Massage should consider the effect of Inflammation on Pain

Inflammation is how a body responds to injury, in the same way that your immune system fights off bacterial and viral infection in a sore throat.  Both begin with an immediate local response designed to protect the body from further injury and tissue damage. Inflammation is an aggressive process that initially causes swelling, heat, a loss of function, redness and pain  (SHARP symptoms). Unchecked, inflammation leads to additional tissue damage, which can lead to more Pain. This is why it is important to match massage treatments to your stage of inflammation: an incorrect assessment can interfere with or  prolong the natural healing process.

Describing symptoms, goals and treatment options for each stage of inflammation (SOI) is complicated.  This post presents general information about inflammation and pain. Future posts will be devoted to elaborating on each stage of inflammation (SOI) and how massage can alleviate your symptoms.  This series is designed to help those trying to rehabilitate from an injury or pain, so the goal of pursuing an active, fulfilling life is aligned with how the body is trying to heal. Here, I generally describe the process of inflammation, what purpose it serves in healing, and briefly outline the unique physiology of each stage.

Why is inflammation so aggressive?  Inflammation attacks potential invaders and walls off a hurt area so that a local injury doesn't become a systemic problem.  Acute pain also slows you down so that you don't keep re-injuring yourself.

Why slow down inflammation when it is a natural part of healing? Inflammation is a very aggressive process which can damage healthy collateral tissue as well.

When used correctly, massage and other forms of bodywork can speed healing, while minimizing pain. This why it is important to match treatments, especially massage treatments, to the stage of inflammation (SOI) you are experiencing. This requires critical thinking by both treatment providers and treatment seekers about the symptom patterns involved with each stage.  Addressing SOI is an essential part of my medical massage and qigong practice for people with medically complex conditions, located at Earthbody Wellness Center, 3810 SE Belmont St., Portland, Oregon, 97214. If you would like to schedule a consultation, click on Contact Me, 

I have been taught to recognize 5 stages of inflammation: Each stage has its own unique physiology and symptom picture.  Treatment goals aim to reduce problematic symptoms related to each stage. Once goals are identified, optimum treatment techniques, hydrotherapy and self care become clear and follow critical thinking guidelines.  A seasoned massage therapist should be able to understand your somatic pathology and stage of healing and together with your input, figure out what will be most helpful.

Briefly described, the five stages of an inflammatory response are:

1. Acute (0-3 days approximate) - Tissue has been broken down due to recent trauma. White blood cells (WBC's) migrate to the area to protect against and clean out toxic substances.  Fibrin and platelets are laid down in the area to wall off the local injury and form a net to catch white blood cells. The area is RED, HOT, SWOLLEN and PAINFUL.
2. Early Subacute (2 days - few weeks) - The damaged area is being filled in with new but very fragile blood-filled connective tissue.  Like a latticework or a scaffolding for a future building structure, this granulation tissue lays down the groundwork for new collagen to fill in.  The area is still RED, HOT, SWOLLEN, and PAINFUL but less so.
3. Late Subacute (2nd - 3rd week) - The latticework is being filled in with more collagen, a triple helix compound which is very stong.  Cross links of collagen reinforce the delicate cheesecloth-like granulation tissue: these cross links of collagen are laid down along lines of stress, and the area is remodeled to reflect those tensions. There is some possible remaining edema (swelling) and pain is less widespread.
4. Chronic Inflammation (3-4 weeks up to years after an injury) - Tissue is now continuing to remodel and reorient to accommodate pulls and tensions on the muscles that were injured.  Remodeling proceeds rapidly in the first few months and then slows. Scars harden and strengthen.  The area can feel cold, hard, and look white or blue. Muscle may be weak and range of motion is limited as the scar connective tissue is not functional like a healthy muscle would be. Pain is pinpoint and usually not felt at all, unless there is pressure or stretch directly on the area.
5. Resolution or Chronic Pain (chronic pain is defined as ongoing pain for more than 6 months)  Chronic pain is when the nervous tissue has become so protective that it is overly sensitive, even though the original injury is mostly resolved.  Resolution is when the tissue performs, for the most part, like healthy muscle.  Remnants of scar tissue do compromise the tissue so it is never fully as functional or elastic as it once was.

The time frame for each stage is approximate, depending on the severity of injury, how large the affected area is, and if the client receives appropriate bodywork and self care recommendations to recover. In my next blog, I will elaborate on appropriate care for the acute stage of inflammation, so stay tuned.