Dynamic Chiropractic

Dynamic Chiropractic Facebook Twitter
Dynamic Chiropractic
Find
Advanced Search
Wellness Blog
Dynamic Chiropractic PracticeINSIGHTS
Current Graphic
Facebook
Dynamic Chiropractic – January 1, 2002, Vol. 20, Issue 01
Dynamic Chiropractic
Printer Friendly Email a Friend PDF RSS Feed
Share |
Dynamic Chiropractic

Which Is Responsible for Healing - Cortisone or the Needle?

By Warren Hammer, MS, DC, DABCO

It has been said that inflammation can occur without healing, but healing cannot occur without inflammation.1 Unfortunately, "ideal" healing, which results in the restoration of anatomic continuity with complete normal anatomic structure and function, is rarely if ever obtained; "acceptable" healing is what we usually hope to achieve. "Acceptable" healing is defined as restoration of sustained anatomic continuity and function. "Minimal" healing is the restoration of anatomic continuity without sustained function.2 Injured tissues, such as tendons or ligaments, repair by scar deposition that never exactly replicates the histologic or biomechanical properties of the original structures.3

"Although commonly treated as an unwanted hindrance to athletic performance, inflammation is a complex vascular, cellular, and biochemical event necessary to healing and repair."1 In a soft-tissue injury that results in inflammation, a type of mechanical load must be present that will cause a vascular disruption. The primary site of injury must occur at capillary and postcapillary venules. Normally within the vasculature there are circulating erythrocytes, leukocytes and plasma components separated from the tissue by the endothelium. As soon as there is damage to the endothelial structure there is local platelet activation, leakage of plasma components, and emigration of erythrocytes and leukocytes into the extracellular matrix. From this moment on, an inflammation occurs.

All of the above refer to an acute lesion due to a macrotrauma causing vascular disruption. But a large percentage of problems we see in a chiropractic office refers to repetitive microtraumatic injuries - especially in tendons. Rather than an immediate vascular disruption resulting in an -itis, a tendinosis results, which is defined as "intratendinous degeneration owing to repetitive microtrauma causing noninflammatory intratendinous collagen degeneration." In this case, there may be a palpable nodule with no tendon or sheath swelling.4 When inflammation does occur, it is more prevalent in the outer layer of a tendon sheath or peritendinous areolar tissue.5 In this type of tissue, there is an influx of inflammatory cells into the tissues surrounding the tendons. Eventually there is exudation of fluid into the tendon sheath.6 The fluid thickens and the tissue becomes more edematous, causing the tendon to lose its gliding properties, resulting in pain and restriction of motion. De Quervain's disease is a good example of the latter. These lesions used to be classified as peritendinitis, tenosynovitis, and/or tenovaginitis. These terms have been replaced by the general term peritenonitis.

Pathologic examinations of tissue from elbow epicondylitis, plantar fascitis, patellar tendonitis and Achilles tendonitis seldom if ever show the inflammatory cells necessary to define it as an -itis.4

A major question now arises. If there is no inflammation in most degenerative microtraumatic lesions, why are cortico-steroids injected into these tissues? An interesting answer appeared in Current Opinion in Orthopaedics.7 The authors state that although the tendinosis is not primarily an inflammatory condition, symptoms may be relieved by controlling pain and "myositis and tendonitis in adjacent areas." Did they check the adjacent areas for inflammatory cells? I doubt it. The statement that really excited me was the other reason why they think the injection works and it has nothing to do with the corticosteroids. "Their mechanism of action may be related to the soft tissue trauma and bleeding caused by the injection, acting as a stimulus for extrinsic healing of the tendon." This is the exact reason given for the healing created by deep pressure (friction massage, Graston technique) on soft-tissue lesions. As previously stated in past soft tissue articles quoting from the authorities based on pre-and-post-biopsies after friction and Graston, a new inflammatory cascade is created to allow healing to occur.

References

  1. Leadbetter WB. An introduction to sports-induced soft -tissue inflammation. In: Leadbetter WB, Buckwalter JA, Gordon SL. Sports-Induced Inflammation: Clinical & Basic Science Concepts. Park Ridge, IL, Amer Acad Orth Surg.1989.
  2. Lazarus GS, Cooper DM, Knight on DR, et al., Eds. Definitions and guidelines for assessment of wounds and evaluation of healing. Scars and Stripes. The Newsletter of the Wound Healing Society 1992;2:7-14.
  3. Leadbetter WB. Soft tissue athletic injury. In: Fu FH, Stone DA. Sports Injuries: Mechanisms, Prevention, Treatment. Philadelphia, Lippincott Williams & Wilkins, 2001:843.
  4. Kibler WB, Chandler TJ, Pace KP. Principles of rehabilitation after chronic tendon injuries. Clin. Sports Med 11 (3), 1992:661-671.
  5. Selvanetti A,Cipolla M, Puddu G: Overuse tendon injuries: Basic science and classification. Operative Techniques in Sports Medicine 5:110-117,1997.
  6. Patton WC, McCluskey III. Biceps tendinitis and subluxation. Clinics in Sports Medicine, 20 (3),2001:505-529.
  7. Singh D, Bednar JM. When can lateral epicondylitis be termed a "workplace disorder"?: a guide for diagnosis and treatment. Current Opinion in Orthopaedics 12 (4), Aug. 2001:297.

Warren Hammer,MS,DC,DABCO
Norwalk, Connecticut



Click here for more information about Warren Hammer, MS, DC, DABCO.

Dynamic Chiropractic

Dynamic Chiropractic
Printer Friendly Email a Friend PDF RSS Feed
Share |
Dynamic Chiropractic
Dynamic Chiropractic
Join the conversation
Comments are encouraged, but you must follow our User Agreement
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.
comments powered by Disqus
Dynamic Chiropractic
Have you ever contacted a local employer about the possibility of directing their corporate wellness program?
Yes, contacted
Yes, directing
Thinking about it
No

Sign Up for Our Webinars
Receive Advanced Notice of Future Webinars

 


Generic Viagra Lowest Prices Pfizer Drugs Viagra No Prescription Order Viagra Online Viagra Non Prescription Deal Sale Prescription Viagra Uk Online Levitra Reviews Viagra Oysters In Australia Viagra Price Australia Cialis Pill Color Generic Viagra Canada Buy Cheap Viagra Viagra Katelaris P Viagra Australia Cheap Levitra Prescription Or Not Viagra Levitra Usual Dosage Buy Tadalafil Cialis Online Viagra And Daibetes Viagra Tablets Uk Viagra Online From Us Pharmacys Generic Money Viagra Cialis And Priligy Next Dat Delivery Generic Viagra Vigora 5000 Effect Viagra Drug Interactions Online Levitra Tablet Viagra Buy Online Levitra Drug Interaction Walgreen Viagra Per Pill Viagra Online Gr 4.26 Buy Cialis Lowest Price Viagra Online Cheap Mexico Viagra Buying Free Sale Viagra Cheap Kamagra Viagra Buy Generic Online Viagra Viagra Online Sales Brand Viagra For Get Viagra Without Prescription Viagra Side Effects Blood Pressure Cialis For Sale In Us Australia Viagra Online Cialis Cheap Visa Auk Cialis Sales Bravejournal Buy Levitra Member Levitra Buy Online Find Cheap Cialis Vardenafil 20 Mg Hcl