Question

I have had the repeated experience of going to physiotherapists with injuries to ligaments or joints and they all expressly aim to reduce inflammation. I don’t understand this. Our mammalian (and previously reptilian ?) bodies have been using inflammation for hundreds of millions of years (mammals have been around for 167-220 million years). Surely this is a tried and true response to injuries and healing injuries - those organisms that practice it have been selected for because it works. Do all mammals experience inflammation in response to injuries? Do reptiles? Why is inflammation considered to be a bad response? Or in other words - why does my physiotherapist(s) actively fight hundreds of millions of years of evolution to stop this response? I understand that stopping inflammation reduces pain- but surely it also stops natures tried and true native healing response?

Answer 1

Inflammation is a beneficial acute response that can become harmful if it turns chronic. Physiotherapists aim to reduce chronic inflammation to prevent tissue damage and improve healing rather than challenging the natural acute inflammatory healing response.

Step-by-step explanation:

Inflammation is a natural response to tissue injury, and it serves to limit the extent of injury, eliminate its cause, and initiate tissue repair. This response is seen in all mammals and likely in reptiles as well, given its evolutionary conserved presence in vertebrates. While acute inflammation can be beneficial, it's the chronic inflammation that physiotherapists aim to mitigate, as it can lead to tissue damage and disorders like arthritis or tuberculosis.

During the acute phase, inflammation is characterized by redness, warmth, swelling, and pain. It involves the release of chemical signals from injured cells that cause vasodilation and increased fluid in the tissue, as well as attracting immune cells to the injury site. If the inflammation is not resolved and becomes chronic, it can cause further tissue damage, establish a persistent inflammatory state, and impair proper healing. In such cases, interventions to reduce inflammation can facilitate recovery and restore function.

Therefore, while your physiotherapists seem to challenge evolution by mitigating inflammation, they are actually distinguishing between the helpful acute inflammatory response which aids in healing, and the harmful chronic inflammation which they aim to prevent. By reducing excessive inflammation, physiotherapists help alleviate pain and encourage better tissue repair.