Your Primer on Inflammation
⌚️ read time: 5 minutes
The health and wellness space loves a good buzzword.
A few years ago, the buzzword was antioxidants. You heard the word everywhere, and products flooded the market touting their ‘antioxidant’ properties.
For the last year or so, I've noticed the same trend happening with ‘inflammation.’ It seems like there's a surge in products and discussions related to combating inflammation. ‘Anti-inflammatory’ this, ‘anti-inflammatory’ that.
Let’s understand what inflammation actually is
To frame this discussion, I want you to think about inflammation as a natural process. Though it may sound like a bad thing, it has actually evolved over millions of years as a helpful mechanism in our body.
Think of it like stress. Stress is good when you are foraging for berries and accidentally wake a sleeping saber-toothed tiger. A surge of cortisol through your body releases glucose for immediate use so you can run like hell — in the hopes of seeing another day.
Now, the same stress response dolled out in small doses all day every day because of your boss's unrealistic expectations about the TPS reports is a complete and total disaster for the long-term health of your organs.
Inflammation is exactly the same. If that saber-toothed tiger gets a swipe at your back, you surely benefit from a process that can quickly stop the bleeding, heal a scab across the wound, and eventually turn that wound back into normal or near-normal tissue.
That's the purpose of inflammation.
But again, if you always have that process switched on — say in your coronary arteries as a reaction to processed food, or in your joints as a reaction to cartilage damage — the end result will be a lot of destruction, pain, and disease.
The science of inflammation
A few words about the nuts and bolts.
While there are many components of ‘inflammation,’ one core system to understand is the clotting cascade (see below).
Image source: Jcchem183, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons
It is immensely complex, but here's a brief primer.
Essentially, this system takes you from the starting point of an injury and uses various building blocks and processes throughout your body to form a clot that ultimately stops the bleeding.
From there, the tissue can remodel back to normal.
In my world, I most commonly see this in the form of tendinitis or arthritis:
Tendinitis is typically an inflammatory process along the tendons – the long white cords attached to muscles and bones. When the muscles activate, they pull through the tendons to move a joint.
Arthritis, as many of you may know, can literally be translated to mean ‘joint pain.’ Typically, this occurs as the soft cartilage end cap between bones breaks down. As this protective layer degrades, the bones rub together and the entire joint space becomes inflamed.
When either your tendons or joints become inflamed, your body steps in to try to help. And what system does it know to use?
Inflammation.
Because your body has a somewhat limited set of tools, it sets off the inflammatory cascade just like it would if you were slashed by a saber-toothed tiger.
Damage done
The problem is that these inflammatory processes have their own downsides.
Extended over long periods of time, they in and of themselves can do tissue damage. Additionally, they often create a large bulk of scar tissue that can start to rub on adjacent structures and irritate them, or even block their intended function.
This sets off yet another inflammatory cascade.
We often see this get out of control with conditions like trigger finger (link here) or De Quervain's tendinitis (link here). All this inflammatory tissue gets trapped inside an anatomic tunnel, usually leading to mechanical clicking, catching, or severe unrelenting pain that just won't get better on its own.
And then there's the issue of chronic joint pain. Loss of cartilage leads to inflammation -> pain -> inflammation -> pain -> inflammation -> pain.
So, why does it matter?
The purpose of today's article is just to serve as a primer, but as you start to understand this, you can also start to understand the various tools we have to combat inflammation.
The first level of this is diet. While the research is still sparse, this is why you see so much out there these days about anti-inflammatory diets. The theory is if you eat better foods, you will create less overall inflammation throughout your body – must be a good thing, right?
The step up from this would be things like getting enough sleep, using ice packs, etc. These are all lifestyle changes that can insert themselves at some point along this inflammatory cascade and dampen down the cycle.
Next is the use of anti-inflammatory medications. Various medications like ibuprofen, naproxen, etc., are designed to attack one component of the inflammatory cascade. They will literally go in and chemically block one step from proceeding to the next; in this way, they shut off the inflammatory system.
The last is surgery. If the inflammatory cycle is out of control and nothing else is working, sometimes we can literally cut it out. This is what we do with a trigger finger surgery or a de Quervain's tendinitis surgery. It's not quite that simple in arthritis because the inciting problem is the loss of cartilage that starts the cycle. To date, we have not discovered anything to regrow that cartilage reliably.
Striking a balance
I'll leave you with one final thought: this is all a balance.
Clearly, inflammation evolved for a reason.
And I want you to think about this when you reach for the bottle of ibuprofen — are you treating a temporary pain that your body is actually healing as it should? Meaning should you let the inflammatory process play out rather than stopping it with a pill?
Or is your inflammatory cycle out of control and really needs some assistance in breaking the cycle?
There are no right answers to these questions, but I often think about them when a patient is one week out from a smashed fingertip and they are pounding Advil — could they be slowing their healing process?
Maybe.
Is it worth it to be able to get through the day?
Maybe.
Today we don't have this answer. So the decision is yours.
Takeaways:
Inflammation is a natural bodily process that can be beneficial for healing in acute situations but potentially harmful when chronic or excessive
The inflammatory cascade, while complex, is the body's primary response to various types of damage, including injuries, tendinitis, and arthritis
Managing inflammation involves a balance of strategies, from diet and lifestyle changes to medications and surgery, with the goal of breaking harmful inflammatory cycles without completely suppressing beneficial healing processes
This is a little scientific/medical insight to the ‘anti-inflammatory’ buzzwords you’ve been hearing recently. There will surely be more to come as we continue to uncover the pros and cons of this process and our various interventions to treat the pain associated with it.
