• Micaela Zettel, PT, MScPT, BScHK(hons), CMAG, CSCS

Acute Inflammation: Friend or Foe? To seek treatment or not?

There’s lots of buzz these days in the health and wellness world about the negative effects of inflammation. First of all, it’s important to know that the body is supposed to have inflammatory responses.

Acute Inflammation is defined as a “short term process occurring in response to tissue injury, usually appearing within minutes or hours. It is characterized by the five cardinal signs of pain, redness, immobility (meaning loss of function), swelling and heat(1).”



Let’s dig a bit deeper on what mechanisms are actually in action and why. First, when there is a physical injury to tissue (skin, muscle, bone etc), there is fluid known as edema, which leaks from damaged cells that make up that tissue (all of our structures in our bodies are made of cells - taking you way back to high school biology :)). When this happens you will likely see swelling in and around the injured area. There can also be blood that leaks from the damaged blood vessels and you would see bleeding or a bruise forming. Something that also happens, that we don’t see, is the activation of the immune system. When there is damage to cells this triggers an immune response by the body, and special immune cells, known as leukocytes, go to the damaged area and fight off invading bacteria to prevent infection.The primary goal of the inflammatory process is to ultimately protect the body. It is a necessary function to keep us healthy and mobile. Our entire system is designed to keep us alive. 


I think we can agree that acute inflammation is necessary and can be helpful. But when is it a problem?


Let’s recap quickly. With damage to the blood vessels and tissue cells resulting in bleeding and edema, there is also an effect of the nervous system, the lines of communication within our bodies. The nervous system controls the function of the blood vessels as well as our motor system (muscles). Acute inflammation should clear up on its own, potentially within a couple of days, depending on the extent of the injury. If you have had multiple injuries in that area, have circulation issues (for example: chronic swelling in the ankles, cold hands/feet, poor lymphatic drainage, diabetes, etc.), or you didn’t take the time needed away from activity to heal before challenging the injured area again, you can run into trouble. When this happens, the body isn’t able to re-absorb the edema completely and tissues don’t heal optimally. The edema and its chemical mediators get left behind and take up space within the cells and scar tissue. These chemical mediators signal to the nervous system and, initially, they are essential in the acute response of the immune system. However, they become detrimental to the function of the neuromotor system (nerves and muscles) when they linger well after “normal” healing time. These mediators end up irritating the local nerves and tissues, altering the signal of those nerves as they communicate to the spinal cord and up to the brain. When this occurs we see residual movement problems from a simple injury such as an ankle sprain or even a wound or bruise. Think of it like hair clogging up the drain. The fluid backs up and nothing can drain properly, and you end up standing in gross dirty water during your shower, until you remove the hair and other grossness (yuck). Your “clean” shower, is not so clean. And if you just keep showering, it just keeps getting worse, until you remove the problem.  Same for the nervous system, friends - you must remove the problem (EDEMA) to properly restore function. 


In my practice I often see this presentation. Someone comes in for treatment of their knee, hip or back, for example, and this pain seemed to start for no apparent reason, just out of the blue one day. After a thorough history and assessment of the neuromotor system, there are findings of old injuries that did not fully recover and are contributing to altered nervous system function and movement patterns. The client is often unaware of this as their “ankle” doesn’t cause them any pain or give them signals that something isn’t right. Much of our processing is done subconsciously without us being aware. In this case, treatment of that old ankle injury results in changes throughout the neuromotor system. I see this at any age, from a youth athlete to middle aged individuals.


When do you need to seek treatment for an acute injury? 


Because of the nature of inflammation and the negative effects it can have when residual edema lingers, I recommend seeking treatment for any acute injury from a qualified health professional. They can guide your recovery effectively, which will be a different approach for each person. Treatment should always include home exercise, activity modifications and guidance for safe return to full participation, manual therapy to help with re-absorption of the edema and restoration of neuromotor function. Neurofunctional electro-acupuncture can also be an excellent modality to aid this recovery and this is something I use often in my practice. As always, a detailed assessment to understand each individual is needed for an effective treatment plan. Don’t leave that ankle injury to heal by chance. There is so much you can do to support effective healing and recovery. Take care of your injuries so that you don’t compromise your function and performance now, and in the future.




References:

1. www.nature.com “Acute Inflammation -Latest Research and News” 


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