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Connective Tissue Damage
The Underlying Culprit of Chronic Pain
There are many articles written on
chronic pain though rarely is mention given to the main culprits for pain, the
connective tissues of the spine and joints. Yet by addressing the deficiency of
connect tissues, the lack of
collagen and weakness in
ligament,
tendons, and
muscle, even people with
Rheumatoid Arthritis can be cured of their pain--even
to test rheumatoid factor negative in the blood, previously thought
irreversible.
What is connective tissue anyway?
Connective tissue is
composed of water,
fibroblasts and
chondrocytes (see research paper), and the substances made by
these cells, collagen and
proteoglycans.
Water
By weight, connective
tissue is comprised of 60 to 80% water. It is water and proteoglycans that
enables connective tissue structures such as ligaments to be strong and somewhat
flexible.
Other than sports or acute
injury, the major reason joints stiffen and cause pain is dehydration. This
especially affects the
articular cartilage and discs, and is a contributing
factors to
degenerated discs. One of the easiest ways to begin the reversal of
connective tissue damage is to drink more filtered or distilled water.
Fibroblasts
Fibroblasts make the
collagen which makes up skin, bone, tendons, ligaments, vessel walls and
viscera, and proteoglycans which make up connective tissue. Fibroblasts are
crucial for healing because they have the ability to proliferate and heal
injury.
Chondrocytes
Chondrocytes are
responsible for formation, maintenance, and repair of articular
cartilage,
though unlike Fibroblasts, their ability to proliferate and repair injury is
greatly inhibited by a lack of a direct nutrient supply from the blood.
Recent research into
Chondrocytes have shown that despite the limited nutrient supply, these cells
can generate new cartilage tissue. These important findings have dispelled the
long held notion that cartilage tissue could not be repaired and damaged
cartilage should be removed by surgery.
Proteoglycans
The proteoglycans are
highly viscous proteins that are very hydrophilic, meaning they are attracted to
water. The shock-absorbing properties of
articular cartilage (see research paper) is primarily due to
the proteoglycans. For people with arthritis or athletes with cartilage damage
oral chondroitin sulfate and
glucosamine sulfate are recommended as these
substances are components of the
articular
cartilages.
Collagen
Collagen is the most
abundant protein in the human body, making up about thirty percent of all
proteins. Collagen is the major component of connective tissue, providing
tensile strength and structural rigidity to tissues.
The cousins of collagen
are the elastins, proteins which give elastic, resilient properties to tissues
which need to expand and contract. These tissues are found in the lungs,
ligaments, skin, and large blood vessels. Wrinkles, sagging skin, bags under the
eyes are all a result of collagen and elastin deficiency.
Soft tissues: muscles, tendons, and ligaments and
connective tissue
whiplash injuries,
back strains,
ankle sprains, loose joints,
fibromyalgia, all have as their root
cause in weakness or deficiency in the
soft tissues of the body.
In normal pain free
function, muscle,
tendon and bone move in unison to create joint motion.
Ligaments which connect bone to bone give the entire joint stabilization. It is
the strength of the ligaments around each joint that is the determining factor
in the joint’s overall stability and ultimately the level of
pain.
The chronic pain error:
ligaments are not muscles and muscles are not ligaments
The main difference
between muscles and ligaments is that muscles are massively strong structures
with a tremendous blood supply. Ligaments, on the other hand, are small tissues
that have a poor blood supply. Muscles, because of their good circulation, heal
quickly and rarely cause long-term problems, ligaments on account of their poor
blood supply, often heal incompletely and are the cause of most
chronic pain.
Ligaments are also more easily susceptible to injury and weakness due to
immobility (lack of exercises) and the aging process.
Articular Cartilage
articular
cartilage acts
as a pad between the surfaces of two bones, it prevents the bones from making
contact and as such is the main line of defense against
osteoarthritis.
As stated, articular
cartilage have the ability to re-grow and heal, yet the long held notion of
damaged cartilage having no regenerative properties led to many people being
subjected to arthroscopies and subsequent
joint
replacement.
Beginning in the early
1960’s medical studies reported that healthy cartilage cells (chondrocytes)
had very little or no ability to proliferate. Since it was then thought that
cartilage could not be repaired, orthopedic surgeons developed techniques to
address the problems of chronic pain in degenerative joints. The first total
hip
replacement surgery occurred at this. A short time later the
arthroscope was
invented.
Medical alternatives to surgery
A small number of
physicians (presently less than 300) have turned to a non-surgical treatment
first developed in the late 1930’s that has shown very promising results in
the treatment of chronic pain. By using
Prolotherapy, these doctors have
accelerated the rate of cartilage growth and strengthened the complete joint
structure in patients with "no cartilage." Using this therapy many
hip
and knee replacements surgeries have been avoided.
In
Prolotherapy, a series
of injections, consisting mostly of naturally derived substances such as cod
liver oil, sugar, salt, or corn extract are given at the site of the chronic
pain—usually where ligaments and tendons attach to the bone. These
Prolotherapy injections
are designed to stimulate the
immune system
by tricking the body into thinking a
new injury has occurred.
The injected substances,
as foreign matter, mimic an injury by causing irritation and mild
swelling in
the painful area. The
immune system responds to this "injury" by
sending macrophages, cells that remove debris and irritants from the body. After
the macrophages carry off the irritants for elimination, the immune system sends
in fibroblasts, cells that rebuild connective tissue where damage has occurred.
This rebuilding process results in new ligament growth which can be 40% stronger
than the original ligament. It also results in the acceleration of re-growth of
cartilage tissue! Consequently, the physical structure supported by this
connective tissue becomes stronger and more stable, thereby eliminating or
greatly diminishing the pain triggered by the corresponding nerves and muscles.
Harold Wilkinson, M.D.
professor and former chairman of the Division of Neurosurgery at the University
of Massachusetts Medical Center, performed a 16 year
Prolotherapy study
culminating in 1995. In his report, Dr. Wilkinson states that it was noteworthy
that "a sizeable portion of people with unresolved chronic pain had more
than a year’s pain relief with only one
Prolotherapy injection." While
these results were obtained with a single injection, most
Prolotherapy sessions
involve multiple injections given in each session.
Non-Steroidal Anti-inflammorty Drugs
(NASIDs)
Cortisone
injections and
anti-inflammatory drugs have the
following effects on connective tissue healing:
- They decrease blood flow which inhibits the ability of
immune cells to get to the area where damage needs to be repaired.
- Inhibits fibroblast proliferation thus restricting the body’s
ability to repair damage.
- Decrease collagen strength by decreasing protein synthesis
and regeneration of collagen tissue
- Decrease tendon and ligament strength
- Accelerate cartilage breakdown
In addition many recent studies have shown
that physician and patient alike are weary of the
prescription of
NSAIDS because
of harmful and well-known side effects.
If someone exhibits
evidence of
systemic inflammation, such as being tender all over or having a
diagnosis of fibromyalgia or a rheumatological disease, then high dose
proteolytic enzymes like bromelain can be given. Omega-3 fatty acids, oils such
as evening primrose oil, borage oil, and flax seed oil may also be used and are
typically necessary when weaning someone off of anti-inflammatories. Initially,
switching from
anti-inflammatory medications to Ultram or Tylenol may be used
because its anti-inflammatory effects are generally negligible.
Many factors affect connective tissue healing
There are many other
factors that affect connective tissue healing, but the next most important
factor is the
nutritional and medical status of the person. People who consume
very healthy
diets and do not have systemic medical conditions, have an
excellent chance to heal their chronic pain. If they experience positive jump
signs where tendons or ligaments attach to the bones, then they have almost a
one hundred percent chance of curing their chronic pain with Prolotherapy.
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