Starting Strength

Stopping the Spread of Misinflammation

by Jonathon Sullivan

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“The one thing everybody knows about inflammation, even your dog, is that it sucks. Your injured paw (or whatever) is hot, swollen, tender, and throbbing, and it doesn’t work so well. Chasing that squirrel just isn’t as interesting as it was a minute ago.  Inflammation is nature’s way of saying: ‘You just f*cked up. Maybe you should stop and limp on home.’”

INTRODUCTION: LOTS OF HEAT, LITTLE LIGHT

There’s an idea floating around out there, in that ill-defined nebula that we could call the Fitness Community, that seems to be picking up steam. It’s an idea whose proponents pride themselves on being iconoclastic and cutting edge, on slaying sacred cows, on bashing the longstanding conventional wisdom of clueless doctors and fuddy-duddy ironheads of the Old Guard. A recent and apparently virulent exposition of the idea can be found in this video, a presentation that will allegedly “blow your mind.”

As expounded in this video and other sources (see, for example, here, here, here, and here) the idea is this: inflammation is how we heal, how we get huge, and how we get strong. Therefore, things that suppress inflammation are bad for you. From which it follows directly that acetaminophen, aspirin, nonsteroidal anti-inflammatory drugs and cryotherapy (cold therapy; ice and other such interventions) are no-nos. We Were Wrong about ice and NSAIDs, the daring iconoclasts tell us, charitably including themselves among those who once cleaved to superstition, and thereby underscoring the difference between themselves and those benighted souls who still won’t see the light. So Wrong.

To be fair, the idea that interfering with the inflammation of injury or training would slow your healing or hold back your gains is not new. For example, Abadjiev and other exponents of the Bulgarian method seem to think so.(1) Questions about the effect of anti-inflammatory interventions on healing, hypertrophy and adaptation have been bandied about in the biomedical literature for quite a while, as we’ll see. What seems to have changed, at least from where I’m standing, is how confident and vociferous the proponents of these ideas have become. Watching the video (which racked up about 35,000 hits on YouTube inside of ten days), you’d think the question was settled: ice and NSAIDs will screw up your training. The science says so. At 11:05, Kelly Starrett and Gary Reinl suggest that the literature offers us a scientific consensus on this issue. So it must be true.

Right?

Well…let’s put a pin in that. Let’s step back, and take a look at where all this is coming from. From where I sit, the anti-anti-inflammation (AAI) guys seem to be coalescing around the following arguments:

1. Inflammation is the body’s natural—and therefore correct—response to injury. Your body knows what it’s doing, so interfering with the inflammatory response is ill-considered from the git-go.
2. Without inflammation, the body would never heal. You want to heal, don’t you? So why in the world would you intervene in the inflammatory process?
3. Without inflammation, muscles cannot adapt to training stress with protein synthesis and hypertrophy. Therefore, interfering with training-induced inflammation (i.e., delayed-onset muscle soreness (DOMS)) will stunt your gains.
4. The scientific literature overwhelmingly supports all of these contentions, and the issue is essentially settled for Those In The Know. In particular, many AAI exponents point to the literature review on cryotherapy published in the Emergency Medicine Journal by Collins in 2008(2); a 2001 study by Trappe showing that ibuprofen and acetaminophen dampen post-exercise muscle protein synthesis,(3) a study by Mikkelson published in 2008(4) concluding that anti-inflammatories block the activation of satellite cells in skeletal muscle after injury, and Novak’s 2009 study of skeletal muscle hypertrophy in mice.(5)

This isn’t Tinfoil Hat stuff. Right or wrong, these claims are not irrational, and they deserve to be considered. So… let’s consider them, shall we?

I hope you’re Getting Your Nerd On.

INFLAMMATION: A GEEKY REVIEW FOR INTERESTED ATHLETES

Inflammation is an ancient, primitive and nevertheless highly elaborate response to insult or injury—just about any insult or injury.(6) Inflammation is involved when you sprain an ankle, sustain a burn, catch pneumonia, go into anaphylactic shock from a bee sting, deteriorate from a wheezing fit to status asthmaticus,(7,8) do a high volume of heavy squats, get appendicitis, have an ischemic stroke,(9) go into septic shock,(10) or start raising antibodies against yourself, as in the autoimmune diseases.  Inflammation is horribly complex in the particulars—it remains a vibrant field of investigation. But the broad scope of the process is well-understood and easily apprehended, even by doctors and fuddy-duddies.

Inflammation begins when injury, infection or some other insult exposes the tissue to pro-inflammatory substances. Such substances constitute a diverse range of biomolecules and toxins, including environmental irritants and antigens, bacterial and viral products,  and inflammatory mediators produced by our own cells. These substances engage in a complex web of interactions with tissue and the immune system to trigger profound changes in the injured area, which manifest as the classic clinical signs of inflammation: tumor, dolor, rubor and calor. That’s swelling, pain, redness and heat, for those of you who, like me, are a bit rusty on your Latin.

That’s the big picture. Let’s fill it in by doing what people like me always do when confronted with the task of explaining complex physiology: put up some geeky cartoons with lots of arrows and tell a story.

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