Why Pain Does Not Go Away

The Most Common Reason Pain Keeps Recurring or Does Not Go Away

When a joint feels pain or doesn’t move as freely as it should, this is your body’s way of trying to tell you something. Listen to it! If you are like most people when you feel pain, you might take an Advil, hoping for it to go away. It might, only to return again and again at a later moment in what we term episodic pain. The reason it becomes recurrent is that the original issue has not yet been resolved. Why hasn’t it healed and why does your pain still linger? The most common reason is…

Myofascial Adhesion and Fibrosis (Scar Tissue)
Many people with soft tissue injuries typically describe a feeling of pulling or tightness, a burning sensation, a catching within the affected area or they often say, “It just doesn’t feel right”. What they are experiencing in each of these scenarios is a build-up of scar tissue or adhesions. Adhesions anywhere in the muscles, tendons or ligaments can result in imbalance, degeneration and pain. This is because of the effect adhesions have on the surrounding muscles and nerves.

Adhesions Will:

Dr. George with SF 49ers RB Kevan Barlow (2001-2005). “ART has really helped me out alot.”

  • Cause muscles to “catch” between each other – For example, an adhesion between the BICEPS and DELTOID will prevent the two layers from gliding smoothly past each other. The result is pain as the two tissues tug against each other and pinch when raising the shoulder.
  • Cause weakness in a muscle by shortening it, not allowing the muscle to lengthen, thereby preventing the muscles from contracting efficiently.
  • Cause repeated injury. Adhesions lead to tight areas of high friction within the muscles that cause repeated strain r microscopic tearing every time we stretch, contract or use the muscles.
  • Prevent adequate blood flow (causing Tissue Hypoxia) to the area of the muscle, tendon or ligament that they affect. Inadequate blood flow can lead to further tissue damage and repeated inflammation. This leads to a constant ache within the injured area.
  • Entrap nerves, preventing them from freely gliding through soft tissues.
  • Create Biomechanical Imbalance (or abnormal biomechanics) within the soft tissues of the affected area when they are being bound or restricted by adhesions. This is particularly true when the affected tissues are “Joint Stabilizers” (i.e. Shoulder/Rotator Cuff, Hip, Knee, Elbow, Ankle). When the function of the stabilizer muscles are being impaired by adhesions, this leads to imbalance and altered motion of the joint, causing strain and injury to surrounding muscles, tendons and ligaments.

The three most common ways your body creates myofascial adhesions

Injuries that result in adhesions can occur in ways not obvious to us. Perhaps you will be able to figure out which mechanism of injury is responsible for your pain when reading this section.


1. Major Trauma (Acute Injury)

caraccidentMajor trauma refers to injuries that occur suddenly with much FORCE, such as blunt trauma, slips/falls, car accidents and typical sprains and strains from a SINGLE incident.

In situations such as these, the large amount of force at impact causes sudden and significant tearing to the soft tissues. Bleeding will then occur, causing scar-tissue/adhesions to set in and essentially glue/brace the damaged tissues. This is all part of the healing process. Quite often however, it does not discriminate and obstructs the healthy tissue as well.

2. Micro-Trauma or Repetitive Injury

Repetitive activity of muscles, such as what happens when we type at a computer, will restrict blood flow and create micro-tears. The end result is adhesion build-up in the muscles over time.

Repetitive activity of muscles, such as what happens when we type at a computer, will restrict blood flow and create micro-tears. The end result is adhesion build-up in the muscles over time.

ANY activity, when done repeatedly over a given time, may be causing microscopic tearing to your muscles or tendons. Typically, people often say, “I was feeling fine yesterday, so I don’t know what happened”.

You will not even notice any pain at first with this level of microscopic tearing. Each time the microscopic tear heal, they do so with a little bit of scar tissue. As the tearing accumulates with repeated use, we may eventually begin to feel a slight pain, tightness or twinge. Eventually, with Repeated “Micro Trauma”, the scar-tissue adhesions grow large enough to cause pain that interferes with our daily activities or athletic events.

 

Micro-trauma Injuries can occur in any occupation or activity that requires repetitive action, involving:

  1. Repetitive tasks with small, rapid movements
  2. Insufficient rest time between movements
  3. Working in awkward or fixed postures for extended periods of time
  4. Excessive and forceful movements, used repetitively

Common examples of Repetitive Micro-trauma are computer / mouse work, endurance sports (such as running, bicycling, swimming, triathlons, etc.), tennis, and other activities that may be. Perhaps the most common and worst form of repetitive stress is that from POOR POSTURE. This is because the muscles in the neck and back are in a chronic state of contraction, seldom getting a chance to rest. The end result is restricted blood flow and adhesion build-up in that muscle over time.

 

sleeping face down

Constant Tension in muscles, such as sleeping face down, will shorten muscles, restrict blood flow and lead to adhesion build-up.

3. NO Trauma at all (Constant Tension WITHIN, or Constant Pressure ON the muscle tissue)
Ever notice that when you make a tight fist your skin turns a little pale?  By squeezing your hand, you are actually pushing the blood out as a result of Constant Tension being applied. Muscles in the body that are constantly tight result in the same situation as that of the hand. The blood gets squeezed out. This condition is called “Tissue Hypoxia”.

A muscle that is tight, is consistently burning energy, requiring a constant need for oxygen, glucose and other nutrients to sustain it. But because blood flow is pushed out of the muscle (tight fist scenario), there is no way for it to perfuse and bathe the muscle with nutrients, hence the fibers starve and chemical damage occurs. This leads to inflammation, tissue hypoxia and the build-up of scar tissue.

“Non-Traumatic” type injuries may also refer to injuries that are chemical or nutritional in nature. For example, smoking can reduce blood supply to muscles and joints through plaque build up, leading to arthritis. Increased levels of bad cholesterol in our body is an example of nutritional trauma, again, resulting in reduce blood supply to joints and soft tissues with similar effects.

 

Why does pain typically hang around or get worse when myofascial adhesions / scar tissue are ignored?

The Vicious Adhesion / Cumulative Injury Cycle

Adhesions can form anywhere in your muscles, tendons or ligaments, negatively impacting the strength and flexibility of that tissue. Through repetitive activity, adhesions build up over time, often spreading to other areas until you eventually feel a problem. This problem if allowed to progress untreated will eventually lead to a more debilitating issue and time off work, which means lost income.

Repetitive Stress Injuries occur as a result of CUMULATIVE TRAUMA and overuse of soft tissues. Soft tissues that are forced to perform the same job repeatedly without proper rest become IRRITATED AND INFLAMED. Over time, the cumulative trauma experienced through the overuse of soft tissues can create more constant tension and reduce the blood circulation (Tissue Hypoxia) to these tissues. The tissue immediately next to the adhesion becomes over-worked, over stressed, develops increased friction resulting in more microscopic tearing and  leading to Repetitive Injury.

The constant tension and repetitive injury lead to more Inflammation and Bleeding, which then leads to even more Adhesion buildup. The body does this because its response to inflammation is to lay down SCAR TISSUE in order to STABILIZE THE AREA. Once this happens, an ongoing cycle begins to develop that worsens the condition. The longer this cycle persists, the more difficult it becomes to avoid permanent soft tissue damage.