By: Anna Staehli Wiser, DPT, FAAOMPT
Historically, after an acute injury, medical advice has been to rest and take pain medication. The idea was that eliminating inflammation would speed up recovery. But with what we now understand about the role inflammation plays in the healing process, is this really the best approach?
What about the use of NSAIDs (Non-Steroidal Anti-Inflammatory Drugs such as Ibuprofen, Aspirin, and Naproxen)? The way NSAIDs control inflammation is by blocking the signaling of Cyclooxygenase (COX) enzymes, which synthesize prostaglandins - hormones essential to the inflammatory process1.
Evidence suggests that disrupting this “chemical signaling cascade”2 through the use of anti-inflammatory medications can slow down the healing process.
Inflammation is essential to recovery. When the inflammatory response is triggered, the body increases blood flow and fluid leakage to the affected area which kickstarts the healing process.
The purpose of inflammation is to:
Clear debris and pathogens: Inflammatory cells like neutrophils and macrophages rush to the site to remove damaged cells.3
Initiate repair: The inflammatory response stimulates the production of growth factors and other molecules that promote tissue regeneration and healing.4
Provide scaffolding for repair: Fibrinogen, which leaks from inflamed vessels, is converted into fibrin fibrils, creating a scaffold for new cells and tissues.5
Stimulate cell division and blood vessel formation: Mediators released by inflammatory cells stimulate epithelial cells and fibroblasts to divide and form new tissue while also promoting angiogenesis (the formation of new blood vessels).3
So how can we speed up recovery without medication?
Active rest. Stay as active as possible without causing increased pain. Gentle, pain-free mobility exercises in the first 2–4 weeks help minimize joint stiffness and stimulate blood flow for tissue repair. Once pain is under control, a strengthening program will restore tissue integrity and allow a return to sports. Cryotherapy (cold packs or cold water immersion) is generally considered to be beneficial in controlling pain and excessive swelling after injury or intense bouts of exercise without significantly delaying the healing process6,7. However, there are some animal studies that suggest that even cryotherapy application can delay healing times8. Therefore, even cold packs should be used judiciously. After the first 72 hours, gentle modalities like heat, massage, and dry needling will help to stimulate the body’s natural healing process.
While medications certainly have their place, treating an injury naturally has been shown to optimize recovery and speed up the return to sport.
References:
1. Schug SA. Do NSAIDs really interfere with healing after surgery? J Clin Med. 2021;10(11):2359.
2. Chen L, Deng H, Cui H, et al. Inflammatory responses and inflammation-associated diseases in organs. Oncotarget. 2018;9(6):7204-7218.
3. Wang J. Neutrophils in tissue injury and repair. Cell Tissue Res. 2018;371(3):531-539.
4. Butterfield TA, Best TM, Merrick MA. The dual roles of neutrophils and macrophages in inflammation: a critical balance between tissue damage and repair. J Athl Train. 2006;41(4):457-465.
5. Luyendyk JP, Schoenecker JG, Flick MJ. The multifaceted role of fibrinogen in tissue injury and inflammation. Blood. 2019;133(6):511-520.
6. Kwiecien SY, McHugh MP. The cold truth: the role of cryotherapy in the treatment of injury and recovery from exercise. Eur J Appl Physiol. 2021;121(8):2125-2142.
7. Kwiecien SY, McHugh MP, Howatson G. Don’t lose your cool with cryotherapy: The application of phase change material for prolonged cooling in athletic recovery and beyond. Front Sports Act Living. 2020;2. doi:10.3389/fspor.2020.00118
8. Racinais S, Dablainville V, Rousse Y, et al. Cryotherapy for treating soft tissue injuries in sport medicine: a critical review. Br J Sports Med. 2024;58(20):1215-1223.
