Inflammation and tissue damage, I feel is an important topic for people to understand because if you understand the what happens during inflammation and tissue damage, you can take control over your health and healing from injuries. It is important to know that this process happens regardless of the type of injury (e.g. a cut or a sprain) and what tissue is injured (e.g. skin, ligament, stomach or brain etc). Following any trauma or tissue insult, the first thing that happens in your body is the tissues become inflamed (Hammar and Leahy, 1999). The inflammatory phase of any tissue injury is crucial and necessary for healing to take place as it is the initial phase in the repair process.
There are two distinct types of inflammation processes:
- Acute Inflammation
- Chronic Inflammation
Acute means recent or sudden onset and is usually defined as less than two weeks following the insult. Chronic means long-term or long-lasting and is usually defined as twelve weeks and onwards. There is a stage in the middle called sub-acute and it ranges from two-four weeks following the injury depending on where your definitions come from. However, some have suggested the phasing out of the sub-acute definition of injury and recovery as most acute injuries should be healed within a twelve week time frame and therefore if an injury persists or recurs for greater lengths of time, it is defined as either chronic recurring or chronic overuse (Knight, 2008).
Acute Inflammation: This is a normal process and how the body responds to injury or damage. It is categorised by a myriad of chemical and biological processes that are very complex, so we won’t be diving in too deeply for this post. The process of acute inflammation has characterised by bleeding, swelling, bruising/redness to the skin, severe/intense pain, heat and impairment or loss of function (Hammar et al., 1999). These signs and symptoms can last between 24 and 72 hours following the initial insult (Hammar and Leahy, 1999) and are crucial to the healing process. If this phase is allowed to continue as the body is supposed to, the healing process will take as much time as it needs to heal the best it can.
Chronic Inflammation: This is a process the body goes through when the acute inflammatory response is prolonged. Factors that can caused this prolonged state include infection, toxic agents, autoimmune disorders and repetitive strains/injuries/micro trauma (Kumar, Cotran and Robbins, 1997; Hammar et al., 1999).
(We love a good flow diagram!)
Following an injury, the body releases a myriad of different cells and chemicals into the blood stream that cause vasodilation causing blood to pool around the injured tissue resulting in the swelling and redness (Stevens and Lowe, 2000). This allows the cells of the immune system to remain at the site and aid in the removal of dead or damaged cells, protect against infection and they play a crucial role in triggering the proceeding phases of the healing process. The fluid collection that causes the swelling allows blood, oxygen, glucose, salts, vitamins and minerals to enter the site and provide appropriate nutrition to the tissues and cells present. This is why adequate nutrition is important for recovery and repair, including for athletes during training (because of repeated micro trauma to the muscles for example to force them to grow larger and stronger). It is also important during times of injury to aid in the appropriate response and optimal healing, for example antioxidants have been shown to block some negative pathways of the inflammatory process that are commonly seen with ulcerative colitis and other autoimmune disorders (Plummer et al., 1999; Miquel et al., 2002; Perkins et al., 2002; Hanai et al., 2006). By using some of these compounds found in certain foods, the healing process can be supported, allowing for both optimal healing and stopping/inhibiting some pathways that trigger chronic or recurring inflammation.
As we said that the start, inflammation is the crucial first phase of tissue healing and repair. Without it, the body cannot healing itself. If the process is interrupted or is blocked by chemicals you consume (e.g. food contaminants and some drugs) it will become chronic, unrelenting and seemingly never ending, resulting in chronic pain, muscle weakness and recurrent flare ups/relapses of the injury (Valdivieso et al., 2018). The use of anti-inflammatory medications following surgery is still a controversial topic of discussion as some researchers and surgeons are concerned with these medications stopping bone fracture healing (Richards et al., 2017). While these effects are seen by some to be short lived and therefore the risk of failed fracture healing using these drugs is seen as low, some are still unhappy to prescribe them to patients with fractures (Richards et al., 2017). Of interest, while this debate is ongoing, the consumption of alcohol is well known to impair bone and general wound healing (Duckworth et al., 2011, Richards et al., 2017).
It is important to support your body with everything it needs in order to heal optimally and function as best it can after any injury. In the next blog, we will discuss tissue healing, how tissues repair and what can be done to help your body heal itself. Your body is a fascinating, self-healing, self-regulating and very clever thing, once you understand how things work within it, you will begin to understand how you can influence it, what you can do help you stay healthy and happy.
- Hammar, W. I. et al. (1999) ‘Pathology of Musculoskeletal Soft Tissues’, in Functional Soft Tissue Examination and Treatment by Manual Methods. 2nd edn. Gaithberg: Aspen Publishers Inc, pp. 21–31.
- Hammar, W. I. and Leahy, M. P. (1999) ‘Active Release Techniques: Logical Soft Tissue Treatment’, in Functional Soft Tissue Examination and Treatment by Manual Methods. 2nd edn. Gaithburg: Aspen Publishers Inc, pp. 549–562.
- Hanai, H. et al. (2006) ‘Curcumin maintenance therapy for ulcerative colitis: randomized, multicenter, double-blind, placebo-controlled trial.’, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. United States, 4(12), pp. 1502–1506. doi: 10.1016/j.cgh.2006.08.008.
- Knight, K. L. (2008) ‘More precise classification of orthopaedic injury types and treatment will improve patient care.’, Journal of athletic training. United States, pp. 117–118. doi: 10.4085/1062-6050-43.2.117.
- Kumar, V., Cotran, R. and Robbins, S. (1997) ‘Basic Pathology’, in Basic Pathology. 6th edn. Philadelphia: Saunders.
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- Perkins, S. et al. (2002) ‘Chemopreventive efficacy and pharmacokinetics of curcumin in the min/+ mouse, a model of familial adenomatous polyposis.’, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. United States, 11(6), pp. 535–540.
- Plummer, S. M. et al. (1999) ‘Inhibition of cyclo-oxygenase 2 expression in colon cells by the chemopreventive agent curcumin involves inhibition of NF-kappaB activation via the NIK/IKK signalling complex.’, Oncogene. England, 18(44), pp. 6013–6020. doi: 10.1038/sj.onc.1202980.
- Stevens, A. and Lowe, J. (2000) ‘Tissue Response to Damage’, in Pathology. 2nd edn. Loanhed: Mosby, pp. 35–58.
- Valdivieso, P. et al. (2018) ‘Does a Better Perfusion of Deconditioned Muscle Tissue Release Chronic Low Back Pain?’, Frontiers in medicine. Switzerland, 5, p. 77. doi: 10.3389/fmed.2018.00077
- Richards CJ, Graf KW and Mashru RP. The effect of opioids, alcohol and non steroidal anti-inflammatory drugs on fracture union. Orthop Clin N Am (2017) http://dx.doi.org/10.1016/j.ocl.2017.06.002
- Duckworth AD, Bennet SJ, Aderinto J, et al. Fixa- tion of intracapsular fractures of the femoral neck in young patients: risk factors for failure. J Bone Joint Surg Br 2011;93(6):811–6.