Soft Tissue Work and Healing

Sometimes people’s muscles hurt. Research estimates that massage therapy was a $16 billion dollar industry in 2017. If you have spent any time in a gym or physical therapy office you have probably seen an increase in foam rollers, massage guns like the Hyperice, “The stick”, Thera Cane, fascia blaster, PSO-RITE Psoas Release Tool and Personal Massager and the list goes on. Muscles hurt for a number of reasons such as joint misalignment, tension, stress, overuse, minor injuries, and nerve dysfunction.

Your body is made up of cells. Together those cells make tissues. Tissues make up organs and organs make up entire systems such as the digestive system or musculoskeletal system. Some cells are specifically programmed to help the body heal from trauma. These are known as stem cells. You have probably heard about stem cell injections as they continue gain more attention.

Trauma leads to:

1. Structural damage (disc herniation or muscle sprain/strain)

2. Inhibits normal circulation to that area

3. Triggers inflammation

Stem cells may respond to trauma and come out of an inactive state. They have the ability to move towards sites of injury and differentiate (change in order to carry out a specific function) into cells required for healing. This means they can become bone cells (osteocytes), chondrocytes (connective tissue), muscle cells (myelocytes) and fat cells (adipocytes).

So where do stem cells live? To name a few sites, they reside throughout the body in brain tissue, muscle tissue, fat tissue, and in a baby’s umbilical cord.

There are 4 main approaches to healing a musculoskeletal injury.

1. Eat nutrient dense foods and remove toxins (processed carbs and medications)

2. Adequate rest to avoid further injury followed by gradual exposure to activity aka “corrective care,” and other stress that create positive adaptations (i.e. sauna, fasting, and supplementation)

3. Correct structural misalignments with specific adjustments and rewire poor movement patterns. This will restore balance to the nervous system that plays a key role in healing through control of the neuroimmune system.

4. Help accelerate the body’s ability to heal by working on the soft tissue (muscles, ligaments, fascia)

I’m not going to expand on number 1 & 2 in this article. However, number 3 should be in a chiropractor’s wheelhouse. To correct a misalignment a specific adjustment should be used. Gross manipulation and a cookie cutter approach fall short in my opinion. Let me give you an example of a specific patient. We’ll call him Mike. Mike plays collegiate baseball. In the last few years he’s torn his quadriceps and his opposite leg’s hamstring. He has worked with the team PT, massage therapist and even a practitioner specializing in myofascial release.

Mike continues to play and his schedule is rigorous. The pain is becoming more frequent and increasing in intensity especially with throwing and hitting.

After evaluating Mike it became pretty obvious what was wrong. He presented with muscle asymmetries in his low back, significant pelvic distortion (rotated and un-level), specific areas tender to palpation, and his non-painful side was severely restricted. His painful side was picking up the slack and overworked. Had Mike decided to continue to play, rely solely on physical therapy and soft tissue treatments without specifically correcting the joint issue - my sense is that he would continue to play injured and below his potential.

Instrument assisted soft tissue mobilization (IAST).

Let’s dive a little deeper into number 4. Using the ceramic spoon is known as instrument assisted soft tissue mobilization (IAST). The instrument is run along the skin, subcutaneous tissue, fascia, muscles and ligaments. This is essentially trauma indicated by bruising (e.g. petechiae) that initiates a cellular inflammatory response.

I’d theorize that the “scraping” may be manipulating the local native stem cells populations at the site of treatment. That said, the literature does not support the theory that you are breaking up scar tissue and I agree with the evidence. This reminds me of a quote:

“If you’re not prepared to be wrong you will never come up with anything original.”

The treatment rationale varies as does the type of tool, force, and application used by the practitioner.

Despite the variations in treatment the general premise is to

• decrease pain,

• enhance myofascial mobility aka connective tissue

• stimulate tissue resorption,

• induce regeneration and repair.

New studies are being published to assess the efficacy and how stem cells work in a clinical setting both in the body and in vitro (outside a living organism)

While we don’t always have perfect information scientists have made great strides understanding how the body works.

Are you the CEO of Your Health and how does Chiropractic care fit

Running a results-driven chiropractic office is less about gadgets and more about providing potent corrective care. It’s more about clinical diagnosis and less concerned with e-stim, massage guns, and pulsed compression sleeves for leg recovery. Through my lens we deal with people and their multi-dimensional struggles. 

If you have suffered an injury we can look at it on three levels. The external level, which equates to the pain, soreness, and the physical extension of the issue. The second part is the internal component. How has this injury manifested from an emotional standpoint? Are you scared, frustrated, anxious, or even apathetic? Lastly philosophically speaking what does it mean to you? Are you dumbfounded that this has happened to you? Do you think you deserve to be aligned and healthy? Are you in a position to look after yourself?

Patients often look to their D.C.s as a primary source of healthcare when helping their children with sports-related injuries. Equally pertinent, are the high number of patients that look to chiropractic treatments after all other avenues have proved ineffective. It’s why taking a thorough history on every new patient and performing an in-depth evaluation is a critical component for any clinician working on neuromuscular issues.

Patient’s present across a spectrum from simple injuries to complex polygenic illness.

At a time where:

2/3 of American adults are overweight,

7/10 Americans take at least one prescription drug,

45 % of the population have at least 1 chronic disease

35 % of Americans are inactive (no regular physical activity),

44% admit to feelings of increased stress over the last 5 years

4/5 Americans are  undiagnosed pre-diabetic or diabetic (insulin resistant)

The large majority has no idea how to tailor eating to optimize their health

The bodies natural ability to function and  heal is being suppressed. Chiropractic is grounded in this idea of lifestyle based medicine. As a clinician it’s my goal to help boost a patient’s wherewithal to look after themselves. In addition to adjusting the joints we act as guides providing accountability when it comes to exercise, reexamining a patient’s eating habits, or informing them on the efficacy of cryotherapy, use of CBD, or other relevant research

Speaking of research, here are two interesting  summaries on new literature that provide additional insights into the nervous system

SCIATICA

• More than 5 million cases of sciatica are seen annually in the US
• Animal studies have uncovered activation of the immune system linking it to neuro-inflammation beyond the brain
• A combination of diagnostic imaging (MR and PET) in a human study shows increased inflammation in the brain, spinal cord, and nerve roots that correspond with the effected leg.
• One of the first human studies to demonstrate evidence of an inflammatory process happening at the nerve root.
  (Journal reference #1)

LEG EXERCISE

• Groundbreaking research shows that neurological health depends as much on signals sent by the body's large, leg muscles to the brain as it does on signals from the brain to the muscle. The brain is receiving direct input from the muscles throughout the body.
• In animal studies, it was demonstrated that limiting the physical activity, specifically the hind legs, led to a 70% decrease in neural stem cells compared to a control group in mice.
• Cutting back on exercise makes it difficult for the body to produce new nerve cells -- some of the very building blocks that allow us to handle stress and adapt to challenge in our lives.

• Quote from Lead researcher
  "It is no accident that we are meant to be active: to walk, run, crouch to sit, and use our leg muscles to lift things," says Adami. "Neurological health is not a one-way street with the brain telling the muscles 'lift,' 'walk,' and so on." -Dr. Raffaella Adami 

(Journal Reference # 2)

REFERENCES

1. Daniel S. Albrecht, Shihab U. Ahmed, Norman W. Kettner, Ronald J.H. Borra, Julien Cohen-Adad, Hao Deng, Timothy T. Houle, Arissa Opalacz, Sarah A. Roth, Marcos F. Vidal Melo, Lucy Chen, Jianren Mao, Jacob M. Hooker, Marco L. Loggia, Yi Zhang. Neuroinflammation of the spinal cord and nerve roots in chronic radicular pain patients. PAIN, 2018; 159 (5): 968 DOI: 10.1097/j.pain.0000000000001171

2. Raffaella Adami, Jessica Pagano, Michela Colombo, Natalia Platonova, Deborah Recchia, Raffaella Chiaramonte, Roberto Bottinelli, Monica Canepari, Daniele Bottai. Reduction of Movement in Neurological Diseases: Effects on Neural Stem Cells Characteristics. Frontiers in Neuroscience, 2018; 12 DOI: 10.3389/fnins.2018.00336