Kumar are alone in this assessment.

Dr. John Kellett, author of Back Pain, Acute Soft Tissue Injuries, Mobilization, and Fibromyalgia from the October 1986 issue of Medicine and Science in Sports and Exercise said 30 years ago, “Steroids have a deleterious effect on collagen, and direct injection into collagen may produce a permanent reduction in tensile strength.”  If taken for injuries to the Connective Tissues, “steroids have no sound biological basis,” because they “retard fibroblastic activity and may well delay healing.  Corticosteroids have little part to play in the management of soft tissue injuries.”  To see why this is, take a moment to read about “CORTICOSTEROID-INDUCED DEGENERATION“.

One year later, in a scientific paper called Acute Soft Tissue Injuries: A Review of the Literature, the renowned Dr. Kellett wrote of NSAIDS, “Use of these drugs, if given, should be restricted to a maximum of three days following injury. Any anti-inflammatory action lasting beyond this period would, theoretically, at least be detrimental since the repair mechanism (phase 2 of healing) is itself an inflammatory process.  Little data exist to support the routine use of NSAIDs in athletes with acute pain syndromes (despite advertisements extolling their benefits).

Yet despite everything we know, not only from our textbooks, but from dozens upon dozens of studies and scientific papers from peer-reviewed journals published in the three decades since (HERE is one from 2017), the medical community continues to push the very drugs that not only inhibit the healing of soft tissues at “every step,” but actually destroys said tissues.  Sometimes I wonder if doctors have a clue about the intimate relationship between Inflammation & Repair.  Which brings us to a bit different sort of Inflammation — Chronic Inflammation.

CHRONIC INFLAMMATION AND ITS
EFFECTS ON THE HEALING PROCESS

Robbins and Kumar tells us that, eventually all the cardinal signs [redness, swelling, heat, etc] disappear, leaving perhaps only some induration (increased consistency) [THIS MIGHT BE A GOOD EXAMPLE OF THIS PHENOMENON] as a sign of fibroplasia of chronic inflammation“.  I have not only shown you the four phases of healing (HERE), but also shown you how important Inflammation is for the healing process.  No inflammation, no healing.  However, when Inflammation runs amok, it not only hinders the healing process, it actually inhibits or even reverses it, leading to degeneration (HERE).  The authors go on to talk a bit about the causes of Chronic Inflammation.

“There are some settings in which chronic inflammation is initiated as a primary process.  Often the injurious agents are of low toxicity in comparison with those leading to acute inflammation.  Three major groups can be identified.   One, persistent infections.  Two, prolonged exposure to non-biodegradeable material.  And three, autoimmune reactions / autoimmune diseases.”

  • Persistent infections are either sub-clinical viral or bacterial infections (Epstein/Barr Virus for example, or a low grade infection IN THE MOUTH, or UNDERNEATH A ROOT CANAL), or various forms of DYSBIOSIS (MOLD, YEAST, SIBO, etc, etc, etc).    The problem with persistent infections is that they are usually treated with the very thing that likely caused them in the first place — ANTIBIOTICS.  If you are interested in solving your infectious problem, you’ll first have to figure out what it’s going to take to get yourself off this class of drug (HERE is a good starting point).
  • Prolonged exposure to non-biodegradeable material could mean any number of things.  It could be a constant exposure to things like lead, ALUMINUM, MERCURY, or even PLASTICS OR OTHER ENDOCRINE DISRUPTORS.  The example that was given by Robbins & Kumar was inhaled silica particles.  Interestingly enough, I have seen all sorts of ugly reactions (autoimmune) to the silica that leaks from breast implants (nope ladies, they’re not worth it). 
  • Autoimmune diseases have become a raging epidemic here in America (HERE).  “In these diseases, autoantigens evoke a self-perpetuating immunologic reaction that results in several chronic inflammatory diseases, such as rheumatoid arthritis.”  See the previous bullet point.

Their list is fine, but it is missing the boat as far as at least one critical aspect of inflammation is concerned.  It completely fails to account for diet.  For instance, peer-review has shown us that certain foods (GLUTEN, FOR INSTANCE) are heavily associated with autoimmunity of all sorts, and that sugar itself is massively inflammatory (HERE).  Secondly, Inflammation and Autoimmunity are a two-way street.  The quote above makes it look like Autoimmunity causes Inflammation, when the opposite is just as (or even more) likely.  And finally (I just wrote about this THE OTHER DAY), the very same inflammation that is associated with musculoskeletal pain and dysfunction is also responsible for most disease processes, including the heavy hitters like DIABETES, CANCER, and HEART DISEASE.

What should you do about Inflammation?  As far as ‘Acute Inflammation’ is concerned; for minor injuries, let it ride.  I usually think about trying to control acute inflammation like I think about trying to control FEVER (which is actually one of the five cardinal signs of Inflammation).  Don’t try and squelch it unless the injury is really severe, and then only in a very careful and specific manner that does not inhibit the healing process (HERE).  As for dealing with Chronic Inflammation, it’s potentially a bit tougher.  But if you value your health, you cannot choose to neglect it.

Should you fail to address your Chronic Inflammation, solving your CHRONIC INFLAMMATORY DEGENERATIVE DISEASES or AUTOIMMUNE DISEASES could prove extremely difficult — maybe even to the point of impossible.  But it is possible if you follow the proper steps.  For instance, HERE and HERE are very cool testimonials from women who kicked severe Autoimmune Diseases using nothing more than diet — after being told they would live the rest of their young lives in misery, getting progressively worse until they were virtually debilitated.  I’ve actually created a protocol that gives struggling people a place to start researching (HERE).  Don’t forget to check out our FACEBOOK PAGE while you are at it.

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