Inflammation

Inflammation is the body’s attempt at self-protection; the aim being to remove harmful stimuli, including damaged cells, irritants, or pathogens – and begin the healing process.

When something harmful or irritating affects a part of our body, there is a biological response to try to remove it, the signs and symptoms of inflammation, specifically acute inflammation, show that the body is trying to heal itself. Inflammation does not mean infection, even when an infection causes inflammation. Infection is caused by a bacterium, virus or fungus, while inflammation is the body’s response to it.

The word inflammation comes from the Latin “inflammo”, meaning “I set alight, I ignite”.

Inflammation is part of the body’s immune response. Initially, it is beneficial when, for example, your knee sustains a blow and tissues need care and protection. However, sometimes inflammation can cause further inflammation; it can become self-perpetuating. More inflammation is created in response to the existing inflammation.

According to Medilexicon’s medical dictionary, Inflammation is:

“A fundamental pathologic process consisting of a dynamic complex of histologically apparent cytologic changes, cellular infiltration, and mediator release that occurs in the affected blood vessels and adjacent tissues in response to an injury or abnormal stimulation caused by a physical, chemical, or biologic agent, including the local reactions and resulting morphologic changes; the destruction or removal of the injurious material; and the responses that lead to repair and healing.

The so-called cardinal signs of inflammation are rubor, redness; calor, heat (or warmth); tumor, swelling; and dolor, pain; a fifth sign, functio laesa, inhibited or lost function, is sometimes added. All these signs may be observed in certain instances, but none is necessarily always present.”

The suffix ¨ – itis ¨ refers to inflamation. Examples : appendicitis, tendinitis,tonsillitis.

Inflamation is not a pathological condition in itself, but rather the body´s reaction to tissue damage.The inflammatory cells remove debris and draw healing cells to the injury site. However, if irritiation continues,the process becomes detrimental and the inflammation becomes a chronic debilitating condition.

Symptoms : 

• pain
• swelling
• skin warmth
• redness

Inflammation helps wound to heal 

Our immediate reaction to a swelling is to try to bring it down. Bearing in mind that inflammation is an essential part of the body’s attempt to heal itself, patients and doctors need to be sure that the treatments to reduce swelling are absolutely necessary and to not undermine or slow down the healing process.

The first stage of inflammation is often called irritation, which then becomes inflammation – the immediate healing process. Inflammation is followed by suppuration (discharging of pus). Then there is the granulation stage, the formation in wounds of tiny, rounded masses of tissue during healing. Inflammation is part of a complex biological response to harmful stimuli. Without inflammation, infections and wounds would never heal.

Difference between acute and chronic inflammation

Acute inflammation – starts rapidly (rapid onset) and quickly becomes severe. Signs and symptoms are only present for a few days, but in some cases may persist for a few weeks.

Examples of diseases, conditions, and situations which can result in acute inflammation include: acutebronchitis, infected ingrown toenail, sore throat from a cold or flu, a scratch/cut on the skin, exercise (especially intense training), acute appendicitis, acute dermatitis, acute tonsillitis, acute infective meningitis, acute sinusitis, or a blow.

Chronic inflammation – this means long-term inflammation, which can last for several months and even years. It can result from:

• Failure to eliminate whatever was causing an acute inflammation
• An autoimmune response to a self antigen – the immune system attacks healthy tissue, mistaking it (them) for harmful pathogens.
• A chronic irritant of low intensity that persists

Examples of diseases and conditions with chronic inflammation include: asthma, chronic peptic ulcer,tuberculosis, rheumatoid arthritis, chronic periodontitis, ulcerative colitis and Crohn’s disease, chronic sinusitis, and chronic active hepatitis (there are many more).

Our infections, wounds and any damage to tissue would never health without inflammation – tissue would become more and more damaged and the body, or any organism, would eventually perish.

However, chronic inflammation can eventually cause several diseases and conditions, including some cancers, rheumatoid arthritis, atherosclerosis, periodontitis, and hay fever. Inflammation needs to be well regulated.

What happens during acute inflammation?

Within a few seconds or minutes after tissue is injured, acute inflammation starts to occur. The damage may be a physical one, or might be caused by an immune response.

Three main processes occur before and during acute inflammation:

• Arterioles, small branches of arteries that lead to capillaries that supply blood to the damaged region dilate, resulting in increased blood flow

• The capillaries become more permeable, so fluid and blood proteins can move into interstitial spaces (spaces between cells).

• Neutrophils, and possibly some macrophages migrate out of the capillaries and venules (small veins that go from a capillary to a vein) and move into interstitial spaces. A neutrophil is a type of granulocyte (white blood cell), it is filled with tiny sacs which contain enzymes that digest microorganisms. Macrophages are also a type of white blood cells that ingests foreign material.

When our skin is scratched (and the skin is not broken), one may see a pale red line. Soon the area around that scratch goes red, this is because the arterioles have dilated and the capillaries have filled up with blood and become more permeable, allowing fluid and blood proteins to move into the space between tissues.

Edema – the area then swells as further fluid builds up in the interstitial spaces.

The five cardinal signs of acute inflammation – “PRISH”

• Pain – the inflamed area is likely to be painful, especially when touched. Chemicals that stimulate nerve endings are released, making the area much more sensitive.
• Redness – this is because the capillaries are filled up with more blood than usual
• Immobility – there may be some loss of function
• Swelling – caused by an accumulation of fluid
• Heat – as with the reason for the redness, more blood in the affected area makes it feel hot to the touch

The five classical signs of inflammation:

Although Latin terms are still used widely in Western medicine, local language terms, such as English, are taking over. PRISH is a more modern acronym which refers to the signs of inflammation. The traditional Latin based terms have been around for two thousand years:

• Dolor – Latin term for “pain”
• Calor – Latin term for “heat”
• Rubor – which in Latin means “redness”
• Tumor – a Latin term for “swelling”
• Functio laesa – which in Latin means “injured function”, which can also mean loss of function

Acute and chronic inflammation compared

The lists below show the difference between chronic and acute inflammation regarding the causative agents, which major cells are involved, features regarding onset, duration, and outcomes:

Acute Inflammation

• Causative agents – harmful bacteria or injury to tissue
• Major cells involved – mainly neutrophils, basophils (in the inflammatory response), and eosinophils (response to parasites and worms), and mononuclear cells (macrophages, monocytes)
• Primary mediators – eicosanoids, vasoactive amines
• Onset (when does the inflammation start) – straight away
• Duration – short-lived, only a few days
• Outcomes – the inflammation either gets better (resolution), develops into an abscess, or becomes a chronic inflammation

Chronic inflammation

• Causative agent – non-degradable pathogens that cause persistent inflammation, infection with some types of viruses, persistent foreign bodies, overactive immune system reactions
• Major cells involved – Macrophages, lymphocytes, plasma cells (these three are mononuclear cells), and fibroblasts
• Primary mediators – reactive oxygen species, hydrolytic enzymes, IFN-γ and other cytokines, growth factors
• Duration – from several months to years
• Outcomes – the destruction of tissue, thickening and scarring of connective tissue (fibrosis), death of cells or tissues (necrosis)

Inflammation Treatment Protocol ( ITP):

The following is a general treatment protocol for most inflammatory conditions.The ITP can reduce the extent of inflammation and its unwanted effects.

Not all aspects of the ITP are needed or recommended for every situation!

1. correct the cause
2. cryotherapy ( usually after activity )
3. heat therapy ( usually prior to activity )
4. anti- inflammatory medication ( OTC or prescription strenght )
5. iontophoresis
6. electrical muscle stimulation
7. ultrasound
8. massage techniques to improve blood flow
9. streching and ROM exercises
10. muscle strenghtening,including proprioceptive and kinesthetic exercises
11. support with athletic tape
12. cortisone injections
13. rest
14. gradual return to activity
15. surgery

Source :    Medical News Today 

NESTA certified Sports Injury Specialist