Inflammation and The Physiology of Healing
If you have ever had an assessment with me, you know that I love physiology. What I love even more than physiology, is explaining to patients the physiology of healing because I have found that this is NOT common knowledge. In fact, there is so much misinformation out there about how the body heals. I can go on and on about all the myths and all the things that are not true about the human body and how it heals- but I will save that for other posts.
What I want to share here is the science- what we know to be true. What can be repeatedly tested over and over again and never change.
The Body is Resilient
The human body is quite amazing, and even though we cannot regenerate limbs like a starfish or lobster, we can repair quite a bit. There are a lot of physiological processes that occur and there are many phases of healing, however, I will keep things simple. For an in-depth look at healing you can read one of my favourites, Vander’s Human Physiology (https://www.mheducation.ca/product/vander-s-human-physiology-ise-9781265131814-can-group)
For those of us who want a visual, here is a YouTube video on the basics of healing in the human body. https://www.youtube.com/watch?v=F9IAw3zrzMw
Note that permanent tissues, such as muscles, tendons, cartilage, are repaired with scar tissue and myofiber regeneration.
Tissue for your Issues
Scar tissue is bad right? Personally, I do not like absolutes, especially when it comes when speaking about ourselves or the human body- we are complex creatures. Scar tissue is no different. It is not good or bad. It just is.
And to be honest, we are lucky that we can even form scar tissue because without it we would have a very difficult time repairing and healing.
Here’s the thing about scar tissue- it can adapt. If you’ve ever had a significant cut on your skin that formed a scar, you know this. Over time, the scar becomes more elastic and adapts to the stress you put on it. There are complex processes like collagen crosslinking, collagen remodelling, and contraction (contractile proteins that bring cells together) that occur during the early stages of healing. This is why dealing with an injury as soon as possible usually leads to much better results than waiting multiple weeks, months, or years (yes, I see patients that have dealt with the same injury for years before they get it looked at- usually they are misinformed).
So, the next time someone says that you should “break down” or “get rid of” your scar tissue you will know better. We need scar tissue. And we need it to adapt and function as closely to the tissue it is replacing. This is done with gradual load and stress- i.e. exercise.
Inflammation
And since we’re on the topic of good and bad, inflammation is another physiological process that gets a bad rap. Everything that we just mentioned about making the scar tissue required for healing is only possible because of inflammation. We need inflammation.
There are times when inflammation can be a problem (chronic inflammation), however, in the process of healing it is necessary to clean up the area and bring nutrients and materials to rebuild the damaged area.
Exercise- The Magic Pill
Exercise is exercise. What do I mean by that? It doesn’t matter if you’re training to max out your back squat or if you’re doing exercise to help you recover from a muscle strain- exercise is doing the same thing in both scenarios.
Exercise provides our body with the stress it needs to change. As long as the stress is safe, consistent, and we allow for recovery, our body will adapt and become stronger/more mobile/more stable/skillful etc.
The main difference between exercise on healthy versus damaged tissue is simply the dosage and scale. Healthy tissue can withstand much higher stress and still repair itself whereas damaged tissue is susceptible and vulnerable at higher intensities. This is why your physio pulls out the 1-5lbs DBs and resistance bands.
The trick here is hijacking our physiology. We can produce similar results using lighter loads IF we provide the tissue with more time under tension. This is why holding a plank for 60+ seconds for most people is difficult. The weight of the exercise does not change, it is the time under tension that increases. As the muscle contracts, it is physically pushing blood away from the area- it’s as if the muscle is holding its breath. Immediately after, the muscle demands blood and oxygen, similar to the way you gasp and hyperventilate for air after you’ve held your breath for a prolonged period of time. As a result, physios can prescribe exercises with low loads, that are specific to an area, and provide a tempo or pause that gives the body just enough time under tension to adapt, but not to further damage the tissue- it’s a bit of an art to be honest because every human and every injury is different.
Summary
Your best bet (without rehab) with most injuries is to move within your comfort level (one big exception is fractures- moving these too early will not only hurt but prolong the break). Sitting still and doing nothing provides zero stress and the area will take longer to heal and the area will only get weaker, leaving you more susceptible to re-injury. This is why stopping an activity completely for a few weeks and then returning usually leads to re-injury (especially after puberty- but the topic of age is for another post).
Rehab (physiotherapy and chiropractic) exist to find the appropriate exercise and appropriate dosage to help give your injured tissue the help it needs to become more resilient. Combined with introducing compound/functional movements we are able to help you get back to the activities you love.
Written by
Cesar Toledo
Registered Physiotherapist
Owner
Brockton Physiotherapy
Sources:
Vander’s Human Physiology
By Eric P. Widmaier, Hershel Raff, Kevin T. Strang
