Living with gratitude / Education focus: Inflammation

Living with Gratitude


My inspiration for this blog has been two-fold. It started out with me wanting to talk about a topic close to home, inflammation, and then current events have lead us to think a bit deeper about how fortunate we are to have our good health, and how quickly things can change - gratitude.


Jay has always been honest and open with his struggle with Psoriatic Arthritis, but not everyone knows about it as he tends to just get on with it - with little complaint. Personally, I was worried lockdown and ZOOM was going to be the end of his joints. On the spot training was not his thing and it is hard on the body to do 4 hour long classes a day (and do everything!), topped off with Covid! Finally, InsideOut went outdoors and I could breathe again.


Psoriatic Arthritis is in many ways similar to Rheumatoid Arthritis, in that they are auto-immune inflammatory joint disorders which lead to pre-mature joint destruction. Like many things in life, its on a spectrum. Jay has caught it early and can hopefully delay and prevent progression.


It is surprising just how many inflammatory conditions there are, affecting many different organs and systems. Food and diet are becoming more hot topics of late in the prevention or aggravation of inflammation. In Jay’s instance, the skin condition associated with Psoriasis was not responding long term to consistent dermatological intervention, light and creams, and after an alternative health practitioner recommended a specific diet to stop the foods that flared up his inflammation, he had zero symptoms after 4 weeks. Unfortunately, it is not always sustainable, and you may need stronger medicinal agents.


The experience has certainly changed our family habits, I have a new respect for the impact what we eat has on our bodies, especially sugars. In Jay’s case, and most others, medical intervention is still fundamental in correct diagnosis and appropriate management, with alternative therapies being a valuable adjunct. We always need to look at the whole picture, the whole person.


In our questionnaire, we asked when you last had a medical check-up. For some of you it was a long while. Covid has further delayed us checking up on those niggles that don’t seem important right now. Please stop delaying. Do your health checks regularly. It could make all the difference.


We have just come back from a perfect weekend away. Family, nature, rest, and relaxation. I must confess that I have continued to feel the collective grief all around us, I think it will be around for a while. This weekend, however, we chose to focus on being truly present in each moment, focussing on all those things we are grateful for.


“Gratitude turns what we have into enough” Anonymous

Education Focus: Inflammation


I have done a lot of reading in preparation. I was surprised how wide the range of inflammation definitions there was! Ultimately, I settled on a source I considered most credible with a definition I felt most comfortable with.

Inflammation is “The succession of changes which occur in living tissue when it is injured provided that the injury is not of such a degree as to at once destroy its structure and vitality”

The understanding of inflammation has evolved over time and the concept and understanding grown exponentially. Initially thought to be part of a healing process and sometimes an undesirable response it is now agreed that it is the cornerstone of disease/injury pathology. We know now (as with almost all medical science this is an evolving machine) that inflammation is far more complex than may appear and is a response by the immune system to tissue damage and infection. As I have learned in life, everything is usually on a spectrum. Inflammation is no different, with some people having severe inflammatory responses and others very mild, some only local responses and others systemic.

There are 2 mains types of inflammation to consider, acute injury (usually local) and chronic inflammation (can be local and sometimes systemic). It is usually described with visual and tactile changes, heat (increased blood through dilated vessels), redness (increased erythrocytes/red blood cells), swelling (increase fluid and cellular permeability) and in more chronic instances, increased connective tissue (I often call it “the white stuff in biltong”, in which too much can lead to stiffness and tightness after an injury). Pain is either caused directly by the mediators/chemistry (from the initial damage /injury or by the inflammation itself) or from the injury/stretch to the nerves/sheaths from oedema.


Acute tissue damage causing inflammation is most common. This include muscle/tendon and ligament injuries, sprains and strains. The stages of healing are well documented:


Bleeding Phase:

Initial reaction to injury, usually lasts 4 to 24 hours and may include swelling and bruising

Protect, rest, ice, compress, elevate (see your Physio or Doctor if you cannot weight bear, asap)


Inflammatory phase:

Lasts from a few days to a few weeks. Increased blood supply, vascular changes, cellular and chemical changes

Seek advice if you are in pain, swollen or red. Relative rest, exercise / activity dependant on severity.


Proliferation Phase:

Lasts up to 3 weeks, when scar tissue is formed. In this phase the injured tissue knits together and form scar tissue according to need.

Treatment in this time is aimed at ensuring healing is guided, protected and that swelling, and pain is kept to a minimum. A graded exercise program / full range of movement is usually encouraged within safe parameters.


Remodelling Phase:

This phase ensures a strong and functional scar is formed. Treatment is aimed at strengthening and return to full function and sport safely.

So we have covered the basics of acute inflammation. The reality we face is that most problems arise from chronic inflammation and inflammatory conditions. Chronic inflammation can be associated with a single injury / joint / tendon / muscle or it can come in the form of a chronic autoimmune inflammatory disease. These are too many and complex for this blog.


A common reason to visit a doctor or physiotherapist is when seeking help with pain due to a chronic (more than 3 months) tendinopathy, bursitis or arthritis . This can take the form of a rotator cuff injury, hip bursitis and knee arthritis just to name a few. Catching it early can make a big difference to recovery time - but my experience with this type of injury, is that that it takes time and discipline. This is not a quick fix, you need to seek advice on your specific injury and know that is will take at least 12 weeks of specific exercises to help ensure minimal long term implications. Sometimes you will need to continuously manage your injury/condition (single joint osteoarthritis), sometimes you can fix it once and for all (tendinosis).


Once size does not fit all here and giving advice on what to do with chronic inflammation would be inappropriate. If you are concerned, have it assessed. Go to your appointment with your list of questions and make sure you understand the answers. The hard part is usually doing the work afterwards, but remember, nothing great in life comes without hard work – and it is worth it!

https://ncbi.nlm.nih.gov/pmc/articles/PMC1074343/

https://www.physio-pedia.com

https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/how-to-use-food-to-help-your-body-fight-inflammation/art-20457586

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