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Soft Tissue Injury and Fibroblast Regeneration

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FIBROBLAST AND SOFT TISSUE REPAIR

Soft Tissue Injury and Fibroblast Regeneration

Mechanical friction during deep tissue massage, fascial manipulation or using techniques like Graston will activate the stimulation the fibroblast reproduction after soft tissue injury. These fibroblasts cells are the most common cells of connective tissue, and they synthesize the extracellular  matrix (ECM) and collagen, which is the main framework of our soft tissues. The properties of the connective tissues depends on the composition of ECM – tendons, ligaments and other connective tissues. Elastic and reticular fibers, glycoproteins, glycosaminoglycans, and collagen are all found in ECM and made by fibroblasts.  Collagen is the most important part of ECM and plays very important role in tensile loading. The stimulation of production of the above mentioned components can be achieved by frictioning tissues (in other words by providing cross-fiber massage).

Fibroblast production and degeneration is a normal process in every day mechanical loading such as walking, running, bicycling or any other form of movement. There are four basic types of loads: tension (tensile force-fibroblasts), compression (chondrocytes), fluid shear (vascular endothelial cells) and torsional shear. Collagen synthesis in patellar tendon ( which is used the most by bicyclist and runners) increases by nearly 100% as a result of just single bout of acute exercise, and the effect is till evident three days later. I guess I am doing a good job with my knees by keeping them busy with prolonged Mountain Bike Riding and avoiding soft tissue injury.

In the beginning of a training period the balance between synthesis and degradation is increased and there is a net loss of collagen. This enables a tendon to restructure and adapt to an increased loading pattern. It is not till training progress that there is a net gain in collagen synthesis. Deep friction massage can also help to repair a mild soft tissue injury to a knee tendon. Fibroblasts play an important role in wound healing. When connective tissue and blood vessels get injured, growth factors cause fibroblasts to enter the wound area, increase its numbers and begin synthesizing new collagen fibers, creating new granulation tissue and assisting in remodeling. The ECM of granulation tissue is created and modified by fibroblasts.

Recently I was exploring a new trail with another rider. During a steep rocky climb my rear wheel lost a traction and my right knee got over extended. I felt sharp pain but continued on riding. Next day I felt sharp pain around and under my right knee cap (patella tendon). Three to four sessions of deep tissue massage, cross friction massage and modalities such as electric stimulation and Erchonia Cold Laser L5000 model made my knee completely pain free. This is a real example of how Fabroblast is working.

There has also been research done that eccentric exercises may provide more benefit than concentric exercises regarding rehabilitation of muscles and tendons. Eccentric exercises provide greater stimulation of fibroblasts, increasing collagen synthesis and therefore stimulating the healing of soft tissue.

 

Chiropractic Rehabilitation and 4 Stages of Soft Tissue Healing

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The healing process is divided into four broad stages which are not mutually exclusive and overlap considerably.

1. Initial vascular reaction – Active Swelling

2. Inflammatory response – Passive Congestion

3. Proliferative phase – Repair

4. Remodeling 

Wound healing refers to the body’s replacement of destroyed tissue by living tissue (Walter & Israel 1987). It comprises of two essential components whose differentiation is based on resultant tissue: Regeneration and Repair.

TISSUE INJURY CAUSES RESTRICTION OF MOTION DUE TO:

  1. Inflammation & Swelling
  2. Pain
  3. Muscle Spasm 

THE MAJOR GOALS OF CHIROPRACTIC CARE:

  1. Relieve Pain
  2. Promote Full Healing
  3. Restore & Maintain Full Function
  4. Reduce the Likelihood of Re-Injury
  5. Prevent Accelerated Degeneration 

Chiropractic Care Should Continue Throughout the Repair Stage. It Take Longer For Tissues to Heal & Normal Function to be Restored Than it Takes for Pain Relief. Pain Relief is not the Only Goal.  Chiropractic Helps:

  1. Restore Normal Motion, Function & Biomechanics
  2. Improve Alignment of New Connective Tissue
  3. Prevent Shortening of Scar Tissue & Chronic Stiffness
  4. Restore & Maintain Flexibility of Ligaments & Muscles
  5.  Restore Normal Muscle Tone
  6. Promote Quicker, More Effective Healing
  7. Restore & Maintain Normal Sensation
  8. Reduce the Risk of Re-Injury and Degeneration 

STAGES OF SOFT TISSUE HEALING

 

STAGE I: ACTIVE SWELLING

  1. Swelling Occurs for 12 to 72 hours
  2. Motion is lost and pain increases 

Goals of Care: Minimize pain and swelling

Care:

  1. Rest & Support of Injured Area
  2. Ice to Block Swelling, Pain, and Spasm 

STAGE II: PASSIVE CONGESTION   

Fluid trapped in tissues restricts motion, causes pain, & delays healing. Begins by second to fourth day

Goals of Care for Passive Congestion:

  1. Remove fluid
  2. Pain Relief
  3. Begin to restore range of motion 

Care:

  1. Chiropractic Adjustments Help
  • restore motion
  • block pain
  • restore normal sensation
  • relax tight muscles
  • remove swelling
  • accelerate healing
  1. Heat and Cold to Remove Fluid
  2. Controlled Motion Exercises
  3. Physical Therapy helps in Some Cases
  4. Acupuncture Can Help With Pain Control 

STAGE III: REPAIR

Beginning 5 days after injury, scar tissue is made for up to 6 weeks. 

Lack of motion causes excess scar tissue in dense patterns disrupting normal function causing:

  1. Excess Scarring
  2. Chronic Stiffness
  3. Limited Range of Motion
  4. Poor Biomechanics
  5. Chronic Pain
  6. Weak Muscles & Ligaments
  7. Loss of Normal Sensation
  8. Poor Nutrition
  9. Increased risk of Re-Injury
  10. Accelerated Degeneration 

If Motion is Restored & Maintained, Tissues Heal in a Much More Functional Way.

Coals of Repair Stage:

  1. Restore Normal Range of Motion
  2. Restore Sensation
  3. Promote Full Healing
  4. Relieve Pain 

STAGE IV: REMODELING 

Connective tissue remodels for better strength & flexibility. This often takes 3 to 14 week but may take up to 1 year with severe injury. 

Chiropractic Helps Achieve these Goals:

  1. Improve & Maintain Motion & Flexibility
  2. Restore & Maintain Function
  3. Reduce Chronic Pain
  4. Reduce Risk of Re-Injury & Degeneration

This Post was based on Dr. Malik Slosberg’s Research.

Questions/Answers #1-#5

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#1 Falling asleep on arm numbness?

Lately I have been waking up just about every night with a tingling, numb arm because I have been falling asleep on it. I figure it becomes like this because the circulation is cut off. Can this be potentially dangerous or hint toward something of greater significance and severity?

Answer:

Thank you for visiting and asking a question. Sleeping for a prolonged period of time on your arm will cut-off a blood circulation to your upper extremity. As a result you will experience symptoms such as: tingling, numbness and loss of sensation. Central Nervous System (CNS – Brain) has a unique defense mechanism. When it senses that your body is in danger it will alarm you automatically. In your particular case your CNS sent you a wake up message. This is not dangerous if it happens only because of the sleeping position. You have to try to change sleeping positions and patterns and the problem should go away on its own. However, if you have something like TOS (Thoracic Outlet Syndrome) misaligned Clavicle and even Subluxated Vertebrae in the early stage, the symptoms you experience could be because of these conditions. Please have yourself checked by a local chiropractor when you get chance. Hope you feel better.

#2 My ankle is the size of a softball. Help?

Today at camp I rolled my ankle pretty bad in one of my games. It hurts so bad when I stand on it for even a second :/ What are some tips and pointers you can give me to ensure a speedy recovery? And have you ever sprained an ankle really bad before??? Your help will be greatly appreciated thank you!! 🙂

Answer:

Hello,                                                                                                                                                                                                                                                                                                                                                                                                                                                                The severity of your injury depends on how badly you have hurt the soft tissue that supports your ankle. From you description it sounds like it is pretty severe due to the size of the swelling you have described. At this point and time I would use ice – 15 minutes on and 45 minutes off every waking hour. This will help to keep inflammation under control. Pick up your phone and make an appointment with your orthopedist or local chiropractor. Most likely your doctor of choice will have XRAYS done on your ankle and order MRI. XRAY will help to rull out a potential fracture and MRI will help to see how sever is the sprain/strain of your ankle. When diagnosis is established you should start rehabilitation process. Assuming you did not rapture your ligaments or tendons I would recommend the following – PT modalities such as Erchonia Cold Laser PL 5000, Ultrasound, and Electric Muscle Stimulation followed by deep tissue massage from CMT.

If your tendon or ligament has severe tear arthroscopic surgery is inevitable.

#3 I thought I pulled a muscle but….?

A couple of weeks ago I was at the gym as usual running on the treadmill, towards the end of my session, I started to feel a pain which is centered on my left buttock. Since then I have not been able to run at all as it is too painful & sometimes I can feel a discomfort just walking around normal or sitting.
At first I thought i pulled a muscle but since it’s now been two weeks… I think it is probably something else.
Thanks

Answer:

From your description it sounds that you have Sacroilliac Joint (SI) misalignment. When SI joint is subluxated symptoms will get worse upon walking. The reason why pain level goes up is because SI joint plays a very important and active biomechanical role in a walking process.

You can self diagnose if your SI joint is misaligned. Stay in front of the mirror with your eyes closed and march in one place for 5 seconds. When you are done marching open your eyes and look at your – 1) ear level, 2) shoulder level, 3) hip level. If one side of your hip is higher than the other your SI joint is misaligned. An even better way is to have someone else take a digital photo of yourself with your eyes closed. You will be able to see it for yourself how the shoulders and neck compensate for your SI joint problem. I would suggest to see your local D.C. and fix the problem in a couple of sessions.

#4 A Fourth Sprained Ankle?

I sprained my ankle twice in the past year. One time I slid on ice and sprained on side in late February and then in March sprained the other side as well as the first side. During June I wore an ankle stabilizer so I would not injure it again in PE but in July the pain came back and went away in a few days. Now I can’t really walk that great on it. I told my Mom but she says it’s fine. After injuring it in Feb and March I was prescribed physical therapy but it isn’t covered by insurance unless it follows a surgery. Does anyone think I may have injured it for a fourth time??
~~~Sorry for the long description.~~~

Answer:

Most likely you have a flare up of an old injury that has never been properly rehabilitated. Weak ligaments and tendons are very easy to injure again. Post traumatic soft tissue fibrosis makes your soft tissue less elastic. Since you do not have insurance I would suggest to find local CMT get some deep tissue done on your ankle. MRI of your ankle would tell the entire story, but it is very expensive. Also Cold Laser therapy by Erchonia PL 5000 and Ultrasound will be able to get some good results. Those modalities should be available in your local D.C. office.

#5 Should I still work if I have a herniated Disc in my back?

I just had an MRI done and found out not only do i have a disc protrusion in the lumbar section of my lower back, I also have chronic arthritis in my spine and degenerative disc disease. Is it good for me to continue at a job that I have to lift heavy objects repeatedly?

Answer:

Repetitive heavy lifting will accelerate the degeneration of your lumbar disc and osteoarthritis. As a result it will cause more pain and your ability to perform Activities of Daily Living. It would be great if you could find a different place of employment that does not require repetitive lifting. You can also ask your employer to provide a modified duty for you if such is available.

Soft Tissue Injury and San Leandro Chiropractic Rehabilitation Process

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SOFT TISSUE HEALINGA Soft Tissue Injury (STI)happens when your muscles, tendons and ligaments get damaged because of a sprain or strain. It happens when one overuses or put too much stress on a particular joint. As a result the pain accompanied by bruising or swelling. STI is a very common problem and it can easily be remedied as long as the pain that accompanies it is not severe.

When STI occurrs, an immediate response applying the principle of “PRICE” would make a big difference. PRICE means Protection, Rest, Ice, Compression and Elevation. After an injury, the patient should be prevented from making any movements as it allows to prevent further damage.  If the patient feels the pain, when he/she bends or walks then he/she should avoid these movements. If absolutely necessary, crutches may be used. Icing minimizes the pain and the swelling especially during the first 3 days after the injury has occurred. Ice is placed on the affected area for 15-20 minutes at a time every waking hour. Take a note that if you have diabetes or poor blood circulation, you must consult your doctor first before applying a cold pack.  Pressure is applied to compress the injured area to control bleeding and swelling. Elevation of the affected area also minimizes the bleeding and swelling. Raise the affected area above the heart level for the first 72 hours or until the swelling would subside.

The “PRICE” management is effective but other treatments may be necessary if the patient experiences extreme pain that lasts for more than 24 hours. A health care professional would be able to make a diagnosis and recommend treatments. Treatments include chiropractic, physical therapy and massage therapy. If a patient suffers from severe pain, prescription medications might be necessary along with a rehabilitation program.

Chiropractic rehabilitation helps to rapidly solve the problem of injuried muscles, tendons and ligaments. One of the chiropractic specialties for such treatments is called ART or Active Release Techniques. Patient would be amazed at how fast your recovery would be if you go for a chiropractic adjustment, ART and Physical Therapy Modalities. It is a hands-on approach that locates then eliminates the scar tissues. The Graston Technique is a treatment using different stainless steel tools and it can be even more effective than ART. The Graston Technique uses instruments to treat the affected areas suffering from chronic inflammation or fibrosis of the soft tissues. SASTM is another chiropractic tool used that is made of acrylic instead of stainless steel as used on the Graston Technique. But, in some cases, in order to get the best result in treatment, both set of tools may be used on the patient as well as different modalities.

Question: What Kind of Therapy Have You Had For Your Soft Tissiue Injury?  What was an outcome like?