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Soft Tissue Injury and Fibroblast Regeneration

September 9, 2011 by drburt

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.

Sciatica Pain or Subluxated Sacroilliac Joint Pain

August 15, 2011 by drburt

Last month I had two patients who came to my clinic because they thought they had sciatica pain. One of the patients has self diagnosed himself and the other patient was diagnosed by a medical doctor. Both of these patients had excruciating pain in their lower back, which radiated down to a lower extremity. It is very common that many patients will wait for their pain to go away with rest, anti-inflammatory and pain medication. As a result, pain symptoms will get worse and get to the point where pain medications will stop working.

The first patient was a male in his early 60’s. He came to my clinic on his crutches. The pain level was so intense that he was not able to support his upper body. The pain would shoot all the way down his right lower extremity past the knee level but did not effect his toes. After thorough examination it was evident that his right SI (sacroiliac joint) was about 2 inches lower than the left SI joint. All of the nerves that were exiting from sacral foraminas (openings) were very irritated and inflamed. Every time this gentleman would place a load on his legs he would cry and I could see tears of pain on his face. After three sessions of full spine chiropractic adjustment, physical therapy (moist heat and electrical stimulation) and deep tissue massage from my CMT (Certified Massage Therapist) he was completely free of pain. I have recommended him to stop by once or twice a month for maintenance care in order to avoid future flare up and pain.

The second patient was a female in her early 50’s. She has had very similar symptoms as the patient I have mentioned above. Her medical Doctor diagnosed her with sciatica and prescribed her pain medications, which eventually stopped working. The examination finding were very similar to a patient I have mentioned above, except the part that the pain symptoms were on a left side. The pain intensity was so great that it would wake her up at night. The treatment parameters were the same with addition of stretching to her lower back and some dietary changes. She was also advised on taking more frequent brakes from prolonged sitting that her job required. After 4 sessions she was pain free and was advised on a once a month maintenance care.

Sciatica Pain and Misaligned Sacroiliac Joint are two conditions that can be misdiagnosed or misunderstood by patients and other medical care providers. It takes much longer for a patient with Sciatica nerve entrapment to respond to a care. Often times Sciatic Pain is presented in athletes with intense training. In conclusion I would like to say that it is important to treat the cause of the problem instead of masking it with pain killers and anti-inflammatory medications. The sooner the cause is fixed the faster the road to recovery is.

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Single Speed Mountain Bike Ride – 50 miles

July 29, 2011 by drburt

I have been an avid mountain bike rider for over a decade now, pretty much ever since I have moved to a beautiful San Francisco Bay Area. Over the last couple of years I have changed my full suspension mountain bike with gears and small 26 inch wheels to a hard tail 29 inch single speed bike. I have willingly sacrificed the comfort of a mountain bike ride in exchange for a speed and aggressiveness of a Titanium 29er single speed bike. I simply adore the simplicity of a single speed bicycle, no dureilers to brake, no shifting problems, and no worrying that you are in a wrong gear. It is simple, reliable – it is you, bike and the trails that you are trying to concur.

I have always wanted to check my limits and see if I can cover 50 miles distance in one gear. My goal was accomplished couple of weeks ago. Over 7000 ft of elevation in one gear 32 teeth in a front and 19 teeth on a back which equals to a 49% gear ratio. For a rider who is six feet and two inches tall and weights over 200 lbs that was not an easy task. Mental and physical preparation was essential for this ride. A large section of the ride was on a territory that has never been ridden by me and my riding partner, Robert, who has joined me on this long and painful journey. Robert had the same gear ratio as my bike.

My bike set up: Single Speed specific Titanium Frame with Niner carbon fiber fork, niner handle bar, XX avid brake set, selle italias saddle with Easton carbon seat post, race face SIXC crankset with 32t Salsa Chainring, Stans Flow Rims laced into Industry Nine hubs and Schwalbe tubeless tires.

Robert bike: Legendary Voodoo Zaka Titanium frame with Reba SL 100mm Suspension Fork, 28” FSA handle bar, with Shimano XT brake set, Moots seat post with Brooks B17 Saddle, SUN rims with racing Hadley Single Speed specific rear hub, white industry crank set with 32t chain ring.

We began our journey from Robert’s House which is about one mile away from Lake Chabot trail. The first 17 miles were the trails that connect Castro Valley Lake Chabot trails to Oakland trails all the way to the end of the East Ridge. On a 17^th mile of our journey we had to take a single track all the way to Tilden Park which is in Berkeley Hills right next to mini Steam Train that adults and kids can ride for $2 for about 7-10 minutes of ride.

We were expecting to see many hikers on a single track but to our surprise only few people were on that long stretch of the trail. The trails in Oakland and Berkeley Hills are very unique in their flora and fauna. I have never seen plants like that anywhere else in Bay Area. At times it seemed that were riding in a Rain Forest. There was way too many things to look at, but we had to concentrate on a riding part of it. Some sections were so steep and wet that we had to hike them with our bikes. It was simply impossible to ride those monsters in one gear. About two miles before we got to our return point which is Tilden Park we saw huge wild plumb tree with the sweetest plumbs I have ever tasted. May be because we were so low on sugar and were ready to eat grass at that point. It was a really nice gift from a mother nature. At that point more than half of our food supply was gone.

By the time we got to Tilden Park the first mechanical brake down happened on my bike. The spring on my egg beater pedal on a drive side broke down. I was still able to continue the journey on a way back but at a slower pace than I have expected. When spring collapsed I was not able to clip in with my shoes and therefore use my hamstring muscles to pull up the cranks. On a 47^th mile of our journey my none drive side pedal broke in half. Now I can not pull on both sides and can not push on a none drive side. Basically I was left with only one working leg. I am glad it almost happened at the end of the ride. Somehow I was able to make it to my Jeep and was very happy about being able to finish this trip in one piece.

Every once in a while one must take him or herself out of the comfort zone and test the limits. It does not have to be a mountain bike, it could be any other sport activity that you are enjoying. Happy trail everyone.

Major Don’ts During Low Back Pain

July 14, 2011 by drburt

Everyone is experiencing lower back pain sooner or later in their lifetime. However, when that time come many sufferers are ready to do anything for the pain to go away. Over the past ten years I have seen people doing all kind of things by an advice of a friend, neighbor or a close relative. My mind was always wondering: “How is that supposed to help a soft tissue injury or misaligned vertebrae?” Some of these recommendations will do more harm to lower back than help. Dr. Orly Avlzur advises to avid the major none professional recommendations.

Bed Rest is not a good idea at all. During prolonged bed rest lower back muscles loose their tone and can lead to a greater pain. Also prolonged supine position can cause loss of lumbar lordosis. One must move around and stretch. That is correct, physical activity is in favor against resting state. Do you remember those days when you get up from a bed and everything is sore in your body. As a day progresses thing seems to get better and the pain level goes significantly down.

People need to learn how to listen to their bodies. It is not recommended to sit up straight during pain with certain lumbar spine conditions. This position can cause an excessive pressure on already pinched lumbar nerve root. Short periods of fetal positioning may help alleviate this pain. Posture has a direct relationship to the health condition of your spine. Read this post – “Why is Posture so Important” and “Stabilizer Muscles’on Role on Role in Injury Prevention.”

People must watch how much they eat. Pendulous Abdominus will cause alteration in a lumbar lordosis and will eventually cause lower back pain. If you are already over weight please consider changing your diet. Getting rid of refined products, white bread and sodas will do good to not only your back but an overall well being. Weight gain can expedite lumbar disc degeneration.

Some buy shoe orthotics with the hope that it will help the pain. These orthotics only work for rare conditions when one leg is shorter than the other. But for most part they will not resolve lower back pain. I always emphasize to my female patients to avoid frequent use of high hill shoes. They will also increase lumbar lordosis.

Several studies suggest that people who suffer from low back pain actually benefit more from a medium-firm mattress. Why? If a mattress is too firm, it won’t support the body evenly and may cause discomfort at the heaviest points like hips and shoulders. If the mattress is too soft, a sleeper could sink into the bed and have a harder time moving, which could cause stiffness and pain come morning. Having a slightly softer mattress places less compression on your body and may grant you a better night’s sleep. Take a look at this post on how to chose a mattress.

Do not use surgery as the first choice of therapy. Surgery is recommended when a patient is experiencing serious motor or nerve deficit. Many common back problems can be fixed by your local chiropractor. If you are a local Bay Area resident try our facility at San Leandro Chiropractic Clinic. And not everyone that undergoes surgery is happy with the end result. A 2009 survey of almost 1000 consumerreports.org subscribers who had undergone surgery for low back pain found only 60 percent said they were completely or very satisfied with the results of their operation.

While the advice is sound and it’s better to: bend at your knees, not at your waist; lift using your leg muscles; tighten your abdominal muscles; and hold the object close to your body – if you have a known back problem, like a herniated disc, it’s best to avoid strenuous lifting entirely. It’s fairly common for me to see return patients who get into trouble because they continued to lift heavy weights at the gym, moved furniture, or shoveled snow.

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