Let me introduce you to my sprain! I did it last Thursday, playing soccer. It has given me some days of reflection on how wound healing works, as I waited for the swelling to die down. Hence this blog post.
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My wound healing process
- I got the sprain last Thursday at 9.20 pm. As a former basketball player with a history of different sprains, as a physiotherapist and especially because of the crack! and the pain, I knew right away that it wasn’t a straightforward one.
- I had to leave the match and go home.
- I lay down on my bed.
- Naturally I did NOT put ice on it or take any pain-killers (anti-inflammatories).
- I tried to relax.
- I didn’t sleep for an hour, as the pain fluctuated between 6 and 9 on a scale of 1 – 10.
- By morning the foot was rested and no longer painful, but it was very swollen and couldn’t bear any weight.
- I figured I would need crutches.
- By about 11 am I could already put the heel down without feeling any pain and the sensations were getting better by the minute.
- By the afternoon I tried to put my toes down but was limping for the rest of the day.
- On Friday I slept like a log.
- On Saturday I woke up and was able to put weight on it and walk normally, though I still felt a bit unsteady. The swelling had disappeared and was replaced by a bruise spreading from the ankle as far as the foot bone.
- Normal life from then on, without adding any pressure.
- Mammoth Hunter sessions avoiding jumps, and on Sunday and Monday squats as well.
- Today, one week later, I can run normally although I haven’t done anything metabolic and I don’t feel anything holding me back, though it still doesn’t feel 100% right.
That’s what happened, but why this reflection?
Because it made me remember how wound healing us usually handled. When sprains are treated wrongly you can expect: two weeks of immobility, compresses, ice for 3 hours, anti-inflammatories, starting to put weight on it .. . and coming back to sports practice at the first possible moment, in a month’s time.
And gave me the chance of revising the science of wound healing and of listening to my body, as I’m always telling you to do. A few generations back if you’d waited three weeks to recover from a sprain you’d never have made it, you’d have been eaten by a lion.
So how did all this happen?
To catch up, I’d like to share with you the various factors that I think helped the healing process.
What is the Inflammatory Environment?
Although it may mean pain and swelling, inflammation is essentially a wound healing response to an injury, anywhere in the body.
For many years I’ve avoided the nutrients that produce inflammation in the body, so my digestive system isn’t under constant attack. As a result, my immune system hasn’t become centralised at that point where most of the danger lies. (This is called Immune System Centralisation and it deserves a blog of its own.) Instead, it has calmed down and now has a chance of giving a better and quicker response wherever the injury happens in the body and correctly evaluating the level of inflammation needed.
Allow the body’s own wound healing resources to work
The accepted view of the inflammatory response is that it has two phases, initiation and resolution, with resolution thought of as a passive process. But recent evidence suggests that this too is an active response, and, most importantly, SELF-LIMITING.
Over millions of years, the body has developed its own means to repair tissue in the best possible way, and to stop symptoms when appropriate. So any disruption that hinders this process may delay recovery, and increase the risk of developing a chronic condition or fibrosis.
What to I mean by ‘disruption’?
- Taking anti-inflammatories. They block the production of the substances released when wound healing starts and that the body uses to resolve this process. In line with up-to-date knowledge, we can confirm that, unless the pain is unbearable, taking anti-inflammatory pain killers isn’t recommended. They may hold back recovery and increase the risk of long-term problems. Remember, in general the body only generates symptoms that we are able to bear.
- Excessive immobility: movement is a signal for regeneration. We know that immobilization does the opposite: it contributes to dehydration and significant tissue loss, that is to say, degeneration. If we don’t move, we lose the main stimulant for that tissue to grow.
- Cryotherapy: the subject of ice is very controversial, with no clinical studies available. So we have to be guided by common sense and biological plausibility. I leave you with three suggestions, and, if you like, one of these days I’ll post a blog about this too. Ice has an analgesic and numbing effect because it affects neurotransmission from the peripheral nerves. It’s a neurotoxin. But the nerves are responsible for directing part of the healing process, so we have to keep them working well. It’s true that with ice we avoid secondary hypoxia, because the area of remodelling is less and less tissue dies, but it may be that part of the tissue that is not being remodelled loses its elastic qualities so recovery isn’t optimal. It’s the well-known phrase ‘better to cut your losses’. And just one last reflection for those who follow the paleo philosophy: I don’t think they had freezers in paleolithic times…..
The role of training in resolving wound healing and inflammatory processes
High intensity physical activity generates a response in the body that is very similar to inflammation, with a big anti-inflammatory response afterwards. Every time I take part in sports activity I train to resolve inflammatory processes and keep my anti-inflammatory mechanisms active. This graph shows how similar the immune response is for a wound and for physical activity.
Understanding wound healing
Very interesting studies on chronic pain show us that when our brain understands what is happening, this reduces the interpretation of danger that the wound gives. The mere fact of telling someone what happened reduces alarm, and with it the level of pain. In my case I trust I am making a good job of this, I am convinced that the symptoms I produce are appropriate (my body doesn’t produce pain just to annoy me, so I don’t have to fight against it). To put it another way, pain is inevitable, suffering is optional. Understanding the healing processes no doubt also helped me in my rapid recovery.
Well, take note that these four factors are my own opinions, based simply on my own experience and certainly highly questionable.
One last piece of advice, if I may: this has been a most enriching process, but no-one should think they need to get a sprain to live through it.
And now I have to go. This is my day for running. I’m looking forward to a good little paleo run!