Treatment and Support of Musculoskeletal Healing
Renata Trister DO
An injury stimulates a sequence of events begins that begin healing. This healing process involves inflammation, repair, and remodeling. Tissue repair and wound healing are complex processes that involving interconnected, biochemical and cellular reactions, beginning with inflammation and followed by the repair and remodeling of the injured tissue. Connective tissue repair and remodeling involves chondrocyte reproduction, the formation of collagen fibers and ground substance. The healing process first involves removal of damaged tissue, then the subsequent rebuilding of healthy connective tissue. The redness, swelling, heat, and pain of inflammation are a natural part of the healing process. Prolonged or chronic inflammation, however, can slow down the healing process, causing continued loss of function. Furthermore, suppressing inflammation with drug treatment also results in delayed healing.
The inflammatory response is a critical part of tissue repair and wound healing.
When there is damage to connective tissue it is important to address the nutritional requirements for the synthesis of both the collagen fibers and the proteoglycans must be addressed when damage to connective tissue occurs. Many nutrients are involved in connective tissue repair and wound healing: glucosamine sulfate, D-glucuronic acid, amino acids, bioflavonoids, and select vitamins and minerals. In addition to nutritional support, homeopathy has been used for generations for both acute and chronic injuries.
The Inflammatory Response
Prostaglandins and related compounds are collectively known as eicosanoids. Most are produced from arachidonic acid, a 20-carbon polyunsaturated fatty acid (5,8,11,14-eicosatetraenoic acid).
The eicosanoids are considered “local hormones.” There are anti-inflammatory eicosanoids and inflammatory eicosanoids. The standard American diet promotes the production of those that are inflammatory. Fortunately, many substances inhibit inflammatory eicosanoids or promote the production of anti-inflammatory eicosanoids classic mechanism for controlling inflammation. They have specific effects on target cells close to their site of formation. They are rapidly degraded, so they are not transported to distal sites within the body. But in addition to participating in intercellular signaling, there is evidence for involvement of eicosanoids in intracellular signal cascades.
They have various roles in inflammation, fever, regulation of blood pressure, blood clotting, immune system modulation, control of reproductive processes and tissue growth, and regulation of the sleep/wake cycle.
Nutrients & Herbs That Modulate the Inflammatory Response
Omega-3 fatty acids, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are precursors of primarily anti-inflammatory eicosanoids. In addition, the omega-6 fatty acid, gamma-linoleic acid (GLA), also supports the production of anti-inflammatory eicosanoids.
Ginger (Zingiber officinale) and Turmeric (Curcuma longa)These herbs have long been used for acute and chronic inflammatory conditions. Studies suggest that both herbs may block activity of the enzymes cyclooxygenase and lipoxygenase. These enzymes are necessary for the production of inflammatory eicosanoids.
Cayenne Pepper (Capsicum annuum) Capsaicin, the main constituent of cayenne pepper, may play a role in inhibiting inflammatory eicosanoid synthesis by blocking cyclooxygenase activity as well. Capsaicin can reduce tissue sensitivity by selectively depleting a neuropeptide needed to transmit pain impulses to the central nervous system. Thereby changing “the perception of pain”.
Nutrients Involved in Connective Tissue Repair
Controlling inflammation is directly linked to the next phase of the healing process repair and remodeling. Following connective tissue injury, it is critical to supply the raw materials and proper nutrients that support tissue recovery and new tissue synthesis. These include:
Amino Acids Supplying amino acids may support the formation of collagen a critical connective tissue. Collagen fibers are made up of long chains of amino acids, of which one-third is glycine. Proline, hydroxyproline, and hydroxylysine are also prevalent.
Glucosamine and Chondroitin Sulfate are building materials that are vital for the synthesis of new connective tissue as well as for the healing process.
Antioxidants free radical production a major consequence of the inflammatory response—may aggravate an injury and delay or prevent adequate healing. Vitamins E and C are major antioxidants. Vitamin C is required for collagen fiber synthesis, a vital process for tissue repair and healing. Copper, zinc, and manganese further protect tissues by supporting the activity of superoxide dismutase—an enzyme that converts damaging superoxide free radicals into less harmful molecules.
Bioflavonoids see additional section below.
Muscle Mechanics, Relaxation, and Rest
Proper muscle use, joint alignment, and biomechanics during tissue remodeling are critical for preventing reduced range of motion due to scar tissue formation. In addition, injury can give rise to increased anxiety, stress, and poor sleep, resulting in prolonged and unfavorable healing.
• Group of plant pigments that are largely responsible for colors of many fruits and flowers
• Useful in treatment and prevention of many health conditions
• PCO (Proanthocyanidins)
• Most potent PCOs are those bound to other PCOs
• Exist in many plants and red wine
• Commercially available sources are from grape seeds and bark from the maritime pine
• serves as backbone for other flavonoids such as citrus flavonoids: rutin, quercitrin, hesperidin
• these derivatives have sugar molecules attached to the backbone
• most active of the flavonoids
• Citrus bioflavonoids
• include rutin, quercitrin, hesperidin, naringin
• standardized mixture of rutinosides known as hydroxyethylrutosides (HER)
• clinical results have been obtained in treatment of capillary permeability, easy bruising, hemorrhoids, and varicose veins
• Green Tea Polyphenols
• derived from tea plant camellia sinensis
• produced by steaming the fresh cut leaf
• polyphenol indicates presence of phenolic ring in the chemical structure
• polyphenols = flavonoids
• polyphenols in green tea: catechin, epicatechin, epicatechin gallate, epigallocatechin gallate, and proanthocyanidins
• epigallocatechin gallate = most significant active compound
• Citrus fruits
• Green Tea
• Red Wine
Average Daily Intake = 150-200 mg
• referred to as “nature’s biological response modifiers” – modify body’s reaction to compounds such as allergens, viruses, and carcinogens
• powerful antioxidants by giving protection versus oxidative and free radical damage
• prevents formation of oxidized cholesterol through antioxidant effects
• greater antioxidant effects than Vitamins C, E, Selenium, and Zinc
• increase intracellular Vitamin C levels
• decrease capillary permeability and fragility
• scavenge oxidants and free radicals
• inhibit destruction of collagen
• crosslinks collagen fibers to reinforce the natural crosslinking
• prevents free radical damage
• inhibits enzymatic cleavage of collagen by enzymes secreted by leukocytes in inflammation and microbes in infections
• prevents release and synthesis and compounds that promote inflammation and allergies (histamines, prostaglandins, leukotrienes)
• antioxidant effects are beneficial in:
• aging process
• chronic degenerative diseases (heart disease, arthritis, and cancer)
• fat and cholesterol oxidation
• antioxidants are produced by:
• inhibiting xanthine oxidase noncompetitively(oxygen free radicals)
• on the cellular level: PCOs are incorporated into the cell membranes along with the antioxidant effects offer great protection to cells against free radical damage.
• anti-inflammatory activity due to inhibition of initial processes of inflammation
• inhibits manufacture and release of histamine
• potent antioxidant activity and Vitamin C sparing action
• beneficial effects for diabetics
• helps prevent diabetic cataracts, and retinopathy
• enhances insulin secretion
• protects pancreatic beta cells from free radical damage
• antiviral activity
• activity vs. herpes virus type 1, parainfluenzae3, polio virus type 1, and respiratory syncytial virus
• in vivo, inhibits viral infection
• may be of some benefit in the common cold
• antioxidant effects
• increase intracellular Vitamin C, rutin, hesperidin, and HER
• beneficial effects on capillary permeability and blood flow like PCOs
• anti-allergy and anti-inflammatory effects like quercetin
Green Tea Polyphenols
• potent antioxidant effects
• increase activity of antioxidant enzymes in the small intestines, liver, lungs, and small bowel
• inhibit formation of cancer causing compounds like nitrosamines in vitro
• suppressing activation of carcinogens
• trapping cancer causing agents
• forms of cancer that green tea prevents best:
1. cancers of GI tract (stomach, small intestine, pancreas, colon)
2. cancer of the lungs
3. estrogen related cancers (inhibits estrogen interaction with its receptor)
• consumption of green tea with meals inhibits formation of nitrosamines (nitrites combined with amino acids)
• Treatment of venous and capillary disorders
• venous insufficiency
• varicose veins
• capillary fragility
• Diabetic retinopathy and macular degeneration
• Prevention of heart disease and strokes
• Lowers blood cholesterol levels
• Shrinks size of cholesterol deposits in the artery
• Inhibits platelet aggregation and vascular constriction
• In vitro, helps virtually all inflammatory and allergic conditions
2. hay fever
3. rheumatoid arthritis
• Beneficial in diabetes and cancer
• Venous insufficiency
• Improve microvascular blood flow and clinical symptoms (pain, tired legs, night cramps, and restless legs)
• Improve venous function
• Relieve hemorrhoidal signs and symptoms in pregnant women
Green Tea Polyphenols
• Used principally to prevent cancer
• Grape seed extract (92%-95%) and pine bark extract (80%-85%)
• Used interchangeably, but grape seed extract is preferred
• Grape seed extract is considered more potent and more effective than pine bark extract because only grape seed extract has gallic esters of proanthocyanidins which are the most active free radical scavenging PCOs
• Available in powder and capsule forms
• For anti-inflammatory effects, combination of Bromelain (pineapple enzyme) may provide additional benefit by enhancing absorption of quercetin
• Amount of Bromelain should equal quercetin
• Mixed preparations are most widely used
• Least active and quantified source of flavonoids
Green Tea Polyphenols
• Commercial preparations that have been decaffeinated and concentrated for polyphenols (60%-80%)
• 1 cup = 300-400 mg of polyphenols
Downside = this dose also contains 50-100 mg of caffeine