When a Joint Injury Becomes Chronic
by Eric Winder, DC
It might be a knee, an elbow, an ankle or a shoulder, and it’s still painful long after healing from an injury. Why does pain continue in a joint months or year later? Sometimes the reasons are obvious, but sometimes they are not what you might think. A clear understanding of the source of pain makes it easier to successfully treat that pain and find relief.
Perhaps the most obvious place to start is permanent tissue damage or altered structure. This can include changes like osteoarthritis, bone spurs, spinal disc degeneration, torn ligaments, or altered alignment or posture such as scoliosis. All these changes might be present in a chronically painful joint, but they are not always the source of pain. More on that when we discuss fascia below.
Another likely suspect is inflammation which is normal in a new injury that is healing. However, sometimes a joint is inflamed long after recovery should be complete. This can mean swelling, tenderness and pain in the affected joint on an recurring basis. Anti-inflammatory medications might offer temporary relief, but in many cases, symptoms return without the medication. For lasting relief, it is important to find and address the root cause of inflammation.
Chronic joint pain can also be caused by instability of the joint. If a joint moves in directions or ways that it is not supposed to—even a small amount—it can cause anything from mild to severe pain. This is a similar to the wheel on a car or a bicycle—it should rotate smoothly without even a small amount of shake or wobble. If a slight wobble occurs, it can ruin bearings and even cause damage to other parts.
Finally, the connective tissue called fascia can have restrictions that cause joints to be painful. Fascia is a network of fibrous sheets and web-like structures that runs throughout the body to cover muscles, bones, joints and other tissues. Fascia contains the nerve endings that give us position sense which provides the information to make coordinated motion possible. All muscular balance, joint alignment and joint stability require accurate position sense. When fascia is restricted or distorted, all those functions can be altered by faulty position sense which, in turn, causes faulty joint mechanics.
Getting to the Root Cause
These four major causes of chronic joint pain can be intertwined. Structural damage such as torn ligaments might cause instability, then lead to inflammation and new fascia restriction. On the other hand, pain from inflammation could trigger muscle tension which, in turn, leads to instability, new fascia restriction and possibly arthritis. Basically, any one of the four factors can lead to developing the others. Successful treatment often requires temporary symptom treatment, but permanent relief requires finding the root cause wherever possible. Let’s look at each of these four factors again from a treatment point of view.
Fascia: Treating joint pain is a large part of my practice. Due to the ability of fascia restriction to disrupt muscle and joint function, I find that treating problems in fascia offers the most powerful results in relieving joint pain for most people. Restoring position sense often returns joint stability and quenches inflammation. I have seen hundreds of cases where a joint that tended to “give out” became more stable with the release of fascia restriction. It is also typical for successful fascia treatment to reduce or eliminate swelling and tenderness in joints that have been inflamed for months or even years.
Structural damage: This can lead to chronic pain, and the structural damage or alternations are usually not reversible. However, it is important to realize that research has found low correlation between severity of join degeneration and severity of pain. Often, pain is due to fascia restrictions and the instability and inflammation that they trigger. If the structural damage is bad enough, a person might need to wear a support or a brace in a consistent basis or even undergo surgery, but it is typical in my practice for such patients to find pain relief with fascia treatment. Their joints continue to look the same on an x-ray or MRI, but their pain is relieved. Also, patients whose arthritis has been worsening each year (as seen on X-ray or MRI) often see the progression stop after a thorough course of fascia therapy.
Instability: Sometimes joint instability is due to permanent ligament damage and can only be treated with muscle strengthening, orthopedic supports or braces, or even surgery in severe cases. However, 95% of the joint instability that I see in my practice is simply due to distorted position sense from abnormal fascia restriction. When these restrictions are released, muscular balance is restored, and the joint becomes stable.
Inflammation: For reasons poorly understood, it seems that inflammation can get stuck in its own feedback loop, perpetually maintaining itself without end, instead of disappearing after an injury heals. If this is the case, a steroid injection is sometimes given to break the feedback loop and resolve the inflammation. However, steroid injections usually do not offer permanent relief, and it is more common that underlying factors cause the inflammation.
Oral anti-inflammatory medications, such as ibuprofen, can be helpful in relieving pain, but they do not resolve chronic pain and sometimes have troubling side-effects too. Fascia therapy, on the other hand, can often remove the underlying stresses that trigger chronic inflammation. In fact, I see long-term pain relief from treating fascia restrictions more often than from using steroids or anti-inflammatories.
Because there are multiple factors involved in chronic pain after a joint has been injured, every case is different. The most effective relief comes from addressing root causes. While at times surgery, orthopedic supports and steroid injections are required, the less invasive option of fascia therapy is, in my experience, more often the most effective treatment. In fact, releasing fascia restriction frequently helps to achieve relief even in cases where surgery or orthopedic supports are also needed. In the end, each patient needs careful assessment and the type of treatment that finds the root causes of their chronic injury-related joint pain.
With the COVID-19 crisis, our evening programs have moved online. You are invited to attend a Zoom webinar on July 28, 6:30 p.m. You will learn in-depth about fascia, why it is important, and how fascia problems are resolved with gentle manual therapy. Dr. Eric Winder will discuss case examples, provide a treatment demonstration and hold a Q&A session following the presentation. Visit GentleBay.com to register for the webinar. Dr. Eric Winder has 23 years in practice and focuses on relieving pain and restoring alignment and motion through fascia release therapies without forceful manipulation.