the inflammation, scar tissue, degeneration conundrum: the three horsemen of chronic pain and disease

THE THREE HORSEMEN OF CHRONIC PAIN
INFLAMMATION, SCAR TISSUE / FIBROSIS, AND DEGENERATION
STOP THE VICIOUS CYCLE OF PAIN & DISEASE

Inflammation Chronic Pain

Wellcome Images #V0012067

“The repair process of damaged tissue involves the coordinated activities of several cell types in response to local and systemic signals. During chronic tissue damage, the inflammatory-cell infiltration and fibroblast activation persists, while the reparative capacity of stem cells (satellite cells) is attenuated.  Abnormal dystrophic muscle repair and its end stage, fibrosis, represent the final common pathway of virtually all chronic neurodegenerative muscular diseases.”  Cherry-picked form the abstract of 2011’s Aberrant Repair and Fibrosis Development in Skeletal Muscle in the journal Skeletal Muscle.

“When inflamed tissue is repeatedly agitated, the chronic exposure to an inflamed region can lead to chronic inflammation and excessive tissue breakdown and result in tissue degeneration.  Inflammation may become disrupted and prolonged when the tissue is continually subjected to repetitive or forceful activities.  This can lead to a vicious cycle of injury, local inflammation, systemic inflammation, fibrosis, and tissue degeneration.  These subsequent changes result in pain, loss of motor function, and depression / anxiety.  The systemic effects of exposure to inflammatory mediators should not be ignored.”  Cherry-picked from Michael Higgins’ book, Therapeutic Exercise: From Theory to Practice.

CHRONIC PAIN is pain that has lasted longer than three months.  According to the most current statistics from our government, almost one third of our population, or 100,000,000 people, is dealing with some degree of Chronic Pain.  Although there are any number of reasons for this pain, understanding a simple biochemical / biomechanical progression — a progression that can turn itself into a life-stealing vicious cycle —- has the potential to turn things around for those of you whose lives have become more of a curse than a blessing.  In order to have a prayer at getting out of pain, you need to understand some simple concepts and how they can work in tandem to ruin your health, destroy your quality of life, and put you in an early grave.

  • INFLAMMATION:  Inflammation is the name of a group of chemicals (HERE) that allows your cells to communicate with one another.  They are a vital part of any healing process.  However, inflammation is another one of the many areas where too much of a good thing can become a bad thing —- in this case a very bad thing.  Inflammation comes in two flavors, local and systemic.  A local inflammation is typically caused by some sort of local injury (a SPRAINED ANKLE for example) or INFECTION.  A “SYSTEMIC INFLAMMATION” is inflammation running rampant throughout your entire body.  The worse the systemic problem, the more likely you are to find an underlying LEAKY GUT.  Be aware that Inflammation is the centerpiece of almost every chronic health problem you can name — even many (probably most) that have been touted as “GENETIC“.

 

  • FIBROSIS / SCAR TISSUE:  Fibrosis is a synonymous term for Scar Tissue (HERE).  Although you will hear me use either (as well as the term “DENSIFICATION“), when speaking to patients I typically use ‘Scar Tissue‘ for the simple reason that people are familiar with the word and tend to understand the concept better.  SCAR TISSUE is tissue, which, instead of its cells lining up in a neat and orderly parallel fashion to each other, is tangled, wadded, and twisted — sort of like the difference between well-combed hair and a hair tangle (HERE).  Scar Tissue is very different than normal tissue in several major ways, including the fact that it is weaker, less elastic, and more pain-sensitive — as much as a thousand times more pain-sensitive (HERE). 

 

  • DEGENERATION:  Degeneration is exactly what it sounds like — something is wearing out.  It is important to understand that degeneration can happen to any organ, organ system, or tissue, in your body.  It is also important to understand that no matter how often your doctor repeats it, birthdays are not automatically associated with degeneration.  If we live long enough, sure; we’re all going to go through some degree of the stuff.  But the whole, “After all Mrs. Jones, you just aren’t as young as you used to be” is for the birds — even though it is a convenient scapegoat for virtually all health-related problems.

When your body is functioning properly, everything is right with the world.  However, when any of these three bullet points get tipped out of balance (particularly the first), a “vicious cycle” begins, which feeds itself until you end up in debilitating pain.  Or worse yet; six feet under (HERE).  A vicious cycle is defined as, “a sequence of reciprocal cause and effect in which two or more elements intensify and aggravate each other, leading inexorably to a worsening of the situation.”  In other words, A causes B, but B causes A.  It’s a cycle that feeds itself, and the faster it turns, the faster it will turn.  And as you will see, even though I refer to it as “Chronic Pain’s Vicious Cycle,” you’ll see that this cycle goes way beyond pain.
Andrikkos is the author of the animated arrow below

Cyle of Pain

CHRONIC PAIN’S
VICIOUS CYCLE

INFLAMMATION

   FIBROSIS

DEGENERATION

CHRONIC PAIN
MOST DISEASE PROCESSES
DEATH

Despite its potential severity, doctors frequently fail to see (or purposely ignore) this cycle.  For one, there are not great tests for much of this cycle, except the endpoint.  I’m not saying that “endpoints” mean it’s too late for you, but starting treatment at the end of the process instead of at the beginning is never the best option.  Think about it another way; how cool would it be to actually prevent degeneration instead of waiting until the process runs its course to the point it actually shows up on a test?  Unfortunately, IN FAR TOO MANY CASES, our medical community has a distorted view of what “prevention” really means.  Let me give you a small taste of what this cycle can do as it spins out of control, eventually landing you on the MEDICAL MERRY-GO-ROUND, which itself will spin out of control.

  • INFLAMMATION CAUSES FIBROSIS: I’ve previously provided tons of info on this phenomenon (HERE, HERE, HERE, and HERE).  Be aware, however, that inflammation is a critical part of the healing process.  When it comes to the musculoskeletal system in particular, inflammation must sometimes be induced in small, local amounts via “HARSH METHODS” in order to stimulate healing processes.

 

  • INFLAMMATION CAUSES DEGENERATION:  A great example of this phenomenon is Tooth Decay (HERE).  For decades, mainstream dentistry told patients that cavities were caused by the acid from bacteria.  Not that this is not true on some level, but ultimately, it’s inflammation that causes teeth (not to mention bones) to rot.  But there’s much more to it than that.  The December 2004 issue of the Annals of the New York Academy of Sciences carried a study called Inflammation and the Degenerative Diseases of Aging, which spilled the beans about inflammation and degeneration.  “Chronic inflammation is associated with a broad spectrum of neurodegenerative diseases of aging. Included are such disorders as Alzheimer’s, Parkinson’s disease, ALS, all of the tauopathies, and age-related macular degeneration. Also included are such peripheral conditions as osteoarthritis, rheumatoid arthritis, atherosclerosis, and myocardial infarction (heart attack). Chronically sustained at high levels, inflammation can seriously damage viable host tissue.”  The “damage” being referred to in the last sentence is ultimately one of two things — fibrosis or degeneration — or both.  The point is moot, however, because….

 

  • FIBROSIS CAUSES DEGENERATION:  Think about it this way using ARTHRITIS or ADHESED FASCIA as an example.  Arthritis (arthr = joint) + (itis = inflammation) will always, for any number of reasons, cause an inflexibility and lack of normal motion in tissues.  How big of a deal is this?  Think about it this way.  After almost any kind of surgery, the nurses have the patient up and walking around while they are still groggy from anesthesia.  Why is this?  It has been known for decades that not only does lack of normal motion cause degeneration (HERE), but it does not take long for said degeneration to begin to set up like an unholy form of concrete.

 

  • DEGENERATION CAUSES FIBROSIS:  As joints deteriorate, they move worse.  Worse movement causes more degeneration.  That same lack of motion also happens to cause increasing amounts of Fibrosis.  For instance, DJD causes joints to both thicken and stiffen, leaving the surrounding musculature and connective tissues weak and inflexible, which in turn causes more of the same.

 

  • DEGENERATION CAUSES INFLAMMATION:  Cellular death (known as apoptosis or necrosis depending on the context) causes the contents of cells to rupture into the interstitial fluid.  Among other things, this causes the chemicals that we collectively refer to as “inflammation” to gain access to a method whereby they can be carried to other areas.  One way to describe degeneration would be to say that there is increasing amounts of cellular death occurring.  Thus, any time we have increased cellular death, whether due to age or injury, we are going to get a spike in local inflammation, and possibly even systemic inflammation. 

What does all of this mean to you, the patient?  It means that while Inflammation is the obvious driver of the process, the cycle can, to some degree, be driven from either of the other two corners of the triangle (Fibrosis or Degeneration).  It is a true “Vicious Cycle”.  And in the triangular diagram above, it’s even worse because we have three variables feeding each other instead of two.  FYI, I used to think of this process in terms of being a more linear-looking loop, which is bad enough as it can also act as a vicious cycle.  No matter how you choose to think of it, Inflammation always leads to Fibrosis, which always leads to Degeneration.  Repeat.

INFLAMMATION

FIBROSIS

DEGENERATION

Allow me to show you why breaking the cycle is so critical to your health and ability (or inability) to get out of pain.  As the cycle spins, it causes symptoms.  These symptoms can be in the form of CHRONIC INFLAMMATORY DEGENERATIVE DISEASES, neurodegenerative conditions such as were listed earlier, OBESITY (OR NOT), or AUTOIMMUNE DISEASES.  It can also come in the form of CHRONIC PAIN.  What I want you to note is that in the vast majority of cases, the medical community is not only not doing much of anything to prevent these problems, but instead is typically only treating the symptoms. Symptoms come from the spinning of the vicious cycle.  If you don’t find a way to actually stop the cycle, you’ll be using increasing numbers and potencies of DANGEROUS DRUGS to mask said symptoms for perpetuity.   What do we know about the effectiveness of using drugs to treat symptoms?

If treating symptoms actually worked, you wouldn’t be reading this post at 2:00 am with tears in your eyes.  Sure, the “BIG FIVE” is going to help you with your pain…. But the relief is short-lived, coming with any number of brutal side effects, one of which is ADDICTION.  Face it folks; if drugs worked, Americans would have the best health on the planet.  But instead, according to our own government’s statistics, even though we only make up about 3% of the world population, we consume 75% of the world’s drugs (HERE).  And you won’t believe how bad our collective health really is.  Overall, we rank consistently about thirtieth in the world.  Despite all our fabulous technological advances in the field of medicine, there’s only one way to solve this particular problem.  Go to your toolbox and pull out the monkey wrench.

THROWING A MONKEY WRENCH
IN CHRONIC PAIN’S VICIOUS CYCLE

Is it really possible that you could solve your health problem(s) on your own —- without the help of a doctor?  The answer to that question is “maybe”.  It depends on whether or not you have a doctor who cares about you enough to actually help you create an “EXIT STRATEGY“.  I probably don’t have to tell you that there aren’t many of them out there.  Mostly they want to do LOTS OF TESTS, prescribe lots of drugs, and then send you to someone who does surgery. It’s what doctors do (HERE).  And in all fairness, sometimes these things are unavoidable and necessary.  If that’s really the case, there’s no dishonor in going that route.  However, regardless of what kind of medical care you are currently receiving, you need to come up with a plan that will help you break the cycle. 

Fortunately for you, I’m into sharing DIY methods for regaining your health and getting out of pain (HERE’S ONE I made for solving back pain).  It’s all free of charge.  That would be free as in “free” —- no strings attached.  I like giving people tools that they can use on their own, and that don’t cost a lot of money to implement.  The fact is, inexpensive (or free), uncomplicated, and rapid-acting, are exactly what most people are looking for as far as solutions to anything are concerned.  And contrary to popular belief, it’s possible to accomplish this with even some of the most stubborn health-related problems.  But it has to be done properly.

Continually searching for pathology when your problems are “functional” is not going to do it (HERE).  More doctor visits, tests, and medications, won’t do it either.  There is no magic bullet.  What I’ve done for you is to lay some groundwork to provide a simple, generic solution that will help many, if not most of you on at least on some level.  And the extra cool thing about it is that UNLIKE THE PRACTICE OF MEDICINE, the side effect profile of this protocol is almost non-existent.  There’s never been a better time than today to turn over a new leaf.

Using even some of the strategies found in THIS POST will allow you to start breaking the vicious cycle at all three corners.  But most importantly, it deals with inflammation.  If you can’t at least put the breaks on the inflammation, you have little chance of truly improving your health and getting out of pain.  It’s the very reason that some of you reading this have not had the results you were hoping for with your chiropractor, therapist, or physician. Although there may be other things you need to do along the way, the bottom line is that you must break the cycle. 

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