chronic inflammation

[tweakxc03]

Just a quick question on inflammation from say a sprain, strain, or tendonitis, I've recently been told that inflammation won't go away on its own with rest, and that you have to actively treat it with NSAIDs, ice, etc. This doesn't seem too far out of line with what I've read on here.

Why exactly is this the case? I have an irritated achilles tendon that's been nagging at me for a few weeks. I've been slack on rehabbing it, thinking it would eventually just go away. What makes inflammation "chronic" for lack of a better word, without active treatment?

[Mark Rippetoe]

That's a Sully/Feigenbaum question. But my stab at it would be that connective tissues are not sufficiently vascular and do not contain the cellular machinery to heal themselves rapidly and effectively like more active tissues, i.e. muscle bellies, do. That being said, they do heal if you make them.

[Titanium]

One resource: "Treat Your Own Achilles Tendinitis" by Jim Johnson.

Apparently the pain persists due to structural changes that locked-in while the tendon was trying to heal but was not given adequate recovery.

The usual treatment involves eccentric exercise to restart the healing process.

Johnson says on page 37: "...the idea with the eccentric training is that it is okay to have some discomfort when you do the exercise, but when you can do the exercise without any discomfort, add some weight to keep stimulating the healing process. Keep repeating this as you need to over the 12 weeks.

"And why 12 weeks? Well, remember that every time you do the exercise, you're sending a signal to your Achilles tendon to re-model itself. Recall the studies we discussed earlier in this chapter that show it takes a 12-week period for the Achilles tendon fibers to realign themselves and get rid of the abnormal neovascularization that has taken place.

"While it may seem just plain nuts that you have to do a briefly uncomfortable exercise to get rid of pain, it's been shown over and over that doing eccentric exercise in this manner is highly effective, a few examples being the five randomized controlled trials listed at the bottom of page 30. So do expect to have some discomfort while doing the exercise, although you definitely need to stop if the pain becomes too intense."

[Jonathon Sullivan]

That's a Sully/Feigenbaum question. But my stab at it would be that connective tissues are not sufficiently vascular and do not contain the cellular machinery to heal themselves rapidly and effectively like more active tissues, i.e. muscle bellies, do. That being said, they do heal if you make them.

That's a pretty good stab, although the mechanisms of chronic inflammation are still under study. It's also important to point out that there is a spectrum of chronic inflammation, depending on tissue type, underlying injury, etc. For example, a true subacute or chronic tendinitis is very different from a chronic autoimmune arthritis or a recacitrant osteomyelitis.

And it's important to differentiate tendinosis, which is a chronic state of histological degradation accompanied by pain and mechanical dysfunction, from tendinitis, which is typically more acute and more classically inflammatory. The two are often confused in the modern medical mind, which of course is pre-confused anyway. And the treatment is different. In my opinion the treatment for acute tendinitis is rest, anti-inflammatories, re-evaluation and correction of technique, and early return to function.

The treatment for tendinosis may include surgical debridement or repair (if there are gross defects). But the ideal, definitive approach would be to load the tendon through a natural range of motion at progressively higher intensities, forcing it to adapt by increasing its cross-sectional area and stiffness.

If only there were some way to do that. Of course there isn't. That's why we have Vicodin, Workers' Comp, and The Rascal. Thank God.

[Desp]

I found this article some time back in search of fixing my tendon pain from playing racquet ball - http://www.rockandice.com/lates-news...s-dodgy-elbows

Seems after many years of medical training most doctors don't know the difference between tendinitis and tendonosis. Also like other injuries active recovery is the only way to heal it, as doing nothing, did nothing to help my problem.

Mine developed pretty bad right around the same time as another friend. He went to the doctor, I went to google. His doctor prescribed him cortisone shot, I exercised. After 3 cortisone shots his problem still persisted, I suggested he read the linked article and try to do some exercises to work it out, he said his doctor told him not to use the arm and they put it in a sling. After several months the pain kept coming back worse and they did surgery. Something with cutting and reattaching the tendon, I believe. After he was able to use his arm again and he did something to use it at near maximal effort (unscrewed a tight lid?) and the pain came back... hmmmm...

As described in the article I did weighted eccentric exercises for the painful areas and it seemed to completely cure it.

Also I haven't heard it mentioned very much, but couldn't a diet high in Omega 6 compared to Omega 3 cause systemic inflammation that could potentially be resolved by balancing that out and maybe removing common food allergies like gluten and other things most people are allergic too?

[Mark Rippetoe]

You think most people are allergic to gluten?

[Adam Skillin]

You think most people are allergic to gluten?

Yeah, that's definitely not the case. But most people are better off without it.

[silachoo]

You think most people are allergic to gluten?

my first thought

[Desp]

You think most people are allergic to gluten?

The research I've read indicates most people are allergic too it at some level. No necessarily Celiac gastrointestinal severity but low level food allergy inflammation.

I've eaten "clean" most of my life, 'healthy' whole grains never researching in depth, after researching more I saw the benefit to cut out grains. After experimenting on many occasions I can definitely tell a difference. It takes about a week of me being gluten free for my sinuses to completely clear. My cheat day would normally be Sunday, and my workouts would stay the same (M-W-F). Sundays after eating something high in gluten I would wake up Monday morning with my ankles and feet feeling swollen and my sinuses congested. The worse reaction I've had so far was eating gourmet pizza for a special occasion (birthday), we had a lot of pizza and a pasta, all made with "High Gluten Flour" (said on the menu). The next day I couldn't breath through my nose I was so congested and my whole body was sore.

Many people will also notice a cognitive increase by removing gluten. It's so readily consumed without specifically trying so very few go without it, thus by many standards they always 'feel fine', not necessarily ever knowing the difference.

It may behoove one to eliminate and monitor.

[Jonathon Sullivan]

You think most people are allergic to gluten?

This would certainly explain why wheat and cereals have played such a small role in human history and the development of civilization.