Soft Tissue injury natural treatment by Ray Sahelian, M.D.
Feb 22 2014

Soft tissue refers to muscles, tendons, ligaments, and fascia, but not bones.. Soft tissue injuries are commonplace and range from minor to very serious, depending on the nature of the injury.

Acute treatment of soft tissue injury
Rest, ice, compression, and elevation are fundamental to initial soft tissue injury healing. The ice helps constrict the blood vessels from flowing to the injured area, which causes the swelling. The elevation uses gravity to draw blood away from the injured area to reduce swelling.

Bleeding Phase
Bleeding often occurs initially into soft tissue following injury but does not last long.

The inflammatory phase
Following the bleeding and tissue damage, an inflammatory phase occurs which is an essential component of the tissue repair process. Many types of cells migrate to the soft tissue injury site to begin the repair process.

Proliferation Phase
The proliferative phase essentially involves the generation of collagen material. The proliferative phase begins within a day or two but takes longer to reach its peak reactivity, which is usually several weeks after the soft tissue injury.

Remodelling Phase
The remodelling phase helps to make the original scar (the collagen deposition) capable of behaving in a similar way to the original tissue before the injury. A proportion of the original fine (Type III) collagen is reabsorbed (due to the action of collagenases) and is replaced with Type I collagen with more cross links and greater tensile strength. Final remodelling may continue for months, and possibly over a year beyond the obvious healing of the damage.

Questions
Q. I receive your newsletter by email & read it regularly. If this has already been addressed in one of them, please forgive me. But so far, I don't recall reading anything on this subject. I feel my question is general enough to apply to others and am not asking personally what I should take but information on this problem for myself & others so afflicted too. I have decades old soft tissue injury - torn and scarred rotator cuff muscles and ligament damage in both shoulders. I know I'm not unique as I've spoken to others with similar problems. My general health is excellent, top notch immune system, reasonably active & not overweight at all. But nothing I know of seems to help my shoulders and the resulting pain & numbness that's slowly increasing over the years. The joints themselves seem to be fine & no abnormalities are found with them. While glucosamine and chondroitin products are often recommended for joint health (cartilage), they do nothing for the muscle & ligament injuries. Is there any group of nutrients that can help alleviate the pain & increase mobility? Chiropractic care has made no changes and massage therapy only produces very short term effects (hours to a day or two). I still pursue massage, acupuncture, and continued activity to prevent faster deterioration but hoped you might be able to suggest certain nutrients that help with such problems. Or perhaps, there's little that can be done other than what I do now. Soft tissue injury and scarring seems to be fairly common with many people I've talked to so if you can address this topic sometime in your newsletters, it would be greatly appreciated. Thank you.
   A. After a soft tissue injury, there is an initial repair with collagen deposition and scar formation that occurs for a few weeks followed by continued remodelling for several more months or a year. I am not aware of any specific supplements or methods to remodel scar tissue that has been formed in old injuries but I need to say that I have not studied this area in any great depth. However, there may be steps to take to reduce chronic inflammation and hence reduce pain. Daily physical activity and deep sleep are crucial. Physical activity improves circulation to the tissues and also helps release endorphins and other substances that reduce pain. Deep sleep is also crucial to healing  Exercise and physical activity also help lead to deep sleep. Many people who have mild or moderate soft tissue pains all over the body find that they are not feeling the pain during physical activity or a few hours afterwards. Sedentary individuals are more likely to notice the chronic pain. I would also recommend yoga as a wonderful healing method, particularly a form of yoga called yin yoga, also called restorative yoga. Diet could make a difference. For instance, eating a diet that produces less inflammation and inflammatory substances in the body could shift the production of pro-inflammatory prostaglandins and other substances to their less inflammatory counterparts. In brief, this involves eating more fish and vegetables and less sugars. See diet for suggestions. It is possible that certain herbs or nutrients could reduce the inflammatory response, for instance fish oils, curcumin and CMO.

Collagens are the most abundant components of the extracellular matrix and many types of soft tissues. Elastin is another major component of certain soft tissues, such as arterial walls and ligaments. Many other molecules, though lower in quantity, function as essential components of the extracellular matrix in soft tissues. Fibronectin with its muldomain structure plays a role of "master organizer" in matrix assembly as it forms a bridge between cell surface receptors, e.g., integrins, and compounds such collagen, proteoglycans and other focal adhesion molecules. It also plays an essential role in the assembly of fibrillin-1 into a structured network. Laminins contribute to the structure of the extracellular matrix (ECM) and modulate cellular functions such as adhesion, differentiation, migration, stability of phenotype, and resistance towards apoptosis. Though the primary role of fibrinogen is in clot formation, after conversion to fibrin by thrombin, it also binds to a variety of compounds, particularly to various growth factors, and as such fibrinogen is a player in cardiovascular and extracellular matrix physiology. Elastin, an insoluble polymer of the monomeric soluble precursor tropoelastin, is the main component of elastic fibers in matrix tissue where it provides elastic recoil and resilience to a variety of connective tissues, e.g., aorta and ligaments. Elastic fibers regulate activity of TGFβs through their association with fibrillin microfibrils. Elastin also plays a role in cell adhesion, cell migration, and has the ability to participate in cell signaling. Mutations in the elastin gene lead to cutis laxa. Fibrillins represent the predominant core of the microfibrils in elastic as well as non-elastic extracellular matrixes, and interact closely with tropoelastin and integrins. Not only do microfibrils provide structural integrity of specific organ systems, but they also provide a scaffold for elastogenesis in elastic tissues. Fibrillin is important for the assembly of elastin into elastic fibers. Mutations in the fibrillin-1 gene are closely associated with Marfan syndrome. Fibulins are tightly connected with basement membranes, elastic fibers and other components of extracellular matrix and participate in formation of elastic fibers. Tenascins are ECM polymorphic glycoproteins found in many connective tissues in the body.