Inflammation and Healing

How the Body Heals

You’re having fun playing with the kids when you make a sudden move and end up on the ground doubled up in pain. What happened and how are you going to fix it are the first thoughts that go through your mind. Our fascination with our bodies takes on a whole new meaning when we are injured. The extent of injury is first of all dependent on the mechanism of injury and the amount of stress you were subjected to. The trauma may be severe injuring even the most robust individual or it may take place insidiously over a long period of time in the form of micro-trauma. If it was a single event, how much damage was done to the tissue and how many fibres were actually disrupted? In the case of micro-trauma, how much damage occurred before you reached the injury threshold? Answering these questions helps to explain some of the problems with healing but there are questions left unanswered. How do you explain an injury that occurs with a simple movement that you have done easily thousands of times before? Regardless of the mechanism of injury the extent of injury and its ability to heal will also be greatly determined by your body mechanics (alignment, strength, flexibility and coordination) and the integrity of the tissue (circulation, nutritional status, nerve supply and the inherent strength of the tissue). Understanding all of this will help you to understand how your body heals and how to prevent the injury from happening again.

Stages of Healing

When tissue damage occurs the body goes through three stages of healing;

  1. Inflammation.
  2. Repair.
  3. Remodeling and Maturation.

Inflammation

Mention the word inflammation and patients cringe and want to do everything possible to get rid of it. Inflammation usually gets a bad rap. Inflammation is not only a reaction to cells being damaged but it is also a process that is absolutely necessary in order for these damaged cells to heal. What we should be doing when we treat inflammation is not eliminate it, but rather keep it under control. The inflammatory process is the body’s way of stimulating our immune system when an injury occurs. This reaction occurs to protect us from possible infections that could ensue and to mobilize the body to rebuild the damaged tissues. The problem is that often the body overreacts to the injury resulting in more inflammation than is necessary and other times inflammation occurs when there is little or no injury present, such as in arthritis. What we want to do is contain the inflammatory response so that the body can do its job of defending us against infections and rebuild the damaged tissue in the quickest and most painless manner.

what happens when we’re injured?

Tissues are stressed and damaged by being overstretched, torn, pulled, crushed or are damaged by metabolic changes within the body, especially when the tissues are deprived of oxygen. The damaged cells release several chemicals that stimulate nerve endings causing pain. These chemicals also cause changes in the local blood vessels resulting in more blood spilling into the injured area causing swelling and more pain. This results in additional cells being irritated bringing about the production of more chemicals that add to the inflammatory process. The inflammatory process varies depending on the site of the injury and the extent of tissue damage. This process is necessary because it recruits cells that will gobble up the debris from the injury and start the repair process with the formation of granulation tissue or early scar tissue. The inflammatory phase generally lasts 3 to 7 days providing that the source of injury is removed and that there is no infection, toxic agents or autoimmune reaction. This is known as “acute inflammation”. The process leads to tissue repair with the restoration of blood vessels and connective tissue to the injured area. In some cases acute inflammation does not resolve. The failure may be due to repeated trauma or micro-trauma, infections, toxic agents and autoimmune disturbances. This is called “chronic inflammation” and is identified by different cellular change and can last weeks, months and in some cases an indefinite period of time.

Can you stop inflammation

No you can’t stop inflammation, but you can keep it under control and reduce some of its effects. Once the damage is done a series of events takes place that will influence the amount of pain and swelling you will experience. These changes occur primarily in the local blood vessels. With acute inflammation you first stop doing anything that causes further damage to the tissues. Next you cool the injured area by applying ice or dipping the body part in ice-cold water. The sooner you do this the better it is. Starting to apply ice even within the first few minutes of the injury will make a noticeable difference to the amount of pain and swelling and eventually your healing time. Ice should be applied for no more than 20 minutes at a time, take a 5 minute break and reapply the ice for another 20 minutes. If you have the time and patience, you can continue doing this all day or take periodic breaks for an hour or two during the day. By cooling the injured area you achieve two things: (1) you slow down nerve transmission, specifically pain sensations which helps to reduce your pain (2) you cause the muscles in the blood vessel walls to constrict reducing the amount of blood going to the area so less bleeding and less swelling occurs. Less swelling results in less pain and faster recovery. The therapeutic strategy is slightly different chronic inflammation. Instead of wanting to shut down the blood supply to the injured area, you want to increase blood supply. There are three basic ways that this can be done and are ranked in order of efficacy:

  1. Application of ice/cold to the injured area for 30 minutes or more, every hour or two.
  2. Application of a cold pack (ice) to the injured area for approximately 3 minutes followed by the application of heat to the injured area for approximately 3 minutes, repeated for 30 minutes. This process is repeated every hour or two.
  3. Application of heat to the injured area for approximately 30 minutes, applied every two to three hours. To further help control swelling, use a compressive bandage or a brace on the injured area. Finally let gravity help you reduce swelling by keeping the injured area elevated above the level of your heart. If your leg is injured then lie down and keep your leg up. If it’s your arm that’s injured, keep it elevated above your shoulder. To remember these four methods for controlling inflammation, we use the acronym RICE which stands for:
  • Rest
  • Ice
  • Compression
  • Elevation

Of course there are other factors and other treatments which will help to control inflammation. Physical therapy in the form of interferential current, ultrasound, and transcutaneous nerve stimulation, can help to reduce pain and swelling, thus restoring function much earlier. Nutritionally there are many options available for controlling inflammation. Dietary changes may be needed with either the addition of certain foods or the elimination of others. Supplementation with vitamins and/or minerals has helped certain individuals. Studies have also supported the use of certain natural compounds. This approach requires extensive investigation and close supervision. Consulting a health practitioner who has training in this area, such as a naturopath, is recommended. Medical treatment involves the use of pharmaceutical drugs to reduce pain and inflammation. Too much pain relief may give the patient a false sense of security resulting in repeated trauma to the injured tissue. Too much reduction of the inflammatory process with the administration of anti-inflammatory drugs has been shown to slow down the healing process and may lead to ineffective healing. Anti-inflammatory drugs seem to play a greater role in the management of chronic inflammation such as with arthritis.

The Repair Phase

The repair phase may last from a few days to a few weeks and basically results in the restoration of normal living tissue. It is characterized by the connective tissue replacement and growth and differentiation of cells in the injured tissue. Some tissues, such as skin heal very quickly while others such as nerve tissue and heart muscle may never regain normal structure and function. The success of this phase of healing is dependent upon the proximity of injured surfaces to each other. If the surfaces are closer together the scar forms more quickly and the tissue regains greater function. Nutritional and metabolic factors also greatly influence the repair phase and since the remodeling and maturation phase overlaps the repair phase, appropriate physical stress to these tissues will ensure a renewed and viable tissue. From a chiropractic perspective treatment is still very important in this phase with ongoing physical therapy to reduce pain and swelling, improve circulation to the injured area and reduce excessive scar tissue formation. Patients usually also need to restore normal biomechanics through joint manipulation or mobilization and soft tissue work. Exercises become more vital in the treatment plan starting with stretching, mobilizing and gentle strengthening exercises which increase in intensity as the repairing tissues become stronger.

The Remodeling and Maturation Phase

Although this phase is critical for completion of the healing process, it is also the phase of healing that is most often taken for granted by patients and doctors. By this time, which is usually weeks or months after the injury, patients are suffering little or no pain. No pain means no problem, right? …. Wrong. The tissues are still very weak and in order to prevent a re-injury you have to stimulate the tissue to heal properly. During the remodeling phase there is a constant turnover of collagen tissue, a gel-like cement that holds connective tissue together. Maturation of collagen progresses to form fibrils that will give the connective tissue (muscle, ligaments, tendons, fascia) its tensile strength. In healthy tissue, fibrils are laid down parallel to each other in a systematized manner to give the tissue its greatest strength and flexibility. Applying stress to these tissues in the remodeling phase will stimulate them to organize the fibrils in such a manner as to resist the stress. The stress can be applied through soft tissue therapies such as massage, Trigenics or myofascial release techniques, or through passive stretching or active strengthening exercises. When tissues are not stimulated, the fibrils will form in a haphazard manner leaving the tissue weakened and very inflexible. The replacing of collagen and formation and re-organization of fibrils into healthy viable tissue may take over a year from the time of the injury. The end result of healing depend on several factors such as the extent of injury, the age of the patient, the availability of nutrients for the healing process, the type of tissue injured, the size of the scar and the forces acting on the scar during the healing process.