scar tissue remodeling for chronic problems: why so harsh?

SCAR TISSUE REMODELING AND INFLAMMATION
AND THE POTENTIAL HARSHNESS OF BREAKING THROUGH FASCIAL ADHESIONS

Inflammation Scar Tissue

Thomas Sørenes

“Fibrosis is a process that follows chronic inflammation. Fibrotic tissue is like a scar tissue, thick, and rigid, due to excess accumulation of protein below the skin.”  From Sclero.org

“Inflammation, like the kind caused by Rheumatoid Arthritis, can lead to pulmonary fibrosis, or permanent scarring of the respiratory tissues.”  From the website Everyday Health (How Rheumatoid Arthritis Affects the Lungs)

“Four million Americans suffer from inflammatory bowel disease (IBD), an autoimmune disorder where the immune system attacks one’s colon and intestines and leads to high levels of inflammation and digestive difficulties. Often, as a result of the constant inflammation, the intestines will form fibroids, or masses of cells that try to reinforce the intestinal walls to protect from further immune attack. This fibrosis is driven by the chronic inflammation but does not always work as the body hopes it will. Frequently, fibroids in the intestines can lead to large amounts of scar tissue that prevent the intestines from being as elastic as they once were and can narrow them, making digestion and elimination difficult or impossible.”  From the June 19, 2023 issue of Medical Daily (Intestinal Bacteria Revealed As Major Cause Of Irritable Bowel Disorder And Fibrosis)

“Intestinal fibrosis is a complication of inflammatory conditions affecting the small and large bowel and often results in serious clinical consequences.    Intestinal fibrosis is common in chronic intestinal inflammation as typically observed in both forms of inflammatory bowel disease (IBD), Crohn’s disease and ulcerative colitis.”  From a 2010 issue of Fibrogenesis and Tissue Repair (First International Summit on Fibrosis in Intestinal Inflammation: Mechanisms and Biological Therapies)

“Probably your own death will be caused by your last inflammatory response.   Inflammation destroys, dilutes, or walls off the injurious agent and sets in motion the limited powers of the body to heal itself. Inflammation and repair can and do themselves damage the body.  Generally, good tissue has been (and is being) destroyed, and there will be some evidence of healing (scarring).”  Cherry-picked from Medial Pathologist Dr. Ed Friedlander’s ‘PathGuy’ site from a lecture titled Inflammation and Repair

“The term fibrosis describes the development of fibrous connective tissue as a reparative response to injury or damage. Fibrosis may refer to the connective tissue deposition that occurs as part of normal healing or to the excess tissue deposition that occurs as a pathological process. When fibrosis occurs in response to injury, the term ‘scarring’ is used.”  From Medical News, What is Fibrosis?

“Scars are areas of fibrous tissue (fibrosis) that replace normal tissue after injury.  Thus, scarring is a natural part of the healing process.  ….Every wound (e.g., after accident, disease, or surgery) results in some degree of scarring.   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.”  Wikipedia

Fibrosis (the MICROSCOPIC SCAR TISSUE I deal with all day long) is a bummer.  Inflammation, which causes FIBROSIS, can cause it to form at any given point in the body.  This Fibrosis almost always leads to both chronic dysfunction and CHRONIC PAIN.  Before we go any further, I want to discuss the “chronic” portion of Chronic Pain.  In other words, what makes pain “chronic”?

By definition, Chronic Pain is pain that has lasted more than three months.  If you go to any of our posts that discuss the three phases of soft tissue healing (HERE, HERE, or HERE), you’ll find that all of the actual “healing” of a soft tissue injury (Phase I & II) occurs within the first month (anything after that is considered to be “remodeling” as opposed to healing).  In an article called Acute -vs- Chronic Pain, the world-famous Cleavland Clinic reveals that, “Chronic pain is pain that persists despite the fact that the injury has healed.”  On a practical level, it means that even though the WHIPLASH ACCIDENT that Dave was in occurred four decades ago (HERE), it is not odd to discover that he has had pain and restriction ever since (despite being a Chiropractic patient). 

Another thing we learn in the article from Cleavland Clinic is that even though their list of things you can do for your pain is quite long, their top five is based totally on symptomatic relief (NSAIDS, Acetaminophen, NARCOTICS, LOCALIZED SHOTS, and Nerve Blocks).  There are a couple of things that we can glean from this list.  Firstly, these five do nothing to actually address any sort of underlying issue, no matter what that issue may be. Secondly, four out of the five (narcotics are the odd man out on this list) have to do with getting rid of Inflammation.  When it comes to dealing with pain, there are two kinds of Inflammation that you have to be familiar with. 

  • ACUTE (LOCAL) INFLAMMATION:  This is a local event that occurs largely within the first 72 hours of the initial injury (Phase I of the healing process) via Macrotrauma (one big event where the tissue sustains a force which is beyond its capacity to elast or compress), or Microtrauma (repetitive / overuse-type issues).  Inflammation is the collective name of a group of chemicals made by your Immune System, and are responsible for the initial redness, swelling, heat, pain, and diminished function, that are all associated with the injury.  These are proteins which, in this phase, act as messengers to bring about healing.  Although Inflammation is not synonymous with swelling, it has the ability to attract fluid to the area and cause swelling.  According to the IAAF’s position paper, Soft Tissue Damage and Healing: Theory and Techniques, after an injury, “Edema [swelling] and anoxia [a complete lack of tissue oxygenation] result in cell damage and death within the first 24 hours, and the release of protein breakdown products from damaged cells leads to further edema, tissue hypoxia [diminished oxygenation], and cell death [sometimes you’ll see this called ‘Apotosis’].  Edema and joint swelling, with or without pain, is associated with a reflex inhibition of spinal activation of skeletal muscle. Phagocytosis [specialized cells that engulf and devour things deemed “bad” by your Immune System] then begins to rid the area of cell debris and edema.”    Even though we don’t really like or enjoy it, Acute Inflammation is vital for your injured soft tissues to heal properly.

 

  • CHRONIC (SYSTEMIC) INFLAMMATION:  Chronic Inflammation is similar to Acute Inflammation in that it is largely related to the same (or at least very similar) Immune System chemicals being released by the body.  The difference is that you do not have one specific area (i.e. the area of injury) doing all the releasing, and the process is ongoing / continual.   It is a process that happens — at least initially — largely due to crappy lifestyle choices (SMOKING, lack of EXERCISE, POOR DIETS, too many REFINED CALORIES, etc, etc).  Dr. Brent Bauer, of the Mayo Clinic recently said in an article he wrote for their site (Buzzed on Inflammation).  “Chronic inflammation, also known as low-grade or systemic inflammation — can play a more puzzling and long-lasting role in the body. Consider the vast array of autoimmune disorders — such as rheumatoid arthritis, lupus and polymyalgia rheumatica — where the body’s immune system mistakenly initiates an inflammatory response even though there’s no apparent inflammation to fight off. Chronic inflammation plays a more obvious role in diseases such as asthma and the inflammatory bowel diseases ulcerative colitis and Crohn’s disease……  Research indicates that heart disease, clogged arteries, stroke and bacterial endocarditis may be linked to oral health. Although more study is needed to confirm this possible link, some scientists believe that bacteria from gum disease can enter the bloodstream and make its way to the heart.   Chronic bladder inflammation due to repeated urinary infections or cystitis may increase risk of a squamous cell bladder cancer. In some areas of the world, this type of cancer is linked to chronic inflammation caused by infection with a parasite.”  Wikipedia states that, “…..inflammatory processes result in multiple chemical and food intolerances, autoimmune diseases and many other symptoms and diseases“.  Just remember that Chronic Systemic Inflammation is extremely detrimental to your body’s ability to heal a soft tissue injury.  HERE and HERE are some links showing the relationship between Chronic Inflammation and Scar Tissue formation.

To see a slightly more detailed picture of the difference between Chronic and Acute Inflammation, just click HERE.

The point here is not to provide you with yet another post showing the health problems associated with INFLAMMATION, as I have previously given you dozens (click the link for some of the most relevant). The point is to show you that even though the same Immune System chemicals are involved in both processes (Chronic Inflammation and Acute Inflammation), the two are extremely different from each other in almost every conceivable way. 

WHY INFLAMMATION ALWAYS MATTERS

IF YOU ARE INFLAMED, THE DOGS ARE ALREADY AT YOUR THROAT

It’s simple; for starters you are going to have to do whatever it takes to decrease the amount of Chronic Systemic Inflammation coursing through your system all the time.  If you can’t diminish Chronic Inflammation, you can probably forget about diminishing (or better yet, resolving) your pain.  But it goes way beyond that.   A failure to adequately address Chronic Inflammation means that you are probably going to wind up with an array of INFLAMMATORY DISEASES, AUTOIMMUNE DISEASES (click it to see a list), CANCERS, ENDOCRINE DYSFUNCTIONS (including FIBROMYALGIA) as well as OBESITY (yep; it’s also considered “Inflammatory”), not to mention IIP / LGS.  Due to all the ANTIBIOTICS you’ll be taking because you are sick all the time, you’ll soon be dealing with DYSBIOSIS and other GUT DYSFUNCTIONS.   Oh; and don’t forget — Chronic Inflammation also happens to be the kind of Inflammation that hyper-sensitizes Scar Tissue by several orders of magnitude (HERE). 

To be brutally honest with you; a failure to deal with Chronic Inflammation means that the odds of any doctor being able to help you get rid of your pain is greatly diminished.  Be grateful that I haven’t left you out in the cold in this area.  HERE is a DIY Page for getting rid of Inflammation.  But again, that is not what I really want to talk to you about today.

In order to get rid of your Chronic Pain — particularly if it was caused by some sort of injury — you may have to go back and start at the beginning.  Allow me to explain.  If you looked at any of my articles on the three phases of healing, you’ll quickly notice that the first phase of healing lasts up to three days, the second phase lasts no longer than a month, and the third phase might last as long as two years, although most studies say a year or less.  What does this mean for those of you who, like Dave whom I mentioned earlier, are dealing with injuries that occurred in the distant past?   It means that you are going to have to do something radical enough to start the healing process over (HERE).  The SCARRED FASCIA is going to have to broken down to the degree that the first phase of healing is re-initiated (HERE).  Listen to what I said in in one of my posts.

When it comes to treating these areas of Fibrosis and Microscopic Scar Tissue, you are either breaking them or you aren’t.  To be considered an ‘effective’ treatment, it has to cause what’s known in the peer-reviewed literature as Tissue Deformation.  The treatment is either over the therapeutic threshold for soft tissue deformation or it’s not.  Let me put it to you another way; no matter how much sub-threshold treatment you get for problems that are the result of hardcore Scar Tissue and Fibrosis, you aren’t going to see the results you want because the treatment is just that —- sub-threshold.  It’s below the level of Tissue Deformation required for physiological changes to occur.  It’s sort of like the old cliche; a whole lot of nothing is still nothing.

This is why I suggest that you “EMBRACE THE BRUISE“.   For real true-to-life CHRONIC PROBLEMS — musculoskeletal problems that have lasted beyond a year or two — you will likely have do deal with underlying Scar Tissue and FASCIAL ADHESIONS.  If you don’t, your relief will be no more long-lasting than what you get with the drugs mentioned at the top of the post or HERE.  And don’t fool yourself; just because your pain only started 3 months ago, does not mean that the injury itself isn’t “chronic”.  It could very well be that old intramural “soccer injury” that happened back in 1999 is finally catching up with you.

PROBLEM SOLVING -vs- CHIROPRACTIC MAINTENANCE
Because proper alignment and motion of the spine works hand in hand with the nervous system (HERE and HERE), I am a fan of periodic “Chiropractic Maintenance” — occasionally having your spine adjusted despite the absence of pain or overt disease.  Let me share with you, however, what Chiropractic Maintenance is not.  It’s not getting adjusted over and over and over again for the rest of your life because you hurt; and the only thing that seems to relieve your pain (albeit it never lasts long) is adjustments.  When I talk to patients who get great results from their adjustments — but those results don’t last more than a few days (or sometimes a few hours) — I can assure you with 100% certainty that their problem has a significant Inflammatory and / or Scar Tissue component to it.  You want to get better?  You’ll have to deal with both.  HERE is what it looks like in my clinic.

THE POTENTIAL FOR A HERXHEIMER REACTION
Although you may never have heard of it, this paragraph pertains to those of you who may be dealing with Chonic Inflammation or Illness due to a “Hidden” (sometimes called “Occult”) Infection.  Certain microbes have an affinity for Fascia.  If you have a Biofilm (a colony of microbes) growing on your Fascia, breaking said Fascia could release an overload of their toxins into your system.  No, it’s not going to kill you.  However, it could make you feel tired, sluggish, give you a headache, or even on rare occasions, make you feel “Flu-like” for a day or so.  While not an everyday occurrence, you can learn more about Herxheimer Reactions by GOING HERE.

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