Inflammation is one of the buzzy concepts that gets such a bad rep in our modern fitness and health culture. And yet inflammation is totally normal. We certainly need to learn how to recognize when we have it and live with it and it is a key component to our healing processes.
When we have an injury, fluid connective tissues (blood and lymph) bring cells into the damaged area to help us with repair processes and debris clean up.
Interestingly, and unfortunately, inflammation is not really addressed in conventional western medicine. It is only a select few (PTs specializing in lymphatic massage following lymph node surgeries), who are usually adept in treating inflammation adequately (!!!) No worries though- you can learn to treat and care for your inflammatory processes yourself.
If you have arthritis, learning to identify inflammation at your joints and regulate your own inflammatory response is a crucial point (and the second action step in our cycle) that you as a mover can work with, to kick yourself off of the degenerative carousel.
There will be signs that you are in an inflammatory phase. You may notice any of the following:
-throbbing/aching around a joint line
-warmth at the skin around the affected area (to test this, lightly press the underside of your wrist to the affected area, and then to the other side. Notice any differences)
-increased pain from baseline - (especially at night or at rest)
Strangely, your inflammation does not mean any new damage has incurred, but simply that you are in an inflammatory phase of your cycle. This usually is set off by overdrawing your account (by not doing enough of the activities that deposit into your body’s account and or by making too big of a withdrawal).
Common subjective reports that relate to overdrawing a body account are:
“I was feeling great so I gardened for 4 hours” (someone with positional back sensitivity)
“I had to rush right off of the plane into a long meeting at the office”(someone with sensitivity in their back to loading)
“My ankle was feeling so good, I went out surfing despite knowing I’m not ready to”
I narrowly avoided this subjective last week. Sometimes, I actually have to write a note on my keys so my inner PT can communicate with my other selves!
Most people who live on anti-inflammatories, have not yet learned the checkbook theory, and are constantly overdrawing their physical accounts. They don’t get enough rest for their tissues, they overdo beyond what they are strong enough for. Indeed, these are the folks doing spinning classes one month out of joint replacements. This kind of overdoing is for taxes- not for the physical body. Do not follow the voices that are calling you to overdo! This is the fastest way to accelerate your arthritic cycling. Instead, quite literally, take a chill pill. Learning to heal your inflammation is the sure fire way to reduce the chances of arthritis after an injury, to reduce the swiftness of arthritic cycling once you have it. Reducing your own inflammatory process is the best way to promote health in your physical body. Here's how you do it.
You can work with this inflammation once you notice you have it using the P.R.I.C.E. method- Protection, Rest, Ice, Compression, Elevation. The PRICE method uses physical positions and supports to pulse extra lymph fluid (and exudate from swelling) away from the injured site and back to the heart. This is the fastest and best way to promote healing in your body.
*Though I am writing about P.R.I.C.E. in the context of osteoarthritis, please know that you use this following any injury to promote health and healing.
This is the biggest piece missing when I listen to patient reports. We tend to roll like this: I fell and hurt my ankle, I cared for it for the rest of that day. The next day I was feeling better, so I did 2 or 3x as much as the first day. (I just did that a couple of months ago).
In reality, you want to protect tissue by using a brace, unloading tissue so that it can recover (such as with walking poles or a walker). One of the happy byproducts of using a brace, is that it signals to everyone else to stay away from your injury (this was super important when I had patients that used crowded BART trains to commute in San Francisco). There is no shame here. Protection should occur in commensurate amounts to the swelling and discomfort that you notice.
Rest seems obvious, but again, most of us skip this step. Many people think rest equates to weakness, and should be avoided at all costs. Nothing could be farther from the truth. In fact, the strongest athletes on the planet all have very nuanced and skilled capacities around rest. Without rest you cannot execute.
When I see a client who is hell bent on not resting (after an injury, even after a surgery such as a fusion or joint replacement) I can almost guarantee that person will damage their surgery/ hardware, continue in chronic pain, and not recover/ heal well. Witnessing patients who will not rest is one of the biggest head scratchers to PTs and doctors.
When you are recovering from a flare or injury, you must chill out. Rest by sleeping, getting your feet up, practicing lymphatic massage. Your normal MO will not heal you- it is what got you into this mess in the first place.
One of my all-time favorite techniques for resting is lymphatic massage. The beautiful thing about lymphatic massage, is that you can do it for yourself, at any time, with little to no equipment. Lymphatic massage uses gravity and diaphragmatic breath to move lymph fluid (the plasma and exudate that can get trapped after and during an inflammatory cycle) out of where you don’t want or need it. It doesn’t only target the lymphatic system, but also the parasympathetic branch of the autonomic nervous system, the respiratory system, and it puts all of your joints and peripheral nerves on slack. Can you say ahhhhh….
(I have a workshop on how to perform lymphatic massage for yourself you can check out here if you're interested).
Traditional ice, placed in a pillow case or t shirt, not against your skin, for 10-120 minutes. Not heat, not a hot tub, not icy hot. Just plain old ice. Ice creates vasoconstriction- a closing/ narrowing of the blood vessels that are super open with inflammation, thereby causing fluid to be moved away from the injured site.
You can use anti-inflammatories/ corticosteroids for the ice component – please talk with your doc. Using medication should only be an adjunct and not the number one go to in controlling arthritic degeneration. I have heard a lot of people talk about these steps as “masking” pain. It is super important to understand that you are actually working therapeutically with inflammation, creating more space in the joint, not just masking pain.
I have also heard of folks suggesting not using anti-inflammatories due to the interruption of normal cellular healing processes (this is big in the cross fit and strength community right now, and is not without some validity). The research I can find suggests this is more relevant when working with normal inflammation due to muscle soreness- not arthritic cycling or healing after a specific injury. If you are at all concerned, please speak with your doctor (not your personal trainer) about this and ask for literature (research). They will have it!
Compression can come in the form of compression socks when dealing with healing after a surgery, or tendonitis. You can use ace bandages, compression shirts, elastic braces (such as for the spine), and neoprene sleeves at the knees. There is a great company 2XU that sells compression gear for athletes. Compression socks at a medical grade should be provided by surgical offices after procedures.
Compression works in a similar way as ice, but it mechanically gently squeezes excess inflammation out of an area.
Raising a limb (foot, ankle, knee, hand, wrist, elbow) slightly above your heart encourages gravity to move the extra lymphatic fluid (that is a result of the inflammation in your joint) back towards your heart where it can be returned to circulate in the blood.
At any given time, we all have a bunch of fluid trapped out in our tissues. Just placing your body in the dead person's float position (shown below), pulses this fluid back to where you want it to go.
Keep treating the inflammation as long as it is there. Once you notice edema is reduced, heat is the same temperature on your other side, congratulate yourself for taking such good care of your healing and move on to your next phase in your healing. If you are uncertain what your next steps are, please see a PT provider.
Next week, we will look at the third action step in the degenerative cycle of OA- restoring motion within your joint capsule.
Until next time, happy P.R.I.C.E. ing!
*BTW- Can we rest too much? In the history of human kind, one thing is certain- we are not good at practicing middle of the road! We move too much, we rest too much, we eat too little, we rest too little. On and on. If there is a pendulum, we will find the end of it's tether, and inhabit that end come what may! I hope to write about this soon-but you can absolutely rest too much. Too much of anything is generally too much. Just like with everything in life, you want to find the middle path- not too much and not too little- on your movement journey.
Lymphatic massage and the accompanying dead person's float position that I am demonstrating here is perhaps, the most helpful tool in our anti-inflammation approach. When I use it, I address all of the elements of P.R.I.C.E. at once. When I am healing an acute injury (like my recent ankle fracture) I use this posture with diaphragmatic breathing and an ice pack at least 20 minutes a day.