The Chiropractor for Ventura and Oxnard!

Inflammation is a natural process utilized by your body to heal itself. Inflammation per se is not a bad thing, but “inflammation gone wild” can wreak havoc upon many different systems within your body. You may have heard, for example, that inflammation as a response to arterial damage is at the root of the symptoms of heart disease. The same line of reasoning applies to other disease processes, like diabetes, rheumatoid arthritis, and it has even been postulated for Alzheimer’s and other, less grave situations. Interestingly, did you know that often, the first overt symptom of heart disease is…a heart attack? (!!!). Similarly, many disease complexes often have no overt signs and symptoms…until your body has reached the point of “This is just the last straw! I cry uncle!”

For the most part, we are concerned with inflammation that has gone beyond the normal control processes that your body innately possesses. The body is a beautiful, elegant system…but when one or more of those systems exceeds its (very large) capacity to adapt to insult or injury, problems will arise…and it can then become a vicious cycle.

The problem is that when soft tissues are stressed they produce a group of chemicals called inflammatories. These include histamine, bradykinin, and prostaglandin. These chemicals are designed to provoke specific physiological responses - which are supposed to be part of the healing process. Ideally, these chemicals are broken down as soon as they are produced by enzyme action as they come in contact with the blood. If the blood supply is inadequate and these chemicals are allowed to build up sufficiently, they produce adverse reactions that may not only slow healing but also increase soft tissue stress. In such circumstances, histamine increases swelling, bradykinin increases tissue sensitivity, and prostaglandin increases pain.

Histamine changes circulation in the soft tissues affected by inflammation by opening the arterioles, which lead to the capillaries, while simultaneously closing the venules leading away from the capillaries. This has the effect of promoting swelling, while at the same time - if deep tissues are affected (tendons, ligaments, joint capsules, or fascial layers) - increasing skin resistance right over the inflamed deeper tissues. When the capillaries are engorged and open up around and in inflamed tissues the capillaries in the skin just over those deep tissues reciprocally constrict, increasing surface skin resistance to the passage of electrical current. Dr. Kevala may use a skin resistance meter to detect these particular changes.

Bradykinin does not hurt overtly, but it does have the effect of making the involved tissues sensitive. This sensitivity increases and can affect adjacent tissues as the bradykinin builds up and spreads out. By rule of thumb, the tissues will remain sensitive (easily irritated) for two weeks after all of the pain is gone. In that period, the tissues remain tender and easy to irritate and re-inflame.

Prostaglandin is an organic acid that burns the tissues it comes in contact with. Prostaglandins are also several different molecules that are responsible for things such as blood clotting, in addition to pain and burning the tissues. Prostaglandins are the molecules whose formation aspirin prevents (you know how they say to take your aspirin a day?). Did you know that omega-3s work upon the identical pathway that aspirin and cox-2 inhibitors work on? (There’s a clue: ask Dr. Kevala about omega 3s!).

Continuing on…if prostaglandin is allowed to remain in the area long enough its burning action causes the body to respond as if it has been burned. The body, responding normally, tries to heal the burn; it floods the area with collagen in the form of collagen fibrils, which would ordinarily collect to form a scar matrix. There is no scar matrix to reasonably form, so these fibrils start sticking tissue layers together, becoming what are called adhesions. These adhesions cause these tissue layers to “catch” as they try to slide over one another. This increases tissue stress and provokes more inflammation, thereby becoming a self-perpetuating process. Adhesions are one source of many chronic problems seen in orthopedics, physical medicine and the chiropractic field.

The first step in “fixing” the problem is to precisely determine the location of the inflammation(s).

The second step in the process is to break whatever adhesions exist in the involved tissues. This involves mobilizing the tissue layers in such a manner that a shearing force is exerted on the individual collagen fibrils, which is sufficient to cause the fibrils to break - thus reducing the adhesion. This is generally accomplished by picking up the tissues and forcefully rolling (or pinching) them between the fingers. Another method utilized by Dr. Ruby is the Graston Technique. These processes are generally uncomfortable, but do afford the advantage of giving almost instantaneous, albeit (sometimes) temporary, relief of some or almost all of the constant chronic pain. Ice packing or high intensity electrical stimulation may be used to facilitate this procedure. In the long term, adhesion breaking, in conjunction with precise chiropractic adjustments, gives you the chance of permanently getting back normal ranges of motion and comfort that other procedures may only temporarily provide you. If the adhesions remain unbroken, the pain will eventually come back.

The third step is to induce your own deep circulation to come into the inflamed area so that the waste products of this cycle can be carried away. In our setting, we utilize ultrasound. The effect is generally immediate with a general decrease in the degree of overt pain. In some cases, the desired decrease in pain has occurred over night or (in a few cases) over the course of a few days. Dr. Kevala will also instruct you in home anti-inflammatory measures that you can take.

The fourth step is directed at increasing capillary circulation in the involved tissues. This is usually accomplished through judicious use of various forms of electrical stimulation and/or vibration. If we can improve capillary circulation, enzyme action will complete the destruction of the inflammatory chemicals and relief will come a good deal faster than otherwise. Indeed, some forms of electrical stimulation will not only increase capillary circulation, but will also inhibit the formation of adhesions in the involved tissues.