Often times when people have an orthopaedic injury, it is accompanied by pain. Pain is message of discomfort that is brought to our attention by our nervous system from a specific type of nerve. Pain has many different types of sensations or characteristics including, but not limited to, sharp stabbing, dull ache, burning, tingling, or throbbing. Simplistically speaking, pain is generally caused by an inflammatory process within the body that activates the specific nerves that give us the perception of discomfort.
Inflammation can be acute, caused by some trauma, or can be chronic, which is more typically caused by repetitive stressors. Inflammation is not limited to our musculoskeletal system, but can be throughout our internal organs and even our brain. For the purposes of this blog post, we will discuss how to manage inflammation for our muscles, tendons, and joints, while acknowledging that inflammation happens throughout our entire body.
The initial inflammatory response is a natural process of our body trying to fight and heal from a trauma. This response is blood flow rushing to the traumatized or irritated area to clean up some debris and bring nutrients to the injured site for further healing. Unfortunately, this natural and helpful process is painful and can become a nuisance over time.
The most basic ways to address inflammation when dealing with injury is through the following: (1) the R.I.C.E. method, (2) medicine, and (3) nutrition. Let’s look at each of these now in detail.
R.I.C.E. is a widely used acronym in the medical field for rest, ice, compression, and elevation. Implementing these four tools help to decrease excessive blood flow to an area.
Rest decreases the need for blood to an area, because the irritant is likely being diminished. With decreased movement naturally comes decreased blood circulation to an area.
Ice or most forms of cold therapy, also known as cryotherapy, constrict the blood vessels. With decreased vessel size, there is decreased ability for blood to freely flow to the traumatized site. People do need to use caution with cryotherapy. Because of the cold’s natural ability to constrict the blood vessels, one needs to be careful to not cause damage to the tissue from extended periods of decreased blood flow. The general recommendation to gain a rehabilitative effect from cold therapy with use of a reusable cold pack with a thin skin barrier, such as a pillowcase, is a minimum of 7 minutes to a maximum of 20 minutes. Some other ways that people can use cryotherapy are ice baths, ice massage, or cryo chambers/cryo saunas. Read about my first time experience in a cyrosauna.
Compression can be done in a variety of ways. The most common tool that people use for compression is bracing or use of a compression wrap/bandage. One also needs to take care when using compression wraps so as to not cut off too much circulation for too much of an extended period of time. Fancier tools for compression exist. There are compression garments, which are specifically woven where the level of compression gradually decreases at certain parts of the garment to prevent injury from lack of circulation. An example of a compression garment would be a compression sock. There are also devices that can be worn that inflate and deflate to give what is a called pneumatic intermittent compression.
Elevation can also help with decreasing inflammation. The lovely force on our atmosphere called gravity can help assist in decreasing blow flow to certain areas when we are trying to achieve decreased swelling.
Normally, a healthy artery pumps oxygen filled blood away from our heart and to our limbs and other body parts for normal function. Because of gravity, the arteries have to work even less when trying to get blood to the lower limbs of our body when we are upright. Therefore, if we want to decrease a slight amount of blood flow to a knee for instance, we would want to try to get that knee elevated above the level of our heart in order to make the pumping of blood to this area more difficult as it fights the ever constant downward push of gravity. In other words, you would lie down flat on your back and place the leg on a stack of pillows so that the level of the knee would be higher than the heart.
There are some cases where the inflammation is more chronic. This can be due to blood pooling because of poorly working veins and, yet again, due to gravity’s constant force. The function of the vein is to transport older blood that is less rich in oxygen and nutrients back towards the lungs and heart. In the case of the poorly functioning vein where blood is pooling causing inflammation, elevation of the body part above the heart is once again used to get older blood towards the heart and lungs via gravity’s unrelenting pull.
Medicines are prescribed to people for various reasons. Often times, the over the counter pain relievers that we take are actually anti-inflammatory medications. These medicines can be quite helpful in the case of healing from injuries or surgeries despite the pain that we are or are not perceiving.
There are countless times that I am treating a patient with loads of joint swelling from an injury or surgery. The patient may have been advised to take a certain over the counter pain medicine or is given a prescription dose medicine, yet decides that they will not take it because of their own reasons (which are typically not discussed with the doctor). Sometimes people feel that if they can fight through the pain, then they will just fight through it. Some fear that all prescription medicines are addictive type opiates. They don’t always understand that the medicine is not just for pain relief, but also to help control swelling, which helps decrease healing time.
If you are concerned about a medication that you are being prescribed, be open with your doctor and ask them what the medicine is for and at what point is it advisable to wean off of it. Having an open dialogue with your healthcare provider is the best way to care for yourself.
Lastly, I wanted to take a moment to discuss nutrition and its effects on inflammation. Earlier it was mentioned that inflammation happens throughout our entire body. The effects that sugar has on the human body are becoming more increasingly well documented, and the verdict is that it is a very strong inflammatory agent. Limiting or decreasing your sugar intake when trying to heal from an injury may prove to be helpful, as your body will have less inflammation to fight overall, so that it may focus on the trauma at hand.
Another delicious food item that is becoming quite trendy in the world of holistic healing is bone broth. Animal bones are simmered for 16 or more hours to extract the natural collagen that these animals possessed in their joints and bones. You’ll notice that a homemade bone broth turns a bit gelatinous when cooled. This is the protein and collagen extracted from the animal’s bone and marrow. Bone broth has been documented to assist with gut healing as the collagen helps to seal the gut lining and is also documented to help with joint issues as the cartilage in our joints consists of a large amount of collagen. Don’t worry about dusting off the slow cooker, because bone broth is now very widely available in grocery stores.
There are many other nutritional agents that claim to have anti-inflammatory properties. However, this not being my expertise, I just wanted to mention a few of the most common and documented examples.
Remember that if you are dealing with an acute or chronic injury that is causing pain, inflammation is likely the culprit behind your discomfort. If you are having difficulty getting this under control, your friendly physical therapists at PhysioDC are always here to help. Give our office a call to schedule a consultation so that we can assist you getting back on the path to improved function and decreased pain.