In these dog days of California summer, I am all too conscious of the grasses in the local foothills drying out- shedding their verdant green for an over-baked tan. The visual changes, the hot weather and time of year has become synonymous for Californians with fire season- a scary prospect we face annually.
There are probably many different ways to promote wildfire prevention- cutting back undergrowth, using sheep and goats to chomp away dry excess vegetation (my favorite and by far the cutest way)- and controlled burns.
Last year, my Mom and I were driving into Yosemite valley from the south, and we were stunned to see large swaths of the national forest lining the roads into the valley scarred and charred from controlled burns- efforts to protect beautiful Yosemite from fire threat.
Inflammation in our bodies gets such, such a bad reputation (why is this?). And yet, in many ways, it is the beautiful, innate controlled burn in our body- helping to sweep out cellular debris, fight infection and keeping our tissues healthy.
Inflammation arises in the presence of an infection or injury- it is considered part of our innate immunity- and is launched quickly by our healthy immune systems.
It orchestrates an incredible biological symphony- creating opening in blood vessels (vasodilation) so that cells can migrate to the appropriate location, sending chemical agents to initiate white blood cells to eat away dead tissue or launch complex attacks on invading bacteria/ viruses.
Without our healthy inflammatory response, we would die with the first exposure to cold or a knee scratch. (Everyone who lived through the 80s remembers that decades weird fascination with the boy/ girl in the bubble stories- often surrounding children born with differently abled immune responses).
The biggest issues I see in orthopedic management- is lack of balance with respect to this (inflammatory response) system. We tend to either quell the inflammation too aggressively- putting out the fire before it has done its good work, or we don’t contain our inflammation at all- continuing to move damaged tissue and use heat (I see this often in rehab situations following joint replacements).
Both of these approaches are mistakes and keep our body stuck in the first phase of healing longer than necessary (which can create more tissue damage), or even render us unable to fully heal in the long term.
There are times when our immune response, and the part of it that mediates inflammation gets out of control. Like a planned fire jumping boundaries to result in an out of control wildfire, inflammation can get out of control when we do not have skills to work with it. We can learn to enhance the benefits of our inflammatory response and contain its effects.
Over the next few months, and in honor of this hot, dry season, I am hoping we can review the basic tool kit required to promote the healthiest controlled burn in our bodies.
We will take a closer look at the practices of PRICE, lymphatic massage and graded motor visualization to assist in cooling and stabilizing our tissues and helping us progress into the next phases of tissue recovery.
To get the right balance of inflammation/ inflammation control in your healing tissues, memorize the acronym PRICE and act early (first day- day 10). You get one shot to provide the best recovery to your body in this phase, at this particular injury/ issue.
Use a brace if you cannot feel your injured/ strained body area well enough to provide adequate immobility. Immobility in this context does not mean not moving at all- but moving less to provide an interval of healing for your tissue. Cells are literally knitting back together. Braces that are elastic or neoprene also offer another element of containing inflammation- compression- which doesn’t allow the tissues to become as distended with edema (swelling).
If you are healing simply after an awesome workout, your rest interval may be only 48 hours- then your inflammation clears and you can get back at it.
If you have a larger soft tissue injury or even bone fracture, you will need to rest up to 6 weeks.
Edema (and not so confidently felt sense) helps inform us about return to activity times.
I: Ice (not heat)
Ice is a vasoconstrictor (it makes your blood vessels close slightly). Your inflammation promotes massive vasodilation (it really opens your blood vessels). Heat is a vasodilator. To help allow your inflammation but not let it get out of hand, use a vasoconstrictor. This is super helpful when used in conjunction with lymphatic massage and/ or the lymphatic drainage position.
Compression doesn’t constrict the blood vessels like ice can, but it keeps the byproducts of inflammation (lymph, blood, large white blood cells macrophages and cytokines) from hanging out in the area and expanding. Talk with your PT provider about compression garments to help contain inflammation.
Ah, gravity. Elevating an inflamed tissue allows blood and lymph and all the cellular material that accompany those fluids to be guided back toward the heart to be processed and recycled back into the circulatory system. If this process is impeded, blood, lymph and other cellular materials get trapped in small spaces, impeding range of motion, maintaining inflammatory response even when it is no longer helpful. (This is perhaps most often seen after joint replacement surgery for the lower extremity, and other orthopedic repairs that can overwhelm the lymphatic structures).
We’ll practice these concepts in a bit more detail in our workshop this month and also into next month.
Until then, happy moving, resting, and thoughtful application of PRICE- ing!
Hills near where we used to live in the North San Francisco Bay, drying in the summer sun