Scar tissue

[Catrin]

My PT found lots of scar tissue in my hamstring yesterday - the consequences of my stubbornness last fall about not stopping and seeing the doctor when I should have. He put me on a 'Iso-Kinetic"? machine that was quite interesting after he tortured my leg for some time with assorted implements of pain to work out the scar tissue.

I guess that it was nice that he found physical confirmation of the hamstring strain/pull - there were multiple things going on that it was difficult to decide what it all was. Doesn't mean there weren't other things happening at the same time, there was, but it was nice to have something confirmed.

He also had me lightly jogging on the treadmill for 6 minutes - that is too hard on my knees to do it again (I HATE treadmills) but no pain in hips, back, or hammies. Progress - even if I am a little sore today - spinning Thursday evening and personal trainer session a couple of hours before PT :)

[emily_in_nc]

Interesting that your PT could discern scar tissue, catrin. Did he say how he knew it was scar tissue?

I'm curious in knowing the difference between scar tissue and trigger points, for anyone who'd care to enlighten. I have what I always call a "crunchy" area in my right butt cheek near where I think of as the piriformis. When I massage this area, it feels "crunchy" if I press deeply and is sore. It "hurts so good" to massage the piriformis area with a firm foam roller.

I believe this area of "crunchiness" developed after my cycling accident in which I fractured my pelvis in 2005, though it's fairly far from the fractured area, which was from the outer wing of my right ilium to the sacrum and is plated and pinned from the front, not from the buttock side. I've mentioned the "crunchiness" to a couple of different orthopedists and PTs, but oddly, none of them have tried to feel the crunchiness, maybe because it's on my buttock and thus an awkward place for them to palpate/massage? I have no idea. My DH thinks it's scar tissue. Does this sound right? Or is a trigger point? Any guesses?

Thanks!

[Catrin]

No, but I didn't ask because I could tell it felt differently from other portions of the hamstring. It felt quite rough and "bumpy"? Difficult to describe, but he did go quite deep with his implements. I do not know what a trigger point is :o

He did give me a piriformis stretch and it is very obvious that it is extremely tight in my OTHER hip - the stretch has me almost to the point of tears...but I am working at it.

[emily_in_nc]

No, but I didn't ask because I could tell it felt differently from other portions of the hamstring. It felt quite rough and "bumpy"? Difficult to describe, but he did go quite deep with his implements. I do not know what a trigger point is :o

From Wikipedia :http://en.wikipedia.org/wiki/Trigger_point:

Trigger points or trigger sites are described as hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers. [1] Trigger point practitioners believe that palpable nodules are small contraction knots[ambiguous] and a common cause of pain.

The description of your scar tissue as rough or bumpy may be similar to my "crunchy" area. If it is scar tissue, I guess I don't understand exactly how it forms. :confused:

[OakLeaf]

I've often heard therapists talk about adhesions in the muscles that form around trigger points. I expect it's the same thing?

[Catrin]

From Wikipedia :http://en.wikipedia.org/wiki/Trigger_point:

Trigger points or trigger sites are described as hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers. [1] Trigger point practitioners believe that palpable nodules are small contraction knots[ambiguous] and a common cause of pain.

The description of your scar tissue as rough or bumpy may be similar to my "crunchy" area. If it is scar tissue, I guess I don't understand exactly how it forms. :confused:

Mine was the consequence of a strained/pulled hamstring - I think that often causes micro-tears - so that makes sense to me but I am no specialist. There seemed no doubt in his mind what he felt.

It makes sense that both scar tissue and little contraction knots would cause pain in a muscle... Perhaps if Knotted or one of our other PT members happens to see this that she can educate us?

[KnottedYet]

I've mentioned the "crunchiness" to a couple of different orthopedists and PTs, but oddly, none of them have tried to feel the crunchiness, maybe because it's on my buttock and thus an awkward place for them to palpate/massage? I have no idea. My DH thinks it's scar tissue. Does this sound right? Or is a trigger point? Any guesses?

Thanks!

Crunchiness is a cool example of how the body reinforces itself.

Don't hate the crunch! It's a sign that all your systems are working!

Imagine the muscles as kind of like sausages, they each have a "wrap" around them, like a sausage skin.

Normally, the wrap is slippery and slimey so the muscles can slide over and under each other efficiently.

When you are injured or out of whack, your body sends out the chemical signal to change that slimey collagen to sticky collagen, in an attempt to splint the injured/inflamed area.

Your muscles start to stick to each other, and when you intentionally push them past each other (either stretching or with massage) the sticky collagen wrap makes crunchy noises like velcro as they skid.

Your job becomes figuring out WHY your body decided its best option was to glue down the neighborhood, and then correcting the irritant (posture? injury? weakness?) so the body feels secure and restores the muscle wrap to its normal slippery and slimey state.

(and trust me, buttocks are not awkward to orthopods or PTs. I've palpated more buttocks in my career than a testosterone-poisoned teenaged boy could ever DREAM of!)

[KnottedYet]

Mine was the consequence of a strained/pulled hamstring - I think that often causes micro-tears - so that makes sense to me but I am no specialist.

Nup. MACRO tears.

But I still think your problem originated in your lumbar spine.

You still doing those lumbar extensions ten times every 2 hours?

Didja tell your PT that I don't think he deserves his Cert. MDT when he misses such a dramatic posterior lumbar derangement sign as you presented? Send him over, I'll beat some sense into him. (Knot pounds fist into palm, and looks as fierce as it is possible for an overweight middle-aged gray-haired woman to look.)
Remind him I'm watching his a$$ and he'd better treat you right and fix you up good!!!!!!

[Catrin]

Thanks for joining in Knotted - is this the same as scar tissue or are we talking about quite different things? Can scar tissue cause trigger points? Am I just confusing myself like I think I am?

[KnottedYet]

Thanks for joining in Knotted - is this the same as scar tissue or are we talking about quite different things? Can scar tissue cause trigger points? Am I just confusing myself like I think I am?

No, scar is scar, and looks just like scars you'd get on your skin. It adapts to the environment, but is never quite the same as the surrounding tissue.

Leave it alone, and it will do just fine. No need to mess with it. (in fact, due to the higher level of collagen -which is a colloidal protein- than elastin, messing with a scar will just make it tougher)

Trigger points are areas where the muscle is stuck in tetany. It's so tightly contracted that it has cut off the capillary circulation to itself, and can't get oxygen nor nutrients. (oxygen allows muscles to release, which is why corpses go into rigor mortis until they start to decompose... no oxygen) Massage or stretching can break the tetany cycle, and allow the trigger points to fade away.

Figure out what you are doing wrong with your posture or technique, and you can eliminate the absurd demand you've placed on the muscles which caused the tetany in the first place.

[Catrin]

Thank you, that is quite helpful.

[Catrin]

Nup. MACRO tears.

But I still think your problem originated in your lumbar spine.

You still doing those lumbar extensions ten times every 2 hours?

Didja tell your PT that I don't think he deserves his Cert. MDT when he misses such a dramatic posterior lumbar derangement sign as you presented? Send him over, I'll beat some sense into him. (Knot pounds fist into palm, and looks as fierce as it is possible for an overweight middle-aged gray-haired woman to look.)
Remind him I'm watching his a$$ and he'd better treat you right and fix you up good!!!!!!

I just saw this :) Yes, I AM doing the lumbar extensions 10xs ever two hours. You know, when I started doing those my back would pop in the most interesting of places, but it has stopped doing that which is probably a good thing.

Regardless of what is doing it, I am finally getting relief :) No real pain in my hips for over a week now, though sometimes it aches a little sometimes. Hip flexors, or whatever it is, are a little more stubborn but that is decreasing as well. I will remind him that you are watching his Argentinean a$$ :)

[emily_in_nc]

Thank you, Knotted! You are a wealth of information, as always!

Wow...crunchy muscle coating, who knew!?

[Catrin]

I have officially graduated from physical therapy :) :D :cool:

I do feel much better, though still have a little discomfort from scar tissue in the hamstring. I am told that this will eventually resolve with time and exercise. I wouldn't even call it pain, I am just aware of it.

Hips are feeling MUCH better, though my left hip is still quite tight - he says the "capsule" is where the tightness is and then he explained what that is. I still have some approved sessions left so I can return if I need to - but quite frankly the new routine my trainer has put together in consultation with the PT appears to be quite effective.

Just in time for the first 45 degree temps coming Sunday - time for a real bike ride :cool: I will use common sense and not over-do things - shouldn't try to ride like a wild-woman on the first real ride in two months! To be honest I haven't had a REAL ride since my injury in September/October but that is something else.

Beer and a fire tonight to celebrate :)

Lumbar extensions are still part of my daily life - it is really hard to remember to do them every 2 hours - but I keep at it.

[KnottedYet]

When you have been symptom-free for a full week, you can stop the every-2-hour thing. At that point your body is repaired.

Then you just need to do them twice a day for about 3 months, as the whole repair finalizes.

[Catrin]

When you have been symptom-free for a full week, you can stop the every-2-hour thing. At that point your body is repaired.

Then you just need to do them twice a day for about 3 months, as the whole repair finalizes.

Thanks - the symptoms have really decreased, but not for a full week quite yet. I should probably mention that I feel the back extension more in my mid/upper back than I do the lumbar spine area but that is probably normal. My back lacks a lot of the curve that most people have - it is pretty straight - though this probably has nothing to do with things.

Thanks for speaking up on the back extensions, I can certainly tell a great difference in how they fell now compared to when I started them! When I started my back was quite the sound-effect factory :eek: :o