Don’t Let Your Healing Get Stuck Between Second and Third Gear

Sometimes pain doesn’t go away as you wish it would

Exam­ples include:

  • chron­ic back pain
  • plan­tar fasci­itis
  • ten­nis elbow
  • patellofemoral syn­drome
  • tight IT band
  • rota­tor cuff prob­lems
  • tight mus­cle trig­ger points any where in the body

Why do these nag­ging prob­lems per­sist? Why doesn’t the body heal itself in these cir­cum­stances?

A med­ical con­sen­sus is form­ing around some of the answers to these ques­tions. And it’s requir­ing a shift in some of the core sci­en­tif­ic prin­ci­ples that have served as med­ical cor­ner­stones for more than a hun­dred years.

Medical genius of the late 1800’s

There’s a basic prin­ci­ple of pathol­o­gy that has stood the sci­en­tif­ic test of time since the late 1800’s. Back then, doc­tors dis­cov­ered the key link between two seem­ing­ly dif­fer­ent health process­es: wound heal­ing and the body’s response to infec­tion.

normal healing cycle

In each of these sit­u­a­tions, your body ini­ti­ates a three-step reac­tion:

  1. Inflammation and immune response

    Extra blood speeds to the affect­ed zone and, quick­ly, use­ful defen­sive forces – immune cells, inflam­ma­to­ry pro­teins, sig­nal­ing mol­e­cules, and more — rush into action. The area swells up.

    The fire fight­ers are on the scene and are spray­ing their hoses and knock­ing down walls and win­dows as need­ed.

  2. Stabilization and proliferation

    Now the fire has been put out but there’s a heap of rub­ble where your func­tion­ing tis­sues used to be. Now that the dam­age has been con­tained, your body cleans up and braces the affect­ed area. One type of cell that’s put to work is a scav­eng­ing white blood cell that gob­bles up ran­dom mol­e­c­u­lar frag­ments that are still float­ing around.

    A sec­ond cell type that’s acti­vat­ed is a fibrob­last, a con­nec­tive tis­sue cell that “blasts” out fibers (struc­tur­al pro­teins such as col­la­gen) to pro­vide phys­i­cal scaf­fold­ing as the region rebuilds.

    By design, your body doesn’t use an “effi­cient” rebuild­ing strat­e­gy. Instead, your fibrob­lasts spit out an over­abun­dance of col­la­gen and oth­er pro­teins that jum­ble togeth­er in a big ran­dom blob.

  3. Remodeling

    Slow­ly, the ran­dom blob of pro­teins that your fibrob­lasts pro­duced gets re-orga­nized into func­tion­ing tis­sue. This is the slow­est part of the heal­ing process – it can take weeks or even months.

    Move­ment is the key to remod­el­ing. Your mus­cles, ten­dons, lig­a­ments, and oth­er con­nec­tive tis­sues reor­ga­nize them­selves based on the phys­i­cal loads placed on them. Where a ten­don needs to be tough, extra col­la­gen is deposit­ed, and the fibers align them­selves in par­al­lel along the lines of great­est force. Where bone needs rein­force­ment, fibers are deposit­ed, align them­selves, and then get filled in by cal­ci­um to forge strong bone.

The first stage of heal­ing – inflam­ma­tion — is ini­ti­at­ed with­in sec­onds, and ramps up to full strength in a man­ner of min­utes or hours. The sta­bi­liza­tion phase might take place over a few days. But the remod­el­ing phase can last for weeks, months or even more.

More modern understanding

This three-step mod­el of the heal­ing process has proved itself invalu­able again and again. But in the past ten to twen­ty years, we’ve begun to under­stand that under cer­tain cir­cum­stances, injuries can hang around – seem­ing­ly indef­i­nite­ly – instead of get­ting bet­ter.

In the past, doc­tors pre­scribed anti-inflam­ma­to­ry med­ica­tion to help peo­ple with chron­ic pain of the joints, nag­ging mus­cle trig­ger points, or ten­donitis. Some­times these meth­ods would relieve the pain long enough for the patient to go about his or her nor­mal busi­ness while the body worked its usu­al inter­nal heal­ing mag­ic and the prob­lem dis­ap­peared per­ma­nent­ly.

But not always. Too often, a patient would have an injury that nev­er ful­ly cleared up. The prob­lem could per­sist for weeks or months.

Now we know why. Ten­dons, mus­cles, lig­a­ments and joints can get stuck in the no man’s land between sec­ond and third gear.

After the first week or so, these tis­sues are no longer in an inflamed state. They’ve left stage one of the heal­ing cycle far behind. So tak­ing anti-inflam­ma­to­ry drugs doesn’t real­ly improve the under­ly­ing mech­a­nism that’s main­tain­ing the prob­lem.

A different healing approach is needed

The new strat­e­gy is to do some­thing to irri­tate the tis­sues – get them stirred up and cre­ate a cas­cade of hor­mon­al sig­nals that makes the body respond with a heal­ing process. It’s almost as if an effec­tive treat­ment reminds the body that a prob­lem exists and jump starts a new round of heal­ing.

There’s more than one way to accom­plish this goal.

One med­ical approach that’s gained pop­u­lar­i­ty is to inject the trou­bled area with the patient’s own com­pact­ed red blood cells. Anoth­er strat­e­gy is to blast the area with super-high-pow­ered ultra­sound.

But in the chi­ro­prac­tic world, we’ve used a tech­nique for many years that can also be effec­tive – trans­verse fric­tion mas­sage.

Trans­verse fric­tion mas­sage uses deep cross-fiber manip­u­la­tion of the con­nec­tive tis­sues of the affect­ed area. It can cause a small amount of dis­com­fort when the tech­nique is applied, and the area can actu­al­ly get red­dened and inflamed after­ward.

That’s the whole point.

The body is thrown back into the first phase of heal­ing. But this time, you make sure your body heals the right way. You give the area the right amount of rest and sup­port ini­tial­ly, but as quick­ly as pos­si­ble chal­lenge it with the appro­pri­ate move­ments so the fibers know how to align them­selves and strength­en. In addi­tion, you may need extra water and pro­tein in your diet to have the raw mate­ri­als to man­u­fac­ture all the heal­ing chem­i­cals and struc­tur­al fibers you’ll need.

So if your heal­ing process is stuck in neu­tral, per­haps you need a more mod­ern approach to heal­ing. Trans­verse fric­tion mas­sage may be your answer to get unstuck.


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About Ronald Lavine, D.C.

Dr. Lavine has more than thirty five years' experience helping patients alleviate pain and restore health using diverse, scientifically-based manual therapy and therapeutic exercise and alignment methods. His website,, provides more information about his approach. Please contact him at or at 212-400-9663.
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