Chronic inflammation can be ‘difficult’ too … use a guiding map for inflammation control to deal with difficult inflammation in patients
NOTE: I am not a researcher, I am a health care practitioner that understands and uses relevant studies related to my health profession. My office is equipped with biologic-regenerative devices that I have cultivated to facilitate Mother Nature. I use a multitude of therapies and products that have the potential to result in beneficial effective treatments, providing a guiding map for inflammation control.
After all these years in practice I am comfortable describing my treatment message to doctors and patients that, “I am trying to use techniques and therapy that work on the signals that proceed to the brain and either excite or inhibit pain. I’m influencing vessel/nerve growth, and other unknown protein healing signals within us.”
You might be familiar with the “up-regulation and the down-regulation” model. I don’t really know what to call what I do other than I know I am innovative and interactive.
We’re discussing difficult inflammation, not chronic inflammation, but chronic inflammation can be difficult too. The circulatory system brings oxygen to tissues throughout the body1,2 and actively coordinates the resolution of inflammation.1-3 If a patient presents with an acute injury, i.e. sports injury or motor vehicle accident injury, we know to follow the PEACE & LOVE model.
Acute -> chronic inflammation
In some patients the acute inflammation phase gets blocked, and the inflammation does not get resolved. This may lead to chronic inflammation with ongoing tissue damage, free radical damage, and we see various diseases occur in the body.
Perpetuation of inflammation can be related to lifestyle behaviors (i.e. not enough sleep, not enough recovery, food sensitivities (dairy, wheat, sugar) and a long list of other factors). Age alone may influence our ability to resolve inflammation and heal properly. Poor or faulty musculoskeletal movement patterns can irritate and perpetuate pain in muscles, fascia, joints, etc.
Then there is the list of negative health conditions such as diabetes, obesity, vascular disease, arthritis, autoimmune disease, etc., that complicate inflammation resolution. All of these factors may pose a challenge to helping patients get out of pain.
A guiding map for inflammation control: modalities to bring down difficult inflammation
First and foremost, let me state that my experience suggests the part of the body which is most likely to cause the majority of inflammation and health problems is the gut. This requires healing from inside out and the patient making better food choices.
Secondly, I use interventions that also work from outside of the body and make use of energy — including motion (including my hands for manipulation), light, sound, vibration, temperature and electricity. In summary, all of my interventions provide a guiding map for inflammation control and are paired with diet, nutrition, manipulation, fascial therapy, topicals (when appropriate), vessel health (blood, nerve, lymph, etc.) and mental health.
- Anti-inflammation processes can be stalled by many things.
- Modalities can act as pro-inflammation resolving signals.
- Complete inflammation resolution (not elimination of inflammation because we need a healthy inflammatory response) provides the return of tissue to homeostasis.
- Acute inflammation is a normal defense mechanism; however, difficult or chronic inflammation is caused by unresolved inflammatory responses (we see it as trapped fluids or dense fascial tissue, etc.) and may be linked to low levels of pro-resolving immune factors, proteins, growth factor, etc. There are probably hundreds or thousands of these growth factors, proteins, hormones, etc., and I have little intention of memorizing or understanding all of them. I am after changing “signals” within the brain-body that need to be re-awakened and/or using modalities as counter-stimulation to pain and disease.
- Diet and modalities may have clinical roles in the management of even low-grade chronic difficult conditions (especially associated with difficult-to-resolve inflammation).
In clinical applications, when the above processes don’t happen normally, I see ongoing difficult inflammation with resultant “every imaginable complaint” (insert whatever you see in your practice).
Please remember that the list of modalities I have available to treat my patients is not exhaustive. I am sharing what I use on a day-to-day basis in my office, not everything that may or may not be available to us in the marketplace. I’m like you, in practice, and I have a budget! I look for therapies and combination therapies that assist the body’s natural process, and these are my intentions:
Limit excessive neutrophil infiltration in affected tissue
I still use cold therapy at this phase. Some people use cryochambers, ice packs, cold baths, vapo-coolants, etc.
What’s new to reduce swelling are the latest devices that include cold and gentle compression. Other devices still not well-utilized are intermittent, sequential compression and negative-pressure devices. The neutrophil reaction is a natural part of the acute pain phase — it’s where you are hurt. Topical gel applications that contain menthol or CBD may be very useful especially in the beginning, and along the whole treatment progression. I recommend using a topical to every patient. If nothing else, I use topicals for self-massage, and while it’s being rubbed on, I encourage movement of the area for the neuroplasticity principles.
Stimulating macrophage phagocytosis to clear cellular debris
Here I may use electrostimulation, PEMF, ultrasound, laser, TECAR therapy (endogenous thermotherapy), vibration therapy, shockwave and pressure-vibration therapy. This is where it gets fun and interesting.
If the body does a poor job clearing cellular debris, I can palpate and feel the quality of the tissue has changed. I might feel boggy tissue, trapped fluids, denser-than-normal tissue, coagulated tissue, or just the consistency of the tissue has changed. I might not even have the right words to describe to you what’s happening underneath the surface I feel, but I know your skilled hands know what I am talking about!
It feels like pus under the skin with varying degrees of density and consistency. Modalities help break up and/or move the accumulation along. To help clear debris, the patient must begin to be active (I start with guided movement).
I use my knowledgeable and skilled hands to drain trapped fluids that I can reach — all … day … long. But most often the cellular debris is deeper than my hands can get to.
I make my decision on which modality (i.e., sound, vibration, touch, light, etc.) to use based on:
- How long has this problem been going on (history)?
- How much of the body has fallen into disuse (complaints)?
- The depth and width of debris I sense in locations and by knowing my anatomy (palpation).
- I ask myself, “Is it in the joint, soft tissue (fascia, tendon, bone, etc.)?” or “Is it stiffness, dense, gliding or not gliding?”
- What active and passive movements is the nervous system allowing the patient to demonstrate with pain and without pain? As well as neural sensations the patient may describe.
Decreasing pro-inflammatory mediator production — All of my modalities may apply here. I’ve learned that it’s the dose delivered of the modality that helps me and my patient gain control of the difficult inflammation and healing process.
Enhancing tissue regeneration and restoring to homeostasis — This is what the majority of my patients come to see me for. They don’t ask for “tissue regeneration” by name, but many people are starting to understand “regenerative medicine” or “biohacking” without drugs or injections (PRP, stem cells, etc.) or other costly and “unknown effect” procedures. Patients just know they want to get out of pain, restore some lost normal function, sleep better, or have something they need to help optimize.
Utilize all your ‘weapons’ against inflammation
I’ve gained certainty in the use of my weapons (the multi-modal approach) to reboot, restore, restart, revitalize, replenish or stimulate growth factors; alter receptors, proteins and hormones; and improve cell membranes and mitochondrial communication.
Again, I don’t know the words the researchers are using, but these therapies provide a guiding map for inflammation control and I know my patients understand and appreciate what I am trying to do.
JEFFREY TUCKER, DC, is the current president of the American Chiropractic Association (ACA) Rehabilitation Council and practices in West Los Angeles, Calif. He writes for Stopain Clinical and can be reached at DrJeffreyTucker.com.