Supporting the healing of Sprains, Strains and Soft Tissue Beyond the manipulation
Steven R. Frank
Repetitive use injuries and strains often cause tendon and ligament damage resulting in pain and debilitation. They can also cause significant miss-use 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.
Since our bodies are primarily made up of various combinations of collagen, the in-ability to produce enough of this vital material results in weaknesses and in-sufficient 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 process 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)
Our livers produce an enzyme that controls the quiescent level of fibroblast activity. As we age, our livers ability to produce this enzyme is reduced. Chinese medicine has acknowledged this connection between the health of connective tissue and our livers 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 plaques. Soft tissue trauma can leave blockages due to micro-clots. 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 micro-tears. (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 the degeneration of joints, but let us focus on the connective tissues.
Chiropractic manipulation can re-establish 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 pain killers 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 relieve pain without interfering with the healing process. Arnica has been shown to break-up the micro-clots which 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 was 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 re-joining of broken bones by accelerating the production of collagen. As it turns out, these two valuable herbs contain a substance known as allantoin which 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 miss-use and micro-tears 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 1800’s. 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 re-build healthy tissue with reduced scarring.
In fact, clinical and field testing of this sort of Bruise, Strain and Tear Repair gel 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 re-injury.
The beauty of this technique to assist the patient in their return to health is that as long as this herbal gel is 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 gel of this sort is a very simple and tremendously valuable tools 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.
1) [Myllyla et al., "Ascorbate is Consumed Stoichiometrically in the Uncoupled Reactions Catalyzed by Prolyl-4-Hydroxylase and Lysyl Hydroxylase. Journal of Biological Chemistry 259:5403-5405. 1984]
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 WI1, Tavill AS.
4) Best Pract Res Clin Gastroenterol. 2013 Aug;27(4):543-51. doi: 10.1016/j.bpg.2013.06.016. Liver abnormalities in connective tissue diseases. De Santis M1, Crotti C, Selmi C.
5) J Orthop Surg. 2008; 3: 18. Published online 2008 Apr 30. doi: 10.1186/1749-799X-3-18 PMCID: PMC2397381 ggstThe role of tendon microcirculation in Achilles and patellar tendinopathy Karsten Knobloch
6) The Holistic Herbal Directory. Penelopy Ody 2001 The Ivy Press Limited. ISBN: 0-7858-1351-9. Pg 155
7) Modern Encyclopedia of Herbs. Joseph M. Kadans, N.D., Ph.D. Parker Publishing Company, Inc.1970, Catalog Card Number 72-124345, pp 97-103
8) Evid Based Complement Alternat Med. 2011; 2011: 917541. Published online 2011 Jan 19. doi: 10.1155/2011/917541 PMCID: PMC3035003 Inflammatory Process Modulation by Homeopathic Arnica montana 6CH: The Role of Individual Variation Ana Paula Kawakami,1 Cesar Sato,1 Thayna Neves Cardoso,1 and Leoni Villano Bonamin1, 2
9) Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Brooke K Coombes, MPhty, Leanne Bisset, PhD, Prof Bill Vicenzino, PhD Published Online: 22 October 2010 DOI: http://dx.doi.org/10.1016/S0140-6736(10)61160-9
Steve Frank is an Herbalist from the Front Range of Colorado with many years of experience in treating musculoskeletal injuries with indigenous plants and herbs. He has studied the actions of these natural remedies in the clinic and the laboratory so that he can bring you the best that science and ancient wisdom have to offer. Mr. Frank can be reached with questions at stevef@NaturesRiteRemedies.com His blog can be found on www.MyNaturesRite.com
Note: The combination of herbs in a water based decoction, gelled and ready to treat can be procured from Nature’s Rite, LLC at www.MyNaturesRite.com It is called Bruise-Strain-Tear Repair.