Posted by: Mae | April 1, 2009

Acute Inflammation

Many of my clients are coming to see me with acute or chronic injuries, and have expressed concern about taking prescription or over-the-counter pain medication or anti-inflammatories, and are hoping massage can help reduce or eliminate the use of these medications.  My short answer is “maybe”. The long answer I will hope to explain in this and the next few posts.

The first thing to consider is the signs and symptoms of inflammation, and the second is whether the inflammation is chronic or acute. Third, I look at whether the inflammation is systemic (throughout the whole body) or local (at the site of an injury, for example). If I cannot safely treat a client exhibiting signs of inflammation, I refer them to their primary health provider, or ask for permission to talk to the provider directly.

The classic signs of inflammation are:

  • swelling
  • heat
  • redness
  • pain
  • restriction of joint movement/loss of function

These are most evident when we have a sprain (usually local), or arthritis (local or systemic). Many of these signs are caused by chemicals like histamine and leukotrienes which are also important factors in allergic response. These chemicals are manufactured and released by the body in response to cell damage, heat, bacteria or trauma, and are an important part of triggering the immune system to get the bad stuff out (bacteria, etc.) and the good stuff in (increasing blood flow to increase nutrients for healing, for example). As a result of the increased blood flow and lymphatic (immune cells clearing out waste) activity, we see swelling and restriction of movement if inflammation is at or near a joint.

Although this natural body response isn’t fun for any of us, in the acute stages (within the first few days of the injury or infection) it actually serves a purpose. The pain, swelling, and restricted movement help to keep us from further injuring the site, or from moving blood too quickly through the area, which can spread an infection. Where we, as owner-directors of our bodies, may need to step in is when the swelling or pain becomes too great or lasts too long. This is where self-treatment or massage treatment can help.

RICE is the first step in treating inflammation.

  • Rest: keep from using or moving the affected area
  • Ice: mediates excessive blood flow, thereby reducing heat, pain, and swelling
  • Compression: a gentle bandaging of the area, for example, can also keep the swelling down and restrict blood flow
  • Elevation: prop the affected area above your heart level, if possible to further decrease blood flow and swelling

Should you seek massage care with acute, local, inflammation, your therapist should avoid the actual area that is inflamed, and will not perform massage if inflammation is due to infection or certain conditions. Massage techniques at this stage focus on techniques that decrease swelling and reflexive techniques (including massaging the opposite limb) to relieve pain and facilitate healing. Your therapist will most likely use ice or cold hydrotherapy as well. Other goals include treating muscles that could be working harder while you avoid moving the injury. Muscles directly involved in the injury will likely not be treated as any spasm present is “splinting” or  helping to keep the injured site immobile.

In a few days, some healing has taken place, and the sub-acute stage begins. At this stage more direct work begins, gently, to prevent scarring that can lead to decreased function down the road. The therapist may begin to move the affected joint to help move fluid and increase mobility.

From here, we can move into healing and repair, or develop chronic inflammation. (More in the next post!)

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