I am sure many of you are wondering when you come into my clinic, “Why am I having pain?” You can’t recall a recent injury or trauma to explain the symptoms you are experiencing. For most of you, the answer is “inflammation.”
Simply put, inflammation is a defense mechanism and a self-protective reaction of your body’s immune system recognizing that there are damaged cells, the foundational building blocks of our bodies that begins the healing process.
When you sprain an ankle in an acute situation, inflammation is a necessary reaction by the body to begin the healing of injured or damaged tissues. This body reaction occurs within the the first forty-eight to seventy-two hours facilitated by the injured or damaged cells of muscles, fascia, tendons, ligaments, cartilage, bones, and nerves near and around the sprained ankle.
A hematoma or bruising begins to form around the injured area which is a manifestation of the acute inflammation in reaction to the injury. Swelling, redness, warmth, and pain are exhibited. That is why it is suggested by many health professionals to apply ice to the injured area for the first forty-eight to seventy-two hours.
At the time of injury, damage to small blood vessels occurs resulting in bleeding and increased permeability by the remaining intact vessels. Therefore, the displacement and retraction of injured tissues is rapidly filled with clotting blood causing the usual discoloration.
There is accumulation of serous fluid around the injured area and surrounding tissues causing the edema. Leukocytes or white blood cells migrate to the injured region which causes initial saturation of macrophages that begins to engage in phagocytosis or ingestion of necrotic tissue and damaged cellular debris.
During this acute, inflammatory phase, collagen concentration is decreased while the total mass of ligament scarring is being increased. 70-80% of a ligament is made up of collagen which is synthesized in connective tissue by fibroblasts. Therefore near the end of the acute, inflammatory stage, fibroblasts are present to begin the scarring process.
Also hypoxia and oxygen deficiency results from the impaired circulation in region caused by stasis which will create an acidic environment resulting in an increase of proteolytic activity.
This acute inflammatory response to an acute injury is necessary to initiate the healing of the damaged tissues from the trauma. Initially, it seems more destructive rather than reparative, but it is necessary in order to draw cells involved with the healing to the area.
In summary, during an acute injury the inflammation phase includes edema, hypercellularity, and early active synthesis of the scar. The repair and regeneration phase or the proliferation phase will now last forty-eight to seventy-two hours after the injury until approximately four to six weeks post injury. That is, if this phase is not interrupted.
However if this inflammatory response becomes chronic going on for a longer time, it can become problematic. In fact, chronic inflammation is now being linked to other systemic diseases like heart disease, stroke, and autoimmune disorders. I know you have heard of the inflammation caused by COVID-19.
Unlike acute inflammation, chronic inflammation can have long-term systemic effects if untreated. Chronic inflammation is also referred to as low grade inflammation because it produces a steady, low level of inflammation throughout the body and this type of systemic inflammation over time can contribute to the development of disease. The reason being that when these inflammatory cells stay too long in the blood vessels, they promote a build up of plaque and you know what that can do to your overall health and well-being.
Just name any common disease today associated with aging like cancer, dementia, heart disease, metabolic syndrome, nonalcoholic fatty liver disease, type 2 diabetes, and chronic inflammation is found to play a role.
In a way, chronic inflammation is like too much of a good thing. Let’s use another example like when cutting a finger. As swelling occurs around the cut, this is an indication that the immune cells are doing their job. They rush to the scene and spew out inflammatory compounds that kill bacteria and prevent infection.
But the chronic low-grade inflammation that persists for weeks, months, and even years is the disease triggering variety. Again, it is the immune cells in action. However instead of fighting foreign bacteria as with the cut finger, they silently begin to attack your own body, your blood vessels, brain cells, and organs.
It is still not entirely clear why this happens, though stress is known to raise levels of inflammatory compounds in your body as does obesity. Fat cells parked deep in the belly emit inflammatory compounds when they reach a critical mass. Genetics too have been found to influence your susceptibility to chronic inflammation.
The choices you make about what you eat can also play a big role in chronic inflammation. Simply, diet matters. When you eat too much white flour, sugar, and fried foods and not enough fruit, vegetables, and fish it can be a cause of chronic inflammation over time.
Recent studies have now shown that following a Mediterranean-style diet reduces the odds of developing Alzheimer’s disease by 34-61%. Significant declines in the rate of heart disease have also been seen in programs combining a similar diet with the cessation of smoking.
Below, I have listed foods the will rally to your defense; to work, they should form the foundation of your daily diet. It looks quite a bit like the traditional Mediterranean diet in order to get the most chronic inflammation-busting benefit.
•Fruits and vegetables. All fruits and vegetables fight chronic inflammation in some way or another. The following reliably pop up as protective in large-scale diet surveys: apples, pears, berries, citrus fruit, green leafy vegetables, yellow vegetables, broccoli, cabbage, and tomatoes.
•Herbs and spices. Herbs such as basil, dill, oregano, parsley, sage, tarragon, thyme, black pepper, cinnamon, cumin, garlic, hot peppers, star anise, and turmeric have been found to be protective from chronic inflammation. Use them generously when making salads, dips, curries, stews, baked fish and chicken, and other dishes.
•Extra virgin olive oil. Buy the extra-virgin that is pungent and even a little bitter having that back-of-throat burn.
•Nuts and seeds. All nuts and seeds have been found to be good for chronic inflammation.
•Seafood and omega-3’s. Just follow the Amercian Heart Association’s recommendations to have at least 3.5 ounce servings of cooked fish weekly.
•Whole grains such as brown rice, barley, bulgur wheat, millet, and whole rye too help with chronic inflammation.
•Coffee, tea, and dark chocolate which contain caffeine has a positive effect on chronic inflammation.
So as you can see, the choices you make on a daily basis regarding your diet impact chronic inflammation and its effects on your body. Scientists are still unraveling how food affects the body’s inflammatory processes, but they do know for sure that diet matters.
Recent research shows that what you eat can affect the level of C-reactive protein (CRP) which is a marker in your blood for inflammation. They believe it could be that some foods like processed sugars help release inflammatory messengers that can raise the risk of chronic inflammation.
Eating with inflammation in mind doesn’t have to be complicated or restrictive. Just follow the simple rules for anti-inflammatory eating:
•Eat more plants.
•Focus on anti-oxidants.
•Get your Omega-3’s.
•Eat less red meat.
•Cut out the processed stuff. Junk food.
To conclude our discussion with anti-inflammatory strategies would be a half-told story if I did not mention the connection with body’s central nervous system and specifically the autonomic nervous system. In fact, communication between the systemic immune system and the central nervous system is a critical, but often overlooked component of the inflammatory response to acute tissue injury, disease, or infection.
In fact, behavioral studies have shown that prolonged psychological stress that facilitates the sympathetic division of the autonomic system can activate the same pro-inflammatory pathways we have been discussing. While psychological stress has been found to promote over-expression of pro-inflammatory mediators, it can also promote overeating unhealthy foods in the absence of hunger.
Repetitively stress-eating, calorie dense, nutrient deficient foods not only further exacerbates psychological distress, but creates a vicious cycle of stress-eating. The integrative nature of our bodies and the central nervous system suggests that strictly dietary or strictly behavioral interventions are not enough to reduce chronic inflammation on their own. Instead, you must consider an integrative diet and lifestyle preventions/interventions simultaneously.
Going forward, science will need better biomarkers and more research looking at individual responses to diet, and better understanding of how food components and behavioral factors modulate genetic targets involved in the body’s inflammatory response. There is so much we don’t know, but hopefully this information will be a start for you to make wise choices in reducing inflammation while trying to manage your musculoskeletal pain for which you are seeing me.
Continue to wear a mask, wash hands, and social distance during these very trying times. Be well.
Terry