The 5 Steps of Healing

There are five steps to properly stimulating your body's healing process. They are essential for relieving pain, preventing re-injury, getting back into shape, and overcoming your physical limitations.  These steps strengthen your damaged tissues, allowing you to return to the physical activities and sports you enjoy. Each step builds on another. You need all 5 steps in progression to gain control over your body again. Without them, the pain and injury will likely continue to have control over you.

These 5 steps are:

1.  Understand your pain and injury.

2.  Learn pain relief exercises.

3.  Resolve scar tissue/ fibrosis.

4. Correct dysfunction in posture/alignment, joint stability, and body mechanics that are at the root of most pain and injury.

5. Use a progressive conditioning exercise program to strengthen your body's ability to "hold" its mechanical corrections to be able to withstand the physical stresses in your life without injury.

 
Most people never learn and use these 5 steps. As a result, they "go back too early" to their activities once pain subsides, or attempt to "fight through" the pain. Either way, the pain and injury returns with the futile attempt of using the same dysfunctional mechanical stresses that caused the injury in the first place.

You can't expect a different result using the same problem over and over again. The answer is to learn and use these 5 steps to stimulate proper healing, and to  condition your body to be able to "hold" proper mechanics to meet your daily physical needs without injury.

So lets begin your journey of pain relief, injury solutions, and the best shape of your life by learning these 5 steps.....

1. Understanding Your Pain and Injury

The following statement may be the most important concept you will ever learn when it comes to overcoming your pains and injuries.....Ready?

Most muscle /  joint pain and injury is the result of 2 very correctable causes:

 
1. Abnormal body mechanics (muscle and joint imbalances, posture/alignment,  movement), and

 
2. De-conditioning  (out of shape, not specifically physically prepared for the stress that the body encounters).

  
Injuries can result from a large, one time macro-stress (slip, fall, lift, crash), or from smaller repetitive micro-stresses that build up over time (posture and movement abnormalities, or fatigue). Regardless of the type, injury occurs because your body cannot withstand the stresses that are imposed on it. Sometimes it is your level of strength and endurance that fails to stand up to the stress (physical conditioning).  At other times, it is muscle imbalance, posture, or incorrect movement (body mechanics) that fails to stand up to the imposed stress.

 
All of these many varieties of stress cause the same end result- a tearing or breaking of some body soft tissue (muscle, ligament, tendon, cartilage, disc, fascia, nerve, etc.). Even in cases of degenerative conditions such as arthritis, stenosis, degenerative discs, spurs, and re-aggravations of previous conditions, the result is the same- torn or broken tissue fibers. When most tissue fibers break, nerves are stimulated which causes pain to be experienced. Pain is the first reaction to injury.  It is the natural warning system of the body to avoid more damage.  Listen to this warning and avoid any aggravating activities!  The next reaction of the body is to begin a "protect and repair response".  The protection comes in the form of muscle spasm to avoid any additional movement that may further aggravate the damage. The repair comes in the form of a 3 phase response known as the inflammatory process.

 
Inflammation is the initial phase during the first 3-5 days after you injure yourself.  Here, the body attempts to break down and remove damaged tissue. The increased blood supply and this initial process causes swelling, while local muscles tighten in an attempt to brace and protect the injured area. The next phase (repair) of the damaged body part begins with the laying down of new soft tissue fibers by fibroblast cells over the next 2-6 weeks, as the broken parts are mended together with new fibers. These new fibers are laid down both in the same direction as the original damaged fibers, and also in many other directions, which results in a local thickening or "scar" known as fibrosis. Tiny new nerves and blood vessels grow inbetween the dense fibers of the scar (angiofibroblastic proliferation), which can become irritated when you move the injured area causing more pain. The final phase of repair (remodeling) may take up to two years, as the body breaks up all the fibers in the scar that are not oriented in the same direction as the original tissue. This breaking up of excess fibers occurs through daily motions of the injured body part. For optimum healing, these motions must be in the correct direction of movement, done with proper body mechanics, and they must occur through an optimum range of motion. If these motions are dysfunctional, or too great for the healing fiber's current strength level, they may tear again.   

 
This 3 phase inflammatory process is what is actually happening with your ongoing pains. It is the same, regardless of your diagnosis: strains, sprains, tendinitis, tendinosis, neuropathy, radiculopathy, sciatica, carpal tunnel, arthritis, arthrosis, degenerative discs, herniated discs, meniscus tears, bone bruises, stenosis, facet syndromes, spurs, plantar fascitis, shin splints, stress fractures, impingement syndromes, bursitis, and practically every type of injury and pain you can think of.

 
It is important to note that discs, cartilage and menisci do not have deep internal blood vessels and nerves, so some may argue that they can't be painful, but they do have peripheral ones, as well as associated soft tissues that are susceptible to the above inflammatory process.  All sensitive tissues are sensitive because they are in some stage of the healing (inflammatory) process.

 
Another concept of musculo-skeletal pain is understanding that injury is an absorbed force that cannot be properly handled by the body tissues. The increased energy that is absorbed by the damaged tissue alters the arrangement of molecules within the tissue protein fibers, causing the fibers to become stiff and rigid. The body's tissues are made up of proteins, which act as semi-conductors, storing and conducting electrical charges through the body. A rigid tissue has a different electrical frequency than a flexible tissue. The more energy imparted with the injury, the more energy will be stored by the damaged tissue, the greater its electric charge, and the more rigid it will be. This area of rigidity will also be more likely to become re-injured because rigid tissues absorb more force than do flexible ones. Healing is associated with the release of this stored energy, and a normalizing of the tissue's electric charge and frequency.    

 
Ideally, all goes well in the above healing process, and chronic, long standing pain, as well as recurrent pain never happens. Realistically, this is rarely the case.  Re-aggravations to the injury are frequent before the damaged tissue is fully repaired. These re-aggravations begin a whole new inflammatory process.  Multiple re-aggravatioins result in multiple phases of the inflammatory process occurring at the same time in the same region. The end result is the damaged area has excess fibrosis (scarring), increased rigidity and electric charge, excessive tiny nerves and blood vessels growing in it (which are ultra pain sensitive), decreased flexibility, and decreased strength and endurance (from not using the body part in an effort to avoid pain). It is also common for these damaged tissues to be under ongoing, aggravating stresses due to the same faulty body mechanics (posture, alignment, muscle imbalance, faulty movement habits) that may have caused the injury in the first place. As your body is trying to heal, the same stresses that caused the injury are still stressing the injury, making it impossible to heal. Add to this the common decreased threshold for feeling pain in the central nervous system (central sensitization), that develops due to the constant bombarding of the nervous system with pain signals- and is it any wonder that so many people suffer ongoing pains? With constant stress, congestion of phases of healing, and a nervous system that feels pain easier with less stimulus, you now have the picture of most chronic pain conditions.

 
What then is the answer to resolving pain?

 
The answer is not to mask the pain with medications and alcohol. These don't permanently solve any of the above problems. Anti-inflammatories (injectable and oral), as well as muscle relaxants are usually temporary solutions as well. That is not to say they do not have their place in managing pain short term. However, long term effects of any medication are well known and many are quite dangerous. You don't want more health problems as a result of your present problems. Discuss the risks of any medication with your doctor, especially those suggested for long term use. 

 
Electrical stim units can relieve spasm, reduce swelling, and decrease pain sensation, but usually are best used early in the injury process. "Rub on" ointments can irritate the skin surface , which stimulates certain nerves that "fool" your nervous system into feeling the skin sensation more than pain. If your goal is to mask the pain, then they are an option. Rest from aggravating activities is wise, but complete or excessive rest is a common problem that causes deconditioning and a lack of local circulation to the injured area, both of which stunt the healing process.

 
Surgery is the right choice if your pain requires a piece of damaged tissue to be removed (torn cartilage, nerve compression, impinging spur, etc.), or if you have a third degree tear of your tissue, which means the ends no longer meet, and conservative care has not helped. Other reasons for surgery include severe instability of a joint, or severe joint erosion (hip replacement), as well as joint infection, or autoimmune damage and bone destruction. However, the vast majority of most musculoskeletal pains do not fit these criteria, and as previously mentioned are related to improper body mechanics, de-conditioning, and a congested multi-phased inflammatory process, where the body is "stuck" in its healing.

 
You must get to the root of your problem for lasting relief and a full return to the activities you enjoy. Even if you use any of the above options for pain treatment, they usually do not solve your real underlying problem that set the stage for injury and pain in the first place. 

 
The real answer is a two step process that allows your body to fully heal itself. First, the excess fibrotic scarring must be removed, which will decrease the painful pulling on local nerves and blood vessels. Second, and more importantly, you have to correct the two inital causes of pain and injury that caused the entire problem in the first place- these being abnormal body mechanics and de-conditioning. 

It is very important to stay away from any aggravating activities while you begin to address these two steps. Healing requires a balance between doing the right things, and avoiding the wrong things. It makes no sense to begin gentle stretches and exercises if you are still participating in activities that are aggravating your pain.  Healing is impossible if you keep doing the things that are tearing your soft tissue fibers. 

 
Rest from offending activities and typical rehabilitative exercises which include stretching the fibrotic scar, decreasing local rigidity, and strengthening the damaged tissues are not enough.  I have an entire practice filled with patients who have been through deep tissue massage, soft tissue and joint manipulation, and tons of physical therapy /sports rehab only to still have pain, and not be able to engage in the physical activities they once enjoyed.

 
That is not to say that all of these are not helpful, but they are not fully addressing the above mentioned two main causes of most pain and injury. The real answer that most people need is to correct their unique body mechanical problems, and condition their body through individualized exercises that address their specific physical needs.

 
By analyzing a person's unique posture and alignment, muscle imbalances, movement patterns, and physical conditioning (including strength, coordination, flexibility, stability, balance & endurance), a proper individualized healing exercise program can be created which corrects all of these issues. The injured and painful body can be brought back to a pain free and fit state of well being.

 
What can you do to help yourself? 

 
Any muscle or joint pain that is not resolving on its own in two weeks, is severe, or progressively worsening,  is associated with a major trauma such as an accident, or is associated with a fever, weight loss, significant swelling or discoloration, nerve or circulatory symptoms, change in bowel or bladder function, or genitourinary symptoms should be checked by a licensed health care professional. It is important to rule out infection, cancer, organ and systemic problems, as well as surgical emergencies first. Remember that for some conditions, surgery is the proper route. However, body mechanics and deconditioning need to be addressed post-surgically.

 
Ice applications (cryotherapy) for 15-20 minutes on a painful area is indicated during the first phase of the inflammatory process (first 3-5 days after injury or reaggravation) in an effort to limit inflammation and swelling.  Pain free (gentle) motion during the ice applications is an old technique for treating sports injuries that decreases healing time by maintaining motion (avoiding some of the deconditioning that occurs with pain induced immobility). These ice/motion applications can be done every hour if needed. Avoid direct ice contact with the skin to limit the possibility of ice burn. 

 
Moist heat applied from 20-30 minutes at a time is an excellent pre-exercise or pre-stretch modality. It can be used after the first 3-5 days of injury as a means of increasing local circulation.  Do not use heat if swelling is still visible as the dilated blood vessels that occur from heat can enhance swelling. Ice applications should continue for swelling. Moist heat is excellent for chronic stiffness as well. Dry heat does not deliver as deep a temperature effect as moist  heat does, and therefore is not recommended. 

 
Alternating 5 minutes ice and 5 minutes moist heat for 30 minutes total duration is known as contrast therapy.  This is good for pumping an area of chronic swelling in an effort to resolve it. It can be done with a comfortable amount of compression to the area, along with elevating the involved body part higher than heart level for an enhanced anti-swelling effect. This may be done several times daily.  Certain types of medical conditions such as neuropathy, diabetes, and Raynauds syndrome cause altered temperature sensations and would be contraindications for both ice and heat therapy.

 
Braces, splints and taping all immobilize the injured area which is necessary if the injury has produced excessive motion at the involved joint (hypermobility or instability).  This is usually not the case, and therefore immobilization is actually the wrong approach for most injuries. By bracing or taping a joint without excessive motion, you will prolong healing time by increasing local stiffness and inducing weakness. With the artificial support of the brace or tape, the local muscles do not get the normal stimulus they need. Subsequently, the local region become weak from disuse, and un-necessarily tight due to the lack of motion.  This causes a decrease in local circulation and prolonged healing. Bracing, splints and taping should only be used for those injuries which have instability, or for athletes/workers wishing to protect against injury by adding artificial support to a joint during sporting events or physical labor.

 
Nutrition is an important aspect of healing any injury. The best exercises for low back pain, neck and shoulder pain, knee injuries, elbow tendinitis and hip pain will be limited if you don't support your healing exercise with good nutrition. What you eat can have an effect on pain and inflammation, as well as provide the nutrients that are needed to rebuild new tissue. Of course, any change in nutrition or diet should be undertaken with caution if you have a medical or nutritional issue.  Check with your doctor before changing your diet if this is the case, as medications can be affected by dietary changes, and depending on your unique situation, some changes may be dangerous for your condition. Generally however, the following holds true for those who are looking to decrease pain and inflammation through better nutrition:

Decrease the amounts of meats and grains, while increasing vegetable and fruit consumption. Meats and grains are sources of potential tissue acids, which can activate inflammatory chemicals, and stimulate nerve receptors to pain.  Vegetables and fruits have the opposite effect. Increase potassium and magnesium (if deficient), and decrease sodium, refined sugars and fats. Add an antioxidant (vitamins, minerals, enzymes) supplement to your diet.  Antioxidants neutralize the harmful effects of free radicals, which promote inflammation. Antioxidant vitamins are Vit. A, C, E, and the minerals zinc and selenium are important. Antioxidant enzymes are found abundantly in sprouts (particularly wheat sprouts) and stimulate your body's production of the same.  Alpha lipoic acid and Co-Q10 are other helpful antioxidants for healing. Avoid hydrogenated fats (packaged snack foods esp.) as they promote inflammation. Substitute olive oil  (extra virgin is best) and omega 3 cold water fish oils for most other fats and oils to combat inflammation. Increase water intake as proper hydration can help to control inflammation.  Add bromelain (pineapples), ginger, garlic, tumeric, flavinoids (citrus fruits), lycopene (cooked tomatoes) to decrease inflammation. Sea vegetables are also a great source of many microminerals and nutrients that may help.  Consider adding hyaluronic acid, chondroitin sulfate, glucosamine sulfate, and MSM as joint health supplements.   Always be sure to check the purity of these commercial products as many have additives or fillers that, while decreasing price, may also decrease effectiveness because there is less of the actual nutrients per serving.

 
Check your mental attitude.  Chronic pain can be worse than it has to be when you are focused on the pain, disability, and all the negatives you can find. A positive mental outlook that there is hope for your condition, and that it WILL improve is very important to the healing process, as well as to your overall quality of life.  Chronic pain is often part of a negative mental and spiritual complex that derails you from being the best that you can be. Life is too short (and way too important) to be wasted on the negative, and not fully matured and developed. Prayer and faith, as well as practicing positive visualization and meditation, can be helpful to aiding your healing. Most long term sufferers need to address this, as being pain free and fit is much more than symptoms- it is a healthy/positive physical, mental and spiritual lifestyle that is meant to be enjoyed.   

 
Early motion is key with any injury that is not a fracture or dislocation. There are many benefits of moving the injured area gently through as many different non-painful directions of motion as possible.  This should be done multiple times throughout the day.  If weight bearing hurts the injured region, try moving the body part in a non-weight bearing way. The hip, knee or ankle can be moved while lying on your back to decrease the weight bearing stress.  Moving frontwards, backwards and sideways, as well as in circles and figure 8 shapes are typical motions that will help. Try moving in each direction as far as comfortably possible, holding the end point for 2 seconds. Repeat 5-10 times in each direction. You can do this every 30 to 60 minutes. This can be done while applying ice during the first 3-5 days, or moist heat after 5 days.  Moving to the point of feeling a slight pull, but not pain, is the key to avoiding re-injury with these mobilization motions. Range of motion usually improves as your practice sessions advance over days and weeks. Realize that in the morning you will be stiffer than later in the day, so don't expect that you will end with as  much range of motion after your first few morning mobilization sessions. Early and frequent non-painful mobilization will aid in local circulation, stimulate your body's healing process, and help retain or increase flexibility and strength.  It also helps to prevent excessive scar/fibrosis formation early after an injury, and helps to break up scar and fibrosis in longer standing cases. This gentle mobilization is the most important first step in successfully handling pain and injury.

 
Massage therapy, manipulation, and other soft tissue therapies can be sought from licensed health care professionals such as massage therapists, chiropractors, physical therapists, and osteopaths to aid in the reduction of scar fibrosis.  Chiropractic adjustments of the spine and extremities are a highly specific form of manipulation which help re-establish normal neurologic function and joint mechanics, which are essential to healing. Some of these practitioners may also offer various modalities such as ultrasound and laser therapy which can also help in the resolution of fibrosis and pain.  

 
Remember that after you control the initial swelling and begin mobilization of your injury, the next (and most critical) step is to address the two probable root causes of your injury- faulty body mechanics and de-conditioning.  While several exercises are presented on this website to help you begin your pain relief, correct body mechanics, condition injured body parts, and prevent future injury and pain, realize that this is only a "scratch on the surface" of what you probably need. Specific exercises designed to restore your unique de-conditioning and body mechanics can only come from a thorough analysis of your individual issues, and an individualized program of healing exercises.

 
This is best accomplished with the help of a specialist in soft tissue injury treatment and rehabilitation. As you can imagine, there is a world of difference between poor, good and great health care providers and trainers. Choose a specialist from personal recommendations, not from a list. Chiropractors, physical therapists, osteopaths and massage therapists who also specialize in rehab are the best to choose from, as they can not only provide the soft tissue therapy needed to resolve the fibrosis and joint dysfunction associated with pain and injury, but can also help you correct faulty body mechanics and recondition your injured area. Realize that most of these practitioners may not specialize in all of these needs, but a few will. Another option is to find a great personal or athletic trainer who specializes in rehab of faulty body mechanics and posture, and use someone else for the soft tissue therapy. Make sure that any rehab is based on an analysis of your unique body mechanics and conditioning levels. If your motions are not being carefully monitored and corrected as you perform your exercises, you are probably only strengthening dysfunction and inviting more pain and injury. There are plenty of doctors, therapists and trainers who unknowingly are providing this type of "rehab". Remember that your goal should be to strengthen proper function, not dysfunction. Get a thorough body analysis first, and then follow a program based and monitored on that analysis.  If you can't find a highly qualified professional, our website offers various products that can help you achieve your goals on your own.

 
Our various products can show you in detail how to analyze and correct your faulty body mechanics, relieve pain, and recondition your injury. The Pain Free & Fit TM Self Help Series are digital books that can get you started today. Separate books are dedicated to lower back, neck, shoulder and knee pain.  We even have a full body 5 Minute Pain Free & Fit TM Healing Program e book. Our newest and most exciting option is our Pain Free & Fit TM Online Workout Program, which is a monthly subscription based healing exercise program that delivers easy to follow along pain relieving and preventing workouts which can be done at home or the gym, at your own pace, and at any time of the day or week. This program streamlines your analysis and corrective exercises, ensures your progress at any level, makes your healing stimulus easy with short (8-20 minute) workouts, and gives you plenty of variety and inspiration with constant updated exercises and techniques. It is a dynamic, fun and super effective way to enjoy the pain free and fit lifestyle without having to make much effort.  You simply follow along with the workout descriptions and videos that are sent to you each week at your own pace, and according to your time schedule. We "hold your hand" with this online workout program, and make healing and conditioning easy. 

Regardless of how you address your body mechanics and conditioning, realize that the most important part is that you do address them, because they are most likely at the root of your problem. So many people needlessly suffer for years from a pain or injury that could be corrected, but because of ignorance, or their doctor fails to tell them of other options, never seek true lasting solutions. No matter how long you have been suffering, or what you have been led to believe about your condition up to this point, realize that the majority of musculo-skeletal pain and injury can be improved by restoring proper body mechanics and conditioning.

2. Pain Relief Exercises

Exercise can be used for immediate relief of musculoskeletal pain. There are several mechanisms by which this occurs. These vary from (1) altering tension in the painful area, to (2) bombarding the spinal cord with sensory information concerning motion, which in turn dampens the incoming pain stimulus, to (3) breaking up fibrosis (scar) that is mechanically irritating local nerves, to (4) increasing local circulation that flushes noxious substances, to (5) releasing of nerve protein chemicals (endorphins, enkephalins) that modulate pain. Any one or a combination of these are at play when exercise decreases pain. The exact type, duration, intensity, and execution (form) of exercise is of more importance in some of these mechanisms than others.

While any type of aerobic (cardio) exercise can increase circulation and release endorphins, the pain modulating chemicals are better released with more strenuous exercise. Preferably, this should be done using a segment of the body that is not injured, so as to avoid aggravating painful tissue. Weight training uses heavier resistance and is a perfect fit for many chronic pains, as long as the exercises chosen do not aggravate the condition, or perpetuate poor body mechanics. The best type of exercises however are those that address the actual painful, and dysfunctional, injured body part.

The most common source of musculoskeletal pain is a state of abnormal tension existing in muscles, tendons, or fascia (the connecting and suppprting webbing of the entire body). This tension can manifest in several ways, including: (1) scar tissue (fibrosis), (2) myofascial trigger points (tight local regions that trap metabolites/toxins and irritate nerves), (3) spasm or hypertonicity of muscles, or (4) over-stretching (increased tension due to over-lengthening) of various soft tissues.

Even when acute pain is due to torn tissue fibers, one of the above states of abnormal tension is usually associated with the pain. Therefore, many of the pain relieving exercises are designed to reduce this abnormal soft tissue tension. Samples of  pain relieving exercises are provided for specific body parts in the navigation bar of this site. Note that there are many possibilities of the best exercise for your pain based on your unique problem and mechanical dysfunction. While only a few exercises are presented here due to space constraints, many more are available. The reader is referred to the various products available on this website for a more detailed exercise solution to their unique pain. Always perform a self-analysis on your own body before attempting any exercise, as healing exercises need to target your unique posture and mechanical faults to be effective. A basic self-analysis is also available in the navigation bar of this website.

3. Resolve Scar Tissue/ Fibrosis

Chronic pain is often caused by torn soft tissue fibers that have not fully healed, or healed incorrectly. It is often the result of chronic inflammation.  Your body heals damaged tissue fibers by laying down new soft tissue fibers as part of the secondary phase of the inflammatory process.  This occurs in bone, muscle, tendon, ligament, joint capsules, bursa, fascia, and to some degree in the periphery of discs and certain types of cartilage. Healthy new fibers are essential to healing and pain relief, as they replace the torn and damged ones. Ideally, the new fibers should replace the old fibers, and be oriented in the same direction as the old fibers. Unfortunately, the cells which manufacture the new fibers (fibroblasts), do not arrange them in an orderly fashion. Instead of arranging the new fibers in the same direction that the original fibers were oriented, they are made and placed in many haphazard directions along the gap of the injured soft tissue. This results in a scar formation, or a fibrotic nodule of excess fibers in the damaged area.

 

This can be further complicated by changes that occurr at the molecular level in your soft tissues.  Trauma (either large or small repetitive exposures such as improper body movement or posture) can cause an electric frequency change in the protein fibers of your soft tissues.  Molecules in damaged areas can tighten, and become more densely grouped, as they absorb energy that they cannot release. As a result, the injured or inflammed body region can undergo a change in its electric charge, causing soft tissue fibers to arrange themselves in an abnormal pattern.  This can cause abnormal tension to be distributed throughout the entire body, and be a cause of persistent pain in multiple regions. Locally, it tightens the area of injury, thus promoting fibrotic/ scar formation. 

 

This clumping together of scar fibers running in all different directions is not ideal for movement. The damaged soft tissue often becomes stiff, causing abnormal joint mechanics and nerve function in the local (and sometimes distant) body regions. Because the scar contains tiny blood vessels and nerves (angiofibroblastic proliferation), pain arises as you try to move the area, as these nerves become compressed or stretched against the scar.  This painful irritation causes you to avoid certain movements, and the lack of full mobility contributes to more scar formation.  It is a never ending cycle of pain, stiffness and weakness, which leads to a gradual deterioration of physical conditioning, and thus poor health. 

 

The body needs motion, exercise, and a certain amount of physical strain to be healthy.  This is true not only for the musculoskeletal system, but for all body systems.  Chronic pain is often the gateway to more health problems because of the poor physical fitness it causes. Who wants to move when it is painful?  The fibrosis or scar tissue often grows larger the longer the inactivity lasts.  If motion across the tissue does occur, it is often improper because of compensatory new movements that have been developed to avoid pain, but are mechanically incorrect. Often, the original posture or movement problem that caused the soft tissue overload in the first  place is still there, causing the scar tissue to remain painful. Local and distant body mechanics continue to compensate, and pains in other areas commonly arise as the abnormal tension is transmitted throughout the body via fascial connections. Some people start with one injury, and seemingly out of nowhere develop multiple pain sites for this reason. Fibrosis and scar formation can occur at these additional sites, thus producing an impetus for the whole cycle to begin again.

 

How then do you resolve the scar and allow the proper healing (and pain relief) to begin? 

 

Getting rid of fibrosis takes direct and very specific mechanical stretching or pressure. A mechanical stimulus is needed to break it up, so only the fibers that are oriented in the direction of the soft tissue remain. The exact mechanism of how this fibrosis is broken up is still a subject of debate among researchers and scientists.  It most likely occurs through one or a combination of three mechanisms: (1) direct pressure or stretch mechanically distrupts cross linkages between fibers, (2) mechanical pressure causes an electrical influence on fiber orientation "piezoelectric effect", or (3) electrical field influence via the motion or pressure causes a resetting of the soft tissue electric frequencies, and thus proper fiber alignment "electric entrainment'. Whatever the mechanism, the fact is that various approaches have been shown to work.

 

There are at least 20 different techniques that are used in a rehab clinic setting to break up fibrotic scar and trigger points, including: joint manipulation, ultrasound, laser, massage, rehab exercises, and specific soft tissue manipulation techniques such as: ischemic compression, myofascial release, active release, transverse friction , Graston, fascial techniques, etc. There are also some that can be done by the layperson at home.  Depending on the location and degree of the fibrosis, these home measures may or may not be feasible. If you can feel a "knot", "cord", or "lump" that is tender in your area of pain, it is likely a trigger point or fibrotic nodule. Again, there is no substitute for professional health care, and a check at your doctor confirming this is recommended, as "lumps" and "knots" may be from other, more serious and dangerous causes. Always check with your own doctor before beginning any self-applications or exercise. 

 

Assuming that the "knot" you feel is a trigger point or fibrosis, the following exercises may be helpful in resolving your fibrosis. If successful, this could solve half of your pain prroblem (the other half of course is to correct your faulty body mechanics and/ or posture ). Included are various methods that can be applied to any soft tissue, but space here allows only an example of each exercise method on one bodypart. Any method could be applied to any body part (other products on this site provide examples for every body part). While  these exercises can cause mild discomfort as fibrosis is stretched or broken, they should never be painful. Remember that more is not better with these, so follow the recommended frequency given for each exercise.  If you do not feel a difference after 2-3 weeks, you will probably need a professional soft tissue practitioner such as a chiropractor, osteopath, physical therapist, or massage therapist to treat your fibrosis.  Once you begin to make progress with breaking up your fibrosis, it will be time to begin the most important part of solving your pain - correcting your faulty body mechanics and posture.

Ischemic Compression and Massage

 
 
By applying direct pressure to a trigger point or fibrotic nodule, blood flow (oxygen) is temporarily restricted to the local area. Trigger points will often release their tension as a result of this and begin to dissolve.  Direct pressure on fibrotic nodules creates a mechanically induced electrical effect (pizo-electric) on the fibers, which helps to re-orient them into their proper direction.

 
To use this method, apply a gentle to moderate amount of pressure to the "knot" and hold steady for 5-7 seconds.  Wait 15 to 60 seconds before applying the pressure again.  Repeat a third time and you are done for the day. Pressure can be applied with your finger, with a tennis or golf ball, or with the use of a foam roller. My experience with patients is that most do not use foam rollers correctly, and often "roll" themselves into needing even more care at my office. The typical mistake is too much pressure with too many rolls. While general massage rolling the point with a foam roller can be effective for fibrosis, specific static ischemic compression holds work better for trigger points.

 
Treatment frequency varies from daily to once every other day.  You can try both frequencies. It helps to apply moist heat, or mild active movement to the area post compression. This will increase circulation, and flush the broken collagen fibers and toxins that are released with the compression. As the days progress, the size of the "knot" should diminish. Some trigger points and nodules may take a few weeks, while others may take a year to fully resolve. If you do not notice some degree of difference within two weeks, try another method, or seek professional help.
 
 
Transverse Friction Massage
 
 
Transverse friction is a self massage  technique that can be used on the same area by rubbing with moderate pressure across the natural fiber direction of the involved soft tissue. You need a little knowledge of anatomy for this one. If for instance, the "knot" is in the ligamnet just below your knee cap (whose normal fibers are oriented north-south on your body), the rubbing would be in a east-west direction across the "knot". A moderate pace and moderate pressure approach is best used for 10 to 20 minutes. In some instances, shorter applications are helpful as well.  Use this method every other day or twice weekly. Daily use will only cause more inflammation and aggravation. It also helps to start with a lighter pressure for the first week or so to allow your body to adapt to the cross friction pressure.

 
 

Slow Eccentric Exercise

 
 

Muscle and tendon fibrosis can also be broken with exercise that emphasizes slow elongation of the involved muscle/tendon. The lowering or lengthening phase of any movement is known as the eccentric phase. Here, muscle and tendon fibers are contracting as they are stretching. This is an excellent method of addressing the problem of fibrosis that simultaneously strengthens the injured tissue.  Be sure to use a light amount of resistance, taking at least 10 seconds to perform each rep of the exercise. This is not a "go to failure" approach- perform 10 or 12 reps with a light resistance that feels easy. This can be done up to twice daily for 1 to 3 sets at a time. Depending on the particular case, some reps may have to be done over a limited range of motion at the beginning, but the goal should be to eventually lengthen the soft tissues over the fullest range possible.  Eccentrics can also be used as a warm-up for stretching, and as a follow-up after ischemic compression, massage, and myofascial release work. Learning to move with correct body mechanics and posture while doing the exercise is preferred, as this will align the fibers in the optimal direction, while facilitating proper neural motor control (re-learning proper movement).

 
Our example will be a common site of fibrosis located in the front of the shoulder  (pectoral or subscapularis muscle) which prevents full range of motion in external rotation.  In the photo below, external rotation would be allowing the forearm to rotate back so that the dumbbell approaches the floor next to the model's head. In this case, fibrosis is in the internal rotators (pectoralis/ subscapularis) and needs to be stretched while eccentrically lengthening these muscles. This is accomplished by beginning in the starting position shown, correcting any faulty shoulder or neck mechanics, and slowly lowering the dumbell towards the floor next to the head.  The elbow remains at a 90 degree angle throughout the movement.  It should take at least 10 seconds of slow (non ratcheting) steady movement to do this. The fibrosis is slowly stretched and broken during this maneuver. At the completion of the rep, the weight is raised at normal speed back to the starting position. Repeat 10- 12 times (reps). 1-3 sets can be performed. Each set should stop at a point where you do not feel fatigued, but could easily perform twice the number of reps. Repeat at least every other day, but depending on soreness, this can be done up to 2 times daily. Be sure to use a very light weight. The exercise is allowed to give you a stretch sensation, but not pain. If you become too sore, decrease frequency and the amount of weight.
 

As with any method of resolving fibrosis, this can be done in almost any region of the body. Simply identify which movement stretches the fibrotic area, and then slowly stretch it against a light resistance. As progress is made, the range of stretch and ease of movement will increase. If you have trouble finding a movement to match your issue, other products on this site can assist you in identifying which exercise is best. 

Myofascial Release


There are four different approaches to myofascial release. They all use the concept of stretching the fibrotic nodule "knot" with finger pressure as the soft tissue is stretched. The four approaches (or levels) are as follows: (1) stretching the fibrosis by sliding the finger pressure through the knot as the area remains in a relaxed state, (2) the stretch is done while the area is in a relaxed and lengthened state, (3) passively stretching the involved tissue as the finger slides through the fibrosis, and (4) actively moving the involved tissue in a stretching direction as the finger slides through the fibrosis.

In all approaches, the finger pressure glides, or strokes through, the fibrosis in the same direction that the soft tissue fibers normally are aligned. For the front thigh muscles (quadriceps), this stroke would be in a up-down direction. Pressure should gradually increase from gentle to more moderate as your body adapts to successive self-applications. No more than 5 strokes should be applied to any "knot" in a given session. Typical application freqency is once every other day. The best results come from a very slow slide through the tissue, with enough pressure to be mildly discomforting. For our example, we will be using the active (level 4) approach. There are many other sources to learn self- myofascial release. The reader is referred to Active Release Techniques by Dr. Michael Leahy for a detailed method which is very popular and recommended as an excellent approach to soft tissue fibrosis.  

4. Correcting Body Mechanics, Posture/Alignment, and Joint Stability

5. Healing Conditioning Exercises

This will make up the majority of your healing exercise. The idea behind healing strength and conditioning exercise is to progressively improve your ability to "hold" the proper mechanics and posture of your RPIs.  This is done by focusing on your mechanical corrections as gradual progress is made in the endurance, strength, balance, power and flexibility challenges of a properly designed healing exercise program. As your ability to "hold" your corrections under increasing challenges improves, so will the healing of your damaged tissues, and your ability to handle the physical demands (stresses) of your daily activities. This is associated with greater fitness levels, and the ability to return to the sports and activities you enjoy without injury.  This is where everyone who doesn't know better tries to go after their pain subsides. Occasionally they are successful, but usually returning to physical activities based on a resolution of pain is a disaster. Because body mechanics and conditioning have not been addressed, the healing tissue is not prepared for the stress of the return. Re-injury thus easily occurs, and a never ending cycle of disappointment, chronic pain, longer periods of inactivity, and a decline in health ensues.

The proper approach is to begin conditioning is while you are healing and fibrosis is being resolved. This entails correcting posture and mechanical faults, as well as beginning reconditioning of the injured tissue in a non-aggravating way. Using proper posture and mechanics, reconditioning can begin after the initial stage of inflammation. Gradually introducing range of motion and resistance exercises (below a level that causes discomfort) while you "hold" your mechanical and posture RPI corrections is the key to stimulating healing and avoiding re-injury. This may be a natural progression from the mobilization exercises described previously, or in motions that replicate the desired activity to return to.

For example, if you want to return to tennis, gradually increasing the range of motion, resistance, and lastly speed of every possible tennis movement you can think of is the proper approach. The emphasis of this is of course to "hold" your mechanical and posture RPI corrections during these motions. If you want to return to running, you would begin with walking, gradually increasing the length of stride, distance/ time and finally speed of a walk to a slow jog, to a medium jog, to a fast jog, to a slow run, to a medium run, to a fast run, to a sprint- all while using your RPIs.  The same for raking leaves, climbing stairs, lifting weights, yoga, cross fit movements, martial arts, biking, swimming, etc. These motions may be practiced at first without a stair to step on, a bike to ride, or water to swim in- just go through the motion in the air- SLOWLY, and in a range of motion that is NON- PAINFUL, while using your RPIs. Feeling a slight pull or stiffness is acceptable, but not pain or a major stretch. There should be no pain during, or after, the practice workout.

Regardless of the activity, the method of approach is the same. You MUST "hold" your RPI corrections and start with a RANGE of MOTION, AMOUNT of RESISTANCE and SPEED that is NON- PAINFUL. Then gradually increase all of these parameters as pain allows over days to weeks, to months in some cases. If you hit a point in your progression where you feel pain (or discomfort), you need to "peel back" and continue to practice (train) at the non painful level for several workouts or weeks, until the healing tissue adapts, and further progress can be made without pain. Practice training every other day to allow your body 48 hours between workouts to adapt, strengthen, and heal. Begin with just a minute or two in severe chronic cases, and build up time practicing your activity over time. Remember to respect pain or discomfort as your guide.

Following these guidelines has produced significant results in almost every case that I have applied them to for over 25 years in treating  the most diverse injuries in my rehabilitation clinical practice. When it doesn't, it is always because body mechanics or posture are dysfunctional (common even with trainers and rehab supervision), or progress is too fast, disrespecting the time needed to heal and adapt. Remember that your body has the ability to heal, it is just that your return approach is usually wrong.

If you have trouble building back up to any activity, you may need the help of a rehab expert, to check posture, mechanics and monitor your progression. While there are some situations that can never be rehabilitated to the point of pre-injury status and activity, I have never seen anyone unable to be rehabilitated to the point of enjoying greater levels of fitness and health.

HOW TO GET STARTED

Begin by taking your own body Self Analysis.  Then learn how to correct your posture and mechanical faults by learning your RPIs.  The best way to learn your RPIs and their conditioning exercises is through any of our products. However, some corrections are available through the sample videos of our Online Healing Workout Program, or through the videos on our Pain Free & Fit You Tube Channel. Practice proper alignment and joint stability as you practice some pain relief and scar tissue resolution exercises. Then use your corrections to begin a few conditioning exercises that are appropriate for your problem.

While we offer multiple sample exercises on this site, it is impossible to provide all of the 5 step exercises for your particular problem, or an in-depth self analysis due to space constraints. For a more complete analysis and corrective exercise program, consider our various products including our Pain Free & Fit TM  Online Healing Workout and Self-Help e Book Series.