If you're a bit squeamish you might want to skip this paragraph, because earlier this week I managed to slice into my thumb with a chopping knife while I was preparing dinner. The cut is reasonably deep and it bled quite a lot, but happily it is now healing nicely, even though it looks like a bit of a Franken-finger.
But it got me thinking about the healing process and how amazing it is. Specifically, it reminded me of a big debate that happened in the Sports Science arena several years ago on the best way to treat acute sporting injuries. Until then, the standard treatment had been known by the acronym RICE: Rest, Ice, Compression, Elevation. All of these actions were specifically targeted at reducing inflammation.
Most of us would be able to spot inflammation if we saw it - it's typically red, swollen, hot, sore and (if it occurs in a moving body part) stiff. It's the current state of my left thumb. But what is actually going on behind the scenes to create this inflammation?
Firstly, your body responds to some sort of stimulus, such as a bacterial infection or an injury, by releasing chemicals called inflammatory mediators. These chemical control how much inflammation you get and how long it lasts. It directs the different stages of healing which are:
- In the blood, chemicals are released to make the blood stickier (this is called the clotting cascade) to make a protective mesh over areas of injury, literally patching things back together. This stops any further blood loss and protects against infection.
- Blood vessels widen and become "leaky" - this allows more blood to flow to the area, and from that extra blood lots of plasma will leak out. This plasma contains different immune cells. These start breaking down all the tissue that has already died or become irretrievably damaged. These guys are on clear-up duty.
- Chemicals are released called bradykinins which increase the sensitivity of nerves in the area. This increases the sensation of pain, and is designed to force you not to overload the tissues that are still healing.
- From all the nutrients that have been brought to the area by the plasma, new structures are built to replace the old damaged structures. Protein strands are initially laid down in big clumps to repair muscles, tendons and ligaments and then gradually remodelled to perfect the tissue. This will include building new blood vessels and nerves to supply the area.
The important thing about the healing process is that it must occur in this order. You can't have new structures being made in step 4 only to be broken down by the immune cells in step 2. Equally, you can't have blood vessels becoming leakier in step 2 before any blood loss has been stopped in step 1.
So looking back at the RICE method I mentioned earlier, it's clear that each of these steps was designed to reduce the initial inflammation so that swelling and pain would not occur. But given that each step is crucial to the one afterwards, reducing inflammation in its early stages would actually hamper the following stages of healing.
So instead of RICE, try MEAT:
- Movement stimulates blood flow to the area, providing a constant source of immune cells for healing and nutrients for rebuilding and repairing
- Exercise (tailored programs that gradually load the tissue that was damaged) has a big effect on the remodelling that we mentioned in stage 4. It means that instead of the new tissue be reformed as one big clump, the protein strands will be thicker, more elastic and aligned parallel to each other to make the tissue stronger.
- Analgesics (pain relief) should be things like paracetemol, rather than anti-inflammatories like ibuprofen or naproxen. You could even use more natural methods of pain relief like pineapple and papaya extract (bromelain and papain), which enhance the "clear out stage" of healing without affecting the overall healing process. Medical Acupuncture may also be helpful here.
- Treatment such as manual therapies (like that provided by chiropractors, physiotherapists or osteopaths) will help to improve blood flow and reduce stiffness in pain in the injured area
So next time you injure yourself and you see inflammation, don't panic and reach for the ice, remember instead that your body is doing the amazing process of healing itself.