Chiropractic manipulation is an essential foundation for correcting problems of use. Massage can release residual trauma and support proper muscle balance. Often in repetitive-use injuries and strains or sprains, the ligaments and tendons need help too. Tendonitis, fasciitis, and microtears in ligaments happen all too often in the aging population. Chiropractors need to address the healing of these tissues to offer a complete and lasting return to health.
Our bodies are primarily made of various forms of collagen. It is critical for the maintenance of our soft tissues that we are able to produce sufficient amounts. 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 destroyed in the process. (1) Since humans are unable to synthesize vitamin C, we tend to operate our bodies in a state where sufficient collagen cannot be produced. Since much of the processed food and “picked-green” fruit is devoid of this valuable nutrient, supplementing with vitamin C is critical to maintaining good health, and it is 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 liver’s ability to produce this enzyme is reduced. Chinese medicine has acknowledged this connection between the health of connective tissue and our liver function for thousands of years. While a base metabolic test may show “normal” liver function, “normal” for persons over 50 is insufficient to maintain sound connective tissue health. 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 microclots. This restricts and inhibits the movement of the semi-motile fibroblasts and the nutrient supply upon which they rely. This diminution of mobility and nutrient flow in an injured region reduces the ability of the fibroblasts to apply reparative collagen over areas of damage and microtears. (5)
We can see that 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. With a little simple dietary and herbal therapy, we can correct this problem.
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 means of treating sprained ankles, rotator cuff issues, epicondylitis, and other common injuries. However, more can be done to support a complete return to health for the patient. This is when 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 sustain 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 applied to the damaged area. Although the pain is undesirable, it is an important part of the healing process and should be blocked without stopping the inflammation. NSAIDs are a reasonable alternative. From an herbal standpoint, arnica contains prostaglandin-blocking constituents, and willow bark contains Salix. Both of these (applied topically) will relieve pain without interfering with the healing process. Additionally, arnica has been shown to break up the microclots, which appear as bruising, and this facilitates 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 macerating comfrey and/or plantain and applying it directly to the site of injury as a poultice. Comfrey’s common name is “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 do that because they contain a substance known as allantoin, which increases fibroblast activity. It is an invaluable tool for repairing soft-tissue damage. (7)
All injuries produce some muscular fixation (residual trauma), which 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 and 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 while 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 wifi 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. Today, one can achieve the same results by gelling the decoction and simply applying it to the skin. This decoction or gel should be reapplied three times a day. It is important to note that supporting the body internally with vitamins A, C, D, and E wifi provide it the constituents necessary to rebuild 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 four to six weeks. By complete healing, we are presenting 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 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 wifi relieve the pain right away, it is important to continue to apply this decoction several times a day for four to six weeks to make sure that the healing is complete. Patients wifi be tempted to stop applying it after a few days because the pain wifi be gone and use will have returned, but as we age, it takes longer for a complete repair to be accomplished.
In a case of 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 is in need of corrective manipulation. Concurrent use of this herbal gel has demonstrated the ability to relax the local fixation and facilitate repair so that the adjustments hold for longer periods. The pain level steadily recedes, and a complete repair is achieved.
When procured commercially, an herbal gel of this sort is a very simple and tremendously valuable tool for the chiropractor to deal with patient injuries in a more holistic manner. Holistic means 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 the natural health industry offers.
References
1. Myllyla et al, Ascorbate is Consumed Stoichiometrically in the Uncoupled Reactions Catalyzed by Prolyl-4-Hydroxylase and Lysyl Hydroxylase. Journal of Biological Chemistry 259:54035405. 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. YoussefWIl, TavillAS.
4. Best Pract Res Clin Gastroenterol. 2013 Aug;27(4):543-51. doi: i0.i016j.bpg.2013.06.016. Liver abnormalities in connective tissue diseases. De Santis Ml, Crotti C, Selmi C.
5. J Orthop Surg. 2008; 3: 18. Published online 2008 Apr 30. doi: 10.1186 1 749-799X-3-18 PMCID: PMC2397381 ggst The 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: 10.115572011 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 Bonaminl, 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/S014...
Note: This 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.
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. Fie has studied the actions of these natural remedies in the clinic and the laboratory so that he can bring you the best synthesis that science and ancient wisdom have to offer. Mr. Frank can be reached with questions at [email protected]. His blog can be found on www.HealthCareToolKit.info
