Beyond the Manipulation
Repetitive use injuries and strains often cause tendon and ligament damage resulting in pain and debilitation. They can also cause significant misuse by forcing muscle compensation from adjacent groups. Sprains, strains, and tendonitis happen with increasing frequency as we age. Let’s explore the myriad of reasons for this.
The Significance of Collagen
Since bodies are primarily made up of various combinations of collagen, the inability to produce enough of this vital material results in weaknesses and insufficient healing of damaged tissue. Unlike other proteins, collagen is comprised of only two amino acids, glycine and hydroxyproline. Vitamin C is critical in the reactions that produce collagen and is in fact destroyed in the process.¹ Since we cannot synthesize Vitamin C and much of the processed food and “picked-green” fruit is devoid of this valuable nutrient, we tend to operate our bodies in a state where sufficient collagen cannot be produced. Supplementing with Vitamin C is critical to maintaining good health and especially important during periods of tissue repair.²
The liver produces an enzyme that controls the quiescent level of fibroblast activity. As we age, the liver’s ability to produce this enzyme is reduced. Chinese medicine has acknowledged this connection between the health of connective tissue and the liver for thousands of years. While a base-metabolic test may show “normal” liver function, “normal” for persons over 50 may well be insufficient. Since the fibroblasts are responsible for producing the reparative collagen, a debilitated liver can leave one susceptible to tendon, ligament, and fascia degradation or damage.3,4 Supporting liver health with restorative herbs is quite advantageous as we age.
As we age, the microvasculature within the ligaments and tendons can become blocked with plaque. Soft tissue trauma can leave blockages due to microclots. This restricts and inhibits the movement of the semi-motile fibroblasts and the nutrient supply that they rely upon. This diminishes the ability of the fibroblasts to lay down reparative collagen over areas of damage and microtears.5
Insufficient supplies from which to make collagen, reduced activity of the fibroblasts, and impaired circulation all contribute to the weakened state of connective tissues as we age. In fact, this weakened state allows repetitive use injuries and strains to become a major health issue in our older years. It also contributes to the degeneration of joints, but let us focus on the connective tissues.
The Herbology Solution
Chiropractic manipulation can reestablish proper skeletal functionality and even maintain balanced blood flow. Therapeutic massage can improve muscle body function, break up local fixations, and promote load sharing while relieving blockages of circulatory and lymphatic flow. These are all valuable and effective when treating sprained ankles, rotator cuff issues, epicondilitis, and other common injuries. Yet there is more that can be done to support a return-to-health of the patient. This is where herbology becomes a valuable ancillary therapy to the musculoskeletal work of Chiropractic and Therapeutic Massage.
Injury and chronic repetitive use usually result in chronic and often acute pain. Anti-inflammatory painkillers or cortisone shots stop the inflammation reaction and can hinder the healing process.9 The inflammation reaction serves as the signal to the brain to start the repair cycle. The brain signals the liver to produce more of the enzyme that increases the level of fibroblast activity and thereby causes more reparative collagen to be laid down over the damaged area. Although the pain is undesirable, it is an important part of the healing process, and it should be blocked without stopping the inflammation. NSAIDs are a reasonable alternative. Additionally, Arnica contains prostaglandin blocking constituents, and Willow Bark contains Salix. Both of these (applied topically) will help relieve pain without interfering with the healing process. Arnica has been shown to break up the microclots that appear as bruising and facilitate the return of circulation to the area of damage. This is a wonderful contribution to the healing process.8
For thousands of years, broken bones and soft-tissue damage were handled by masserating Comfrey and/or Plantain and applying it directly to the site of injury as a poultice. Comfrey was often called “knitbone” for its ability to facilitate the rejoining of broken bones by accelerating the production of collagen. As it turns out, these two valuable herbs contain a substance known as allantoin that increases fibroblast activity. This is an invaluable tool for repairing soft-tissue damage.7
As with any injury, there will be some muscular fixation (residual trauma). This can cause poor load sharing within the muscle group and reduced circulation. Poor load sharing can cause joint misuse and microtears in adjacent portions of the tendons. Rosemary & Thyme increase lymphatic and vascular circulation when applied topically. Witch Hazel improves muscle fiber flexibility and lubricity, thus encouraging better load sharing.6 Better load sharing and increased flexibility are important to keep from disturbing the area under repair.
All of the valuable constituents of these herbs can be extracted with a simple low-temperature water decoction. One simply makes a tea of them whilst being careful not to use water that is hotter than 150 degrees Fahrenheit. The decoction can then be applied directly to the skin over the injury where it will be readily absorbed. Soaking a cloth in the decoction and then tying it around the injured area may not be as convenient and socially accepted as it was in the 1800s. Now-a-days, one can achieve the same results by gelling the decoction and simply applying it to the skin. It is important to note that supporting the body internally with Vitamins A, C, D, and E will provide it the constituents necessary to rebuild healthy tissue with reduced scarring.
In fact, clinical and field testing with products that contain these herbs have demonstrated dramatically reduced recovery times and improved healing outcomes. In younger athletes and animals, the repair times were as much as 50% shorter. With older patients and recalcitrant injuries, complete healing was observed in 4 to 6 weeks. By complete healing, we mean that return to service did not produce a reinjury.
The beauty of this technique to assist the patient in their return to health is that as long as these products are applied, the area will continue to be stimulated to maintain the repair. \While the pain relieving analgesics and prostaglandin blockers of the Willow and Arnica will relieve the pain right away, it is important to continue to apply this decoction several times per day for 4 to 6 weeks to make sure that the healing is complete. Patients will be tempted to stop applying it after a few days as the pain will be gone and use will have returned. But as we age, it takes longer for a complete repair to be accomplished.
In cases of low-back trauma and damage, the local fixation can prevent an adjustment from holding. Each week the patient returns with the same level of pain and in need of corrective manipulation. Coincident use of this sort of herbal gel has demonstrated the ability to relax the local fixation and facilitate repair so that the adjustments hold for longer and longer periods of time. The pain level steadily recedes, and the repair is completed.
When procured commercially, an herbal product, such as a gel, of this sort is a very simple and tremendously valuable tool for the Chiropractor to deal with patient injuries in a more “wholistic” manner. “Wholistic” meaning to deal with all of the aspects that the body needs to produce a complete return to health. Chiropractors can do more than adjust the musculoskeletal system without being herbalists by utilizing the carefully engineered support tools that are offered up the natural health industry.
Published with permission from Mr. Steven R. Frank. The author’s opinions are their own, and DC Aligned does not take responsibility for content statements and opinions. You should seek expert counsel in evaluating opinions, treatments, products and services. For more information, see our Editorial Policies.
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¹ Myllyla et al., “Ascorbate is Consumed Stoichiometrically in the Uncoupled Reactions
Catalyzed by Prolyl-4-Hydroxylase and Lysyl Hydroxylase. Journal of Biological Chemistry
² Roger J. Williams, Nutrition Against Disease, 1971. Pg 85-86 (paperback)
³ J Clin Gastroenterol. 2002 Oct;35(4):345-9. Connective tissue diseases and the liver. Youssef
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