Today I want to talk to you about pain and inflammation. The two tend to go hand in hand even though from a body point of view they're quite separate. Pain and rehabilitation seems like a very short subject. If I've got pain, I can go to the doctors or the chemist and I can get medication to help with both. So I can get over-the-counter painkillers that are quite strong, paracetamol, aspirin, those type of things. I can also get ibuprofen or Nurofen for anti-inflammatory. If I need stronger medication I can get Co-codamol or Naproxen from the doctors on prescription. The next level is more injection based, and relates to hospital intervention with steroid injections or morphine based medication.

How this medication works is by shutting off the pain communication system so it stops the nerves communicating. So it's a bit like turning the power off to your computer and saying, right, there's no more signal, so because there's no signal, it's fixed.

So importantly pain killers don’t  actually help anything, they just switch the system off. Now when you think about it in those sort of formats, you think, okay, well what would happen if I didn't take the medication?

How would that work?

What did we do before medication?

All pain signals are sent to the brain, that’s where you feel pain. So the actual tissue itself doesn't feel pain in that way. The reason for pain is it's communicating to help at a physiological level from a cellular point of view to send lots of cells to help deal with the injury or the problem, whether it's an infection, whether you've cut yourself, broke something, injured something, it's about the body trying to repair itself, and to rebuild the tissue. So that's what pain's for. The other thing it's for is to stop you moving around. So if you hurt your foot, you don't want be walking on it. If you hurt your shoulder, you want to support it and hold it.

The next phase in healing is looking at inflammation. So what happens is the affected area swells up if that's internally or externally, so you can't always see the swelling. The swelling means it holds lots more cells there and fluid so that it can repair the damaged tissue. So it's got a lot more cells to do the repair work. As the tissue goes into the remodelling phase the swelling reduces as the tissue heals and you enter a rehabilitation phase. So you've got three clear steps, pain, inflammation, remodelling.

Now pain and inflammation tend to feel like they're coming at the same time. So you tend to get caught in a pain inflammation loop where your body repeats the cycle every time it feels pain. That is why rest is important or immobilization so the body can heal.

Now the problem with pain killers and anti-inflammatory drugs is they stop communication with your brain so your body does not follow the pain inflammation cycle and send the required cells to reduce pain and increase inflammation to repair the damaged area.

Fortunately medication is temporary which is why you need doses at regular times in the day for pain relief. From my previous blogs you'll know that the nerve system is 98% electronic and only 2% chemical, which is why you need medication quite regularly for it to be effective or to actually last and feel anything. And if it's quite severe pain you'll find that you'll need stronger and stronger medication to have a bigger impact on your nerve system.

So when the medication is effective its stopping the natural body repair process. As the medication wears off the body starts sending natural pain relief chemicals and inflammation cells to start repairing the damaged area.

So why do we have medication ?

It hurts and we want it to stop! We have all been there, but our lives get in the way. We have to function at home and work look after family and friends so we over ride the rest and immobilization option and work within the limits of pain relief.

This can start a pain inflammation cycle so when the pain relief is wearing off, the body starts healing its self. Which is why if you have anti-inflammatories, it can take quite a long time for your body to reduce the swelling because every time the medication wears off, your body's desperately trying to get in to put some inflammation there to be able to heal that part of your body.

When the pain relief wears off and most of that is when you're asleep at night then your body's trying to send all the various chemical cells to be able to help with pain relief naturally because obviously then the pain starts to increase that’s why if severe you wake up. Your body is more aware of the pain as the medication has stopped working and the communication is back open.

Now the reason I mention night is that most of your growth and repair is done when you are asleep. So you've got two nervous systems, one that you can control and one that you don't control. So the one that you control is the one that I'm using now I am moving my hands to type this. So all of the stuff that you can consciously do, is controlled by one nervous system. All the things, the important stuff as I call it, that you can't control, like breathing, heart rate, digestion, Oh, tissue repair, it's all done automatically. Now within that, most of that automatic system is most prevalent and most active when you're asleep, which is why sleep is so important, around 8 hours.

So the reason why babies sleep is so important is physical development and growth and repair. Athletes adopt the same process and sleep in the day to recover from hard training sessions and do multiple sessions in a day. lots of athletes will rest massively before a big event or a race and do very, very little hardly move around, so that the body is in the best condition to be able to perform.

So we've got pain and we've got inflammation and I've said if you have a painkiller or an anti-inflammatory, it cuts off communication. But when that communication starts to open up channels again because the pain relief and the anti-inflammatory is wearing off, that's when your body starts to jump in to help the situation. Now the other problem is if you have pain relief and anti-inflammatory, what tends to happen then is you can overcome a problem because mentally you can't feel any pain. So because you can't feel any pain, you can override your nervous system to be able to walk, to move your arm, to go upstairs, to jump up and down, to jog, to do all sorts of things within the limits of the various pain relief or the anti-inflammatory.

The Key thing to note is that pain killers cut communication and stop pain they don’t repair tissue it’s the same for anti-inflammatory medication.

So they don't actually help at all with tissue repair.

We take medication to speed the process up and get on with our lives.

An example might be we fall and hurt our knee, its painful when we walk and it starts to swell. The biggest problem in the knee swelling up is movement. So what the body's trying to do is to stop you moving it with inflammation and pain when you stand. We  to sort of balance that with everyday life you need to do some movement but it needs to be unweighted so it needs to be not loaded and lots of people still walk around and oh, I'll manage this or I'll stand here or do this, it's about doing at least amount in that first 24 hours.

That's not always the case. I'm not saying it is, but if you can, it'll make a big difference. And then also it's about recovering in steps. So what people forget is that the reason for pain is it's a limiter. So the idea is if it starts to become painful, okay, how painful is it? And we use a pain scale. So if you're around a two and a three, that's quite low level pain. A six is quite intense. Eights, nines and tens is you should definitely be sitting down and not doing that activity. But we do, we have the capacity to overcome pain at quite a high level, and there's loads of examples of people doing it, but you can definitely overcome pain for a short period of time. So what you need to look at is within threshold what you can do with that pain level today inflammation is something to worry about less so lots of people with inflammation use either heat or cold treatment.

In doing hot and cold treatment they're looking at manipulating your circulation. So what the heat does is it forces blood and it's a bit like breathing out so it forces blood to move back to the heart to get recycled and move to other parts of the body so that it can cool down because your body likes to be at a certain temperature 37 degrees. So by putting heat there, it forces the blood to move, which takes cells, which takes some of the waste products which is a good thing. Conversely, lots of people use cold, which is to calm down inflammation. What they actually do is stimulate more blood flow to the area to warm it up, so over time it increases blood flow and inflammation. I suggest that you do a combination of hot and cold to increase blood flow and toxin removal.

People tend to do too much in the initial stages of a injury and not enough once they are up and moving again. I suggest low resistance movement in the day at frequent times to help start the mobility process. For example if sitting in a chair with a knee injury do 9 leg raises, break. Do it again short break, do it again. And then the next hour do exactly the same. The next hour do exactly the same. It doesn't need to be weighted, it's just literally moving the joint. That can be a knee, it can be a hip, it can be an ankle, a shoulder, a hand elbow, whatever. It's to move the body by moving the body. What you're doing then is obviously helping with circulation, which then helps with this inflammation but also the pain elements for swapping cells around so that it's constantly fresh cells. If these fresh cells they can help with the pain, help with the inflammation.

The last thing is obviously moving generates electricity as we know by generating electricity that's directly helping the cells. So it means the cells don't start working anaerobically, which means without oxygen because they're getting tired and they're in that area and they're working quite hard. It allows the cells to work longer using aerobic respiration as opposed to anaerobic. And the difference between the two, aerobic respiration is like long distance running. So using an athlete, we could use someone like Mo Farrah, he's good at running long distance, he does it at a fast pace and he's won loads of medals for it, but he keeps going at a very quick pace. Bear in mind that his marathon pace is 13 miles an hour, which is faster than most normal people can sprint.

Then you've got the other extreme where it's very, very short duration but high output. So that would be looking at sprinting that anaerobic sort of respiration. What means is that you can have a really fast big acute change and that tends to happen very early on in the first phase when you've got high pain and you've just hurt yourself. All the cells go into almost panic mode and they work anaerobically. So they work at very high intensity but waste a lot of energy. So that's a bit like Usain Bolt and sprinting. So they move over a known distance a hundred meters in that example over a very quick time. So it's very, very fast and they're running at roughly 26 miles an hour. So that's a lot faster, but they can only maintain that for a short period of time. So when you initially have pain it's really, it can be really, really like, oh god, it's absolutely killing me. It crashes quite quickly. When I say it crashes, it comes down to it's really painful, but going from a nine or a 10, it drops down to say around a six intense pain quite quickly.

And the reason for that is all of your pain cells, your natural body healing has all jumped into try and help the situation. They've all worked anaerobically so they've worked without oxygen 'because they produce things very, very quickly. The next phase, what you want and where it takes that time is to work a slightly slower pace but work aerobically so that they're working with the body in that sort of sense, which is why the transfer is so important. Now if you can keep moving, you generate electricity which helps the cells work aerobically for longer, but it also helps the cells that were working anaerobically to start working aerobically. So you get like a double whammy, a two for one. So the movement, even though it's not loaded, really, really helps, but not just for helping reduce swelling and maintaining contained knee movement in this example, it also helps on a physiological level.

So anything to do with pain and inflammation, consider how painful it is, the type of medication, what happens in the sense it switches off communication, what you can do to help that, what movements you can do to help that. And then going forward how much medication you take. Now the majority of people I speak to and work with, they do regulate how much medication they take, most people appreciate that the side effects and long-term use of medication isn't necessarily good for the body. Everybody, myself included at some point has had to have medication. I've had two or three major surgeries. So yes, I want you to knock me out. Yes, I want the epidural pain medication. I don't want you to do a hip replacement without, I think that'd be quite painful.

But, by the same token, I've not had lots of pain relief post-surgery.

Remember you body is healing itself all the time and has complex mechanisms for growth and repair. A good example to finish. If you break your arm, it’s extremely painful, so you hold it and stop moving it. The pain reduces as you are at the hospital. At the hospital they x-ray the arm, put it in the correct place and then plaster it to stop it moving. The body does the rest and after 6 weeks its completely healed by its  self then you can move it and just need to exercise the muscles.

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About the author

Stephen Grinnell MSc Health and Rehabilitation
Pain and Physical Rehabilitation Specialist
Stephen has had his own Pain and Rehabilitation Clinic for over 11 years where he has treated well over 2500 people with lots of different pain and injury issues. Stephen’s personal physical rehabilitation journey started with a serious injury while on active service with the Royal Marines 25 years ago. This injury resulted in a long journey of complementary rehabilitation and two replacement hips. Stephen has developed his own bespoke treatment protocols using a variety of medical devices to help pain and inflammation resulting in accelerated recovery. Expert areas of focus are Plantar Fasciitis Treatment, Back pain issues particularly Lower Back and Sciatica and hip and knee replacement rehabilitation. Stephen previously had a successful academic career lecturing at a variety of Colleges and Universities in the Sports Science, Rehabilitation and Training areas. Stephen has also worked in The Queen Elizabeth Hospital Physiotherapy department during the Covid 19 Pandemic helping the recovery of COVID patients. In 2022 Stephen has been extensively researching and trialling protocols to treat plantar fasciitis. His Expertise has resulted in the successful treatment of 103 people and counting with a current success rate of 93%

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