Any harmful stimulus to the body will result in inflammation of the injury site. Inflammation is defined by 5 cardinal signs: pain, heat, swelling, redness and reduced function, with these signs first described over 2000 years ago by the Roman physician Aulus Cornelius Celsus. The process of inflammation is a natural phenomenon, and it promotes the healing and recovery of the damaged area. However, sometimes the body can respond in an exaggerated manner, and end up causing more damage than good.
The increased heat, swelling and redness of the area is due to the dilatation of blood vessels which aims to increase blood flow (vasodilation) and increased permeability of these blood vessels to allow blood plasma and white blood cells into the surrounding tissues (exudation). The main aims of the inflammation process is to ‘flush out’ and dispose of the toxin or pathogen in the area in order to prevent further damage, then to increase blood flow, hormones and nutrients to the area to allow the healing process to begin.
When Will I Get Inflammation?
After damage to any tissues, such as a muscle strain or sprain, there will be some components of swelling to the area. This will often come out with some bruising and tenderness due to the increased blood flow to the area. It will often begin to happen instantly after the incident, with its intensity determined by the degree of injury. For instance, an ACL rupture will mean your knee will instantly swell like a balloon from bleeding into the joint area, whereas a sprained ankle may take a few hours to swell.
You do not need to have an actual ‘injury’ to the body to trigger this inflammation response. Heavy weight lifting or intense physical exercises (such as running a marathon) will cause delayed onset muscle soreness (DOMS) in the following 24–48 hours due to micro-tearing of muscles. People will often feel like the muscle groups being worked are ‘swollen’ and sore as if there has been damage. This doesn’t necessarily need acute management strategies.
Why Do We Want to Reduce Inflammation?
The issue with inflammation is the associated pain and reduced function it causes to the individual. This pain is sometimes beneficial to the healing process by preventing the individual from using the limb and giving further damage to the tissues. However, with the exaggerated swelling response, nerves come irritated through compression and the influx of chemicals and hormones to the area, ultimately causing more pain.
How Should I Reduce Inflammation?
The management of swelling should commence as soon as the injury happens. The most common management protocol uses the acronym ‘RICE’ which stands for:
Rest: Discontinuing to prevent further damage. This can be achieved by talking the individual out of the situation in which they were injured.
Ice: Cold compression to the joint to reduce the effect of increased blood flow, stopping further bleeding and swelling pooling in the area.
Compression: Providing support to the damaged structures and preventing swelling.
Elevation: Lifting the injury site above the heart to reduce blood flow and swelling.
If inflammation characteristics are persistent for more than 2 weeks, or the injured joint feels particularly unstable, it is advisable to seek medical attention, as the damage could need further management.
Returning to Normal Activity
As a rule, it is not advisable to return to sport until the swelling has completely resolved, however it is usually possible to return to training in a controlled environment before this. Working with your physiotherapist in a controlled area (such as a gym) can help restore you back to normal functional and sporting intensity.
Talk to your therapist about swelling management if you are having particular difficulty following an injury or surgery. They can assist with your management strategies, as well as beginning your rehabilitation in order to return to your normal activities.
Post by Zoe Birch, Head of Orthopaedic Physiotherapy at Physiocomestoyou.