Fibrosis and Fibrosis Removal
Fibrosis (AKA scar tissue, granulation tissue, fibrotic repair) is the presence of the left-over dried “goo” and collagen fibers that are laid down during an episode of an inflammatory event. Inflammation is brought to an area to help the body heal after an injury or to wall off the area to keep it separate from the rest of the body (infection, infestation). Inflammation is a natural and normal part of the healing process.
When a muscle remains in a contracted state for a prolonged period of time, or is over-used and under-stretched, it becomes hypoxic. Hypo- (low) -Oxic (oxygen) means “low oxygen” in the muscle. This low-oxygen state is seen as an injury by the body. And the body sends its response to injury, inflammation, to the area to help heal it. Inflammation is “goo” and collagen fibers. It acts like a glue or duct tape or sticky Saran Wrap. It infiltrates the area of hypoxia and lays down within, between and around the injured tissues. These now glued-together tissues create altered biomechanics in the area. These altered biomechanics create more stress on the tissues setting up a cyclical event of fibrotic repair (fibrosis lay-down). (see fig. 4)
With repeated accumulation of this fibrosis, the tissues become less and less like filet mignon (normal meat, capable of contraction and full lengthening upon relaxation) and more and more like beef jerky (tighter, shorter and less resilient meat that is incapable of full contraction). Check out figs. 1 & 10, they show some of the intricacies of the workings within the muscle. These tiny “ratchet systems” are not capable of proper movement in the presence of an accumulation of fibrosis. The result is that the muscle can’t properly contract.
Fibrotic tissue appears weak. It can not do its job properly. If its job is to support the head and neck against gravity, or to help you throw a discus, or help you chew your food, these jobs are not going to be done properly, and the body will help you by recruiting other muscles to accomplish the task. This stress added to other muscles eventually causes them to experience the same fate.
You can’t take beef jerky to the gym and expect results. You CAN expect a greater likelihood of injury however. So the answer isn’t “REHAB THOSE MUSCLES”, rehabilitation is great, but it needs to be used at the RIGHT TIME IN THE JOB. And that right time is NOT before the fibrosis has been removed.
Fibrosis Removal is the art of removing the accumulated fibrosis without adding to the problem. Being too aggressive will bring more inflammation and invite more fibrotic repair. I consider fibrosis like snow. Sticky, gooey snow, but snow. Sometimes it takes a broom to get the snow off the sidewalk (ART)….sometimes it takes a shovel (Graston and SASTM)…and sometimes it takes a plow (my own new technique)…Very often the sweep is all that is needed, and it is often needed after the plow or the shovel, so I find ART is best for a healthy-eating, healthy-living patient that is in a world where they continually create fibrotic repair due to Repetitive Strain Injury (RSI). (like musicians and athletes) ART is the most specific and sensitive of all the fibrosis removal techniques, but when there is an abundance of fibrosis, just like an abundance of snow, the shovel and the plow need to come before the broom. It makes the job go more quickly (think cost-effective!) The shovel is for the thicker areas of fibrosis, often found near the insertions and origins of muscles, near junctions where tendons cross ligaments or other tendons, or fibrous arches, where fibrosis accumulates. It can also be needed on the bellies of the muscles. The plow is for the chronic areas found in older athletes and those that were subjected to the old days of “ice and anti-inflammatories” where areas of the body were repeatedly subjected to trauma and allowed to have LAYER after LAYER of fibrotic repair accumulate (College and Pro athletes from the 60’s until today).
The key is to remove the fibrosis, so the muscle can adequately fire and pull on its skeletal attachments with the correct amount of force. If the fibrosis is in the joint capsule, removing it allows the joint to move more freely, taking stress off the muscles that are responsible for moving it, whether it be an elbow or a thumb or a lower neck facet joint. There’s a reason they call it the MUSCULOSKELETAL system. Fibrosis removal adds a great thoroughness to the care of any patient. Very often it is the fibrosis removal alone that finally allows the skeleton and nervous system to function properly. It also greatly cuts down the number of visits required to fix a given problem.
