Inflammation – not always the bad guy

y Robin Holland

Inflammation is a word that is tossed around regularly, and most people think it’s bad news. Something you want to get rid of as quickly as possible. But wait – I’m here to tell you that inflammation is good! It’s a necessary part of the healing process.

When is inflammation bad?

Let’s clear this up to start with. Long-term, chronic inflammation is not helpful. It’s linked to a host of chronic diseases, such as rheumatory arthritis, allergies, and heart disease. The verdict is still out as to whether chronic inflammation is the result of these diseases or the cause. If you have chronic inflammation, anything longer than about 6-8 weeks, or severe inflammation, e.g. pain that makes you want to cry, it is best to discuss it with your doctor.

Acute inflammation – the good guy

On the other hand, acute inflammation – what happens immediately after an injury – is our body’s natural response to injury. We need inflammation to kick start the recovery process. Tissue repair happens in three phases – inflammation, repair, remodel. You cannot get to the repair and remodel phases without first going through the inflammation phase. Inflammation sets off a chemical process that triggers specialised cells, including neutrophils, macrophages and monocytes, to clear away damaged tissue. Inflammation increases blood flow to the area, which brings these specialised cells to the injured area. Inflammation also increases permeability of the blood vessels, allowing the cells to pass through the walls of the blood vessels into the damaged tissue to do their job.  Swelling, or the build-up of fluid, then occurs, helping the inflammation process progress. Furthermore, swelling increases your sensitivity to pain and restricts your movement, both of which help prevent you from doing further damage. You cannot start to rebuild and repair until you first stop further injury and clear away the damage.

The problem with anti-inflammatory drugs

After an injury, people will often turn to anti-inflammatory drugs such as Ibuprofen to ease pain and reduce inflammation. However, this disrupts the body’s natural healing process. In fact, studies have shown that anti-inflammatories delay the healing process, and there is some suggestion that they can even cause more damage in the long term[1]. Pain is a natural part of the inflammation process. Pain forces you self-protect the damaged area, helping to keep you from doing further damage. If you mask the pain, you put yourself at risk of causing more damage. Furthermore, anti-inflammatories impede the cellular processes that clear away damaged tissue and synthesis new, healthy tissue. There have been recent studies showing that athletes who regularly take anti-inflammatories have less adaptation to training[2] (e.g. they don’t demonstrate the same strength or fitness gains and non-pill takers). This is a double-edged sword. You get poor healing from any tissue damage and poor strength and fitness improvements – both putting you at greater risk of further injury.

Current recommendations

So, as you can see, anti-inflammatories do not help an injury get better faster. Rather, they actually slow down the healing process. However, there are no evidence-based guidelines on the safe use of anti-inflammatories. There is a lot of debate now around when and how anti-inflammatory drugs should be used following an injury. Some guidelines suggest that anti-inflammatories should be avoided in the first 48 hours following an injury. Other experts go even further and suggest anti-inflammatories should be avoided for the first 3 days. After that, once you get into the sub-acute phase, the research is less clear. The general consensus is that occasional use to help with pain is probably okay, but it’s best to avoid them if you can.

Ice therapy

Many people have heard they should put ice on an injury. RICE (rest, ice, compression, elevation) is the common go-to treatment for many injuries and is widely recommended by health professionals. However, these recommendations are not based on research, and there is NO evidence that it will help[3]. In fact, the NICE guidelines (the gold-standard clinical evidence published by the NHS) recognises that ‘there is insufficient evidence to determine the effectiveness of these measures’ but describes them as commonly accepted practice.’[4] Ask yourself, what are you trying to achieve with ice? You’ve probably heard that you should apply ice to reduce swelling and inflammation. Ice slows the blood flow to the area, which does reduce inflammation, but there is no evidence demonstrating a reduction of swelling.  However, these reactions are not a mistake by your body! Inflammation and swelling in the acute phase, as discussed previously, are your body’s natural response and an important part of the healing process. That said, there is also no evidence to show that ice will do any harm, and it can help with pain. Ice numbs the area, which temporarily interrupts the pain signals. So, if you’re in a lot of pain after an injury, ice can be useful to provide some temporary relief.

What to do instead

Acute inflammation is your friend – embrace it. Listen to your body. Rest any sore or injured area, and if you’re concerned, seek professional medical advice. There are a number of things you can do to control pain and safely aid the rehabilitation process:

  • If needed, you can take non-anti-inflammatory pain killers, such as paracetamol.
  • Use ice to numb the area for some temporary pain relief. Apply ice for up to 10 minutes, then take it off for at least 20. Repeat the cycle a couple of if needed. However, be aware that too much icing may interrupt the healing process.
  • Try heat therapy, such as a hot water bottle or wheat bag, once you’re in the sub-acute phase (about 72 hours post-injury). Heat increases the blood flow to the area, which may help with the healing process. Heat has a similar pain numbing affect as ice, but without the risk of interrupting the body’s natural healing response. Avoid heat in the first 72 hours after an injury, though, as the increase in blood flow can make symptoms worse during this initial phase.
  • Book in for a massage or some manual therapy. Manual therapies, such as deep tissue massage and joint mobilizations, are a very effective way to reduce pain and stiffness. These therapies can help you get moving quicker and more comfortably. Be aware, though, recent, large-scale studies have shown that, while manual therapies can provide great short-term relief, they need to be combined with exercise therapy to provide any long-term benefit.
  • Get a good rehabilitation plan. Inflammation kick starts the healing process, and rehabilitation exercises finish the process. Appropriate exercise therapy helps the healing tissues to realign in an organised pattern (as opposed to scar tissue, which can be disorganised and ‘messy’). Exercises also help strengthen the injury and surrounding areas to prevent reoccurrence. It’s best to get personal advice from a qualified professional, since every injury is different. Your ankle sprain could be due to a completely different biomechanical cause than your friend’s!

Concluding thoughts

Inflammation is the natural way our body deals with injury, and thus it’s best to avoid anything that interrupts this process. Our bodies are pretty amazing, and evolution has provided us with the optimal physiological response. Anti-inflammatories don’t need to be completely avoided, but you need to think carefully about when and how to use them. As with any medical problems, if you have any questions or concerns, speak to your doctor or another qualified medical professional.