Interesting new research into soft-tissue injuries shows that when there is an injury, an inflammatory response begins in the connective tissue. Fibroblasts attract inflammatory cells to heal the injury (this also happens with cuts and wounds). An inflammatory program is released which heals the wound, and rebuilds the collagen and connective tissue.
However, if inflammatory cells stay in the tissue – a situation in which there is chronic inflammation – the fibroblasts secrete more and more tissue and then the injured area can become fibrotic. Helene Langevin relates that ultrasound studies of people with chronic low back pain show that connective tissue in the back is thicker and less mobile than normal connective tissue.1Interview with Helene Langevin
Acupuncture in the Treatment of Soft Tissue Injuries
Acupuncture is one treatment of choice in chronic injuries due to its ability to go into and release tissue bind, fibrotic tissue and even scar tissue adhesions, as well as relax and align ligaments, tendons and muscles. Probably some of this is due to the fact that channels and collaterals follow the planes of the fascia and connective tissue, and due to the connection between the Sinew Channels (Tendino-Muscular Meridian) and the fascia.
My own experiences with acupuncture over 30 years of practice and teaching is that acupuncture can produce remarkably quick changes in the tissue and in body function. Acupuncturists who needle appropriate points often achieve rapid results. A few examples of this that regularly happen in a clinical setting are:
- An irregular heartbeat returning to normal within a minute.
- Constipation for several days or even weeks relieved during a single treatment. The person gets up off the table and has to go to the bathroom.
- Sprained ankles blown up like a softball that slowly reduce before everyone’s eyes over 10 minutes.
- Needling through sheets of fascia or across planes of fascia that are spasmed and the tissue quickly relaxes and falls back into place.
- Needling though an ankle from GB 40 to KID 6 (with the ankle under traction to release the interosseous talocalcaneal ligament) and the ankle falls back into alignment with a very gentle Zheng Gu (“Correct the Bone”) technique.
- Needling through the interosseous membrane of the lower leg allows a spiral fracture of the tibia to virtually realign itself.
These are not extraordinary occurrences. They occur with some regularity in clinical practice.
In addition to acupuncture, a variety of techniques and self-care practices are used in Chinese medicine to heal and strengthen the fascia and connective tissue. Three such techniques are:
Tui Na (“pinch pull”)
Tui Na hand techniques and manipulations (pinching, pushing rolling) provide many ways of modulating the tissue – bones, muscle, joint, tendons, ligaments, connective. Each technique sends a different “wave” into the body that penetrates to different depths, and affects the humors and substrates of the tissue differently.
These techniques are part of protocols for fibrotic tissue that is chronically “inflamed.” Some hand techniques like pushing are also designed to realign fibers or packets of fibers within the muscles and fascia.
External Herbal Therapy
Many of the externally applied poultices and plasters, soaks ointments, and liniments used in Chinese medicine also restore normal circulation, and prevent the build up of inflammatory by-products which interfere with normal circulation leading to the production of granulations in the tissue and thickened fibrous tissue.
One particularly interesting external therapy is called ironing therapy – herbs cooked and placed in a soft bag, sometimes with heated “iron sand”, and the tissues are the ironed with the bag. This allows the herbal ingredients, which improve local circulation and relax spasm and binding, to penetrate into local tissues, while the action of ironing simultaneously aligns and literally “irons out” anomalies in the fascia.
Most people would agree with the idea that stretching helps reduce the possibility of injury, and that regular stretching can reduce pain and stiffness. The questions that are increasingly being asked about stretching are: What kind of Stretching? How often? Before or after other exercise or sports activities?
There is increasing evidence and agreement that stretching before running or athletic activities is not only not helpful but may be harmful. Dr. Ian Shrier conducted a systemic review of 24 studies on stretching. His conclusion:
There are many different ways to stretch. Static stretching was used in most of the studies, but the effects were observed with PNF (Proprioceptive Neuromuscular Facilitation) stretching as well. Dynamic stretching is a combination of both stretching and warm-up (i.e., muscle is contracting). This review found that the effects were consistent across different modes of stretching for isometric force, isokinetic torque, and jump height. Although different modes of stretching in running produced conflicting results, another methodological difference was the duration of stretch, with the longer stretch producing worse results.2 “Does Stretching Improve Performance: A systemic and Critical Review of the Literature.” Ian Shrier, MD, PhD. Clinical Journal of Sports Medicine. Volume 14, No. 5, Sep. 2004.
Although stretching immediately before competition can be counterproductive, it seems that long-term and regular use of such dynamic stretching can positively influence the architecture of the connective tissue in that it becomes more elastic when correctly performed. Indeed, when practiced regularly, static as well as dynamic stretching have shown to yield long term improvements in force, jump height, and speed.3 “Does Stretching Improve Performance: A systemic and Critical Review of the Literature.” Ian Shrier, MD, PhD. Clinical Journal of Sports Medicine. Volume 14, No. 5, Sep. 2004.
In general, most fascial experts advocate a mix of stretching styles – static and dynamic (elastic), and changing the angle of a stretch to access different fascial planes.
Internal Martial Arts for Injury Repair and Prevention
Internal martial arts practices incorporate stretching, strengthening and other principles to heal injuries and promote “whole body” power.
In these forms, such as Phoenix Stretch, or the Xing Yi Nei Gong Exercise ‘Strengthening the Meridians by Rubbing the Knees & Stretching the Body’, slight adjustments are made throughout the exercise in conjunction with breathing into the low back and sacrum, thereby changing the fascial planes that are being affected. Additionally, breathing into the low back and sacrum increase the intra-abdominal pressure, adding other dimensions to the stretch.
Rather than relying on segmented movements that increase momentum to generate power, internal styles try to initiate force from the whole body moving as a unit. Therefore, rather than strengthening individual muscles, training focuses on “whole-body”, “unified” power, in which the body moves as a single unit, gathering and releasing power simultaneously. This is done by increasing the strength and connectivity of the Jin, the sinews. When the sinews are correctly trained the result is an elastic, power dynamic.
The connection between traditional Chinese ideas about the Sinew channels and tendon strength and power, and recent discoveries about fascia and its relation to health and fitness are fascinating. For a more in depth look at these connections, see the Tendon Strength Series and other free articles at Internal Arts International.