Inflammation: Friend or Foe?

An age old question?
One posed recently in light of widespread anti-inflammatory interventions in musculo-skeletal injury. But it poses more questions than the use of non-steroidal anti-inflammatory drugs(NSAIDS) for mere traumatic injuries.

For example, exercise is known to cause a cascade of events including degeneration, inflammation, regeneration and fibrosis, with the regenerative events triggered by the inflammation phase.

So this poses questions as to our management of injuries, disease states and of exercise. Is it sensible to approach all inflammatory states with caution and viewing inflammation as a foe to be combatted? Or is it all part of our anthropological background in that inflammation is a necessary friend in acute states, and only when it becomes maladaptive is it a problem after the initial 36-38 hours? This has been raised by a paper from US Army Research in the latest Journal of Applied Physiology Urso ML March 2013.

The inflammation response needs a careful manipulation to ensure that that regeneration is effectively triggered, and injured skeletal conditions appropriately dealt with The Inflammatory Response to Skeletal Muscle Injury: Smith et al 2008. This may require a change in the way medics manage eccentric exercise programmes as well as injury-are ice baths really The Way Forward after a gym session for example, and should we monitor athletes' NSAIDS medications when the plan is for exercise plans to be based in pro-inflammatory states, i.e. hypertrophy and strength phases of weight training?

Physios and conditioning coaches need also look at their use of ice baths in these instances, as an anti-inflammatory effect has been claimed for short exposure use, but is a cascade of regenerative growth not something to encourage for muscle growth? The exercise-induced stress-response in skeletal muscle: Morton et al 2009

In tendon injuries, short term application of NSAIDs has been shown to have similar effect to heavy slow resistance training, but ends up being less effective in mid-long term follow ups with a better more highly prized collagen turnover with exercise rather than medication, therefore suggesting at least scrutiny of long term drugs use in sport needs to be challenged. Check out this reference RCT of medications v Exercises in Patellar Tendinopathy: Konsgaard et al 2009 for a randomised-controlled trial into clinical, structural and functional effects of the use of steroid injections, eccentric squat training and havy slow resistance training on patellar tendinopathy. 

It is fascinating stuff, and certainly adds to the weight of evidence and material suggesting that clear clinical reasoning in both health and disease states is required with a respect and understanding for the inflammatory process.

Watch your step-the frigid temperatures can have long lasting effects

Is this the last week of Winter?

Injuries sustained this week could still see you needing attention long into the Spring or even early summer (whenever that might be).

Geruatricians on Care of the Elderly wards used to talk with @Spaceclinics staffers in their NHS days as being comfortable with falls on the wards as that fact illustrated that our older population was at least trying to be mobile.

A colleague had recently indicated that his partner had sustained a wrist fracture with a slip, and was interested in the reasoning that at least this meant that she had the reactions and capability to put her hand out to break her fall.

As we get older that capacity for reactive abilities mean that it is less likely that we can get a hand out and instead the force is sustained elsewhere in the body, usually the upper leg causing the oft-seen fractured neck of femur.

Either way, physio could be useful in a rehabilitative phase to ensure a return to fitness. All in all, our twitter images of city of Edinburgh(https://mobile.twitter.com/SpaceClinics/status/311444486922309634)may have been beautiful but there is danger on the icy streets & the message to watch yoyr step is very well-intentioned, and we would urge our younger population and silver surfers to avoid the temptation to text whilst walking!

Days we'll remember all our lives...sport does that!

Wales used to empty for Scottish rugby fixtures.

The days of 20,000 Welshfolk descending on Edinburgh from the Tuesday onwards may be passed, but some teams have preserved some long-fought fixtures, especially in the Scottish borders and Edinburgh, prior to 'The Big One' at Murrayfield on the Saturday.

These days matches often commence at 5pm or later, on Sundays, and even have taken place on Friday nights, with television seeking to maximally expose the annual 6 Nations' rugby championship.

Here are some classic memories from bygone years in both Edinburgh and Cardiff, with the Welsh footage dominating, possibly unsurprisingly given results over the past decade.

BBC Sport Scotland v Wales highlights

Anyhow, as the 2 teams in 2nd place in the Championship play off this weekend, it still feels right to look back before we look ahead to the weekend, and the latest instalment of The Big One between the two Celtic nations...

Urban Running: Edinburgh Springtime Edition

February ended up with clear blue sun-filled skies and perfect air: terrific conditions for running through the streets of Edinburgh near @SpaceClinics Central!

We blogged a year ago about the joys of running through the cities of Europe, and even found some pleasures in the oft-choked citiescapes of North America.

Joys of Urban Running

Winter is a terrific time to be out and about: many of the patients we see at this time of year are in preparation for the marathons of London, Edinburgh or Paris. They are currently accumulating miles, and occasionally injuries or niggles for which they rock up at Dalry Road in a bid to maintain their mileage and ensure they are on course for 'their' time.

Marathons and running timetables are useful now as the demand for events has risen (eg Marathon & Running Events Calendar 2013), possibly as a result of urban running being an inexpensive way to 'keep fit' long after the gym membership has expired or been cancelled. This appears to be very much the case in cities such as Dublin, where JT & Stephen visited last Autumn, finding heaps of weekend running groups traversing the millenium-old roadways. We were told that gym membership was being seen as an expensive luxury item, and more folk were taking to the streets with their trainers and running in packs for cardio-vascular exercise.

And there are other events of lesser distances to which training is essential to prevent disappointment (and possibly injury).

Why wouldn't you, when you get to run through areas in Edinburgh such as these.

Of course, if you are anxious about commencing running, or have an injury that has you concerned about whether or not you should try running on roads, drop in to the clinic in Edinburgh's West End, or email us with a specific query: only too happy to help and get Scotland moving!!!