Repetitive use injuries and strains often cause tendon and ligament damage, resulting in pain and debilitation.
They can also cause significant misuse by forcing muscle compensation from adjacent groups. Sprains, strains, and tendonitis can also happen with increasing frequency as you age. Let’s explore the myriad reasons for this.
Because our bodies are primarily made up of combinations of collagen, the inability to produce enough of this vital material results in weaknesses and insufficient healing of damaged tissue. Unlike other proteins, collagen is composed of only two amino acids, glycine, and hydroxyproline. Vitamin C is critical to the reactions that produce collagen and is destroyed in the process.1
Because we cannot synthesize vitamin C and much of the processed foods or “picked green” fruit is devoid of this valuable nutrient; we tend to operate our bodies in a state where sufficient collagen cannot be produced. Supplementing with vitamin C is critical to maintaining good health and is especially important during periods of tissue repair.2
Effects of aging
The liver produces an enzyme that controls the quiescent level of fibroblast activity. As one ages, the liver’s ability to produce this enzyme is reduced. For thousands of years, traditional Chinese medicine practitioners have acknowledged this connection between the health of connective tissue and the liver. While a base metabolic test may show normal liver function, “normal” for people over 50 may be insufficient.
Because fibroblast cells are responsible for producing reparative collagen, a debilitated liver can leave one susceptible to tendon, ligament, and fascia degradation or damage.3,4 Supporting liver health with restorative herbs is quite advantageous with age.
As the body ages, the microvasculature within ligaments and tendons can become blocked with plaque. Soft tissue trauma can leave blockages due to micro-clots. This restricts the movement of the semi-motile fibroblasts and the nutrient supply they rely on. This diminishes the ability of the fibroblasts to supply reparative collagen to areas of damage and micro-tears.5
Insufficient supplies from which to make collagen, reduced fibroblast activity, and impaired circulation all contribute to the weakened state of aging connective tissues. In fact, this weakened state allows repetitive use injuries and strains to become a major health issue in a person’s older years.
Chiropractic manipulation can re-establish proper skeletal functionality and even maintain balanced blood flow. Therapeutic massage can improve muscle function, break up local fixations, and promote load-sharing, while relieving blockages of circulatory and lymphatic flow.
These are all valuable and effective when treating sprained ankles, rotator cuff issues, epicondylitis, and other common injuries. But more can be done to support the health of the patient. This is where herbology becomes a valuable ancillary therapy to the musculoskeletal work of chiropractic and therapeutic massage.
Injury and repetitive use often result in chronic and acute pain. Anti-inflammatory painkillers or cortisone shots can stop the inflammation reaction but also hinder the healing process.9
The inflammation reaction serves as the signal to the brain to start the repair cycle. The brain signals the liver to produce more of the enzyme that increases the level of fibroblast activity and therefore causes more reparative collagen to be laid down over the damaged area. Although pain is undesirable, it is an important part of the healing process and should be blocked without stopping inflammation.
Natural NSAIDs are a reasonable alternative. For example, arnica contains prostaglandin blocking constituents and willow bark contains salix. Both of these herbal remedies, when applied topically, can relieve pain without interfering with the healing process. Arnica has been shown to break up the micro-clots that appear as bruising and facilitate the return of circulation to the area of damage, making it a wonderful contribution to the healing process.8
For thousands of years, broken bones and soft-tissue damage were healed by macerating comfrey or plantain and applying it directly to the site of injury as a poultice. Comfrey was often called “knitbone” for its ability to facilitate the rejoining of broken bones by accelerating the production of collagen. As it turns out, these two valuable herbs contain a substance known as allantoin that increases fibroblast activity. This is an invaluable tool for repairing soft- tissue damage.7
As with any injury, there will be some muscular fixation or residual trauma. This can cause poor load-sharing and reduced circulation within the muscle group. Poor load-sharing can cause joint misuse and micro-tears in adjacent portions of the tendons.
Rosemary and thyme increase lymphatic and vascular circulation when applied topically. Witch hazel improves muscle fiber flexibility and lubricity and encourages better load-sharing,6 which are important to keep from disturbing the area under repair.
All of the valuable constituents of these herbs can be extracted with a simple low-temperature water decoction. Make a tea with them (but be careful not to use water that is hotter than 150 degrees Fahrenheit). The decoction can then be applied directly to the skin over the injury where it will be readily absorbed.
Soaking a cloth in the decoction and then tying it around the injured area may not be as convenient or social
Nowadays, one can achieve the same results by applying a decoction to the skin or using a commercially produced herbal gel. Supporting the body with vitamins A, C, D, and E provides the ingredients necessary to rebuild healthy tissue with reduced scarring.
In fact, clinical and field testing of this sort of remedy have demonstrated dramatically reduced recovery times and improved healing outcomes. In younger athletes and animals, the observed repair times were as much as 50 percent shorter. With older patients and recalcitrant injuries, complete healing (meaning the return to service did not produce a re-injury) was observed in four to six weeks, on average.
The beauty of this technique is that as long as this remedy is applied, the area will continue to be stimulated to maintain the repair. While the pain relieving analgesics and prostaglandin blockers of willow and arnica will relieve pain right away, continue to apply this decoction several times per day for four to six weeks to make sure that the healing is complete.
Patients will be tempted to stop applying it after a few days as the pain will have subsided. But with age, it takes longer for a complete repair to take place.
In cases of low-back trauma and damage, local fixation can prevent an adjustment from holding. Each week the patient returns in need of corrective manipulation.
Coincident use of this sort of decoction described herein has demonstrated the ability to relax the local fixation and facilitate repair so that the adjustments hold for longer periods of time. The pain level steadily recedes and the repair is completed.
When procured commercially, an herbal gel is a simple and tremendously valuable tool for dealing with patient injuries in a more holistic manner. Chiropractors can do more than adjust the musculoskeletal system without being herbalists by using the support tools offered by the natural healthcare industry.
Steven R. Frank, is an herbalist from the Front range of Colorado with many years of experience in treating musculoskeletal injuries with indigenous plants and herbs. He has studied the actions of these natural remedies in the clinic and the laboratory. He can be reached with questions at firstname.lastname@example.org and his blog can be found on mynaturesrite.com.
1 Myllyla, R, et al. Ascorbate is Consumed Stoichiometrically in the Uncoupled Reactions Catalyzed by Prolyl-4-Hydroxylase and Lysyl Hydroxylase. Journal of Biological Chemistry. 1984;259:5403-5405.
2 Williams, Roger J. (1971). Nutrition Against Disease (p. 85-86). New York City: Bantam.
3 Youssef WI, Tavill AS. Connective tissue diseases and the liver. J Clin Gastroenterol. 2002;35(4):345-9.
4 De Santis M, Crotti C, Selmi C. Liver abnormalities in connective tissue diseases. Best Pract Res Clin Gastroenterol. 2013;27(4):543-51.
5 Knobloch, K. The role of tendon microcirculation in Achilles and patellar tendiopathy. J Orthop Surg. 2008;3:18. 6 Ody, Penelopy. (2001) The Holistic Herbal Directory (p.155). London: The Ivy Press Limited.
7 Kadans,Joseph M. (1970). Modern Encyclopedia of Herbs (p. 97-103). Virgina: Parker Publishing Company.
8 Kawakami AP, Sato C, et al. Inflammatory Process Modulation by Homeopathic Arnica montana 6CH: The Role of Individual Variation. Evidence-Based Complementary and Alternative Medicine. 2011;2011:917541. doi: 10.1155/2011/917541.
9 Coombes BK, et al. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. 2010;376(9754):1751-67.