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Common biological features of chronic injury Microvascular limitation: the tissue is under-perfused, which slows nutrient delivery and waste removal Inflammatory persistence: cytokine signaling stays elevated and disrupts remodeling Disorganized collagen: collagen exists, but it is poorly aligned, weak, or prone to reinjury Mechanical mismatch: loads exceed tissue capacity due to weakness, compensation, or instability Neurogenic sensitivity: irritated tissues and nerves amplify pain signals even when imaging is normal In other words, chronic injuries do not usually need one intervention

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10.1016/S0002-9440(10)62498-4 Am

The MCA experienced ~1 C atmospheric warming in the TNA 50,51 , which would have amplified local evaporative demand similar to the period from 1960 CE to present (Fig