“Man is free to choose not to be conscious, but not free to escape the penalty of unconsciousness: destruction.”
~ Ayn Rand
Case 2: Healthy inflammatory response that plays out such that it results in more tissue damage.
There are some instances where the body mounts a healthy inflammatory response and it is just too much. One example of this would be compartment syndrome. I have only observed this one time my career. The person was an elite rock climber who had just spent weeks in the desert putting up new routes. She had so much inflammation in her forearms that the pressure from the swelling was causing tissues to become ischemic (essentially dying from lack of blood flow). This was clearly a problem and needed outside intervention. I think in this case she was able to control the issue with anti-inflammatories but in other instances the person may need what is called a fasciotomy where a surgeon goes in and makes cuts in the fascia that separate the different compartments of the forearm (or lower leg) to release pressure and prevent tissue death. Some may disagree but I would argue that this was a healthy inflammatory response. The amount of inflammation was proportional to the circumstances (essentially a crush injury from so much climbing) but, given the body part affected, it became a problem.
I would also put in this category cases where people undergo a very large surgery or multiple surgeries at once. Examples of this would include someone with multiple broken bones and maybe lacerated organs after a motor vehicle accident or someone with second- or third-degree burns covering substantial body surface area. This is not an area where I spend time in my practice but I believe what happens here is that the body mounts an inflammatory response that, although proportional to the tissue damage, can be just too big to handle without outside support. Anyways these situations are important to acknowledge to better comprehend the more typical “inflammation gone right” scenario, but they will not occur with your average injury.
Case 3: Healthy inflammatory response that is chronically stymied by activity, medication or another modality.
I find cases in this category to be quite common. This is the case of an everyday tissue injury that never gets a chance to go through the motions of inflammation because the process is chronically or almost constantly interrupted with activity, anti-inflammatory medication such as Ibuprofen or use of ice or massage.
Here is a fairly common example that may sound familiar to you. Our subject is recovering from a minor knee surgery called a meniscectomy (but this really could be any other injury). She is a go getter and does not like to take down time. She takes Ibuprofen every time her knee hurts. Sometimes this really does a great job of taking away any amount of pain that she has so she will then subsequently do all kinds of work around her house, mow her lawn or even go on a hike. Then, when the Ibuprofen wears off, the flood gates of her body’s inflammatory response open with a vengeance. She has kept her body from doing its job for too long and, additionally, she created even more tissue damage doing all of that activity while the pain was masked. Now her body has to deal with that too. She is then miserable with pain and swelling, does not sleep well, and lies awake at night wondering what is wrong with her knee. Visions of additional surgeries and long complicated diagnoses dance through her head. The next day she is exhausted and can’t comprehend tolerating another hour in pain so it’s Ibuprofen down the hatch again. Eventually, after a few days of relatively little pain, she thinks (she hopes!) that she must be better so she goes out and does a normal amount of activity for her as before. The Ibuprofen is doing its job and she is able to get through it. Then that night she is miserable and in pain. Again.
In this particular case, this cycle repeated itself for almost two months. Every time this person came in to see me, we had a similar conversation. She would drill me as to “what was wrong” and “why can’t I just get back to normal?” My answers also sounded like a broken record as I refused to deliver any more technical sounding of an explanation besides that stages of healing were being interrupted. Then I would also beg her to stop taking Ibuprofen or at least to hold herself back from doing her normal activities until she had built up to it. Just when it appeared that we would be on this hamster wheel forever, someone told her that Ibuprofen put you at greater risk for severe COVID and she finally stopped taking it (I am not saying this is true or not, I am just relaying the story). Afterwards, she did have some pain in her knee throughout the day and this resolved in just three days. She got back to mowing her lawn and doing a full day of activity about a week later.
Many do this because they don’t see the terrible bargain they are making. In an effort to return to activity as quickly as possible and to avoid discomfort, they sign up for weeks or months of recurring pain and swelling. All this when the other option was a few days of pain and resigning one’s self to being laid up. I know what I would pick having seen each side of the coin and I do put this into practice regularly. Just last night I had a splitting headache that was so bad I didn’t even want to read or eat. I had been stressed earlier this week and I calmly took this headache as a sign that my brain needed to play catch up on some routine repairs that had been neglected. So, I just laid in a dark room trying to sleep for a few hours. Was this fun or comfortable? Absolutely not. But I am perfectly fine the next day, I anticipate not having recurring headaches and I am glad to suffer for a few hours as opposed to messing with my nervous system’s ability to heal itself.
I want to discuss one caveat here. Anti-inflammatories are a powerful tool. Humans are incredibly clever beings to have invented them. Is there a time and a place to use them? Perhaps. What if you are on the last day of a ski trip and it snowed a foot overnight but your knee is hurting? You might consider taking an anti-inflammatory to help yourself through. What if you got a headache right before you were about to go to Elton John’s last concert ever? This could be why humanity created Ibuprofen and it’s your opportunity to find out. What if you are a single mom and you broke your finger when you slammed it in a car door which only happened because you were rushing because you were late to take your child to her therapy appointment and it is right before finals week and you are one term paper away from graduating and thus bettering your life immeasurably but it is too painful to type? Maybe some Ibuprofen wouldn’t be the worst thing right now. What if something far less dramatic is happening but you hurt and you just can’t handle it right now? Man, I don’t know! I firmly believe that no one can tell you what to do. You are a sovereign being with the power to weigh the consequences of augmenting your bodily functions and experiences with your present goal. It could only be up to you if it is worth it or not. My voice is here not to tell someone what to do or not do but to be informed about it. Go ahead, take anti-inflammatories, overdue on activity, ice yourself until you can’t feel anything. Only do this with full knowledge of what you are doing. You are messing with necessary functions of your body’s immune system and it will (not might, will) catch up to you later in one way or another.
Best of luck in your decisions.