- Dr. Piotr Solowiej PT, DPT
Is Inflammation Good or Bad?
What do you picture when you hear the word inflammation? Well it has "flame" embedded in it. So the implication could easily be something like what is shown to the left of the page. And if you aren't thinking that, well you are now. That's the power of words and loaded questions, intentionally or unintentionally...but that's a discussion for another post. Internal fire is a scary thought though. Who would want a fire going on inside of them?
Reality is much more placid.
The answer, good or bad, depends on the context.
Inflammation pretty much across the board has a negative connotation associated with it, and it is often regarded as something that should be eliminated immediately. And it can certainly be negative, but there is more to the story. I believe it is a mistake to always try and reduce or eliminate inflammation.
Let's try and take an objective look at the process.
In order to objectively discuss the role of inflammation, the entire process of tissue healing should be considered. Theres are 4 stages to tissue healing:
Stage 1) Hemostasis aka Clotting (Begins at Injury Onset)
- Lasts seconds to hours
Stage 2) Inflammation (Defense)
- Lasts hours to days
Stage 3) Proliferation (Repair)
- Lasts days to weeks
Stage 4) Maturation (Remodeling)
- Lasts weeks to months
Keep in mind these timelines are a general breakdown. The injury severity, tissue type, and a host of other factors can all affect how long these stages will last.
In regards to acute musculoskeletal injury, I will point out that inflammation is an essential, second step in the process of connective tissue healing.
Here's a summary of what happens during the inflammatory process, and if you really want to nerd out check out this paper for all the biochemical nuances:
Neutralization of injury causing agent (i.e. bacteria or other foreign material)
Debridement and decontamination (think of this as digestion and break down of foreign or impaired material)
A useful metaphor for this entire wound healing process is home construction. Before any development work can begin, the site has to be cleaned of obstacles (inflammation) and prepped in a way that will optimize for the placement of foundation and scaffolding (proliferation/repair phase).
Inflammation is destructive in nature, but that is because it needs to be. It 'cleans' the affected area of debris and foreign material if present. So if this process were to be arrested, it would remove an essential step in the healing process. In acute musculoskeletal injuries, it is entirely expected and desired that your body goes through the inflammatory process.
Inflammation is painful. The process releases chemicals that irritate, as well as creates swelling in the affected area which can manifest as pain/tightness.
There are also a number of persistent or chronic inflammatory processes. And since inflammation is a destructive process, left unchecked for long periods of time, chronic inflammation can certainly cause problems. Here are some examples:
-Other autoimmune diseases and more
In cases of persisting inflammation, the cause is typically something systemic. Therefore, the management of these conditions (and the inflammatory process) will require the expertise of a number of healthcare providers (physician, any relevant specialists, pharmacists, physical therapist, and possibly others).
As you can now see, the good or the bad depends on the situation you are in.