the 20-something’s guide to inflammation (aka:: debunking the fear surrounding inflammation, why it happens, & how we can better manage it within our own bodies)
continuing the debunking series…
we are going to dive into inflammation! inflammation is such a scary term, & the way it is presented makes us think that inflammation is the bad guy. well, like cortisol, i’d like to argue that inflammation is just another part of the misunderstood, mean girl clique. there is a time & place for inflammation; inflammation is actually part of the healing process within our body! however, it is that persistent inflammation that can make things more difficult for our bodies. so let’s take this time to debunk inflammation, what it is, what it isn’t, how it helps, how it harms, & what we can do to control the level of inflammation within our bodies!
check out our wellness big sis:: the pod episodes!
the physiology of inflammation
“inflammation” is so broad, so in order to truly understand it, i think it will be best to define it, then break it down into its parts. let’s start broad… what is inflammation? inflammation is the process our body goes through in order to heal a certain disease or injury. it involves activating the immune system to send various signaling & response molecules to a region to promote healing. it works in a slightly different way in various body regions & tissue types, so let’s look at inflammation broadly, then we will dive into how inflammation works specifically at multiple different tissue types.
the 3 (broad) phases of inflammation
phase I:: the inflammatory response/ acute phase
our body senses the injury or infection, & the blood vessels surrounding the area begin to vasodilate (enlarge). the blood vessels also start to increase their permeability in order to allow certain immune cells & proteins into the injured or infected area. our blood vessels act as a highway to allow for these immune cells to reach the area that is injured. at the same time, the cells of the damaged tissue release “help” signals of their own in the form of histamine, prostaglandins, & cytokines, which manifest in the body as redness, swelling, & warmth. these signals are picked up by our immune system, which sends the necessary cells to the scene.
neutrophils (the garbage collectors):: these guys clean up the area, take out the trash, & help to clear out debris. they’re super quick responders & usually the first on the scene. they also release signaling molecules (just like the damaged cells) to send for back-up. neutrophils are busy workers; they work really hard, release a lot of signaling molecules to cue other inflammatory cells, & die off early. they’re short acting &, if left unchecked, can get a bit out of control. i think of neutrophils as the excitable little brother that always wants to play, never naps, & sleeps really hard.
phase II:: repair & regeneration/ subacute phase
the inflammatory response increases, & the immune system starts to send even more specialized cells to the area to help clean up & eventually transition to repair & remodeling. this phase can be painful as the inflammatory response continues, & it eventually needs to convert to phase III (the ultimate healing phase) in order to not risk a chronic inflammatory cycle.
macrophages:: these are like the older sister… still a leader of the pack, but usually a bit more cautious & calculated in their approach. macrophages are usually the 2nd on the scene & help the neutrophils clean up the mess. they also release cytokines to help sustain the inflammatory response (& let other cells within the immune system know the area still needs help!), but they will eventually transition to anti-inflammatory in phase III, calming down the inflammatory response in order to help heal & repair the region. later on in the healing process, they also help build back up the cells needed in the area.
lymphocytes:: these are like the sister that has a long hit list of all the people that have wronged her siblings in the past…& she definitely holds grudges. there are various lymphocytes that work throughout the inflammatory process that are targeted towards specific molecules.
T-cells:: respond to specific antigens by coordinating other immune cells, continuing to destroy damaged & infected cells, or helping to reign in excessive inflammation.
B-cells:: work to produce antibodies against certain antigens. they also target specific invaders for eventual destruction & removal.
Natural Killer Cells:: help prevent the spread of infection early on in the inflammatory process
phase III:: remodeling/maturation/ chronic phase
the body transitions to now working in an anti-inflammatory state after all of the invaders, trash, & debris has been cleared. macrophages switch to their anti-inflammatory properties, releasing cytokines that help to call off the inflammatory response, in addition to stimulating fibroblasts that help to build back up the damaged tissue.
& there you have it! the broad phases of inflammation & all of the helpers that are involved. now let’s look at inflammation at the level of various tissues & how it corresponds to the healing of certain tissues. this list is not exhaustive, but i do feel like it encompasses some of the tissues that we tend to care the most about!
inflammation, wounds, & the skin
hemostasis (immediately after injury to a few hours after injury):: the blood vessels that go to the skin constrict to limit blood loss, platelets group together to form a clot as a barrier for blood loss & to prevent infection, & the clot releases “help” signals to attract immune cells to the area
inflammation (1-3 days after injury):: blood vessels around the wound start to vasodilate (sound familiar?), neutrophils come in to clear out the debris, macrophages & lymphocytes work to clear debris, target invaders, & build back up the tissue.
proliferation/tissue formation (4-21 days after injury):: fibroblasts help to build new extracellular matrix & collagen that will form the scaffolding for the new tissue to be built upon. new blood vessels are formed (as a highway!) to supply the injured area with the right nutrients to build healthy tissue. keratinocytes help to build back the outer layer of the skin. this phase is working to build immature tissue to eventually be remodeled into stronger, more durable tissue.
maturation/remodeling (21 days to years after injury):: collagen helps to reorganize the immature tissue into a more mature tissue. the scar tissue built up takes time to become more elastic & behave like the surrounding tissue. it might never behave or be as strong as the original tissue, but it will try its best!
again, we notice that the body has to transition out of the proinflammatory state to a repair & rebuild phase, so if the inflammatory phase persists, we could end up with excessive scarring or tissue formation, preventing the true healing & rebuilding of the skin tissue.
*depending on the severity of the wound, it may be beneficial to get more specialized help from a wound care expert. there are certain molecules, lubricants, moisteners, bandages, etc. that can promote wound healing & the formation of healthy skin!
acne is an example of when we need inflammation & healing within our skin tissue! acne can be caused by foreign invaders & pathogens, so in order to remove that stimuli & transition towards healing, we need that inflammatory response & switch from inflammation to anti-inflammation in order to fully heal from the trapped invader under the skin! so the redness, swelling, & elevation of acne can be indicative of the body doing its job to heal that area!
inflammation & muscle injury (skeletal muscle…like our biceps, quads, & diaphragm!)
injury & inflammation:: damaged muscle fibers rupture, & bleeding can spread into the region surrounding the injury, leading to swelling while also acting as a “help” signal to begin the inflammatory process & clear out the damage.
repair & regeneration:: as the name suggests, this is where the tissue starts to get rebuilt. satellite cells (some of my favorite type of cells!) are activated to help form new muscle fibers or repair muscle tissue damage. fibroblasts also come into play to help build a collagen matrix for a quick fix to help improve the strength & integrity of the injured area.
remodeling & maturation:: as with all quick fixes, we eventually have to build a more permanent fix, which is where this phase comes into play! collagen & muscle fibers realign along the length of the muscle to provide a more mature fix to the injured area. some scar tissue is remodeled, & some might remain, depending on the rehab after (little plug for physical therapists!). the rehab after usually consists of
*as a physical therapist, i also have to add that in order for full healing to occur, we have to build back up the actual capacity of the muscle, meaning we have to build up its abilities to contract in a variety of different ways & in a variety of different positions.
knowing the inflammatory process for skeletal muscle can help us to actually build muscle! when our muscles experience microtrauma (like with exercise), they go through an inflammatory process to eventually heal & build back up the area! so if we want body composition changes, we need that inflammatory response!
inflammation & our gut health (smooth muscle!)
smooth muscle is very complex, especially smooth muscle in our digestive tract. if you want to learn a bit more about smooth muscle, check out our gut health series here!
a few things to note:: smooth muscle is under subconscious control, meaning we can’t actively contract the smooth muscle within our digestive tract to move things along, & we usually can’t see it or feel it as acutely as a skeletal muscle injury or wound on our skin, which makes figuring out the process of inflammation within our own bodies extremely difficult! so with that in mind, let’s try to grasp it a little bit better…
our digestive tract senses an initial trigger or invader:: this can be an infection, virus, bacteria, an autoimmune response, a pathogen, or a toxin of some sort. the immune cells that live within our digestive tract sense the invasion & send out inflammatory “help signals” to start the inflammatory process to clear out the invader.
call in the little brother & sisters (specialized immune cells):: neutrophils, macrophages, & lymphocytes rush to the site & start to work to clear the invader or eliminate the cause of the immune response signal. however, smooth muscle is very sensitive, so as these guys start to do their job, the smooth muscle layer of the digestive tract might be damaged in the process. once the cause for the inflammatory signal & the damage is cleared, we start to shift towards an anti-inflammatory state.
during this inflammatory state, our digestion is affected. our smooth muscle might not contract in the way that it needs to move food along, so our digestion is affected. we might also have increased permeability within the digestive tract due to the smooth muscle damage. & finally, some of the communication released from these molecules can affect our overall digestion, motility of the food along our digestive tract, & the signaling within our autonomic nervous system. because the inflammation within our digestive tract can affect our digestion & the permeability of the smooth muscle, we can sometimes have more exposure to foreign invaders, perpetuating the inflammatory cycle. it is important that we work to control what our body is exposed to in this state so that it can switch out of the inflammatory cycle into an anti-inflammatory response.
resolution & repair:: once the signal is controlled, our immune response starts to shift towards an anti-inflammatory state, releasing messengers that limit the inflammatory response & call in the guys responsible for tissue repair.
remodeling & recovery of smooth muscle function:: the smooth muscle undergoes repair & remodeling after damage. again, it is important for this phase to happen so that scar tissue & excessive collagen production along the smooth muscle doesn’t affect how our gut contraction & permeability is affected long term.
since our digestive tract is so linked to our nervous system, it is important that it goes through the inflammatory cycle to help remove any invader or pathogen that might disrupt the functioning of our gut!
so when do we want to inflame? & when do we want to anti-inflame? & how do we help the body transition between the two?
inflammation is required for the healing process, so how do we know when we want to promote inflammation? a lot of it relies on timing, & it totally depends on the tissue type involved & the degree of damage, whether from a wound, invader, or trauma. in general, in the beginning, initially after an injury, we do want to promote inflammation. this is why, in my physical therapy practice, we try to educate patients on why NSAIDs after exercise can affect how their body adapts to the exercise stimulus. in the same way, we don’t want to hinder the full inflammatory process within other tissues prior to when the body is ready to transition out of its proinflammatory state. age also plays a role…the younger we are, the better we are able to heal. as we age, the “normal timelines” for healing start to change, & we need to adapt our expectations. as the time progresses throughout the healing time frame, we want to start to work with our bodies to promote anti-inflammation. i tried to include timelines & symptoms above to help us figure out & understand when we need to promote inflammation & when we need to promote anti-inflammation.
here are a few of the ways we can promote a healthy inflammatory/anti-inflammatory balance::
remove the stimuli:: clean the area of the wound, limit exposure to pathogens, refrain from the muscle activation & length challenge that caused the muscle injury
hydration:: to create good, healthy blood vessel highways & help our lymphatic system clear out the debris!
fueling:: eat nourishing foods so our body can get the nutrients it needs!
breathwork:: overall stress reduction & promoting stress-reducing responses & stress-reducing nervous system activation! (especially if our smooth muscle & digestion is involved!)
a note on systemic inflammation
in the examples above, we are primarily talking about local inflammation, meaning inflammation at a specific region & tissue type within the body. however, there are instances when we experience systemic inflammation. systemic inflammation is slightly different in that it usually involves a low grade inflammatory response throughout the body at the level of multiple tissues, rather than just an inflammatory response at one tissue region because of a certain injury or pathogen. this chronic, low grade inflammation can perpetuate the inflammatory cycle within multiple tissue regions. this inflammatory response is protective! it is important to remember that our body thinks it is in danger, so it cues the inflammatory process to protect us! however, we want to be able to reassure our bodies that they are not in danger, or if they are sensing danger or on edge in some way that we have ways to reduce that perception of danger.
what causes systemic inflammation?
infections:: sustained infections can keep the immune system on high alert
chronic diseases:: obesity, diabetes, autoimmune conditions, & cardiovascular disease can cause systemic inflammation
stress:: heightened stress with poor recovery strategies (sleep, exercise, meditation) & a poor ability to return to baseline can affect the levels of systemic inflammation within our bodies
poor diet:: diets with processed foods & lots of sugar can cue pro-inflammatory pathways within our bodies
environmental toxins:: pollutants, chemicals, & smoking can all contribute to systemic inflammation
how does systemic inflammation affect my body?
just like in local inflammation, systemic inflammation can affect tissues in different ways. in our cardiovascular tissue, just like in the smooth muscle of our digestive tracts, chronic inflammation can damage that lining, increasing plaque build up within our blood vessels & leading to cardiovascular disease. chronic, low grade inflammation can also affect how our bodies respond to insulin. with increased inflammation, our bodies become less sensitive to insulin, leading to poorer metabolism, poorer management of blood glucose, & contributing to type II diabetes. in our musculoskeletal system, chronic, low grade inflammation can lead to joint pain & poor response to exercise. in normal exercise, we want an acute elevation of those inflammatory processes to help us build muscle, but in chronic, systemic inflammation, our body doesn’t tolerate exercise as well or recover in the ways we need it to in order to get the benefits of exercise. our muscles fatigue quicker, don’t build back up as quickly, take longer to recover, & have a higher risk for injury. our nervous system can also be affected with low grade inflammation, feeding into our gut health/digestive tracts & contributing to neurodegenerative diseases like Alzheimer’s. systemic inflammation is no joke & can lead to a variety of different challenges if not kept in check!
so how can i manage inflammation?
fueling/diet/nutrition:: limiting pro-inflammatory foods like processed foods, alcohol, & allergens your body might not tolerate as well
sleep:: sleep is when our body heals & recovers! if you’re not getting sufficient sleep for your body, then the recovering, flushing out, & cleansing of your brain & body might not be happening as efficiently. focus on cleaning up your sleep routine, & check out this episode & blog post to help! (& understand how our brain cleanses!)
movement/exercise:: this one can be tricky, especially if you are in a chronic, inflammatory state. making sure to incorporate a proper warm-up, cool-down, & exercises within your body’s tolerance is super important! i would recommend starting slow, controlled, & shorter in duration, & incorporating parasympathetic nervous system practices like breathwork to help your overall recovery! this makes me think i need to build a systemic inflammation program!
stress management:: okay this one annoys me because telling someone to better manage their stress is so much easier than actually doing it! however, i’ve found that actually setting aside time in my day to focus on mindfulness & breathwork & putting it in my calendar really helps!
exposure to toxins:: this is a constant work in progress, but limiting exposure to certain toxins in cleaning products, candles, the air, skincare products, make-up, etc. can really help limit our exposure to stimuli that can contribute to that low grade inflammation!
how can i tell if i have chronic, systemic inflammation?
there are a few blood markers to look for that can give an umbrella perspective on systemic inflammation. having elevated levels of c-reactive protein (CRP) & interleukin 6 (IL-6) can be markers of systemic inflammation, but you don’t necessarily need a blood test to tell you. if you experience any of the symptoms, it might be worth it to take a look at some of the strategies to manage systemic inflammation to see if there are 1 or 2 that you might be struggling with incorporating in your own life. try setting a few actionable goals to help you focus on those areas to see if that affects your symptoms. it usually comes down to the interplay of all of these variables, so focusing on 1 or 2 at a time can really help us set goals, see results, & learn to be consistent with some of the habits we need to incorporate to better help us manage systemic inflammation overall!
okay well that was a lengthy blog, but i hope it allowed you to see the important role inflammation plays within our own body, how to better manage our own inflammation, & how to promote anti-inflammatory processes when inflammation has gone on for too long! take a listen to our podcast series on the topic to find out more!
thanks always for reading & supporting! in health & happiness,
kelsy
references
Landen N, Li D, Stahle M. Transition from inflammation to proliferation: a critical step during wound healing. Cell Mol Life Sci. 2016 May 14. Accessed November 7 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC5021733/#:~:text=The%20wound%20healing%20process%20is,1%20year)%20%5B1%5D.
