“Nature does not hurry, yet everything is accomplished.”
~ Lao Tzu
After the last post we know that inflammation is not a mistake our body makes but is a necessary and intricate process that we can love and understand. So now let’s spend some time thinking about what to do during the inflammatory stage of healing to enhance outcomes.
First, I want to talk about the fundamental mindset. When inflammation is present the distress level can be high and it is easy to start thinking that something is very wrong. However, if we ask ourselves the question “is my body’s response to injury a mistake?” this can refocus the situation. It is time to dig your heels in and trust your body. Also part of our fundamental mindset is how we view pain at this stage. I think of pain not as a malicious byproduct of the situation but rather as part of the exquisite design. My body needs rest and time away from certain activities while inflammation is taking place and thankfully pain is there to tell me not to do things. Without pain we would certainly overdo and disrupt inflammation at work.
With this attitude we are ready to fully embrace the situation. What can we do now? Really there is no magic potion at this stage. Our biggest job is to not get in the way of the work that our body is trying to do. Are you picking up on a theme of acceptance here? It’s not totally out of your hands though. There are things that you can do to help yourself and I have listed them below with categorical headings.
Nutrition: Following injury or surgery, a body’s nutritional needs, especially for protein, increase significantly. Not only does the body need fuel and building materials to repair tissues but it also needs to keep up regular bodily functions and maintain our precious lean body mass. Although we should be doing this everyday of our lives, it is especially important to focus on drinking plenty of water, consuming enough protein and micronutrients and also avoiding processed carbohydrates and fats during the inflammatory stage of healing. My estimate for protein consumption is between 0.8 and 1.35 g/lb of body weight depending on sex and how active you are. I don’t believe we need to do anything fancy with micronutrients. Just keep (or start!) eating a rainbow of fruits and vegetables.
Sleep/rest: The body needs rest right now. Sleep is when the body does its best repairs so I recommend 10 or more hours of sleep at this time. Naps are good too. If pain is really getting in the way of sleep, bedtime Is when I recommend doing some pain control either with medication or ice. Sleep is too important to let pain get in the way for long.
Movement: As above, our biggest task is to not get in the way of the healing process. Rest is king but a little movement is good to maintain some fitness and keep bodily fluids moving. I believe movement works via other mechanisms during this stage as well. I am sure that gentle movement helps our nervous system to not “forget” about the injured area and thus prevent muscle atrophy and maintain all joint mobility that is possible. Also when someone loses a limb, part of their recovery is to spend some time looking at their new stump because just looking at it and touching it helps the nervous system accept the change. I think something similar happens even with much smaller traumas. Doing some simple movement helps the brain “accept” what is happening and, I believe, move forward with the healing process appropriately.
The movement you do at this time should be very light such as doing submaximal muscle contractions or small joint circles around the site of repair. Some exercise or movements of the joints above and below the injury may be ok. If the injury is in the lower body and it is painful to walk, using walking sticks for assistance or just outright avoidance by using a wheelchair or other device should be utilized. For inflammation following injury to the upper body, walking can be an excellent choice to keep the body moving. Although you may quickly discover that you need to keep your walks short because of how much you actually use your arms when walking and also because you are more tired than normal. Again, rest is the top priority. Even walking can wear out an arm that is doing its very best to heal.
I also recommend that you never take any kind of pain medication or other analgesic before doing movement. You need the pain signal fully intact so that you don’t accidently overdo and harm the healing tissues.
Community/relationships: This may seem like an odd category to include but I have grown to consider this to be just as important as anything else. In just seven years practicing as a physical therapist, I have seen too many people lose their connections to work, relationships, and recreation after slipping into a negative spiral even after relatively small injuries. Recovering from an injury or surgery can be a long arduous process. It takes an incredible amount of patience, discipline and mental fortitude. Especially in this first stage of inflammation, it can be isolating and depressing. Even if you start out with the best intentions, if you have to stay away from what is meaningful to you long enough, it is easy to lose sight of why you were trying in the first place. That is why I believe it is so important to make a conscious effort to stay connected to the communities that you are a part of while you are healing. Read conscious effort because it will probably be more difficult at this time and how you interact may look different especially if your community is based around a particular kind of activity. I also think this is a great time to focus on other work and hobbies that you are able to do. You may want to take the time to make a list of all of the things that you can do so that you can refer back to this when you are feeling down about being laid up. If you have a hand injury and can no longer play guitar maybe you can read or hike. If you can’t walk, maybe it’s time to finally learn to play guitar. Challenge yourself to make this into a good thing where you are growing as a person and not wasting away in front of a screen.
If you are brave enough to take this to the next level, now is a great time to ask yourself some deeper questions. What can you learn from this injury? Were you overtraining? Were you not resting or not eating enough? Were there signs of injury looming such as soreness or pains that you were ignoring? And, if so, why were you not paying attention them? Did you get injured doing something that you truly enjoy? How important is it to you to be able to return to that exact activity or lifestyle after healing? Are there any modifications that you would make? Throw away the attitude about fate, genetics and factors “out of your control”. Look at this as thoughtfully as you can and it will be impossible to not takeaway some new insight. You may learn there is much in your power to change in the future and this could just be the best thing that ever happened to you. Finding meaning in being swollen and painful may even make you feel better in the moment. Or not. But I would still invite you to make this experience as worthwhile a possible.
Given the above in a healthy individual, inflammation should do its job and you will be out of this stage in about one to seven days (maybe more) depending on the extent of the injury. I do want to point out that even if we do everything right, we DO NOT speed up inflammation. We can optimize the inflammatory process and we can slow it down but it will not necessarily go faster. Inflammation has to happen and it will take time. We don’t get a free pass for being super healthy and following directions. We will know that we have moved out of the inflammation stage when pain is no longer is constant and the other cardinal signs of redness, swelling and heat have greatly dissipated. Then we move into stage two which will be the subject of a future post. But first we will stop to examine what happens when inflammation doesn’t go so well.