As inflammation progresses, the damage to the ECM becomes more apparent. Fragments of ECM can find their way to pattern recognition proteins (such as toll-like receptor) and intra-macrophage inflammasomes. This can set up a cycle of more aggressive inflammation, damage to the ECM, activation of PRP/inflammasomes, etc. Treatment requires plant extracts that can interrupt this inflammation, as well as physical medicine, hydrotherapy, and avoidance of certain provocative factors.