Reducing Inflammation: A catch 22?

RICE – Rest Ice Compression and Elevation. It’s the term many people know when they suffer from an injury. It’s the standard protocol and its purpose is to reduce swelling and inflammation which should reduce pain. Throw in some anti-inflammatory pills (Non-Steroidal Anti-Inflammatory Drugs – NSAID’s) like Aspirin. Ibuprofen or naproxen and you’ve really stunted the inflammatory process.

This treatment protocol has been followed for decades, however, more clinicians and researchers are questioning this protocol. The question is, do you really want to stop the inflammation? Do you want to take NSAID’s, apply ice or get a steroid injection. Do you really want to put an end to the swelling?
The answer is appearing to be yes…and no. If you really need a short term solution, then go ahead and reduce the inflammation. If you are concerned about long term implications, you may be better off to let the inflammation run it’s course. In other words, there appears to be a trade off: reduce inflammation now and benefit – just understand that you are sacrificing the health of the tissue in the long run.
Confused yet? Let’s break it all down:

Inflammation is a complicated process involving not only the physical appearance of redness and swelling, but a whole host of cellular processes designed to lay down the building blocks of healing. While sometimes painful, it’s also a necessary process needed to heal tissue. Do you really want to blunt that course of action? Let’s see what happens when you do:

Two new studies in the past couple months have strengthened the notion that, contrary to popular belief, swelling and inflammation are very beneficial to the healing process.
The first study found that mice that were genetically altered so that they could not produce swelling were unable to heal from muscle injuries. This isn’t exactly my favorite study since first of all, it was done on mice and secondly, genetically altering something doesn’t really reflect real world scenarios. The point of the study however: no swelling=no healing.
The second study was published last month the British medical journal – The Lancet. Here, they found that injections of cortisone (a powerful anti-inflammatory steroid) brought initial relief for tendon injuries such as tennis elbow, but produced significantly worse outcomes 6 and 12 months later compared with patients who did nothing or performed exercises.
Results seem to be a trade-off between short-term and long-term benefits: reducing swelling with ice or anti-inflammatory drugs may ease your pain now, but slow down your ultimate return to full strength.
Ultimately, the best advice may be to treat any injury as much as you need to – but not more.

That is the end of this newsletter for those of you who want to go with what is written above and don’t want to be bored with more research studies. For those who want more evidence, I have listed a few more studies below.

1) This report reviewed 25 other clinical trials involving athletic injuries with cortisone injections. In their conclusion, they report, “Tendon and fascial ruptures are often reported complications of injected corticosteroids”

2) Another article which reviewed the past 50 years of published literature reports ” Several reports from animal and in vitro studies have demonstrated impaired bone healing in the presence of conventional NSAIDs, as measured by a variety of different parameters.”
3) There are many many studies done on rats where the researchers break the legs of the rats, feed them varying doses of NSAID’s and see which ones heal the fastest. Invariably, the rats given the most NSAID’s heal the slowest. There aren’t many human studies because, let’s be honest, who wants to volunteer to have their bones broken? However, there are some studies on humans. This study looked at the healing rate of patients who underwent spinal fusions. Of the 288 cases that were randomly given NSAID’s, it was found that nonunion occurred in 5 of 121 (4%) of patients not taking NSAID’s and 29 of 167 (17%) patients receiving NSAID’s. The rate of non union went up as the dose of NSAID’s went up.