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.
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.
