The Process of Inflammation and treating Yoga Injuries

The Process of Inflammation and treating Yoga Injuries

Inflammation (from Latin inflammatio) is part of the complex biological response of body tissues to injury or harmful stimuli, such as pathogens,
damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molecular mediators. It is characterised by varied combinations of redness, pain, heat, swelling and loss of function.

The process of Inflammation is instinctive, a process that the human form has evolved since its conception (Smith, 1991). Therefore, the Inflammatory process is not something that necessarily needs to be stopped; it is necessary for healing.

TYPES OF INFLAMMATION
There are two basic types of inflammation – acute and chronic. 

Acute inflammation is of short duration, which could be anything from a few minutes to a few days. Such inflammation is caused by foreign substances entering the body or by physical damage. A viral infection may also precipitate acute inflammation.

Chronic inflammation on the other hand is long lasting.
It may persist for weeks, months or even years. Chronic inflammation may be brought on by acute inflammation or it may be the result of an auto immune disease.

As a general rule of thumb, students should back off inflammation on the yoga mat. This may mean stopping practice altogether or backing off certain poses, depending on the area that is inflamed and how serious it is. For example, a student with some inflammation on the neck may still be able to do a decent yoga practice, without weight bearing on the arms and leaving out head and shoulder stand. The reason why we back off inflammation is because increasing blood circulation in the area can increase the inflammatory response. Even though it is a natural process and not to be stopped, we also do not wish to increase it
, as the healing period will take longer if we do. Let take a look at the different phases of inflammation to explain why.

STEPS OF INFLAMMATION VASCULAR PHASE (first 5 days) 

  1. Damaged cells release several chemicals such as histamines, prostaglandins and leucotrienes. 
  2. A function of these chemicals is to cause vasodilation (increase in the diameter of the arteries and arteriole blood vessels). 
  3. Vasodilation results in an increase in blood in the injured area. As a result of this, more phagocytes, oxygen and nutrients are delivered to the site of injury. 
  4. This increased blood flow results in redness, heat and some of the pain associated with inflammation.
  5. The histamines, prostaglandins and leucotrienes have a direct effect on the capillaries in the area. They cause the walls of the capillaries to become leaky. This allows more fluid to leave the capillary and enter the tissue spaces causing swelling or oedema. 
  6. The increased blood flow delivers phagocytes such as monocytes and neutrophils to the scene. The phagocytes stick to the walls of the blood vessel in a process called margination. These phagocytes then squeeze through the gaps in the blood vessel in a process called emigration or diapedisis. 
  7. Within about 60 minutes of tissue damage the phagocytes begin to destroy the invading micro-organisms by phagocytosis. After consuming large amounts of micro-organisms and damaged tissue the phagocytes die, forming puss. Platelets (the clotting agent in blood) seal off the site of injury.

During this phase of healing yoga students should use the RICE recipe (Rest – Ice – Compress – Elevate) to treat inflammation and completely back off all yoga asana and other exercise and movement which overloads and/or stretches the afflicted area.

REPAIR PHASE (5 days- 8 weeks)
Wound closure is achieved by a network of relatively thin type 3 collagen fibres and does not provide the tissues with any of the great mechanical stability. Less perfused tissued like ligaments and tendon can last up to 8 weeks in this phase. The means that the amount of weight bearing should be increased more slowly. 

The goal during repair is to promote collagen synthesis. Yoga practice should be balanced in such a way to prevent excessive muscle atrophy and joint deterioration of the injured area. Disruption of newly forming collagen fibres should be avoided by gradually  introducing low-load stresses to allow increased collagen synthesis and prevent loss of joint motion. What that means is that to protect the new, relatively weak collagen fibres, the yoga student should avoid strenuous yoga, excessive weight bearing, over-stretching and fast jerky movements in relation to the damaged tissue. Movements should be mindful, slow and breath centered. However, too little activity can also have a negative effect, as newly formed fibres will not align optimally and may form adhesions, thereby preventing full range of motion. Using Isometric contraction, static stretching in long holdings can be helpful. 

REMODELLING PHASE (week 8 – 1 year)
This results in the replacement of the type 3 collagen with stronger and more stable type 1 collagen fibre. 

Optimising tissue function is the primary goal during the final phase of healing. Yoga students improve function by continuing and progressing the yoga asanas performed during the repair phase and by adding more advanced variations that allow progressive stresses to be applied to the injured tissue. The student can sometimes be tempted to do “too much too soon,” which may further damage the injured tissues. It is important to remember that, while there may be less pain with activity at this point, the injured tissues have not fully healed and require further attention to achieve complete recovery. Progressive tissue loading, achieved by an increase in weight bearing allows improved collagen fibre alignment and fibre hypertrophy. Its a fine line for the student to get right. Re-injuries are common during the repair or re-modelling phase, as people start to gain confidence in the affected area and start to use it again, but then realise all too soon, that the strength in the areas is not back yet. Sometimes the realisation happens on a yoga mat when a student is not allowing enough recovery time and re-enters the old poses they loved before the injury too deeply or too fast; other times it happens in daily actions when someone thinks they are ready to jump off the last step of the stairs or carry that bag of shopping.
One of the most common examples of this for yoga students is the hamstring tendon tear. This comes from moving too fast into forward bends and leveraging with the arms to touch the toes or the nose to the shin. A hamstring tendon tear needs rest. Students should back off yoga classes for about 3 weeks completely and use the protocol described above: RICE for the first week until inflammation goes down and the start to gently increase load and range of motion. Then they should enter back onto the mat with caution. They should work with the knee of the damaged leg bent for standing and seated forward folds to not over stretch the area. They should also be aware of increasing the load on the muscle gradually for relevant movements. It has been reported that students who treat a hamstring tear correctly can be pretty much in action again after 8 weeks; whereas students who do not treat the injury properly by overloading and stretching the afflicted area too soon, can postpone their injury time to 12-20 months.

This writing is taken from my new Anatomy Manual that accompanies the Anatomy CPD trainings

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