Archive for January, 2017

Over the last 15-20 years, a great deal of research has looked at the role fascia plays in pain, reduced function, range of motion and more.

For example, Stecco has shown that an increased concentration of hyaluronic acid in the extracellular matrix can cause stiffness and pain. By using a deep form of manual treatment, the clinician can actually reduce the concentration ( for viscosity) of the hyaluronic acid and thereby reduce pain and increase range of motion and function. We also know that fascia covers every cell in our body. There is a growing body of research showing that treatment in the eccentric position hastens recovery. Remember, there are no local problems and there are no local treatments, we must look at the body as a whole and look at how the fascia interconnects multiple body parts.


Scar formation is a natural part of the wound healing process. Scars are formed by fibrous connective tissue assisting would repair in the skin and other body tissues. Scars are formed on the skin, underlying tissue, and internal organs where an injury occurred, an incision was made, some part of the body was cut, or a disease infected and caused damage to the tissue. The damaged tissue is replaced by scar tissue to maintain the normal body processes (Waibel & Rudnick, 2015), but scar tissue is unlike normal tissue and may cause pain and limitations in motion, thus needing medical intervention.

Scar formation on organs or muscles can alter the way the tissue moves. Movement is altered around a scar because the flexibility of the scar tissue is different from that of normal tissue. The scar tissue is weak and less elastic. It is vulnerable to injury.

Smaller forms of scar tissue are called adhesions. Adhesions cause the inability of tissue to glide and slide over one another, resulting in stiffness and reduction in strength and range of motion. The nerves become entrapped in the tissue instead of being able to slide through the muscles, which limits range of motion of the involved limb.

Reduced range of motion can be avoided with a prescription of manual therapy and correct motion exercises to help avoid myofascial adhesions around the affected area. Treatment of scars can be easily performed in chiropractic, massage, or physical therapy clinics. For the best outcomes to improve scar tissue flexibility, intervene as early as one can without disrupting tissue healing. Using kinesiology tape can help lift the skin allow for fluid to move easier to the heart.

The latest CDC statistics show that , in 2012, 54 out of 100 people had self-reported musculoskeletal conditions. That is six times more than self-reported cases of cancer, double that of respiratory disease, and one-third more than circulatory disorders. If we extrapolate that to a more current population in the United States of 321 million, that equates to 173 million people reporting musculoskeletal problems in 2012.

Many of these are spine patients who suffer long term without any type of bio-mechanical assessment or functional case management. Why does health care fall short with spinal conditions despite the compelling literature that states the opposite in treatment outcomes?

The front line of medical care for spine-related pain is typically the prescription of pain medication, particularly at the emergency care level, and then if that doesn’t work, a referral is made to physical therapy. If physical therapy is unsuccessful, the final referral is to a surgeon. If the surgeon does not intervene with surgery, then the diagnosis becomes ” nonspecific back pain,” and the patient is given stronger medication since there is nothing the surgeon can do. ¬†FOr surgical interventions that result in persistent pain, a commonly reported problem, there is an ICD-10 diagnosis for failed spine surgery.

According to Mulholland (2008), “[Surgery] Spinal fusion became what has been termed the ‘gold standard’ for the treatment of mechanical low back pain, yet there was no scientific basis for this.” Simply put, surgery does not correct the underlying biomechanical failure or the cause of the pain.
Opioid pain medication use presents serious risks, including overdose and opioid use disorder. From 1999 to 2014, more than 165,000 persons died from overdose related to opioid pain medication in the United States.

Clearly, there needs to be a nationwide standard for the process by which patients with spine pain are handled, including academic and clinical leadership on spinal biomechanics. The only profession that is poised to accomplish such a task is Chiropractic.

MDs tend to use medication, including analgesics, muscle relaxants, and anti-flammatory agents, for the treatment for acute nonspecific spinal pain, whereas DCs favor spinal manipulation therapy as the primary treatment for this condition.


Firefighters have very physically demanding, psychologically taxing, stressful, and dangerous occupations, resulting in frequent cardiovascular events, Musculoskeletal injuries, and behavioral health concerns.These issues compromise health, fitness, and well-being throughout their career and into retirement, severely impacting the ability to protect our communities.

The purpose of this article is to provide an overview of: the current state of wellness and fitness programs in the fire service, our firefighter wellness and fitness projects in the Tampa Bay region, barriers to implementation of these programs; and recommendations for successful implementation of firefighter wellness and fitness programs.

Many stakeholders agree that firefights need to be physically fit and psychologically healthy in order to have long and successful careers. Thus much emphasis has been placed on strategies to improve and maintain wellness and fitness, including fire service guidelines, such as the IAFF-IAFC Wellness Fitness Initiative. Low back pain and injuries are some of the most common and disabling disorders in firefighters.

Properly designed and implemented wellness and fitness programs will help transform fitness across the State of Florida and, ultimately, the United States. Based on our recommendations and the guidance of well-versed stakeholders, this is a real possibility. Regional implantation will serve as a model-enabling other fire departments to replicate and standardize and approach addressing all current and future needs for firefighters who serve and protect and protect our communities.

Through successful implementation at the regional and national levels, such programs will result in improvement health and wellness outcomes that will be delivered in a cost-effective and pragmatic manner, Stay tuned for our future updates from our Florida-based firefighters Wellness and Fitness initiatives.

Originally published in Florida Fire Service Magazine, October 2016, Copyright Florida Fire Chief’s Association