Inflammation - not always a bad thing
Anyone who has ever experienced
low back or neck pain, strained
ligaments or muscle tears will be
familiar with the swelling associated
with that injury.
In some instances, swelling is evident
almost immediately after injury whereas, at
other times, swelling may emerge overnight.
The implications of how rapidly swelling
presents itself can be a strong diagnostic
indicator in identifying what structure has
been injured and perhaps to what degree.
Immediate swelling points towards a
bleeding structure – think bone or muscle,
both of which are well vascularised with
capillaries. Damaged capillaries invariably
result in haemorrhaging into surrounding
soft tissues such as muscle or into a joint
capsule such as a knee joint.
A bleeding injury will generally feel
warmer than the surrounding skin and
may feel “doughy“ to the touch especially
after several days as the blood starts to
consolidate into a mass of scar tissue.
Swelling that occurs overnight is much
more likely to be largely inflammatory in
nature. In this instance, the fluid produced is
largely the “straw coloured” plasma which
constitutes part of the blood without the red
72 Complete Health
and white blood cells. This is an important
factor in providing the raw substrate
necessary to create scarring, ultimately
bonding the damaged tissue.
So, given that inflammation is a primary
cause of swelling which restricts joint
movement and causes pain and dysfunction,
it would be reasonable to assume that
reversing the inflammatory process would
be beneficial to recovery.
In the case of bleeding, it is vital that
haemorrhaging cease ASAP hence the use of
ice, compression, elevation, rest from further
aggravation and the avoidance of heat,
massage and stretching. Bleeding within
a joint or between muscle compartments
can lead to further pain and dysfunction as
the blood breaks down into waste product.
This process can create a mildly acidic
environment resulting in excessive scarring
through tissue irritation and can initiate
erosion of the articular surface of a joint
leading to early degenerative changes. In
this case, it would be important to clear the
affected tissues of stagnant blood after 72
hours which is generally considered the
safe period following trauma by which time
active bleeding should have ceased. Options
can include gentle soft tissue massage,
exercise, therapeutic ultrasound and in
extreme cases of bleeding within a joint
[generally a knee], aspiration [removal of
blood via a syringe] may assist. Aspiration
is generally considered as a last option as
there is a small but present risk of creating a
possible intra- articular infection.
In the case of joint inflammation not
involving any bleeding such as osteo or
rheumatoid arthritis, non-steroidal anti
– inflammatory medication and gentle
movement can certainly assist. The list of
NSAI medications can include Ibuprofen
[marketed as Nurofen, Advil and Bugesic],
Diclofenac [marketed as Voltaren and
Fenac], Naproxen [Naprosyn, Naprogesic,
Aleve] or Celecoxib [Celebrex].
These drugs all work to chemically block
the inflammatory process through slightly
different pathways as does cortisone when
injected directly into a joint.
As a practitioner working to restore full
function post injury, I would argue that in
many cases, the use of NSAI medication
may not serve the best interests of the
patient. These cases include shoulder and
patella [knee cap] dislocation and most
commonly, spinal disc prolapses [disc bulge
or “slipped“ disc] in which the outer layer
of the disc is stretched or torn allowing
the disc nucleus to bulge onto surrounding
structures including nerves causing referred
pain. In such cases, it would be far more
preferable to undertake appropriate manual
therapy for spinal disc pain and a period
of immobilisation for shoulder and knee
dislocation without the use of NSAI to
encourage significant scarring as a result
of the inflammatory process to help restore
joint or disc stability. It would appear to
be counter-productive to a damaged disc
or dislocated joint to chemically block the
inflammatory process that can restore some
degree of healing and subsequent stability
through scarring.
It may be worthwhile discussing
management options with your doctor or
therapist in these specific cases.
Peter Georgilopoulos
APA Titled Sports
Physiotherapist
Physiotherapist to the
Socceroos 1990-2000
Peter owns
Spine+Body Centre of
Allied Health in Bundall
on the Gold Coast. PH:
07 5531 6422
He has a long standing clinical interest in
muscle flexibility in the sporting population
particularly in relation to neural influences and,
his association with Bond University over the
last few years has enabled him to undertake
research in this area resulting in two studies
to date the first of which was published in
“Manual Therapy”.