The Real Reason Your Pain Is Holding You Back

Being injured sucks. I say it all the time to patients in my clinic. It’s even written on our promotional t-shirts. It’s even worse when an injury produces a significant amount of pain. Pain has a way of robbing you of attention. It keeps you from doing the activities you love, and it can frustrate the hell out of you.

We all like to think that when we go to a doctor, we are going to get good treatment and hopefully a resolution to our injury. Unfortunately, that resolution doesn’t happen as often as it should, leaving patients fed up and frustrated with their injuries. Doctors end up trying to mold the diagnosis into what they happen to be trained in, instead of what the problem truly needs.

What if I were to tell you the most common musculoskeletal problem could be what’s causing a majority of your pain? What if I told you it is completely reversible with the right treatment?

How Do I Know If I Have Adhesions?

Do you have any of the following?

Pain
Decreased Range of Motion
Weakness

If so, chances are you have adhesion, which is a technical name for scar tissue. There are three common pathologies in the human body when it comes to injuries:

Adhesion
Weakness
Degeneration

It is almost completely impossible to have either weakness or degeneration without the presence of adhesion as well. People who try to argue that adhesion isn’t present or that it cannot cause pain, weakness, or decreased range of motion are wrong. In many surgical reports, surgeons note a high amount of adhesion present when trying to fix degenerated tissue. It is one of the most under-diagnosed problems. In many cases it doesn’t show up on MRI or X-ray and is usually completely missed during the diagnostic process.

What Is Adhesion?

The technical definition of adhesion is as follows:

It is a focal area of dense immature collagen fibers. The fibers are laid down by fibroblasts in response to either a hypoxic (lack of oxygen) environment from a crush/tear or sustained contraction (sitting all day at a desk).

The less technical definition goes like this:

It’s like someone poured glue inside the muscle. The only jobs muscles have to do are to contract and relax, but when adhesion is present it causes the need for more force to be applied to contract the muscle. This increased force leads to more tension and a higher production of inflammation in the area.

Adhesion isn’t the same as a trigger point. If we put a cell of a trigger point under a microscope, it would look pretty similar to a healthy muscle. Adhesion has a different look and feel to it. The tissue looks disorganized and the cells are not uniform. This can happen in a muscle, tendon, ligament, or even inside a joint.

When to Seek Help

You’ve already tried self-care to help with your injury, such as:

Stretching
Foam rolling
Mobility work
Self-myofascial Release
Medication
Corrective exercises
Exercise modifications
Self-taping

But that hasn’t made much difference. You’ve also enlisted the help of multiple musculoskeletal professionals, such as:

Chiropractor
Physical therapist
Massage therapist
Corrective exercise specialist
Acupuncturist
Primary care physician
Orthopedic surgeon

But none of those options have worked, either. So if you’ve failed with self-treatment and professional treatment, what’s left? The key to fixing this problem is finding a practitioner who focuses on getting a tissue-specific diagnosis, preferably soft tissue dysfunction. The good news about adhesion is that it is completely reversible with the correct treatment. The point of any treatment is to reverse the pathology.

Finding a Care Provider

This is where it can be a little tricky. Look for these must-haves in getting resolution for your injury.

Tissue-specific diagnosis. This is a key component of ensuring the right treatment. No treatment can begin unless you know what the problem is in the first place. The diagnosis needs to be complete and accurate. Simply stating something is tendinitis/bursitis/tight is incomplete and lacks true substance. The practicioner should know exactly what tissue is involved so they can get in there and fix it.
The goal of the treatment. This should always be to remove the dysfunction and return normal capacity back to the muscle, which in turn should allow the area to function at a higher level and relatively pain-free. Trying to work around the injury can often prove to be a bigger problem down the road.
Progress should be measurable. Everything should have a measurement or benchmark goal to help define where the treatment is going. Relying solely on the patient’s pain level can often lead the doctor in the wrong direction. Having specific, measurable results lets the patient and doctor know they are on the right path to fixing the injury. An example would be taking a measurement of ankle dorsiflexion. A “healthy” ankle needs at least 5 to 6 inches of dorsiflexion to have an optimal range. Until that range of motion is reached, you can’t have a fully functioning ankle. Clean tests determine discharge, not level of pain. If you don’t have full function and capacity in the muscle, the chance for re-injury goes way up.
10 to 12 visits. This is usually the sweet spot for fixing the majority of problems that walk through the door. Avoid practitioners who want to see you for anything over 24 visits right out of the gate, because chances are they aren’t the one to fix your problem. It shouldn’t be a long, drawn-out process that takes months. If the practitioner accurately diagnosed the injury and removed the relevant adhesion, the process should take around 10 to 12 visits if there are no other issues. If it is going to take a lot longer, it’s more likely that you have an irreducible block (see below), which won’t respond well to manual therapy. Or the diagnosis could just be wrong.

What About Irreducible blocks?

Irreducible blocks include disc injuries, labrum degeneration, tears, and cartilage damage. If these blocks are present it will shift the focus of the treatment and make it more into a long -term maintenance care. This longer approach will prevent the degeneration from getting any worse and keep you functioning at sub-symptom threshold. In some cases the blocks can be so bad that no amount of conservative care will fix it. These are the prime surgical candidates, which ends up being roughly ten percent of the population.

Save Yourself From Pain

If you find yourself not responding to your current treatment methods, be it self-treatment or professional help, perhaps it is time to consider what you are overlooking. If you have been dealing with an injury for a long time, you owe it to your body to get the problem accurately diagnosed and fixed.

The best soft tissue practitioners in the world will take the time to accurately diagnose your injury. They have the skills to apply the correct treatment to your specific problem. Trying to fix it yourself with various self-treatment methods or whatever the practitioner happens to be trained in will only produce temporary results, if any at all, leaving you frustrated and in pain again. Good luck!

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