Foot Pain - Plantar Fasciitis - Back Pain - The Scar Tissue Connection
Gut Bacteria & Health… What?
This article is about resolving chronic mechanical pain, not about the gut. Bear with me however, because it is useful to reflect on the way our knowledge our bodies progresses.
It seems like only a scientific moment ago we had virtually no awareness of the importance of the gut biome to our health. In fact, we have only been aware of the existence of microscopic life itself for a handful of generations, and aware of the importance of gut bacteria for a few short years. In a handful of years we have watched our general awareness of gut bacteria’s significance shift from virtually zero to common knowledge. It is now common knowledge that the health of the lifeforms in our gut do not only dictate whether we have a tummy upset but are implicated as playing a role in everything from Alzheimer’s to eczema.
The ultimate value of any development in our understanding of health is determined by whether we can actually use that information to become healthier and stronger. The dawning of our awareness of the ecosystem within our gut most definitely has value in this respect. It is early days but there are a rapidly growing number of us finding we are able to use this awareness to improve our health, mood, wellbeing and quality of life through what we choose to eat… and let’s be honest ‘what we don’t eat’.
The basic realisation we have had about the gut ecosystem may yet prove to form somewhat of a ‘unifying theory’, tying together many of the problems we suffer within our digestive and nervous systems. Somewhat astonishingly we are learning that we rely on the gut bacteria to manufacture the neurotransmitters that are used in the brain for example. It’s a lot of understanding in a very short space of time, understanding that we can put to good use.
Weakness, Scar Tissue & Chronic Pain
Wouldn’t it be wonderful if there was some similar (to the gut bacteria discovery) unified understanding of what caused our pandemic of perpetual back pain, plantar fasciitis, osteoarthritis pain, knee pain, hip pain, bursitis etc. Some new model of understanding that we could put into action and have more of us get out of pain. It just so happens that I believe there is.
I believe that there is a binary theory that holds together the majority of our aches and pains. In the same way that the food/bacteria combination dictates so much of our health there are a pair of interconnected factors that drive much of our physical pain. Muscle weakness & scar tissue.
It’s a combination of muscle weakness and microscopic scar tissue that drives a significant number of the stubborn aches and pains that we suffer with.
The science is most definitely ‘in’ on the weakness topic. An absence of strong, well coordinated muscle contractions around joints in the body is known to be a major contributor in many chronic pain conditions. This is the truth we are referencing when we feel stubborn pain in our back and say to ourselves ‘I really need to work on my core’.
The confounding fact about weakness however that you often don’t get the kind of results you might hope for when you instruct chronic pain sufferers to fix themselves with strength exercises. The fact that so many fail in this endeavor points clearly to the need for recognition and management of other factors.
When the bodies soft tissues are subjected to repetitive strain, they can over time lay down scar tissue as a means of reinforcing and protecting themselves. In the same way that inflammation can run riot and cause problems for the body, scar tissue can cause adhesions that inhibit movement and create additional pain and irritation of tissues.
The most surprising thing about this learning for most of us is the fact that scar tissue can build incrementally. Most of us have been conditioned to believe that scar tissue is only laid down at times of major trauma. The truth is however that tracts of microscopic scar tissue can build up over time and they are a major cause of pain.
For many chronic pain sufferers there is a seminal moment where they find that the back pain/shoulder pain/neck pain they have been working on has responded well to rehab work but that they are still fundamentally in pain. For these hard working and motivated individuals who have truly had enough there is a mixture of relief at having resolved a bunch of pain, mixed with frustration that the strength/gym/rehab work was not the whole job.
There are many possible reasons why rehab can fail to resolve the entirety of a chronic pain condition. Incorrect exercises and/execution of exercises can cause rehab to fail. Undue amounts of emotional stress can perpetuate pain in a way that prevents rehab from taking hold. Stiff joints that need to mobilized can cause pain to linger long after muscles have been strengthened. Muscles that are simply too stressed and irritated to respond to exercises can prevent rehab from working. I am however going on record here and saying that scar-like adhesions are the number one reason why valid rehab protocols fail.
Bringing It All Together
The key to great pain management is flexibility. Most stubborn pain is far too complex and layered for a ridged approach to its management. A stubborn pain complaint in your knee, ankle, hip or back for example almost certainly involves the joint, the muscle, the ligament, the fascia, the tendon and the central nervous system. Pain that has set up camp for years ultimately impacts all of the tissues in the area and even neighboring areas too. A whole box of tricks is often required to make meaningful and lasting change to chronic pain.
In the instance of the scar tissue/muscle weakness combo which underpins so many stubborn pains, a 2 pronged attack is warranted. Firstly a consistent and focused clinical attack on the scar tissue needs to be undertaken. Treating scar tissue like this basically involves heaps of weekly visits to a clinician who knows how to break it up using a combination of blunt scraping tools and deep joint stretching. Over time the scar tissue breaks up and remodels usually leaving you in a lot less pain. Once this process is complete or at least well under way a careful and extremely specific strength routine must be developed to target the primary muscles that have weakened as part of the condition.
Once there is a widespread understanding of these principles (as there now is with gut flora) we will have a breakthrough in the amount of chronic pain we suffer as a culture. The combination of strength work and scar tissue remodeling is not enough to make us all pain free or save the world; but it will make a huge difference I promise you. And it is entirely possible that it will be enough to make you totally pain free.
For many pain sufferers merging strength work that targets the right muscles in the right way with deep release of scar tissue adhesions is the game changer they had been looking for. It’s a beautiful thing. There is nothing quite like the feeling you get when you realise you are finally getting better!