Understanding Inflammation

By Andy Schmalz, DO(MP), CAT(C)

Inflammation is a word that most have likely heard but few may actually understand.  There are two different aspects of inflammation that should be explained as they have very different effects in the body.  Acute inflammation is what happens when we have experienced an injury or are fighting off an illness.  It follows a predictable pathway in the body and is important in the healing process. Chronic inflammation on the other hand, is a much bigger issue for our bodies to deal with. This type of inflammation is a significant health concern that has been linked to diseases like rheumatoid arthritis, heart disease, diabetes, other autoimmune disorders, and even cancer.  Unfortunately, these are common diseases that affect our everyday lives and/or the lives of loved ones.  Although acute and chronic inflammation have different effects in the body, they are not different inflammatory responses.  They are one and the same, they simply have two different timelines; one is short-term, while the other is long-term.  Once we understand that inflammation can be linked to so many diseases, do we really know what it is or where it comes from?  How can it be both good and bad for us at the same time?

Inflammation is the body's natural response to injury, illness, or infection.  It is an important part of the healing process.  It is meant to happen and should be allowed to happen because it is inflammation that helps to clean up the affected area of the body while setting stage for healing to occur.  Think of inflammation as a traffic accident; a collision between two cars.  Initially there is a call for help, then within minutes the police, fire department, and ambulance are there to help the situation.  Traffic around the area may build, but the people who are affected by the accident are going to be taken care of.  If we allowed regular traffic to flow, it might restrict access to the injured people or make the situation more dangerous for those involved.

Just as in the example of a car accident triggering an immediate response, when we injure an area of the body or have a local infection, the inflammatory response is triggered.  Instead of calling 911, our cells send out their own signals that indicate that something is not right in that area of the body and an inflammatory response is activated.  This creates a cascade of events that help coordinate the response to the injured tissue.  In simple there, the injury is somewhat quarantined from the rest of the body, and the immune system takes control.  It's the immune system's job to fight off the infection or clear away damaged tissue.  It is in the midst of this chaos, that we actually begin the healing process.  It may look like chaos with so many emergency vehicles and personnel moving around the accident site, but in truth they are all working together to help the injured and clear the roads.  If handled properly, a typical inflammatory response should last 48-72 hours.  When this response occurs in our body in an acute inflammatory situation, it is healthy and should be allowed to happen after the injury has occurred.  However, if it is not handled properly, it can easily last longer or become chronic, this is when the risks for long-term damage is present.

In order to understand why things can go wrong with chronic or long-term inflammation, there are two things we need to elaborate on first, when the initial call (or immune response) is triggered, there are cells that initiate the inflammatory process.  The make sure the "help" (immune system) is able to access the affected area.  However, these cells not only allow the immune system to take over, they also tell the body to stop the inflammatory process and move into a healing phase.  That being said, if the signal to make that transition does no occur, it can sometimes lead to a prolonged response.  Second, the inflammatory response can be compared to the demolition phase of a home renovation.  Tissue and cells that have been damaged are broken down to make space for new, healthy cells.  In a typical, acute scenario described above, this is perfectly safe and normal.  However, if this demolition phase does not stop, the "house" will soon become too damaged to function properly.

The inflammatory response has evolved to occur in short time frames; a few days or possibly slightly longer.  It does not have the capacity to handle long-term stresses or repetitive injury that are common in our lives.  In other words, the short-term inflammatory response is not an ideal solution for the long-term, repetitive causes of inflammation - most commonly food and stress.  If we are continuously putting the body in an inflammatory response due to stress, food, or repetitive strain, the tissue in the affected area will slowly breakdown over time.  Remember, the inflammatory response is like a demolition intended to clean up something that needs to be fixed - if it continues without stopping there can be serious consequences.  Heart disease can happen as a result of inflammatory signals continuously circulating in the blood.  When this demolition phase occurs too often, it can scar the arteries and promote the development of plaque.  A constant inflammatory response will also place the nervous system in a sympathetic (fight or flight) state that will suppress the immune system.  It is this result that is strongly linked to autoimmune disorders.  Many of the biggest changes and consequences from inflammation happen in the digestive system but that's a whole separate topic for another article.

Inflammation and Connective Tissue

All structures in the body – muscles, organs, nerves – are surrounded by layers of connective tissue.  Chronic inflammation will also affect these tissues and lead to many of the long-term aches and pains that show up over time.  Much of the connective tissue in the body is made up of individual fibres of type 1 collagen that look like smooth, braided nylon ropes.  During an inflammatory response, the ropes will fray, dry out, and become weak.  The frayed ends of the “ropes” are sticky and begin to adhere to the other layers of tissue around them, while at the same time they shorten.  The end result is a series of tissues that are tight, weak and ready to tear.   Our body tries to compensate around the “weak link in the chain” knowing this is the area likely to tear.  Unfortunately this is only a short-term solution and in time more tissue damage occurs. At some point the body can no longer compensate around the accumulated damage and we end up feeling pain.  The constant exposure of healthy tissue to inflammation has caused it to break down to a point where injury will occur and we will experience pain.  What we really need to ask ourselves is if the pain we are experiencing is just due to our most recent activities, or if it is the result of many long-term changes in the body due to this chronic inflammation.

Moving into Healing

Now that inflammation is better understood, the question becomes: Is there anything we can do to help decrease the damage or possibly stop it all together?  The answer is yes – but it needs to be addressed on multiple levels.  The root causes of the inflammation need to be determined and those can be different for everyone.  Generally speaking, long-term inflammatory changes are most often linked to one or more of the following: food and potential food sensitivities, accumulation of old injuries, or long-term stress.  In truth, it’s usually a combination of all 3, but the proportion of each is different for everyone.

If diet proves to be a culprit, it is important to work with a naturopathic doctor, nutritionist, or holistic nutritionist to address the changes in diet that are needed to stop the inflammation from continuing to occur in the digestive system.  If there is an emotional stress or trauma that we have not yet healed, we can work with counselors, psychotherapists, or naturopaths to help heal any emotional scars that could have caused an inflammatory response to continue.  We also need to address stress in our daily lives – something that sounds simple but is much more difficult to put into practice.  Methods of dealing with stress are located here.

Don’t forget that the long-term changes in the connective tissues from chronic inflammation still need to be addressed.  Think of it as collateral damage – the layers of connective tissue might not have been damaged initially, but will become affected with time if the inflammation is not dealt with.  The best way to handle this type of tissue change is with a skilled manual, hands-on therapist – Osteopathic practitioner, Physiotherapist, massage therapist, etc. – who can address the tissue degeneration directly.  These therapies look to breakdown any scar tissue or poorly formed collagen tissues and help realign the tissue in a more functional way for the body.  Different forms of myofascial release or myofascial unwinding will reverse the tissue damage caused from inflammation and help the body to function in an optimal way, reversing the effects of repetitive strain injuries.  Movement based therapies like yoga can also help to realign the layers of connective tissue to provide more mobility and less pain in our lives.

There are many different factors that can trigger inflammation in the body, and the effects of long-term inflammation are very detrimental to our health.  It is likely impossible to rid ourselves of all inflammatory damage in our bodies but there are important things we can do to minimize the effect it has on our health.  Understanding the things that happen in our body is our first step. From there we can begin looking at small changes in our daily lives and seek help for the bigger injuries or traumas we have experienced.  It is all part of taking control of our lives and giving time and energy to our bodies and overall health.