Advance Magazine for Physical Therapists and PT Assistants
Vol. 17 •Issue 11 • Page 42
Friend or Foe? -Inflammation can have curative value for wellness
The word inflammation has become a dreaded one, especially by our patients. When thinking about inflammation, the first thoughts that usually come to mind are severe pain (dolor), heat (calor), redness (erythema) and swelling (edema).
Inflammation has become one of our patients’ “worst enemies.” The pharmaceutical industry has tried to provide a solution by convincing patients to take “anti-inflammatory” medications to attack this enemy—while in the meantime embracing inflammation as their friend that helps them make billions of dollars a year.
As physical therapists, we are sometimes trained in our academic institutions to treat inflammation as an enemy, something to rid the body of because it interferes with the healing process and is often the cause of delayed healing and/or poor quality of life.
However, what if inflammation is not always the enemy? What if inflammation really serves a vital role within the healing process?
Part of Healing
Of course, to most physical therapists, this concept should make sense. Most books on rehabilitation and therapeutics acknowledge that inflammation is the first stage of healing. This concept supports the idea that the human body was designed to heal itself and
that the body will take all necessary actions, which are right actions, to accomplish this task.
Inflammation was not meant to be a curse, it was meant to be a blessing. This necessary action (inflammation) taken by the body is a protective and curative one, not something nature intended for us (therapists, patients, doctors, or anyone for that matter) to always interfere with. It is by inflammation that healing may be perfected—e.g., broken bones are mended, wounds are closed, and foreign and/or hurtful matter is eliminated from the body safely.
Healing is a biological process. Repair and regeneration are always occurring within the body—most of the time in a non-painful and non-injurious manner—so as not to even be aware of its existence.
However, when extraordinary processes of repair become necessary (e.g., inflammation), the repair process can become painful, intense and exhaustive. Although this may not be commonly viewed as healthful, but rather “an abnormal condition (disease),” inflammation should still be viewed as a curative process all the same.
The initial state of inflammation is usually called irritation, which then later becomes inflammation—the immediate process of healing. After inflammation usually comes a stage of suppuration, in which body tissues undergo liquefaction for the purposes of elimination. Finally, there is the granulation phase, at which point the healing process is further carried out and completed. Therefore, we may consider inflammation as a purpose to heal (a friend), not a purpose to impede healing (a foe).
In many cases, inflammation does not have to be something that is combated, it is the combat. It does not have to cured, it is the cure! Whether inflammation is termed a healing process, or disease process, every step in it is necessary and serves a purpose.
For example, the heat and redness that often accompany inflammation are signs that the body has increased its nutritive processes in order to safely and accurately meet the demands for healing. Swelling allows the body part to hold more nutritive material (blood
and nutrients dissolved within the blood) and helps to dilute irritating metabolites or toxins that cannot immediately be eliminated from the body.
Pain is often a symptom that there is pressure on sensitive nerves within a healing area, or that necessary biochemical reactions are occurring. Pain serves the purpose of temporarily crippling a body part to help conserve energy and allow it to better heal itself. Pain is a sign for a need to rest, as well as a need for change in lifestyle mode. Pain—just like fever, increased pulse rate, quickened
respiration, vomiting, coughing or sneezing, increased bowel or bladder action, or any other eliminative action in the healing process (a.k.a. acute disease) is often not meant to destroy us, but rather save us.
Therefore, disease action, just like health action, is right action; yet it occasions suffering because of the adverse conditions that have been imposed upon the body. Health and disease may be considered relative terms to explain different degrees of bodily action, which don’t change in function, but rather in the degree to which the body can carry out its function—e.g., functioning in an efficient manner (health) vs. an impaired manner (disease).
In most cases, inflammation may be considered “proper healing.” In other words, our patients don’t suffer because the actions of their bodies are wrong, but because their bodies are under the control of self-preservation seeking to free itself from the impending dangers inflicted upon it. These dangers may be the result of their own bad habits, which usually result in self-inflicted illnesses,
illnesses brought on by unexpected external circumstances (e.g., poisoning from the environment), and/or injuries that are not under the patient’s control (e.g., motor vehicle accident).
How Inflammation Occurs
Inflammation may be classified as acute or chronic. Acute inflammation will usually run its course quickly, especially in a healthy body. However, it is important to realize—so as not to interfere with the healing process—that a healthier individual may experience more intense symptoms because his body is more vital and capable of healing.
The good news for the healthy individual is that less time will be needed to overcome the discomforts sometimes associated with inflammation, allowing healing and repair to occur more quickly. Conversely, the sick or less healthy individual may suffer less
in intensity, but often requires a much longer duration period before his body heals.
Chronic inflammation is usually a more involved process than acute inflammation, and presents more variations and symptoms to describe a single condition—often termed with the suffix “itis” (e.g., arthritis). Chronic inflammation may be due to a continuous series of acute inflammatory reactions, especially when the persistence of cause has not been addressed.
Inflammations of different body parts, which secrete different exudates, often receive different names. For example, catarrhal or mucosal inflammation involves the mucous surfaces of the body and is often characterized by increased secretions of mucous that are of an altered character (e.g., bronchitis). Fibrinous (croupous) inflammation tends to develop on the inner surfaces of the body and is characterized by a thick deposit of fibrin on the inflamed part (e.g., pneumonia).
Serous inflammation involves the serous membranes of the body and is characterized by an effusion of serous fluid into body tissues and cavities, such as the membranes of joints (e.g., arthritis) or the peritoneum (e.g., peritonitis).
Purulent inflammation involves the formation of pus, as seen in septic infections or with foul conditions of the body in general. Simple inflammations may become purulent in nature if the conditions are right. Interstitial inflammation involves the supporting tissues of an organ, such as the kidney (e.g., interstitial nephritis).
The body tends to localize inflammation whenever possible. However, when resistance is low or the blood is foul—which can be the direct result of poor lifestyle and dietary habits—or when well-meaning interventions (including physical therapy or medical interventions) interfere with the healing process, inflammation may spread throughout the body and become a crisis situation. The location of inflammation is one of the most important factors helping to determine whether or not inflammation can be dangerous and should be treated as a medical emergency.
For example, inflammation of the brain, heart, respiratory or kidney regions can suspend vital functions and may result in serious consequences if not treated properly by a qualified medical practitioner. However, when inflammation is not a medical emergency
situation, the body is most often capable of healing on its own.
So what is the best way to help our patients deal with inflammation? Most often, one of the best things we can do is to not interfere—but rather support—the healing process and to encourage our patients on how to do the same. Inflammation is a symptom of a cause, not the cause.
Once again, inflammation is often not something to be cured, it is the cure. Helping a patient find and correct the cause(s) of inflammation is the key. For example, addressing poor lifestyle and dietary habits, correcting faulty posture, modifying poor
exercise/body mechanics, fixing poor breathing habits, and teaching joint protection and injury prevention techniques, can often bring patients much success in both acute and chronic inflammatory states.
Flies don’t cause garbage.
In other words, if there is no garbage around, then there are no flies around.
Likewise, if there is no garbage in the body to clean up, then there is no need for inflammation to hang around.
A therapist might document a goal in the patient’s chart as: “STG #1: Eliminate pain and inflammation in right ankle to help improve weight bearing needed for functional ambulation.” The goal itself is a worthy one, but the way to achieving the goal must be considered. Since our patients don’t have ultrasound, electrical stimulation, hot and cold pack, or NSAID deficiencies, these interventions are often palliative at best and should take a back seat to patient education and common sense—and yes, we can bill and get paid for patient education.
The R.I.C.E. method has its place, just not first place. Keep in mind that health comes from healthy living. The same factors that keep a well person well can help a sick or injured person become well—e.g., fresh air, clean water, sunshine, rest/sleep, proper diet, exercise, positive attitude.
Even the application of massage or manual therapy should be done with caution, since although reduction in swelling in a body part may bring about short-term relief for a patient, it may have long-term consequences, especially in patients with poor health, impaired elimination, little or no reserve energy, and plenty of bad lifestyle habits.
So is inflammation friend or foe? It really depends on who you ask.
Dr. Samuel A. Mielcarski is an expert in the field of rehabilitation. He has a doctor of physical therapy degree and is currently licensed as a physical therapist in Georgia and Florida. He has earned an advanced specialization in Performance Enhancement with the National Academy of Sports Medicine. He is a member of the American Physical Therapy Association (APTA).