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PEACE and LOVE: A modern Understanding of Inflammation in Injury Recovery

Here at Accelerate: Sport and Spine in New Braunfels, we often encounter the topic of inflammation amidst discussions of injury treatment. The journey towards recovery is nuanced, requiring a delicate balance between managing symptoms, and facilitating the body’s natural healing processes. The instinct to reach for anti-inflammatories, ice, or analgesics in pursuit of immediate relief is understandable. These methods can be beneficial, allowing for continued activity and motion that are crucial for recovery. However, the caveat lies in their potential to mask pain so that further damage occurs unnoticed, ultimately prolonging the healing journey.


This brings us to the critical crossroads of injury management: the choice between short-term relief and the long-term health of our tissues. The risk of re-injury looms largest in the shadow of a previous injury, highlighting the importance of each decision we make in the face of a new challenge. In navigating the path of injury rehabilitation, we find a parallel with life itself — the age-old dilemma of forgoing immediate gratification for the promise of future success.

 

Historically, the emphasis has been placed too heavily on pain as the sole indicator of healing. This perspective falls short in recognizing the complexity of pain — it serves not only as a signal to protect the affected area from further harm in the acute phase but also as a reflection of the inflammatory processes that are critical for the long-term rebuilding of damaged tissues.

 

It’s time to broaden our approach and embrace the PEACE and LOVE (1) perspective on injury recovery. Before doing so, let’s dive into a fascinating, albeit less known, aspect of recovery—how the improper use of anti-inflammatories can actually delay the healing process.

 

The Negative Impact of Anti-Inflammatories on Injury Recovery


Anti-inflammatories, or NSAIDs, are commonly used to manage pain and reduce inflammation. Yet, what if I told you that by doing so, we might be interfering with the body’s natural and necessary healing mechanisms? According to the insights published in  “Current and Potential Roles in Sports Pharmacy: A Systematic Review” (2), a growing body of evidence suggests that using anti-inflammatories in the acute phase of an injury could be more of a hindrance than a help.

 

The crux of the matter lies in understanding the role of inflammation in healing. Contrary to what many believe, inflammation is not just a symptom to be quashed—it’s a critical part of the body’s repair process. It’s the body’s way of signaling that it’s time to mend and rebuild. By reducing inflammation too soon with anti-inflammatories, we might be dampening this vital call to action, delaying the arrival of nutrients and cells essential for repair, and ultimately prolonging the recovery period.

 

This perspective challenges the traditional view of injury management and underscores the importance of informed decision-making in medication use. It also highlights a significant gap in the knowledge among health professionals and athletes alike, pointing to the necessity for more comprehensive education on the implications of using anti-inflammatories post-injury.

 

Recovery Without Anti-Inflammatories?


At this point, you might be thinking that the negative impacts of using anti-inflammatories are the price to pay for injury recovery. However, that isn’t necessarily the case. In a groundbreaking article published earlier this year in the European Spine Journal (3), researchers presented a compelling narrative on the body’s intrinsic healing capabilities, marking a pivotal shift in approaching injury recovery and treatment.

 

The study meticulously tracked the progress of 90 patients over a year through serial MRI scans, revealing that ALL participants experienced disc resorption—a testament to the body’s ability to heal itself without anti-inflammatory intervention. Remarkably, this was achieved with an average time to resorption of just 4.4 months and without a single case necessitating surgical intervention.

 

This study opens an intriguing dialogue on rethinking injury recovery, focusing on supporting the body’s innate healing processes rather than immediately resorting to anti-inflammatory medications or surgery.

 

Anti-inflammatories and fire extinguishers

Now, don’t get me wrong—medications and pharmaceutical products have tremendous value when administered properly. A way that I explain this to my patients here in New Braunfels is with the following analogy:

 

Imagine your kitchen stove catching fire. A fire extinguisher might make a mess but it is better than burning your house down. This scenario mirrors how anti-inflammatories can work in the body during acute or traumatic injuries. They are powerful and effective at quelling the flames of inflammation, providing much-needed relief, and preventing further damage to the body’s tissues.

 

However, envision waking up every morning and preemptively dousing your kitchen with a fire extinguisher “just in case” a fire ignites. Not only would this routine be unnecessary, but it would also lead to a multitude of problems, from a messy, chemical-filled kitchen to potentially damaging the very appliances you’re trying to protect. This is akin to the overuse of anti-inflammatory medications. When deployed without necessity or as a “preventative measure” against inflammation, these medications can disrupt the body’s natural healing mechanisms and introduce unwanted side effects. After all a small fire on the stove is what you USE to cook with. We need it.


Inflammation, much like fire, is not inherently evil. It is a critical component of the body’s immune response, kickstarting the healing process after injury. Inflammation recruits necessary cells to the injury site and begins the repair of damaged tissues. Suppressing this process without cause can hinder recovery, much like how prematurely extinguishing a controlled and necessary burn in a fireplace would prevent the warmth and benefits it provides.

 

It’s important to recognize that there are instances where the inflammation systems in the body can become akin to a wildfire, out of control, and destructive, such as in chronic inflammatory diseases or certain autoimmune disorders. In these cases, long-term anti-inflammatories use may be akin to a necessary and ongoing firefighting effort, carefully managed and monitored by healthcare professionals to maintain health without causing harm.

 

At Accelerate: Sport and Spine Rehab, our approach is to assess everyone’s situation with care and precision, understanding when to deploy the “fire extinguisher” of anti-inflammatories and when to allow the natural “fire” of inflammation to fulfill its healing role. We advocate for a balanced perspective, recognizing the value of anti-inflammatories as a tool when used appropriately (4) but also respecting the body’s innate capacity to heal (5).

 

Anti-Inflammatories vs. Icing – Which is Better?




Some of my patients tell me they will avoid anti-inflammatories altogether and instead rely wholly on icing to reduce inflammation. During our conversations, they learn that while using different methods, they’re actually causing similarly negative consequences in the healing process.

 

A pivotal study (6) demonstrates that icing can attenuate or delay the expression of key proteins and factors involved in blood vessel formation within the injured muscle. These alterations potentially slow the natural progression of muscle repair, which relies heavily on establishing a new vascular network to support the regenerating tissue.

 

Interestingly, despite these disruptions, the long-term outcomes, such as capillary density and muscle fiber growth, show no substantial deviation between treated and untreated groups. This suggests that while icing might modulate the early stages of muscle repair by tempering inflammation and influencing vascular responses, the body’s inherent regenerative capabilities eventually overcome these initial delays, leading to comparable recovery outcomes. This insight challenges the blanket application of icing for all muscle injuries, underscoring the need for a nuanced approach that considers the timing, duration, and specific circumstances under which icing is employed.

 

PEACE and LOVE In Action



Okay, let’s get back into PEACE and LOVE and what that looks like for comprehensive healing. This comprehensive approach, focusing on both the immediate and subsequent phases of injury management, not only aims at optimal physical recovery but also considers the patient’s psychological well-being. The acronyms PEACE and LOVE serve as easy-to-remember guidelines that highlight the importance of a balanced and informed approach to soft-tissue injury rehabilitation.

 

PEACE: Immediate Care After Injury

·       Protect: Restrict movement for 1-3 days to minimize injury aggravation.

·       Elevate: Raise the limb higher than the heart to reduce swelling.

·       Avoid Anti-inflammatories: They may impair long-term healing by interfering with the inflammation process necessary for tissue repair.

·       Compress: Use bandages to limit swelling and provide support.

·       Educate: Encourage an active approach to recovery over passive treatments, which can foster dependency.

 

LOVE: Subsequent Management

·       Load: Introduce movement and exercises early to promote repair and build tissue tolerance through mechanotransduction (a fancy way of saying how your cells and tissue interact and communicate with each other).

·       Optimism: Foster a positive outlook; psychological factors can significantly impact recovery outcomes.

·       Vascularisation: Engage in pain-free cardiovascular activities soon after injury to support circulation and healing.

·       Exercise: Specific exercises can restore mobility, strength, and proprioception, which is crucial for both immediate recovery and preventing future injuries.

 

In our practice at Accelerate NB Chiropractic, we advocate for a holistic approach to injury recovery. By understanding and respecting the body’s signals, including pain and inflammation, we can navigate the rehabilitation process more effectively. It’s about shifting our focus from merely “feeling better” in the short term to truly “getting better” in the long run.

 

As we adopt the PEACE and LOVE approach, we invite our patients to join us on a journey that heals, educates, and empowers. Together, we can achieve recovery, resilience, and a greater understanding of our bodies.

 

 

Citations

1. Dubois, B., & Esculier, J.-F. (2020). Soft-Tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine, 54(2), 72-73. doi:10.1136/bjsports-2019-101253.

 

2. Hooper, A.D.; Cooper, J.M.; Schneider, J.; Kairuz, T. (2019). Current and Potential Roles in Sports Pharmacy: A Systematic Review. Pharmacy, 7(29). doi:10.3390/pharmacy7010029.

 

3. Albert, H.B., Sayari, A.J., Barajas, J.N., Hornung, A.L., Harada, G., Nolte, M.T., Chee, A.V., Samartzis, D., & Tkachev, A. (2024). The impact of novel inflammation-preserving treatment towards lumbar disc herniation resorption in symptomatic patients: a prospective multi-imaging and clinical outcomes study. European Spine Journal, 33, 964–973. https://doi.org/10.1007/s00586-023-08064-x.

 

4. Paoloni, J. A., Milne, C., Orchard, J., & Hamilton, B. (2009). Non-steroidal anti-inflammatory drugs in sports medicine: guidelines for practical but sensible use. British Journal of Sports Medicine, 43, 863-865. doi:10.1136/bjsm.2009.059980.

 

5. Tidball, J. G. (2005). Inflammatory processes in muscle injury and repair. American Physiological Society, volume 288, issue 2. doi:10.1152/ajpregu.00454.2004.

 

6. Singh, D. P., Barani Lonbani, Z., Woodruff, M. A., Parker, T. J., Steck, R., & Peake, J. M. (2017). Effects of Topical Icing on Inflammation, Angiogenesis, Revascularization, and Myofiber Regeneration in Skeletal Muscle Following Contusion Injury. Frontiers in Physiology, 8, 93. doi: 10.3389/fphys.2017.00093.


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