May 2016 28

All swell (all's well?) - the inflammatory process

By: Dave Wheeler

I must admit that I've felt like a bit of an idiot this last week: I'd damaged a ligament in my wrist through sport... a case of "sports massage therapist heal thyself!"

Ligaments are strong bands of soft tissue that connect bone to bone (think of the ligaments at the knee joint, such as the anterior cruciate ligament). They allow joints to move freely in one direction, but stop it moving in others - again think of the knee which allows the lower leg to go forward in the kicking motion, but which can't "kick out" sideways from the upper leg, because ligaments stop it.

It took a trip to A&E and an x-ray to determine that I hadn't broken a bone, and that it was "just" a ligament strain.

As I've mentioned before, the traditional treatment for a strain is RICE:

  • Rest
  • Ice
  • Compress
  • Elevate

It's worth understanding these - mostly so that you can figure out when (and why) to ignore the advice completely


To RICE or not to RICE, that is the question

The purpose of rest after injury is to stop injuring yourself! 

It's no more fancy than that: if you carry on using the injured area after screwing it up, you'll screw it up more. That means it'll take longer to heal, and longer til you can get back to normal.

So rest (as in stop using it) is the one thing that's imperative. The other elements, I C E are a bit different.

Each of Ice, Compress, Elevate are strategies to reduce inflammation. They're different to Rest. The point of "ICE" is to reduce swelling.

And if you're in a lot of pain, then that's exactly what you should do... but if you can cope with the pain, it worth understanding the purpose of inflammation and the inflammatory process.


The purpose of the inflammatory process

When tissue in the body gets damaged, the natural response of the immune system  is to try to repair it.

Inflammation or the inflammatory response is the immune  system's way of marshalling the healing resources of the body to fix the damaged tissue.

There are 5 ways of recognising the inflammatory response in the body:

  • swelling
  • redness
  • heat
  • pain
  • restricted function

So when I strained the tendon in my wrist a week or so ago, it hurt like hell, swelled up,  was very slightly warm to the touch, a bit swollen... and I couldn't move it without it hurting like a bitch. All the classic signs of the inflammatory response.

The inflammatory response is a natural mechanism to dilate (widen) the blood vessels around the area of the injury - this allows more blood to be pumped to the site of the injury.

More blood is good, since it's the blood that contains the necessary agents of healing to flood the damaged tissue and heal it. Antibodies and a number of chemicals contained in the blood get to work straight away to repair what's been torn.

So we want more blood to the area: in other words, we want swelling, redness and heat - they're signs that the body is healing itself.

Loss of function ain't such a bad thing either: it forces you to rest the injured area so that you stop damaging it further.

Pain is a by-product of the swelling that impinges upon nerve endings. It's a bit of an unfortunate consequence of the inflammatory process (though as it reminds you not to move, in other words to rest, it's perhaps not all bad).

It's when the pain becomes intolerable that the "ICE" part of RICE (ice, compress, elevate) makes sense... these will reduce the inflammation and reduce the pain.


When RICE ain't nice

There's no question, you should always rest the injury. This will stop you making it worse.

But should you do the rest of RICE: the icecompress, elevate bit?

If you do ice, compress, elevate, it'll alleviate the pain, but it will also slow down the body's natural defence and healing mechanism.

In my case, where it was an acute injury and (because of the x-ray) I knew for certain that it was soft tissue damage I decided to let the inflammatory process take it's course. I rested the damaged wrist ligament, but didn't ice, compress or elevate... and yes I whined like a baby (I would, after all, I'm a man)... but the body did it's magic and healed itself.